CONDUCT DISORDER By: Takiyah King

Background The IQ debate The IQ debate Impulse control Impulse control Response Inhibition Response Inhibition

Background Prevalence Prevalence Range from 4-16% Range from 4-16% Higher in urban rather than rural areas Higher in urban rather than rural areas Higher in males over females Higher in males over females Most frequently diagnosed condition in mental health facilities for children Most frequently diagnosed condition in mental health facilities for children Co-occurrence Co-occurrence ADHD, ODD ADHD, ODD Conduct problems in childhood predict future negative outcomes: Conduct problems in childhood predict future negative outcomes: Adult antisocial behavior, substance abuse, early pregnancy, health problems, psychiatric illness, such as depression, Mood disorders, Anxiety disorders, and Somatoform Disorders Adult antisocial behavior, substance abuse, early pregnancy, health problems, psychiatric illness, such as depression, Mood disorders, Anxiety disorders, and Somatoform Disorders - DSM-IV-TR 2000

DSM-IV-TR Criteria Conduct Disorder def.- a persistent pattern of behavior in which a child or adolescent ignores the basic rights of others and breaks major norms or rules of society” A. must have occurred in the past 12 months, with at least one criterion present in the past 6 months: Aggression to people and animals Aggression to people and animals Destruction of property Destruction of property Deceitfulness or theft Deceitfulness or theft Serious violations of rules Serious violations of rules

DSM-IV-TR Criteria Conduct Disorder B. Disturbance in behavior must also cause 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.

DSM-IV-TR Criteria Conduct Disorder ONSET ONSET Childhood-Onset Type Childhood-Onset Type Adolescent-Onset Type Adolescent-Onset Type Severity Severity Mild: (few if any in excess of those required for diagnosis) Mild: (few if any in excess of those required for diagnosis) Moderate: (number of conduct problems and affect on others is intermediate) Moderate: (number of conduct problems and affect on others is intermediate) Severe: (many conduct problems in excess of those required for diagnosis or conduct problems cause considerable harm to others) Severe: (many conduct problems in excess of those required for diagnosis or conduct problems cause considerable harm to others)

DSM-IV Criteria Antisocial Personality Disorder Def. A pervasive pattern of disregard for, and violation of, the rights of others occuring since the age of 15, as indicated by three or more of the following: Def. A pervasive pattern of disregard for, and violation of, the rights of others occuring since the age of 15, as indicated by three or more of the following: 1.Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest 2. deceitfulness, as indicated by repeated lying, use of aliases, or coning others for personal profit or pleasure 3. Impulsivity or failure to plan ahead 4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults 5.Reckless disregard for safety of self or others 6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor finanical obligations 7. Lack of remores, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another The individual is at least 18 The individual is at least 18 There is evidence of CD w/ onset before age 15 There is evidence of CD w/ onset before age 15 Not exclusive during the course of Schizophrenia or a Manic Eposide Not exclusive during the course of Schizophrenia or a Manic Eposide

Neurobiology Genetics and Environment Genetics and Environment Disruptive child = disruptive parent Disruptive child = disruptive parent Difficult temperament Difficult temperament Parenting practices Parenting practices Neurotransmitters Neurotransmitters 5-HT: Serotonin The Cortisol Debate (low cortisol, low self control) CSF 5-HIAA Norepinephine

Neurobiology Prefrontal Regions of the Frontal Lobe Prefrontal Regions of the Frontal Lobe Frontal Region Frontal Region Dorsolateral Prefrontal Cortex Dorsolateral Prefrontal Cortex Orbitofrontal Cortex Orbitofrontal Cortex Ventromedial Prefrontal Cortex Ventromedial Prefrontal Cortex

Neurobiology Prefrontal Dysfunction Prefrontal Dysfunction Executive Function Deficits Executive Function Deficits Head Injury and Lesion Studies Head Injury and Lesion Studies Neuroimaging Studies Neuroimaging Studies Risk Factors of Prefrontal Damage Risk Factors of Prefrontal Damage Birth complications Minor Physical Anomalies (MPAs) Prenatal Exposure Postnatal Development

Educational Implications Parental Management Training (PMT) Parental Management Training (PMT) Multisystemic Treatment (MST) Multisystemic Treatment (MST) Cognitive Therapy Cognitive Therapy Anger control training Anger control training

Educational Implications Research Opportunities Research Opportunities Longitudinal Research Longitudinal Research Prioritization of treatment resources Prioritization of treatment resources New psychological intervention New psychological intervention Discovery of pharmacological treatment Discovery of pharmacological treatment Early diagnosis Early diagnosis Appropriate and timely medical referral Appropriate and timely medical referral Combating co-occuring diagnosis Combating co-occuring diagnosis

Educational Implications Helpful resources Book: Lahey, Benjamin B., Moffitt, T.E., Caspi, Avshalom. (2003). Causes of Conduct Disorder And Juvenile Delinquency. Book: Lahey, Benjamin B., Moffitt, T.E., Caspi, Avshalom. (2003). Causes of Conduct Disorder And Juvenile Delinquency.