1、Conduct Disorders,Conduct problemsage-inappropriate actions and attitudes of a child that violate family expectations, societal norms, and the personal or property rights of others Contextmost kids do this stuff (some of it) sometimes 80% of teens have tried alcohol 60% have tried cigarettes 50% hav
2、e tried marijuana Most of these beh appear and then decline 50% of parents of preschoolers report that they lie, steal, disobey, destroy propertybut 10% of parents of young adolescents Aggression is pretty stable over time -.7 same as IQ Social and economic costs About 5% of kids, but these kids are
3、 responsible for about 50% of all crime and 30-50% of clinic referrals More teens die from firearms than all diseases combined Figure 6.2cost of one lost youthdrop out due to life of crimeabout $2 Million,Oppositional Defiant Disorder,Defiant, oppositional, hostile, negative beh for at least 6 mos M
4、ust be beyond what is expected for age and gender At least 4 of Loses temper Argues with adults Blames others Angry or resentful Actively defies reasonable requests Deliberately annoys Touchy or irritable Spiteful or vindictive Cant be comorbid with CD Prevalence 2-16% of kids Higher rates in adopte
5、d kids (20%), especially those with preadoption abuse or neglect More common in boys before puberty, = after, probably because boys move to CD Low SES more at risk, 75% of clinic referred preschoolers are low income,Conduct Disorder,At least 3 of 15 Initiates physical fights Bullies, threatens, inti
6、midates Stealing Fire setting B&E Runs away overnight Physically cruel to animals Physically cruel to people Sexual coercion Destruction of property Lies frequently Truant,Two Types of CD,Childhood onset (life course persistent) More severe, more likely to persist into adulthood, more likely to begi
7、n with early problems in infant temperament and with early troubles in parent-child relationships Adolescent onset or limited More likely to be associated with troubled peers; may go until 20s Other important distinctions: Socialized/unsocialized Degree of callous-unemotional traitslack of guilt or
8、remorselow empathy Lack of behavioral inhibitionthis subtype has more freq contact with police, stronger parental hx of ADHD,Associated Characteristics,Oppositional attitudes toward parents, teachers, authority figures Academic problemsearly dropout, failing classes Peer rejection Substance use Earl
9、y, risky sexual behavior Increased risk for ADHD,Cognitive, Verbal and Academic Deficits in CD,8 pts lower on IQ tests (15 pts lower in childhood onset) Performance verbal Children with both verbal impairments and family adversity have 4x as much aggression as kids with only one of these School and
10、learning problemsincreased levels of special education, retention, dropout, suspension, expulsion Underachievement in language and reading, but this goes away when we control for ADHD,Self-Esteem and Peer Relationships,Self-esteem Inflated, unstable, tentative view of self Overestimate acceptance by
11、 other kids Peer problems Social rejection in elementary school is a strong risk factor for adolescent conduct problems Able to make friends by often like-minded antisocial friends Deviant peersstrong predictor of substance use, delinquent behavior, violence (group tx may be damaging-deviancy traini
12、ng) Overestimate amount of aggression directed at them (hostile attributional bias) Underestimate their own aggression and its negative impact,CD and ODD,Much debate over whether these are separate or not ODD emerges 2-3 yrs earlier than CD (6 vs 9) But most dont progress to CD About 25% move to CD
13、About 25% sx remit and no longer have ODD About 50% hold at ODD Possible that CD criteria arent sensitive enough for younger kidssame requirement for number of sx, but fewer opportunities,CD and APD,40-50% dev APD as adults APD may also show psychopathycallous, manipulative, deceitful, remorseless L
14、ess is known about psychopathy in kids, but some 3-5 yo have been found to have a lack of conscience,Family Problems in CD,Among the strongest and most consistent correlates of antisocial behavior 2 types General family disruptionsparental psychopathology, family hx of ASB, marital discord, limited
15、resources, antisocial family values Specific disturbances in parenting practices and family functioningharsh discipline, lack of supervision, lack of emotional support and involvement, parental disagreement about discipline These 2 are interrelated High levels of conflictcommon Poor parenting practi
16、cesineffective discipline, negative control, inappropriate punish and reward, lack of involvement and child rearing Parents may show similar social-cognitive deficits Especially high levels of conflict in CD kids and their sibs,Health Related Problems,Premature death (before 30) is 3-4x higher in bo
17、ys with CPs Homicide, suicide, accidental poisoning, traffic accident, overdose Associated with early onset and persistence of risky sex behavior Associated with illicit drug use Commit more than 50% of all felony assaults and thefts,Prevalence of CD,1-4 million in North America 1-10-26% (6-16% boys
