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Chapter 6

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Psychology 2042A/B
Scott Wier

Child Psychology Chapter 6: Conduct Problems Introduction  High prevalence of youths with conduct problems and the harm inflicted on their victims  Youths often have a background that suggests a history of social isolation and subjection, unusual social behaviour, and a fascination with violent themes  Media portrayals fuel popular beliefs that aggression is inherent in humans Description of Conduct Problems  Conduct Problems:  Antisocial Behaviours:  Conduct problems and antisocial behaviours are terms used to describe a wide range of age-inappropriate actions and attitudes of a child that violate family expectations, societal norms, and the personal or property rights of others  Children with conduct problems display a variety of disruptive and rule- violating behaviours  Children with severe conduct problems frequently grow up in extremely unfortunate family and neighborhood circumstances where they experience physical abuse, neglect, poverty, or exposure to criminal activity  Children with severe conduct problems are often seriously disturbed and need help  These children walk a fine line between pleas form the mental health and juvenile justice systems and demands from the general public and the criminal justice system to punish the offenders and protect the victims Context, Costs, and Perspectives  Very few adolescents reform from antisocial behaviour entirely  Antisocial behaviours appear and then decline during normal development  Important features of antisocial behaviours in the context of normal development: o Antisocial behaviours vary in severity, from minor disobedience to fighting o Some antisocial behaviours decrease with age, whereas other increase with age and opportunity o Antisocial behaviours are more common in boys than girls during childhood but this difference narrows in adolescence  Children who are the most physically aggressive in early childhood maintain their relative standing over time  Youngsters with conduct problems make it the most costly mental health problem in North America  The lifetime costs to society for one youth to leave high school for a life of crime and substance abuse has been estimated to costs at least 2 million dollars  Different Perspectives: o Legal  Conduct problems are defined as delinquent or criminal acts  Juvenile Delinquency:  Legal definitions exclude the antisocial behaviours of very young children that usually occur at home or school  The minimum age of responsibility is 12 in most states and provinces  The most common reason that children carry a weapon is self defense  Clear boundaries exist between delinquent acts that are a reaction to environmental conditions and those that result from factors within the child  A legal definition of delinquency may result from one or two isolated acts, whereas a mental health definition usually requires the child to display a persistent pattern of antisocial behaviour o Psychological  Externalizing Behaviour:  Children with one or more standard deviations above the mean, are considered to have conduct problems  The externalizing dimension itself consists of two related but independent sub dimensions labeled “rule-breaking behaviour” and “aggressive behaviour”  Two additional independent dimensions of antisocial behaviour have been identified: over-cohort and destructive- nondestructive  Over-Covert Dimension:  Overt antisocial behaviour tend to be negative, irritable, resentful in their reactions to hostile situations, and have higher levels of family conflict  Covert antisocial behaviour are less social, more anxious, more suspicious of others, and have little family support  Most children with conduct problems display both overt and covert behaviours  Destructive-Nondestructive Dimension:  Crossing the overt-covert with the destructive-nondestructive dimension results in four categories of conduct problems:  (A) Covert-destructive – property violations  (B) Overt-destructive - aggression  (C) Covert-nondestructive – status violations  (D) Overt-nondestructive – oppositional behaviour o Psychiatric  Disruptive Behaviour Disorders: o Public Health  Blends the legal, psychological and psychiatric perspectives with public health concepts of prevention and intervention  The goal is to reduce the umber of injuries, deaths, personal suffering, and economic costs associated with youth violence  The public health approach cuts across disciplines to understand conduct problems in youths and determine how they can be treated and prevented DSM-IV-TR: Defining Features  Oppositional Defiant Disorder (ODD):  ODD has a pattern of stubborn, hostile, and defiant behaviours which usually appear by age 8  Youngsters with ODD also have a substantial risk of developing secondary mood, anxiety, and impulse-control disorders  Conduct-Disorder (CD):  Children with CD display a persistent and antisocial acts that involve inflicting pain on others or interfering with rights of others through physical and verbal aggression, stealing, or committing acts of vandalism  Key features of CD are: o Children with CD engage in severe antisocial behaviours o Often have co-occurring problems such as ADHD, academic defiance’s, and poor relations with peers o Their families often use child-rearing practices that contribute to the problem, such as harsh punishment, and have their own problem and stresses such as marital discord, psychiatric problems, and unemployment o Their parents feel these children are out of control, and they feel helpless to do anything about it  Childhood-Onset Conduct Disorder:  Adolescent-Onset Conduct Disorder: A specific type of conduct disorder for which the characteristics are not exhibited prior to 10 years of age.  