1. Conduct Disorder John Carmichael Abnormal Psychology

2. Conduct Disorder Objectives Know what Conduct Disorder is Why it’s important Significant facts regarding this disorder

3. Conduct Disorder Children and adolescents with this disorder have great difficulty following rules and behaving in a socially acceptable way. They are often viewed by other children, adults and social agencies as "bad" or delinquent, rather than mentally ill.

4. DSM IV Categories Within the DSM IV, Conduct Disorder is placed in the category of Attention-Deficit and Disruptive Behavior Disorders. This category is defined in the DSM IV as a set of externalizing negative behaviors that co-occur during childhood Oppositional Defiant Disorder (ODD), is defined as "a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures". Attention-Deficit/Hyperactivity Disorder (ADHD), is defined as a “Persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and is more severe than is typically observed in individuals at comparable level of development.”

5. Conduct Disorder Definition: The essential features of Conduct Disorder (CD)involve “a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated”, resulting in a clinically significant impairment in functioning. This includes aggressive behaviors, behaviors that result in property loss or damage, deceitfulness or theft, other serious rule violations (e.g., running away from home, truancy).

6. DSM IV Conduct Disorder Criteria For 12 months or more has repeatedly violated rules, age-appropriate societal norms or the rights of others. Shown by 3 or more of the following, with at least one of the following occurring in the past 6 months: Aggression against people or animals Frequent bullying or threatening Often starts fights Used a weapon that could cause serious injury Physical cruelty to people Physical cruelty to animals Theft with confrontation Forced sex upon someone

7. DSM IV Conduct Disorder Criteria Property destruction Deliberately set fires to cause serious damage Deliberately destroyed the property of others (except fire-setting) Lying or theft Broke into building, car or house belonging to someone else Frequently lied or broke promises for gain or to avoid obligations ("conning") Stole valuables without confrontation (burglary, forgery, shoplifting)

8. DSM IV Conduct Disorder Criteria Serious rule violation Beginning by age twelve, frequently stayed out at night against parents' wishes Runaway from parents overnight twice or more (once if for an extended period) Frequent truancy before age 13 These symptoms cause clinically important job, school or social impairment. If older than age 18, the patient does not meet criteria for Antisocial Personality Disorder.

9. DSM IV Conduct Disorder Criteria Childhood-Onset Type:at least one problem with conduct before age 10 Adolescent-Onset Type: no problems with conduct before age 10 Note. Age of onset subtypes have been supported using trajectory analyses in longitudinal cohorts by finding that those with childhood-onset type typically continue to meet criteria up to their late 20’s (Mofitt, 2007) Severity: Mild (both are required):There are few problems with conduct more than are needed to make the diagnosis, and Problems cause little harm to others.

10. DSM IV Conduct Disorder Criteria Severity: (cont.) Moderate. Number and effect of conduct problems is between Mild and Severe Severe. Many more conduct symptoms than are needed to make the diagnosis, orSymptoms cause other people considerable harm.

11. Distinctions between Disorders Diagnosis of ODD and CD have tested and proven differences Subjecting gathered data to multidimensional scaling techniques resulted in some significant findings which has helped narrow the focus of study regarding behaviors associated with CD oppositional defiant and aggressive characteristics were located on one end of the dimension (overt symptoms). Substance use and other non-aggressive conduct disorder symptoms were located on the other (covert symptoms). Behavior directed towards property or persons in a destructive way was located on one of the dimension (destructive behavior). Behavior on the opposite end were non-destructive such as substance abuse, status offenses (non-destructive behavior).

12. Distinctions between Disorders These findings provide general support for the distinction between oppositional defiant and conduct disorder. They also suggest that conduct problems may be more meaningfully grouped into four, rather than two, general categories. These include overt & nondestructive behaviors reflecting symptoms of ODD overt & destructive symptoms of aggression covert & destructive behaviors, such as lying and stealing covert & nondestructive behaviors such as truancy and running away from home (status offenses)

13. Four Dimensions of Conduct Disordered Behavior OVERT/DESTRUCTIVE (Aggressive Behaviors) Fights Bullies Assault Spiteful

14. Four Dimensions of Conduct Disordered Behavior OVERT/NONDESTRUCTIVE (Oppositional Features) Annoys Defies Stubborn Angry COVERT/DESTRUCTIVE COVERT/NONDESTRUCTIVE (Property Violations) (Status Offenses) Cruel to Animals Runaway Vandalism Truancy Steals Substance Use Fire setting Breaks Rules

15. Under the Umbrella of Conduct Disorder However defined, the general term conduct disorder refers to a heterogeneous groupof problem behaviors. Some are aversive, disruptive and problematic for parents and teachers. Others involve aggression toward property or persons. Others involve actual violations of the law which might result in the child being labeled as delinquent if the behavior were to come to the attention of legal authorities.

16. Delinquency: A Definition Delinquency is a legal term rather than a psychological construct. It refers to a juvenile (usually under 18 years) who is brought to the attention of the juvenile justice system for committing a criminal act or displaying a variety of other behaviors not specified under criminal law. These "other behaviors", are usually referred to as status offenses. They include truancy, curfew violations, running away from home and the use of alcohol. These are only violations of the law as a result of the child's age and his/her status as a minor.

17. What follows Conduct Disorder Antisocial Personality Disorder Note: Antisocial is used under a technical definition “Pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.” For diagnosis, must have a history of some Conduct Disorder symptoms before age 15. Not actually diagnosed prior to age 18.

18. Etiological Factors in Childhood Conduct Disorder While the etiology of Conduct disorder is not fully understood it has been shown to be related to a range of psychosocial factors including; living in environments with high crime rates. marital conflict & broken homes, dysfunctional and rejecting family environments, inconsistent and severe discipline, Physical and sexual abuse social learning experiences (e.g., the learning of problem behavior through observation and/or its reinforcement by parents, siblings and others).

19. Etiological Factors in Childhood Conduct Disorder While a range of factors has been implicated in the development of conduct disorders, no one factor has been determined to be “the cause”. Each of the factors listed here may contribute to conduct disordered and delinquent behavior in some instances. It’s likely that there are numerous possible combinations of contributing variables that can result in the clinical manifestations of these disorders.

20. Coercive Family Behavior and Conduct Problems Conduct problems has been strongly associated with ongoing patterns of coercive parent-child interactions that are characterized by; Escalating parent and child demands, Escalating negative consequences Where the person who dispenses the most negative consequence “wins”. Problems with “winning the battle” while “losing the war”.

21. Treatment of Conduct Disorder Treatment of children and adolescents who have Conduct Disorder has frequently been carried out in institutions or within community based programs. Research suggests that treatment within the context of standard institutional programs is often unsuccessful, with a 70-80% rate of recidivism.

22. Treatment of Conduct Disorder Use of multiple forms of treatment, using a combination of family-systems therapy, child-focused therapy, and Multi-systemic therapy has had modest success Research suggests that treatment within the context of standard institutional programs is often unsuccessful, with a 70-80% rate of recidivism.

23. Conclusion Treat your kids well and most likely you won’t have a child with Conduct Disorder. Understanding Conduct Disorder and the associated symptoms and causes will help you if you ever want to have kids, or work with kids.

24. Questions and Discussion