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psych 2042 conduct disorders.docx

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Health Sciences
Course Code
Health Sciences 1001A/B
Shauna Burke

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Psych Jan 29 , 2013 Last week: children with a neurobiological deficit CONDUCT DISORDERS: Work of Weir (guest speaker): - Max. security detention centre - Young offenders (aged 16-18) - Crimes: possession of stolen property, break and entering, car theft, assault, narcotics possession, breach of probation, attempted murder, murder - Worked with them from between 2 weeks and 2 months Research Methods - Qualitative approach - Data collection: content analysis of ‘journal entries’ (family, violence, drugs, sex, world view/future, racism, friends, freedom, reform, influences of incarceration) - Personal experiences (inmates, guards) - Personal observations (guards, inmates, mental health specialists, administrators) Conclusions: - Personal opinion: many of the 16-18 year old men and women I worked with were beyond rehabilitation BUT efforts short still be taken to reform their destructive ways - Provided our treatment efforts are not naïve; that such efforts take into account the variety of factors that contribute and contributed to how they got where they were, positive change may be possible - The deleterious effects of incarceration: rehabilitation in prison is severely compromised - The attitudes of the inmates about themselves and one another, in addition to those of correctional officers toward the inmates impaired psychological and behavioural change DSM-IV: Oppositional Defiant Disorder - Not a single incident (but is ongoing) - Consistent, age- inappropriate behaviour - Stubborn, hostile, defiant behaviour - Frequent predictor of unhealthy parent-child relationships - They are easily annoyed by other, spiteful, DSM- IV: Conduct Disorder - Violating the basic rights of others and/or property - General rejection of societal and cultural norms and rules - Examples: aggression towards animals; school bully; intentional destruction of property; order a meal and don’t pay; take a taxi and don’t pay Childhood vs. Adolescent Onset CD - Show symptom of conduct disorder before the age of 10 - Symptoms usually includes some form of aggression - More likely to be boys - Persist over time (lifelong) - High correlation between early onset CD (childhood CD) and unemployed parents; low SES; multiple partners; abuse Adolescent Onset CD - Occurs in both boys and girls with the same level of frequency - Less severe behavioural psychopathology - Less likely to commit violent offenses - Less likely to continue with anti-social behaviour ODD or CD? Which is it? - At times there are used interchangeably - CD are usually preceded by ODD - ODD almost always come before CD, however, the DIAGNOSIS of ODD may be missed in the CHILD who is identified with CD - Most CHILDREN with CD continue to display ODD symptoms - Most CHILDREN who display ODD symptoms, DO NOT progress onto a diagnosis of CD Conduct Disorders and APD - Youths who display symptoms of both ODD and CD are at an elevated risk for a diagnosis of antisocial personality disorder (APD) as adults - Up to 40% of children with CD are diagnosed with APD as adults - Psychopaths: the absence of a conscience; callous acts of deception and manipulation; no sense of remorse Associated characteristics of CD: - ADHD is the single most frequent comorbid psychiatric/psychological disorder - High rates of poor grades (particularly with language and reading); being held back a grade; spec. ed. Placement; dropouts; suspensions - Childhood CD TOGETHER with an association of deviant peer group, strong predictor of CD in adolescence - Family: economically impoverished households and neighbourhoods; single parent households; multiple parent households; parental psychopathology; family history of domestic violence; antisocial family values; incarcerated family members- parents, uncles, aunts siblings - Most conduct disorder patients have ADHD - Vacillate an extreme use of punishment or on other hand extreme emotional distancing(like they are not existence) Question period notes: - The more severe of ODD And CD is CD - ODD does not always lead to CD - If diagnosed with CD almost always had ODD before that NORMAL CLASS: Context, costs and perspectives (cont’d) - Social and Economic costs o Conduct problems are the most costly mental health problem in North America o Early, persistent and extreme pattern of antisocial behaviour occurs in about 5% of children; these children account for over 50% of all crime in the U.S. and approximately 30-50% of clinical referrals o As much as 20% of mental health expenditures in the U.S. are attributable to crime o Public costs across healthcare, juvenile justice and educational systems are at least $10,000 a year per child o Lifetime cost to society per child who leaves high school for life of crime and substance abuse is estimated to be at least $2 million Myth Buster: - Adolescence is inevitably a time of turmoil?? o 1 paragraph of text  From ‘a time of storm and stress (1904)  From ‘to be normal during the adolescent period is by itself abnormal (1958) - Based on American data, there is an INC. in conflicts with parents, taking more risks and mood changes - However, the majority of youth in most surveys in countries around the world, report general happiness in their home - In contrast to the US data given in the text what percentage of youth were charged with a Criminal Code offence in Canada in 2011? Self- Esteem Deficits: - Low self-esteem is not the primary cause of conduct problems o Instead, problems are related to inflated, unstable and/or tentative view of self - Youths with conduct problems may experience high self-esteem that over time permits them to rationalize their antisocial conduct - 50% of people with ODD do not progress to have CD, and 25% of those left over go on to develop nothing at all Peer Problems - Young children with conduct problems display poo social skills and verbal and physical aggression toward peers - Often rejected by peers, although some are popular o Children rejected in primary grades are five times more likely to display conduct problems as teens o Some become bullies o Often form friendships with other antisocial peers  Predictive of conduct problems during adolescence o Underestimate own aggression and its negative impact, and overestimate others’ aggression toward them o Reactive-aggression children display hostile attributional bias: attribute negative intent to others o Proactive- aggression view their aggression actions as positive - **refer to graph on context, costs and perspectives Family Problems - Family problems are among the strongest and most consistent correlated of conduct problems o General family disturbances (e.g. parental mental health problems, family history of antisocial behaviour, marital discord etc.) o Specific disturbances in parenting practices and family functioning (e.g. excessive use of harsh discipline, lack of supervision, lack of emotional support. Involvement, etc.) o High levels of conflict are common in the family, especially between siblings o Lack of family cohesion and emotional support o Deficient parenting practices o Parental social-cognitive deficits Accompanying Disorders and Symptoms: - Attention- Deficit/Hyperactivity Disorder (ADHD) o More than 5-% of children with CD also have ADHD o Possible reasons for overlap:  A shared predisposing vulnerability may lead to both ADHD and CD  ADHD may be a catalyst for CD  ADHD may lead to childhood onset of CD o Research suggests that CD and ADHD are distinct disorders - Depression and anxiety: o About 50% of children with conduct problems also have a diagnosis of depression or anxiety  ODD best accounts for the connection between conduct problems and depression  Poor adult outcomes for boys with combined conduct and internalizing problems  Girls with CD develop depressive or anxiety disorder by early adulthood  Males and females: increasingly severity of antisocial behaviour is associated with INC. severity of depression and anxiety  Anxiety may serve as protective factor to inhibit aggression Prevalence, Gender and Course - Prevalence: o ODD more prevalent than CD during childhood; by adolescence, prevalence is equal o Lifetime prevalence rates  12% for ODD (13% for males, 11% for females)  8% for CD (9% for males, 11% for females) o Prevalence estimates for CD and ODD across cultures are similar, but most comparison have been made between Western countries rather than between Western and non-Western countries Gender: - Gender diff. are evident by 2-3 years of age o During childhood, rates of conduct problems are about 2-4 times higher in boys o Boys have earlier age of onset and greater persistence o Gender disparity INC. through middle childhood, narrows in early adolescence and increases again in late adolescent, when male delinquent behaviour peaks o Early symptoms for boys are aggression and theft; early symptoms for girls are
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