Children with childhood onset CD are more likely to be boys, show more aggressive symptoms, illegal activity, and persist in their antisocial behaviour over time  Adolescent-onset CD are as likely to be girls as boys and do not display the severity or psychopathology that characterizes the childhood-onset group  Age of onset does make a difference  Overlap between the symptoms of CD and ODD  Symptoms of ODD typically emerge around 2-3 years before CD symptoms (6 vs. 9)  ODD symptoms are possible precursors of CD however, most children who display ODD do not progress to more severe CD  CD are almost always preceded by ODD, and nearly all children with CD continue to display ODD symptoms  Persistent aggressive behaviour and CD in childhood may be a precursor of adult antisocial personality disorder (APD)  Adult Antisocial Personality Disorder (APD):  CD, adults with antisocial personality disorder may also display psychopathy  Psychopathy:  Less is known about psychopathy in children than in adults however, signs of lack of conscience occur in some children as young as 3-5  Adolescents with CD are less likely than peers to show affective empathy or embarrassment  Callous and Unemotional Interpersonal Style:  This is characterized by lacking in guilt, not showing empathy, not showing emotions, and narcissism and impulsivity  Children who display callous-unemotional traits also display a lack of behavioural inhibition  Children with callous-unemotional traits display a greater number and variety of conduct problems, and have a more frequent contact with police and a stronger than other children with conduct problems  Different developmental processes may underlie the behavioural and emotional problems seen in children with CD who also display callous- unemotional traits  Possible that callous-unemotional traits are related to adult forms of psychopathy Associated Characteristics  Most children with conduct problems have normal intelligence, they score nearly 8 points lower than their peers on IQ tests  IQ deficit may be greater fro children with childhood-onset CD and the lower scores may be related to the co-occurrence of ADHD  Verbal IQ is consistently lower than performance IQ in children with CD, suggesting a specific and pervasively deficit in language  May affect the child’s receptive listening, reading, problem solving, expressive speech and writing and memory for verbal material  Suggested that verbal and language deficits may contribute to conduct problems  Lower IQ and verbal intelligence are present before the emergence of conduct problems  Verbal deficits may increase the child’s vulnerability to the effects of a hostile family environment  Deficits in executive functions similar to those of children with ADHD  Because ODD/CD and ADHD frequently co-occur, deficits in executive functions could be due to the presence of co-occurring ADHD  Possible executive functioning deficits experienced by children with ODD and CD may differ from those experienced by children with ADHD  Children with conduct problems display many school difficulties  Little evidence that academic failure is the primary cause of conduct problems, particularly in early childhood  It is more likely that a common factor underlies both conduct problems and school difficulties  Underachievement and conduct problems are also likely to influence one another over time  Children with poor academic skills are increasingly likely to lose interest in school and to associate with delinquent peers  Little support for the view that low self-esteem is the primarily cause of conduct problems. Rather, these problems seem to be related to an inflated, unstable, and/or tentative view of self  Self-esteem among youth gang members seems to conform to a pattern in which any increment in self-esteem for one group member takes away from what is available for others  Thus, may experience high self-esteem that over time permits them to rationalize their antisocial conduct  Children with conduct problems display verbal and physical aggression toward other children and poor social skills  As they grow older, most are rejected by their peers  Some of these children become bullies  Children with conduct problems are able to make friends, but are often based on a mutual attraction of like-minded antisocial individuals  Involvement with antisocial peers becomes increasingly stable during childhood and supports the transition to adolescent criminal acts  Involvement with deviant peers is also one of the strongest predictors of accelerated autonomy and early sexual activity in adolescence  Friendships between antisocial boys are abrasive, suitable, of short duration and not very productive  Deviant peer involvement is an especially strong predictive of substance use, delinquent behaviour, and violence makes intervention in this area a high priority  Unfortunately many well intentioned programs tend to create groups with conduct problems  Aggressive children also show distortions in how they think about social situations  Reactive-aggressive children display hostile attributional bias  Hostile-Attributional Bias:  Proactive-Aggressive Children view their aggressive actions as positive, and value social goals of dominance and revenge rather than affiliation  It is important to keep in mind that many children with conduct problems live in highly aggressive and threatening circumstances  Their aggressive style of responding may be an adaptive reaction to that world Family Problems  Two types of family disturbances are related to these problems in children: o General family disturbances o