18、, 2-9% girls) Boys: more confrontational, aggressive beh Girls: more nonconfrontationalrunning away, skipping school, abusing substancesonset is also latergender diff is evident by age 4 Gender diff is much greater (10:1) for chronic rather than transient (2:1) Gender diff has decreased over past 50
19、 yrs by more than 50% More prevalent in low SES 40-50% will grow up to have APDfairly stable over time 35-75% of clinic referrals,Comorbidity,50-90% also meet criteria for ADHD Why the overlap?common underlying factor such as impulsivity, poor self-regulation, temperament may lead to both ADHD may b
20、e a catalyst for CDcontributes to persistence and escalation ADHD may lead to childhood onset CD But2 distinct disordersADHD is more likely to be associated with cognitive impairment, neurodevelopmental abnormalities, increased accidental injuries, increased inattention in class Both are worse than
21、either alone Internalizing disorders common in girls 1/3 meet criteria for depression or anxiety Most girls with CD will develop depression or anxiety by early adulthood More severe ASB, more severe mood/anxiety dis CD is also a risk factor for suicide Substance abusecommon,Course of the Disorder,Be
22、gins with difficult temperament Aggression in kindergarten predicts years later Earlier and later aggression-.6 to .9 corrcomparable to IQ Tends to decrease graduallyless severe before more severe; diversification of behavior over time More stability over time (& a progression from ODDCDAPD) is asso
23、c with Parental hx of APD or criminal involvement Problematic family environments Low ses Early onset Severe aggression Comorbidity with ADHD Low IQ High #s and large variability in conduct problems,Adult Outcome,By early 20s, # of active offenders decreases by 1/2. By late 20s, 85% of former offend
24、ers have stopped But-coercive interpersonal styles, family, health, and work difficulties may persist LCP (childhood onset)as adults Lower skill attainmenterratic work hx Difficulty getting along with coworkers More violent marriages Increased rates of divorce More likely to select partners with sim
25、ilar backgrounds,Causes of CD,Multiple causes that operate in a transactional way Genetic influences More minor physical anomalies and allergieslike ADHD CPs are not inherited, but difficulty temperament, hyperactivity-impulsivity, lack of fear in the face of danger are Multiple studies have shown a
26、 link between temperament and externalizing problems Age 3restless, impulsive, risk-taking, emotionally labileincr ASB in adolescence Adoption and twin studiesabout 50% inherited LCP pattern2x genetic risk of AL pattern Aggressivemore heritable than non-aggressive in childhood but genes and environ
27、are = in adolescent onset,Biological Pathways,Temperament, impulsivity, insensitivity to punishment, etc. can create antisocial propensity Such factors may increase likelihood that a child will be exposed to other risk factors-divorce, maltreatment, etc. Genotype may moderate sensitivity to environm
28、ent Prenatal and birth complications Malnutrition Lead poisoning Mothers use of marijuana, alcohol, nicotine Neurobiological factors Gray 1987two subsystems of the brain, each with its own region and neurotransmitters BAS-stimulates beh in response to reward or nonpunishment BIS-produces fear and in
29、hibits ongoing beh Proposed that CD kids have overactive BAS, underactive BIS Early onsetdecreased cortical arousal, low autonomic reactivitymay lead to fearless, stimulus seeking temperamentmay lead to lack of necessary anticipatory fear,Family Factors in CD,Lots of factors implicated, nature of ca
30、usal role is still debated Family difficulties are more related to CD than ODD and more to LCP than AL Reciprocal influencechilds beh both influences and is influenced by the beh of others Coercion theoryGerald Pattersonparent-child interactions set stage for ASB Reinforcement trap Attachment theori
31、es Increased stress is assoc with beh in the home Poverty is a strong predictor of CD and high rates of crime Costello et al Amplifier hypothesisstress amplifies the maladaptive predispositions of the parents, disrupting their family management and ability to be supportive Parent criminality and psy
32、chopathology,Societal Factors,Neighborhood and schoolincreased rates in poor neighborhoods with criminal subculture. Antisocial people select neighborhoods with those like themsocial selection hypothesis. Poor schools increase risk, positive schools decrease risk Media By grade 6have seen 8000 murde
33、rs on tv and 100,000acts of violence Can be short term precipitating factor and a long term predisposing factor Wingood et al 2003hip hop videos Huesmann et al 2003tracked 329 adults originally studied in late 1970s at age 6-9 Appears causal, debate persists Cultural factorsrates vary widely around
34、the world,Treatment and Prevention,Restrictive approachesresidential tx, inpatient tx, incarceration Expensive and not terribly effective. Deviancy training. Boot camps, wilderness programs, etc. Also not effective Office-based individual tx is cheap, but not effective So what works? Two-pronged app
