Chapter 8 Conduct Problems Bilge Yağmurlu PSYC 330 Developmental Psychopathology

Disorders usually first diagnosed in infancy, childhood, or adolescence Attention-deficit and disruptive behavior disorders Attention-Deficit Hyperactivity Disorder 314.01 Combined subtype 314.01 Predominantly hyperactive-impulsive subtype 314.00 Predominantly inattentive subtype 314.9 Attention-Deficit Hyperactivity Disorder NOS Conduct disorder 312.81 Childhood onset 312.82 Adolescent onset 312.89 Unspecified onset 313.81 Oppositional Defiant Disorder 312.9 Disruptive Behavior Disorder NOS

Conduct Problems Externalizing behaviors Aggression Oppositional Disruptive/antisocial Figure 8-1 depicts the behaviors viewed as problematic from childhood through adolescence

Conduct Problems ASPD Psychopathy – not a DSM diagnosis Personality disorder Diagnosed after age 18 A pervasive pattern of disregard for and violation of the rigths of others. Characterized by aggressive antisocial behaviors beginning by age 15 and continuing into adulthood Psychopathy – not a DSM diagnosis Interpersonal trait Deceitful, unremorseful, impulsive, unemotional, glib

Oppositional Defiant Disorder Loses temper Argues with adults Actively refuses to comply with adult requests or rules Deliberately annoys others Touchy & easily annoyed Angry & resentful Mean & hurtful Negativistic Hostile Defiant 4 behaviors for at least 6 months Not normative: more often than typical Impairs functioning significantly Table 8-2 disorders that characterize ODD

Conduct Disorder Aggression toward people and animals Bullying, fights, weapon, cruelty Destruction of property Fire setting Deceitfulness or Theft Breaks into, lies, steals Serious Violations of Rules Runs away Persistent pattern of behavior that violates the rights of others and age-appropriate social norms 3 or more behaviors for at least 12 months Behavior causes impairment Childhood Onset (prior to age 10) or Adolescent Onset Diverse behaviors: heterogeneity in conduct disorder

Conduct Disorder Aggression to people and animals (1) often bullies, threatens, or intimidates others (2) often initiates physical fights (3) has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun) (4) has been physically cruel to people (5) has been physically cruel to animals (6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery) (7) has forced someone into sexual activity (is a rapist) Destruction of property (8) has deliberately engaged in fire setting with the intention of causing serious damage (9) has deliberately destroyed others' property (other than by fire setting) Deceitfulness or theft (10) has broken into someone else’s house, building, or car (11) often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others) (12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery) Serious violations of rules (13) often stays out at night despite parental prohibitions, beginning before age 13 years (14) has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period) (15) is often truant from school, beginning before age 13 years B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

Conduct Disorder According to the current DSM classification system, a diagnosis of conduct disorder is based on the following criteria: A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months: B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Distinctions for Externalizing Symptoms Aggressive vs. rule breaking Salient symptom Overt vs. covert Destructive vs. nondestructive Age of onset (child vs. adolescent) Figure 8-q showing mean aggressive and rule breaking behavior demonstrates that males engage in more aggressive and rule breaking behaviors (Stanger Achenbach & Verhulst, 1997) . Aggressive behaviors decline with age rule breaking increased during adolescence (for males). Figure 8-3 the overt covert destructive non destructive graph. From Frick 1998b

Figure 8-q showing mean aggressive and rule breaking behavior demonstrates that males engage in more aggressive and rule breaking behaviors (Stanger Achenbach & Verhulst, 1997) . Aggressive behaviors decline with age rule breaking increased during adolescence (for males). Figure 8-3 the overt covert destructive non destructive graph. From Frick 1998b

Gender Differences Boys diagnosed with conduct disorder more often than girls Girls more likely to engage in relational aggression Purposefully excluding others Shunning someone when angry Telling lies about a person - spreading rumors Threatening the person with the relationship Can begin in preschool Victims can be rejected, anxious or depressed Children that engage in gender nonnormative aggression have a higher rate of behavioral problems

Other Issues Delinquency Legal term: juvenile (< age 18 ) who has committed an index crime or status offense Violence Extreme form of physical aggression with serious harm

Other Issues Bullying Can begin in preschool Increasing use of internet to bully More common in males Males also more likely to be victims Peaks in middle school Typical bully Aggressive to peers and adults Positive attitude toward violence Impulsive Strong need to dominate Little empathy Physically stronger Bullying can be direct or indirect (subtle) girls more likely to experience indirect, boy report both direct and indirect bullying experiences.

Other Issues Typical victim Anxious Insecure Nonaggressive Low self-esteem Having a close friend can ward off bullying or the effects Bullying tied to risk of long-term problems Olweus (1994) found 60% convicted of at least 1 crime by age 24

Epidemiology Rates range from 1-16% for both ODD and CD Higher male-to-female ratio in CD. 4:1 Higher rates of CD in urban areas Higher rates in minority youth and in high crime neighborhoods ODD may be superceded by CD—cannot have both diagnoses at same time Most kids with CD also meet ODD criteria ADHD Figure 8-4 From Maughan et al 2004-shoes rates of CD and ODD in boys and girls aged 5-16 Average age of onset for ODD is 6; for CD 9

Co-occurrence ODD CD Children with these disorders: 50% will continue to have disorder 25% will remit 25% will develop CD 35-70% will also have ADHD CD Depends on age of onset—younger typically more persistent & aggressive Also depends on family of origin 30-50% will have ADHD Children with these disorders: May be rejected by peers Exhibit neurocognitive impairment Lower school achievement Verbal language deficits Internalizing disorders Anxiety Depression At risk for substance use

