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PSY341 Conduct Disorders - additional reading .docx

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Hywel Morgan

CONDUCT DISORDERS Jonathan Hill - The term 'conduct disorders' refers to aggressive, destructive and disruptive behaviors in childhood that are serious and likely to impair a child's development - Ex. repeatedly hitting other children, often causing injury; breaking household objects; and frequent refusal to obey commands and keep to house or school rules - In DSM-IV o ODD = recurrent negativistic, defiant, disobedient and hostile behaviors o CD = presence of repetitive & persistent violations of societal norms and other people's basic rights. - In ICD-10: oppositional and conduct problems are both included under the heading of CD - Many of these behaviors are common normal development in young kids, especially oppositional behaviors - In young children, if the behaviors occur in combination and are persistent & frequent, they carry a high risk of persistence into adolescence  this brings increased risks in later life of a number of problems, including: o Antisocial beh, a range of psychiatric disorders, educational & work failure, relationship difficulties - Delinquency that develops in adolescence without preceding conduct problems probably has less serious consequences in adult life. Difficulties in The Diagnosis of Conduct Disorder - There is no natural cut-off, so generally it is not useful to determine whether a child has the disorder, but rather to what extent, and what the particular area of vulnerability are - Research has used behavioral scores of the severity & diversity of CD problems. These scores are commonly derived from items that differ in some respects from those found in the DSM-IV & ICD-10 systems - Children with conduct problems often have other emotional and behavioral difficulties, especially symptoms of ADHD & depression. There's debate over whether comorbid conditions are distinct diagnoses or represent the co-occurance of different conditions CAUSES OF CONDUCT DISORDERS There a 2 correct approaches: 1. Ascribe CD to individual differences such as complicated birth or inherited characteristics - Evidence suggests that there is substantial heritability of conduct problems, and although little is known about the mechanisms, they are likely to involve psychological and temperamental processes. - Children with conduct problems (especially those appearing before puberty) are more likely to have: * Lower IQ * Low tolerance of frustration * Poor verbal skills * A lack of anxious inhibition of rule-breaking * Problems of hyperactivity * Impaired attention and concentration * Impaired functioning on tests of executive functioning 2. Environment: Clinicians commonly look for explanations related to the particular experiences the child has received within the family - It's well established that parenting practices in families of conduct-disordered children are characterized by: * Hostility and criticism * Harsh discipline * Low monitoring of children’s behaviors * Lack of consistent rules * Marital disagreement - Its still uncertain which env factors play a causal role in the genesis & maintenance of conduct problems - Several genetic studies have found that environmental risks for conduct problems are particular to the conduct-disordered child (non-shared environmental influences), rather than shared with siblings - Patterson's 'coercive cycle' hypothesized that parents inadvertently behave in ways that promote oppositional behaviors. The cycle starts when a parent initially attempts to control aggressive or disruptive beh, which the child then increases. At some point in the escalation the parent gives in, reinforcing the behavior  The failure of a child to reinforce effective parenting may also contribute to such sequences, and parental behaviors may be influenced by the same genetic factors as those that influence the child's conduct problems 1 - A combination of inherited vulnerability plus negative parenting, especially early negative affect & intrusive control, contribute to the development and the persistence of conduct problems MIND & 'MINDLESSNESS' IN CD CHILDREN - Violence is often characterized as mindless & its a common clinical experience in CD children's behavior - These are promising coherent theories of the way conduct-disordered children think and feel... A. Social Cognition—(Dodge) Reactive aggression (i.e. aggressive behavior in response to actual or perceived provocation) is more likely to arise when the child * Focuses on the aggressive features of others' behavior * Interprets neutral behavior as aggressive * Accesses/favors aggressive responses when faces with social challenges - Findings regarding reactive (as opposed to proactive) aggression have not been consistent B. Self-Esteem—Studies have consistently found that compared to most children, aggressive children rate their own physical, academic & social competence more highly than do informants such as peers, teachers or parents. - This overestimate in competence could be that it reflects an inflated & fragile self-appraisal system, and when it is threatened the child responds aggressively - Children with inaccurate self-perception are likely to be inefficient at social information processing and therefore ineffective at solving social problems, and hence may deal with social incompetence through aggressive attempts to assert control C. 'Psychopathy'—There is controversy over whether a subset of children with conduct problems show evidence of social behaviors that may be the precursors of psychpathy in adult life - One proposal: The 'fledging psychopath' is distinguished by the combination of antisocial behaviors and hyperactivity and inattention. ~ Another argues: Psychopathy in childhood is characterized by an indifference to the feelings of others similar to that seen in adults - There is some evidence that children who score high on a scale of 'callous-unemotional' traits differ from other CD children in several aspects: Their mean IQ is not lower than the general population, there is a high generic contribution to the callous-unemotional traits, and they are less likely to come from families with the psychosocial difficulties outlined earlier. - A small number of children with conduct problems have difficulties in understanding social interactions; this is sometimes referred to as 'social pragmatic disorder'. Their aggressive & disruptive beh may be related to difficulties in understanding the requirements of social situations, poor interpersonal problem solving, misinterpretation of others' actions, or bullying or low self-esteem associated with their social deficits. PEERS - Children with CD are often rejected by other children who do not have behavior problems & are more likely to have a peer group of children with similar difficulties. This could be for a number of reasons: * Children who are rejected respond with aggressive and disruptive behaviors * Children with these behaviors are avoided by their peers * A common factor gives rise both to conduct problems and to peer relationship difficulties - Much of the evidence favors an effect of conduct problems on peer difficulties - i.e. most children generally
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