35、roach Ongoing interventions for older youth and parents Early intervention/prevention for young kids just starting out Parent management training Teaches parents to change beh at homespecific new skills Can be individual or group, clinic or home Minimal or no intervention of therapist with child Par
36、ents learn to promote + beh, decrease ASB Sessions cover use of commands, rule setting, praise, tangible rewards, use of mild punishment, etc. Need to address parents beliefs about why beh is occurring,Treatment and Prevention II,Problem-Solving Social Skills training Focus on cognitive deficiencies
37、 and distortions Steps to solve problems Multisystemic Treatment (MST) Family and community basedwork with parents, schools, peers, juvenile justice staff, etc Uses PMT, PSST, marital tx, spec ed if necessary, etc Long term benefits, which make it cost effective Prevention Easier to prevent than to
38、treat More cost effective Webster-Stratton2-8 yo or at risk for CPs Teaches child management skills Personal self-control strategies for parents Teachers taught to improve relationships with students, to teach social skills, improve anger management Effective for 2/3 of kids whose parents are involv
39、ed Other programs exist that work with the kids themselves,Anxiety Disorders,JPSP Dec 2000two meta-analyses Trait anxietyboth studies1 of 40,192 college students and the other of 12,056 kids aged 9-17found evidence of large increase in anxiety levels such that normal children today report more anxie
40、ty than child psychiatric pts in 1950s. Anxiety disorders general characteristics Presence of anxiety Unacceptability of sx to the sufferer Relative intactness of reality testing Sx do not actively violate social norms Approx of adult sx originate before age 15 Anxiety disorders in childhood increas
41、e risk of later problems,Separation Anxiety Disorder,Characterized by extreme, developmentally inappropriate worry that child will get hurt or caregiver will get hurt if not with child Somatic complaints are common Considered abnormal only when it occurs after the normal period Common after stress O
42、nset is often sudden Progresses from mild to severe More common in girls or = depending on the study School avoidance in 1/3 meet criteria for depression Course is variablefrom spontaneous remission to chronic Chronicity assoc with later onset, psychopathology in the family, and comorbidity Prevalen
43、ce about 4-10% Peak onset between 7 and 9; age of referral 10-11,School Refusal,AKA school phobiano actual dx Can be part of other disorders; not the same as SAD 17/1000 kids Not truants Big differencerefusers want to be home with parents Somatic sx disappear within an hour of being allowed to stay
44、home Unrelated to IQ Huge secondary gains from being allowed to stay home Berg3 yr follow-up1/3 little improved, 1/3 quite a bit. 1/3 remitted were still unable to go to school some of the time In HS may be prodromal sign of schizophrenia Ok in non-school settings Older onset than SAD More males Txw
45、armly but firmly send kid to school,Generalized Anxiety Disorder,Formerly overanxious disorder of childhood Excessive and uncontrollable anxiety and worry about many events or activities on most days Apprehensive expectation Worry about everything; future 95% worry all the time Seems to be chronic 3
46、-6% prevalence (some estimates as high as 19%) = in boys and girls; more common in girls in adolescence and adulthood Average onset 10-14 Sx diminish with age,Fears and Phobias,Fearnormal reaction to an environmental threat Most research is on fears 1935Jersid & Holmeskids age 2-6 had between 2 and
47、4 fears Parents report fewer fears in kids than kids do Most fears are transient and disappear in 3 mos Most research shows more fears in girls than boys, but it may be more acceptable for girls to report them Both # and intensity of fears decline with age Morris and Kratchowill (89)ages of fearsTod
48、dlerseparation, animals, darkPreschoolstrangers, toddler fears, bodily harmSchool agebeing alone, imaginary beings, violence, death, dark, injury, storms, peer teasingTeenspeer rejection, achievement, family problems, global issues Starting in childhood and decliningdoctors, injections, darkness, st
49、rangers Declining slowlyspecific animals, heights, storms, enclosed spaces Some fears persist into adulthoodcrowds, death, injury, illness,Specific Phobias,Marked and persistent fear of a specific situation or object that is excessive and unreasonable Inappropriate for age Almost immediate anxiety r
50、esponse when exposed Adults and adolescents must acknowledge that fear is unreasonable but this criterion doesnt hold for kids Subtypes Prevalence2-4% (2.5% of kids, 3.5% adolescents) in general population meet criteria, but few are referred for txparents my not view these as harmful to dev Not a lo
51、t of conclusive data on gender diffsome are more common in girls (blood) Most common comorbid dx is another anxiety dx, but comorbidity rates are somewhat lower for phobias than for other dx Age of onsettypically begin 7-9 for animals, blood, darkness, injury Likely to decline with age, though less so than other fears Stable for about 5-15% of kids Peak 10-13,