Specific disturbances in parenting practices and family functioning  The two types are interrelated  High levels of conflict are common in families of children with conduct problems and with poor parenting practices  There is often a lack of family cohesions  Conflict between siblings is especially high between children with conduct problems and their siblings  Suggested that their difficulties are not simply reacting to the annoying behaviours of their antisocial brother or sister  The collaboration of siblings on one another’s deviant behaviour can be as powerful as deviant peer relationships in heightening the risk for later conduct problems Health-Related Problems  Young people with persistent conduct problems engage in many behaviours that place at high risk for personal injuries  Antisocial behaviour in childhood predicts an early onset and persistence of sexual activity and sexual risk taking by age 21  Illicit drug use and adolescent antisocial behaviour are strongly associated  Early conduct problems are a known risk factor for adolescent substance use and this relationship is mediated by drug use and delinquency during early and late adolescence Accompanying Disorders and Symptoms: ADHD  Most youngsters with conduct problems suffer from one or more additional disorders  About 50% of children with CD also have ADHD. Possible reasons for this overlap: o A common underlying factor such as impulsivity, poor self-regulation, or temperament may lead to both ADHD and CD o ADHD may be a catalyst for CD by contributing to its persistence and escalation to more severe forms o ADHD may lead to childhood onset of CD, which is a strong predictor of continuing problems  Two lines of research suggest that CD and ADHD are distinct disorders: o A model that includes both CD and ADHD consistently provides a better fit to the data than a model based on only a single disruptive behaviour disorder o CD is less likely than ADHD to be associated with cognitive impairments, neurodevelopmental abnormalities, inattentiveness in the classroom and higher rates of accidental injuries Accompanying Disorders and Symptoms: Depression and Anxiety  About 50% of children with conduct problems also reveice a diagnosis of depression or anxiety  Boys with combined conduct and internalizing problems have poor outcomes in early adulthood  Girls with CD develop a depressive or anxiety disorders by early adulthood,  Both sexes, the increasing severity of an antisocial behaviour is associated wit the increasing severity of depression and anxiety  Adolescent CD is also a risk factor for completed suicide  Some studies, co-occurring anxiety has been found to be a protective factor that may inhibit aggressive behaviour  Other studies have found that anxiety may increase the risk for later antisocial behaviour  Boys with CD and anxiety disorder show a higher level of salivary cortisol – associated with a greater degree of behavioural inhibition ‘In boys with CD, lower levels of salivary cortisol are directly associated with more aggressive and disruptive behaviours  Hypothesized that the relation between anxiety and antisocial outcomes may depend on the type of anxiety  Children with callous-unemotional traits show less anxiety than other children with conduct problems Prevalence  ODD is more prevalent than CD during childhood, but by adolescence the prevalence is bout equal  ODD either declines or stays constant  CD increases Gender  Gender differences in the frequency and severity of antisocial behaviour are evident by 2-3 years of age  Conduct problems for boys showing an earlier age of onset and greater persistence  Gender disparity in conduct problems increases  Boys with CD are aggressive while girls usually display sexual misbehaviors  Antisocial girls are more likely than others to develop relationships with antisocial boys  Aggression by girls does not seem to forecast continued physical violence and other forms of delinquency as it does for boys  Antisocial behaviour is increasingly becoming an equal opportunity affliction  Reasons for gender difference could be genetic, neurobiological, and environmental risk factors  When girls are angry they are more likely to use indirect and relational forms of aggression  The function of their aggressive behaviour increasingly revolved around group acceptance and affiliation, for boys aggression remains confrontational  Fewer differences in antisocial behaviours exist between boys and girls referred for treatment than for children in community samples  Girls behaviour is considered more covert while boys demonstrate more overt antisocial behaviours  Boys symptoms are more noticeable at a younger age  Displays of antisocial behaviour are less visible in girls, lower thresholds or different diagnostic criteria may be needed to detect girls with CD at a younger age  Some Girls have an early menarche, which may indirectly heighten their conduct problems by increasing their involvement with deviant peers  Early onset of menarche predicts increased delinquency primarily for girls who attend mixed-gender schools  Girls exposure to boys who model antisocial behaviour and pressure girls for early sexual relations may interact with early physical maturation General Progression  Early signs of conduct problems are usually not so obvious  Preschool | Difficult Temperament | Hyperactivity | Overt Conduct Problems/Aggressiveness | Withdrawal | Poor Peer Relationship | Academic Problems | Covert or Concealing Conduct Problems | Association With Deviant Peers | Delinquency (arrest) V Adolescence  A difficult temperament often precedes later conduct problems but is not specific to them  Childr
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