1. Chapter 8 Conduct Problems Bilge Yağmurlu PSYC 330
Developmental Psychopathology

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

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

4. 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

5. 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

6. 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

7. 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.

8. 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.

9. 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

10. 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

11. 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

12. 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

13. 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.

14. 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

15. 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

16. 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

17. 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.

18. 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

19. 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

20. 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

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

22. 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!

23. 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

25. 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

26. 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

27. 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

28. 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.

29. 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

30. 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

31. 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.

32. 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