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Lecture 7

PSY341H1 Lecture 7

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Hywel Morgan

PSY341H1S L7; July 29, 2013 o Diagnostic requirements require that they break laws o Don’t need to have been convicted – can get away w it Conduct Disorder  CD – attention received is reinforcing  Very disruptive bhvr’al disorder usually first diagnosed in o Suggests attachment is not there middle childhood (age 9-10)  Not just children who engage in delinquent bhvr o Is psychological!!  Quite common  Rather unpleasant symptoms o Due to lack of attachment  Theory that it begins as Reactive Attachment Disorder in  Not all delinquent children tested for CD o More violent crimes  more likely tested early childhood o No attachment formed w caregiver  Ppl usually not tested o Ex. 3 yr old sleeping w knives, setting things on fire o Defense lawyer may suggest this  guilty by insanity o Ex. 12 yr old rapist o If not treated (w social interaction)  manifests as CDelinquency o Often referred to erroneously as Juvenile Delinquency  Delinquency = legal term  Often referred to as Delinquents – often break o Juvenile delinquent = Broken law, under age 18, rules & law convicted of a crime  CD is the psychiatric term  Not all Juvenile Delinquents are conducted disordered  Treatable w family therapy o Have to have been convicted  Research shows if CD untreated  manifests as Antisocial  Stealing = delinquent bhvr Personality Disorder o Makes you a delinquent o Can treat o Can learn from conseqs  Difficult to treat o But doesn’t mean you have CD o Can’t cure  In Disruptive Disorders category w ADHD on DSM IV Some of the bhvrs of CD (symptom categories) o Often comorbid  Cannot get by w/o breaking laws  Early onset (middle childhood) & late onset (adolescence) DSM V: ADHD & CD separated o Better prognosis for diagnosis in middle childhood  ADHD: Neurological Disorder than diagnosis in adolescence  CD: Disruptive Impulse Control & Conducts Disorders o Since treatment earlier o Basically unchanged in diagnostic symptoms  DSM very specific on symptoms o RAD also here  4 major cateogries o Oppositional Defiant Disorder  Disobedient, very noncompliant 1) Aggression to ppl & animals  Not as serious as CD  Quite common in younger children in CD  Won’t follow rules (“I won’t...”) o Start w animals (more vulnerable)  ppl  Pathological – interferes w development & daily  Tormenting pets – abuse, torture, murder lives (ex. won’t go to school)  Bully, intimidate  Not a form of intellectual delay  Initiate physical fights – often use a weapon that can cause o Antisocial Personality Disorder serious physical harm  Key feature – lack of empathy (can’t understand o More likely to use unsophisticated weapons others’ pts of view from an empathetic o Ex. stick, stone, baseball bat perspective)  Physically cruel  What can they get out of you? Don’t call about  Steal from a victim while confronting them hurting you. o aka Assault (legal term)  Can feel sympathy (feel bad for you, but don’t  Rape & sexual assault care)  Assault, harassment  No pity (requires empathy) o Intermittent Explosive Disorder  Proposed many yrs ago 2) Destruction of property  Deliberately destroying someone else’s property  Very spontaneous & sudden explosions of anger  Arson – common in this category  Violent, aggressive  Not uncommon  Vandalism o Pyromania 3) Lying & stealing  Setting things on fire o Kleptomania  Deceitfulness  Stealing  breaking into someone else’s house, car  stealing items w/o confronting a victim CD vs Delinquency o aka Burglary (legal term) CD  lying to obtain goods, favors, or to avoid obligations  CD = psychiatric term, psychopathology 4) Violation of rules o Sickness of the mind o Require treatment  Typically aren’t considered breaking the law  May not be considered illegal o Often used interchangeably w “Delinquency”  All children w CD are delinquent  Serious violations of rules  Not going to school o Psychotherapy modifying how the parent interacts w  Running away from home the child  “a man is more likely to have a serious criminal record if he’s Prevalence been severely physically abused as a child”  2% of girls o Difficult to form bond w an abusive caregiver (esp is  10% of boys physical abuse) o Common  ½ of all children in guidance clinics Video: The Trouble with Evan  Filmed in 1990s o Fairly common  70% in psychiatric clinics  Much controversy  20% of all arrests are under age 18  Evan has CD o Talking about delinquency  Unique treatment option – Portage Treatment o Strong correlation btwn delinquency & CD  There will be a Q about this on the exam!  1 in 5 arrests involve children  Possible that a significant portion of them have  Lyndon Makintire examines the roots of rage untreated