Executive function A key cognitive ability that refers to the collection of processes like attention shifting, working memory, and inhibitory control, which guides behaviors towards a goal A cognitive component of self regulation that leads to behavioral competence. Begins in infancy, with a gradual and steady improvement in the core module, attention that simultaneously gives rise to the development of other cognitive processes in early years. Poor EF is significantly associated with externalizing behaviors (Hughes et al., 1998) and lack of empathic and prosocial behaviors in preschool children (Hughes et al., 2000). One study (Hughes & Ensor, 2008) showed that the relation between EF and problem behaviors remained significant even after family disadvantage (i.e., low education and income, disturbed family structure, and maternal psychosocial risk), ToM, and verbal ability were controlled.

Course Stability over time Childhood onset Adolescent onset Related to persistent problems “life-course peristent antisocial behavior” Less common than adolescent onset More likely to have neurocognitive deficits and academic problems ASPD Adolescent onset Fewer childhood problems Many discontinue behaviors

Etiology Socioeconomics Aggression as learned behavior Family influences Parent-child interactions Patterson’s Coercion Theory Social learning perspective Discipline and monitoring Ineffective Table 8-4 reviews the MANY Factors associated with child aggression. From Loeber & Farrington, 2000 Poverty-see accent. Poverty can interact with discrimination and disorganized communities to create violence Figure 8-6 Patterson’s Model Patterson, Reid & Dishon 1992

Etiology Figure 8-7 Depicts how parent pathology variables can interact to create child antisocial behaviors Maltreatment-See accent. Physical abuse a risk factor for conduct problems Parental supervision and community/neighborhood characteristics can impact peer infuence Cognitive Influences-Crick and Dodge model of cognitive processing-aggressive kids see aggression when it is not there, misinterpret environmental cues, have hostile attributions and beliefs. Reactive-hot blooded retaliatory response; problems in the early stages of encoding; demonstrate problems at earlier ages; had higher rates of adjustment problems, more peer rejection Proactive-goal oriented aggression, deliberate; problems in the later stages-see aggressive choices as positive Parenting behaviors such as supervision and warmth can influence the impact of these types of aggression

Etiology Other influences: Temperament Family stressors Antisocial families Parental substance use Marital discord Maltreatment Peer relations Hostile attribution bias

Social Information Processing Encode Interpret Formulate social goals Generate problem-solving strategies Evaluate strategies, Select Enact What happened? Did he mean to...? What do I want to happen? What can I do? What will happen then, what will work? Just do it!

SIP and aggression Reactive/hostile aggression An angry response to frustration Acts for which the major goal is to inflict harm or injury on the victim Proactive/instrumental aggression Deliberate behavior controlled by external reinforcers (gain access to objects, space etc.) Acts are aggressive in form and may harm another person but are motivated by other reasons

Social Information Processing Ambiguous scenario Problem Definition: “What do you think is happening in this story?” about intent attribution Response Selection: “What would you do if you were in this situation and he/she did that to you?” about solution offering Anticipation of consequences : “What do you think would happen after you did that? 25 25

Social Information Processing and Aggression Reactive/hostile aggression Proactive/instrumental aggression Different SIP biases for different forms of aggression Hostile attribution bias Expecting positive outcomes

Mechanisms in the cycle of violence Question: What is the process by which antisocial behavior occurs in abused children? Time 1: Mothers interviewed about Child temperament Discipline practices at age 4 Whether child had been harmed by an adult visible bruises, medical attention Time 2: Children’s SIP assessed at age 5 Time 3: Aggression in the school environment assessed Teacher ratings, peer ratings, observations

Findings Harmed children biased SIP at age 5  aggression at age 6 early harm  biased SIP  aggression temperament did not correlate with aggression and physical abuse. Experience leads child to conceptualize the world in deviant ways that perpetuate the cycle of violence. Internalizing problems were higher in harmed children than in no-harmed children.

Age, SIP and Aggression SIP skills of rejected-aggressive 6 year-olds were immature, typical of much younger children Changes in cognitive skills (attention, memory span, speed of processing, perspective taking and ToM) With age children start to encode more information 29

Social Information Processing All steps Influenced by the child’s history: abusive or harsh parenting, security of attachment Expectations: about others’ intent and behaviors Knowledge of rules: is it appropriate to display aggressive behavior when frustrated? Does it help solve problems? Encode Interpret Formulate social goals Generate problem-solving strategies Evaluate strategies, Select Enact

Etiology-Biological Genetics Likely inherit risk factors Twin studies evidence for moderate genetic influence, but environment is very important Likely inherit risk factors Sensitivity to alcohol Temperament Irritability Impulsivity Sensation seeking -> make more prone for antisocial bias Figure 8-8 depicts the research of van Lier and colleagues. Kids with a genetic predisposition for aggression and aggressive peers were the most aggressive.

Etiology-Biological Neurophysiological Neuropsychological Behavioral Inhibition System (BIS) underactive Behavioral Activation System (BAS) overactive OR both systems underactive as child tries to seek sensation Reduced threshold for fight or flight Neuropsychological Frontal lobes Problems with verbal and executive functions BIS related to fear and anxiety and inhibits action in novel situations BAS activates behavior in the presence of reinforcement associated with reward seeking