Conduct Disorder, Aggression, and Violence

Overview of Session n Scope of the problem n Definitions n Reasons for antisocial and violent behavior n Treatment and Prevention

Washington, DC. Thursday, February 10, 2000 'JUST TOTALLY SENSELESS'; TWO WILSON HIGH SENIORS SHOT DOWN AFTER LEAVING GAME Manassas, Va., March 26, 2000 – Prince William County police say three teens from Stonewall Jackson Middle School were caught with instructions and materials to build bombs. SANTEE, Calif., March 6 -- San Diego County sheriff's investigators said today that 15-year-old Charles "Andy" Williams took a.22-caliber long-barrel revolver from his father's locked collection of weapons, brought as many as 40 rounds of ammunition to his high school in his backpack and fired 30 of them during the shooting rampage in which the boy allegedly killed two schoolmates and injured 13 others.

Washington Post, March 7, 2001 In the nearly two years since the massacre at Columbine High School, officials at Santana High School developed elaborate security plans for the campus. There were phones in every classroom. Security guards patrolled the hallways with two-way radios. And a sheriff's deputy was assigned to visit the campus each day. But even with that elaborate security net, school officials could not avert Monday's shooting rampage at the suburban San Diego school because friends of accused gunman Charles "Andy" Williams -- and the one adult who heard Williams's plans -- did not turn him in. For Schools, a Calculus of Rights and Safety

April 20, 1999….

… and Every Day... Trauma room specialists stand helplessly as the mother and brother of a teenager killed in a drive- by shooting collapse in grief on the hospital floor. The family was allowed to see the boy's body, which lies in a nearby room, just moments after the emergency room team failed to revive him.

Gun Ownership in US

Violence Every Day n Between 1985 and 1991, annual homicide rates among males years old almost tripled (from 13 to 33 per 100,000). n In 1997, 6,083 young people years old were victims of homicide. –That translates to 17 youth homicide victims per day. Homicide is the second leading cause of death for persons years of age, and is the leading cause of death for African-American youths in this age group.

Violence Every Day (ctd…) In each year since 1988, more than 80 percent of homicide victims years of age were killed with a firearm. In 1996, 85 percent of homicide victims years of age were killed with a firearm

Carrying a weapon or gun, past 30 days (h.s. students)

H.S. students carrying a gun, past 30 days

Carrying a Weapon on School Property, Past 30 Days

Missed School Because Felt Unsafe: Past 30 days

Property Stolen or Intentionally Damaged at School, Past Year

A Few Additional Points n Rates of all violent behavior decrease from 9th grade to 12th grade n Rates of violent behavior very high in Washington, D.C.

Definitions & Diagnostic Criteria n Antisocial Behavior n Conduct Disorder n Juvenile Delinquency

Conduct Disorder (DSM-IV) n Aggression to people and animals –Often bullies, intimidates –Often initiates physical fights –Used a weapon than could physically harm –Has been physically cruel to people –Has been physically cruel to animals –Has stolen while confronting victim –Has forced someone into sexual activity continued...

Conduct Disorder Continued n Destruction of Property –Deliberate fire setting with intent to cause damage –Deliberately destroy others’ property n Deceitfulness or theft –Broken into house, building, car –Often lies to obtain desired goal (e.g., “cons”) –Stealing without confrontation (e.g., shoplift) n Serious rule violations –Often stays out past curfew –Run away from home overnight >= 2x –Often truant at school, beginning before age 13

Two Trajectories of Antisocial Behavior: 1. Early Starters n Antisocial tendencies as small children n Antisocial behavior at ages 9, 10 predicts length of arrest record in adolescence, and arrest at those ages predicts adult arrests n Training with deviant peers, beginning late childhood/early adulthood n Big jump in frequency and intensity of antisocial behavior in early adolescence, which later tapers off n Highest risk of persistence in adulthood

Two Trajectories of Antisocial Behavior: 2: Late Starters n Those whose first antisocial acts occur in adolescence are likely to have a less chronic course, and less likely to continue to commit antisocial acts after adolescence

Course of Antisocial Symptoms From Adolescence to Adulthood n High stability r’s from childhood through adolescence n 31% of antisocial teens qualify as adults for diagnosis (Antisocial Personality) n 94% had employment problems as adults n 85% violence as adults n Multiple moving traffic violations (72%) n Severe marital difficulties (67%) n Fewer than 20% show good social functioning as adults

Is Conduct Disorder A Mental Disorder? Richters and Cicchetti Article: –Concept of Harmful Dysfunction: A condition is a disorder if and only if: - It causes harm, or deprivation of benefit, to the person (as judged by one’s culture) AND The condition results from the inability of some internal mechanism to perform its natural function, from an evolutionary perspective

Why Do Youth Become Antisocial?

Risk Factors Beginning in Childhood n Impulsivity (and ADHD diagnosis) n Irritability n Inattention n Academic deficiencies/school failure

Neuropsychological Deficits n Deficiencies in: –Attention modulation –Self control and impulsivity –Verbal skills –Memory –IQ –Visual-motor integration n Deficits worse among those with chronic antisocial problems that begin in childhood

Biological Deficits  Low levels of serotonin metabolite 5- hydroxyinadolacetic acid acid (5-HIAA) in spinal fluid, low norepinephrine, low 5-HT (hydroxytryptamine); all part of Gray’s behavior facilitation system  Under-responsive to electrodermal stimulation, low resting heart rate  ‘Difficult’ temperament in first year of life

Interpersonal Functions of Aggression/Anger  Dominance/Power  Remove threat to self or self-concept  Attachment: expression of separation distress  Protection of loved one  Unifying force – achieve common goal

Peer relationships: Social Aggression n During Childhood, aggression is physical n Girls: develop social aggression ages –Proportion of female conflicts involving social aggression rises from 14% in 4 th grade, to 56% in 10 th grade. n Boys: Use little social aggression even in adolescence. –Severity of aggression increases in adolescence, boys stronger and more often use weapons

Peer rejection  Peer rejection in middle childhood has been linked to externalizing problems in childhood, as well as adolescence  Rejected/aggressive boys tend to persist in aggression when other aggressive kids stop  Males who are rejected and aggressive in middle childhood are more likely to show high levels or increasing in antisocial behavior across adolescence

Adolescent Peer Groups  Reduction (vs. childhood) in social constraints  Increased access to firearms  Confrontation,aggression are the norm  Affiliation with deviant peer group in childhood  Aggression fuels aggression in other members of group

Social Cognitive Deficits n Encoding cues: tendency to attend to hostile features n Inaccurate interpretations of peers’ intentions- -biased towards assuming hostile intent in others (Dodge) n Response generation n Response evaluation n Enactment Question: Are these deficits in capacity or in production?

Family Process n Family Coercion Model: (GR Patterson) –Involves parental irritability, child provocation –Negative reciprocity ends with parent backing down –Negative reinforcement of aggressive behavior results n Poor monitoring n Poor parenting (inconsistent, harsh) n Parents do not prevent escalation of aggression with peers

Other Social Factors n Experiencing or witnessing violence within the family, including being physically abused n Viewing violence on TV and films n Access to firearms n Poverty, economic inequality, discrimination

Treatment n Not reimbursable by insurance plans n Parent management training (Patterson and Forgatch) n Focus on deviant peers at early adolescence n FAST Track program

Prevention n Parent training at early age (when children are preschoolers). Reduce violence in home. n Teaching emotion regulation, conflict resolution in schools n Target children with antisocial behaviors by age 9 or 10 n Reduce availability of weapons n Address social context (discrimination, economic disparity) n Reduction of violence in media