CD o Been a reporter for 30yrs o “the saddest story he’s ever told” Possible causes  Cameras installed in their home Psychological  Parents striving to do well in parenting  Suggest antisocial bhvr may be a defense against anxiety &  Hamilton Ontario lack of attachment  Age 4 – classified as conduct disordered  An attempt to recapture the mother-infant relationship  Teacher’s comments: Aggressive bhvr at school  Result of maternal deprivation o Gouged fingernails into classmates w/o reason  o Very confused, unhappy, not in control  Age 11, grade 6, above avg intelligence Sociological  Shoplifted – parents aware  CD is the child’s attempt to cope w/ a hostile envt  Lately started smoking  Learned from ppl around to cope w the hostile envt o Caught at school, suspended   Mother (Karin), hearing-impaired sister (Kimberly, 7yrs), stepfather (Mike) in industry (worked since evan’s age, father Biological died at age 14)  Child inherited a vulnerability o Generation gap growing due to frustration w Evan’s o Genetic bhvr o Since occurs early on o Both parents work  Neurophysiological  Often in trouble for playing w matches o Brain damage o Almost started forest fire o Disproportionally large # of children w CD that suffer Parents posted unsubtle reminders on walls for Evan from epilepsy – usually is focused brain damage  Parents enrolled in parenting class  seizures o Evan soon became focus of grp  Mike loses composure easily for a while Organic Factors o Affects everyone  Brain damage o Knows it makes the situation worse  Heredity o Parents w problems w impulse control & aggressive  Installed cameras in home for 3mths bhvr tend to have child w same bhvr  Provided Evan w his own camera to record from his own o Suggests both genes & envt! viewpoint  Serotonin  Day 1 – Evan suspended for 2ndtime in 1 mth o Abnormal levels o Put paint, clay, in teacher’s coffee as a joke o No clear if it’s a cause or effect o Issue w childcare  Testosterone o Parents talk to each other in front of Evan o Largely discredited now o Yell at Evan  Evan says he’s 11, pretty smart, can be good when he tries Treatment really hard but most time chooses bad choices – doesn’t know  Drug therapy why o SSRIs – same treatment as depression  Mike’s cheque gone through wash o Antipsychotic medication – varying degrees of success o Lint in Evan’s pocket  blame him  Distorted view of reality o Evan denies it, thinks he was set up  Psychotherapy o Karin explains how this will hurt the family o For the child w CD & the parent  Social worker – sees pattern in Evan’s bhvr, sees bad  Bhvr modification prognosis  Family management o Karin fears him being a teen out on the streets selling o For envt & genetic causes drugs  being put in correction centre – uses portage o Good results o Portage – emphasize basic structure, serious routines o Start w “I’d like to present baggage from the past” Portage o Role play parent & child  Portage saved Pierre Robert (social worker) from heroin  Asks for most painful memories  4wk parenting class  brought back memories of childhood o Ex. if you don’t want to go to fucking school, then get violence the hell out of my house  Child beaten w hockey stick for taking popsicle  The mental & verbal abuse to harder to accept and deal with  Child avoided talking to me than physical abuse  Child beaten over anything minor by father  Child beaten w whip  shut outside out  Mike says he’s fed up  Girl – suicidal o Calls Evan names  Greg – always felt very small, afraid o Similar to the portage scene o Mike says his father would’ve killed Evan  Hyper settings  Teacher found familiar themes in childhood memories  Kids don’t forget these things easily, affects them o Conflicts w parents, esp stepfathers o Saps confidence o Affects social, emotional development o Consistent sadness running through recollections of parents even tho they love them o Blocked from developing o Had food, shelter, but no sense of family Portage  Tells man to act like he’s talking to his stepdad, for how he wished he had been  Men make tableau of emotion poses from strong memories o Another man pretends to be he stepdad o Others asked to guess the situation  Abusive parents – cold eyes, hatred o  resolves childhood pain  Childhood pain  violence later in life o Jennifer’s perspective  Robberies, drugs, smoking, drinking  Men then reveal what they portrayed o Very polite to each other  When rebellious is no longer seeking for an identity  drugs replace other types of pleasure, theft replaces pleasure or o Relate to each other, emotional support earning money  Superficial images of harmony in Evan’s house Signs in Evan’s life  Trouble trying to move  Bullying  Mike & Karin’s relationship got worse after marr
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