1. Outline: Lecture 6 – Feb. 11/03 Ch 6: Conduct Problems
Overview of Conduct Problems
Defining Conduct Problems
The legal perspective
The psychological perspective
The psychiatric perspective
Sex Differences
Developmental Pathways
Loeber [1988]
Patterson [1992]
Developmental Outcomes
Etiology, Assessment, & Treatment

2. Overview of Conduct Problems
Children with conduct problems display age-inappropriate anti-social behaviour.
An extremely costly problem.
Some anti-social behaviour is relatively
common -- especially in adolescence.
The prevalence and type of anti-social behaviours children display change with age.
However, conduct problems, particularly early ones, are reported to be fairly stable across time.
Extreme patterns of anti-social behaviours are less common (<5% of children).

3. Types of Aggressive Behaviour
Instrumental vs. Hostile
Instrumental - goal-directed.
Hostile - has no reason other than to inflict pain.
Verbal vs. Physical
Verbal - name-calling, swearing, taunting.
Physical - assault,
hitting, biting, bullying.
Direct vs. Indirect
Direct - source is clearly identifiable.
Indirect - involves a third-party; can also involve spreading rumors.
Reactive vs. Proactive
Reactive - in response to the actions of others.
Proactive - engaging in offensive action without provocation.

4. Defining Conduct Problems
The Legal Perspective: Juvenile Delinquency
refers to individual under 16 or 18 who has committed:
An index crime – an act illegal for adults as well
A status offense – illegal only for juveniles
Subtypes of Juvenile Delinquents
Socialized: Associate with delinquent subgroup & accept values of that subculture
Unsocialized: Not part of a group, psychologically disturbed [Psychopathic]
Prevalence [Official delinquency]:
15% to 35% for males
2% to 14% for females

5. Defining Conduct Problems
The Psychological Perspective [empirically derived]
Conduct problems seen as falling on a continuous dimension of externalizing behavior
Achenbach’s CBCL:
Delinquent Behaviour and Aggressive Behaviour
Other Approaches to classification:
Salient Symptom Approach
Dimensional Distinction
Overt/Covert Dimension
Destructive/Nondestructive Dimension

6. Empirically-Derived Syndromes
Figure 6.3
Four categories of conduct problems.

7. Defining Conduct Problems
The Psychiatric Perspective
Conduct problems viewed as distinct mental disorders based on symptoms listed in DSM
In the DSM-IV, conduct problems fall under the category of disruptive behavior disorders. Two disorders described:
Oppositional Defiant Disorder (ODD)
Conduct Disorder (CD)
Childhood Onset
Adolescent Onset
In the ICD-10: under disorders confined to family context
Socialized vs unsocialized

8. Oppositional Defiant Disorder [ODD]
Defiant non-compliance is central feature
Age-inappropriate stubborn, irritable, and defiant behavior lasting at least 6 mo. - frequent anger, temper tantrums, swearing, etc.
Symptoms typically appear prior to age 8 and no later than adolescence.
More common in boys than girls
Serious cases may develop conduct disorder
Prevalence rate about 12%

9. Conduct Disorder [DSM diagnosis]
Repetitive and persistent pattern of conduct that violates the basic rights of others and the major age-appropriate societal norms or rules.
Major associated behaviours:
In adults, can be Antisocial Personality Disorder [APD].
aggression to people and/or animals
destruction of property
deceitfulness or theft
serious rule violation

10. Conduct Disorder [DSM diagnosis]
Children with childhood onset CD
display at least one symptom before age 10
more likely to be boys
are aggressive
account for a disproportionate amount of legal activity
persist in antisocial behavior over time
Children with adolescent onset CD
as likely to be girls as boys
do not show the severity or psychopathology of the early-onset group
less likely to commit violent offenses or persist as they get older

11. ODD vs CD ODD CD Deliberately defiant or noncompliant with rules
Frequent loss of temper, arguments with adults
Deliberately annoying others, blaming others for own behaviour
Touchy & easily annoyed
Angry & resentful, spiteful or vindictive
Most children with ODD do not progress to CD CD
Aggression toward people and/or animals
Destruction of property
Deceitfulness or theft
Serious rule violation
Most cases preceded by ODD and continue to display ODD symptoms
About 40% of children with CD go on to develop APD

12. CD - Developmental Pathways
Life-Course Persistent
Children display anti-social behaviours continuously from early childhood through adulthood.
Accounts for 7% of all children
Also called “childhood-onset” pathway
Adolescent-Limited
Antisocial behaviour begins at puberty and continues into adolescence, stops by young adulthood.
30% of young people fall into this category
May be related to temporary situational factors

13. CD - Developmental Pathways
Loeber [1988] - increasing diversification of antisocial behaviour
Describes 3 paths:
Aggressive-versatile path
Nonaggressive antisocial path
Exclusive substance abuse path
Loeber [1990] See Figure 6.4 in text
Patterson [1992]
Four-stage model

14. High crime neighborhood Positive reinforcement Institutionalization
Patterson et al
Stage 1 Preschool
Outcome
Antisocial child
Social incompetence
SES
Difficult infant
Antisocial parent
Divorce
Stress
High crime neighborhood
Contextual Variables
Determinants
Poor family
management skills:
Monitoring
Discipline
Positive reinforcement
Problem solving
Poor academic
performance
Peer rejection
Parental rejection
Depressed Mood
Chaotic employment
career
Disrupted marriage
Institutionalization
Deviant peer
group
Delinquency
Substance Abuse
Stage 4
Adult
Stage 3
Adolescence
Stage 2
Middle Childhood

15. Gender Differences in CD
Frequency in general population: 2%-6%
6-16% for boys
2 - 9% for girls
During childhood, boys outnumber girls (3 or 4:1)
This gender difference increases in middle childhood and generally disappears by age 15.
Do girls catch up or is there a definitional issue here???
Earlier age of onset in boys (< 10 yrs) and it tends to be more persistent in boys.
Boys are consistently more violent across all ages

16. Problems associated with CD
Cognitive and learning problems.
Lower IQ scores (may be due to comorbid ADHD).
Verbal IQ is consistently lower than Performance IQ.
At school: academic underachievement (especially in reading and language), grade retention, special education placement, and school-based punishments.
Difficulties in interpersonal relationships.
Likely to suffer peer rejection.
In adolescence, more likely to associate
with similarly defiant peers.
Deficits in self esteem.

17. Other Related Problems
Social cognition deficits
Cue misperception
Misattribution of the intent of others
Lack empathy
Family disturbances
Conflicted relationships
Lack of family cohesion
Poor communication patterns
Poor parenting practices
Risk-taking behaviour

18. Developmental Outcomes
Kratzer & Hodgins (1997)
Assessed the mental health and criminal records of 6,449 males and 6,268 females with conduct problems as children.
By age 30:
76% of the males and 30% of the females with childhood conduct problems had either a criminal record, a mental disorder, or both.
Almost all of the mental disorders were severe substance abuse.

19. Developmental Outcomes
Zoccolillo & Rogers (1991)
55 psychiatric inpatient adolescent girls (aged yrs) with diagnoses of conduct disorder (CD), majority also had depressive or anxiety disorders.
53 Ss were reevaluated 2-4 years later.
Outcome was poor:
6% had died a violent death
the majority had dropped out of school
one-third were pregnant before the age of 17
half had been re-arrested
many suffered traumatic injuries

20. Co-morbid Disorders ADHD co-morbid in 30-50% of CD cases
CD + ADHD - usually more severe problems
Depression co-morbid in about 1/4 of CD cases
More common to be comorbid in preadolescence for boys, then declines.
Consistent comorbidity for girls from adolescence through adulthood.
Anxiety
May have an inhibitory effect -- boys who have comorbid anxiety problems are less aggressive.

21. Causes/Correlates of Conduct Disorder
Biological influences
Genetic, neurobiological factors
Social-Cognitive influences
Moral development, interpersonal relations
Family influences
Coercive parent-child interactions, marital discord, parental psychopathology
Aggression as a learned behaviour
Societal influences, cultural factors

22. Causes/Correlates of CD
Genetic Factors:
adoption and twin studies support genetic contribution, especially for overt behaviors
some children may have “reward deficiency syndrome”, which has been linked to a variant form of the dopamine D2 receptor gene
Neurobiological factors:
overactive behavioral activation system (BAS) and underactive behavioral inhibition system (BIS)
higher rates of neurodevelopmental risk factors
Social-Cognitive Factors
deficits in social information-processing
hostile attributions to ambiguous stimuli

23. Family Contributions
Coercion Theory [Patterson, 1976] - child learns to use increasingly intense forms of noxious behavior to avoid unwanted parental demands [Negative reinforcement & reinforcement trap]
Societal Influences
more common in neighborhoods with criminal subcultures, frequent transitions, low social support among neighbors
Cultural Factors
associated with minority status, but this is likely due to low SES

24. Assessment of ODD & CD Clinical interview Behavioural Rating Scales
DSM diagnosis
Behavioural Rating Scales
Child Behavior Checklist [CBCL]
Eyberg Child Behavior Inventory [ECBI]
Self-Report Delinquency Scale [SRD]
Behavioural Observations
Behavioral Coding System
Dyadic Parent-child Interaction Coding System

25. Treatment Very few effective interventions
Interventions with some empirical support:
Parent-Management Training (PMT)
Cognitive problem solving skills training (PSST)
Multisystemic treatment (MST)
Medication - mixed findings - may reduce overt behaviors, must be used in combination with other interventions

26. Treatments for Delinquency
Depends on prevailing social and political attitudes [treatment vs punishment]
Functional Family Therapy
Social learning + cognitive behavioural + family systems
Institutional Treatment
Community Based Treatment
Juvenile Diversion Projects