Transcript Conduct Disorder - Kelley Kline Phd

Conduct Disorder
The Origin of Criminal Behavior
I. What is conduct disorder?
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A repetitive & persistent pattern of seriously
antisocial behavior, usually criminal (illegal) in
nature & marked by extreme callousness.
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Diagnosis is made in individuals under 18
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Behaviors may include (but not limited to):
Cruelty toward animals and/or people
Vandalism
Lying
Theft
Physical aggressiveness
Behavior is often—vicious, callous, remorseless
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DSM-IV TR Criteria for Conduct Disorder
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Repetitive & persistent behavior pattern that violates the basic rights of
others or conventional social norms as manifested by the presence of 3 or
more of the following in the previous 12 mos. & at least one of them in the
previous 6 mos.:
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A. Aggression to people & animals (e.g., bullying, initiating physical
fights, being physically cruel to people or animals, forcing someone into
sexual activity).
B. Destruction of property (e.g.,fire-setting, vandalism).
C. Deceitfulness or theft (e.g., breaking into another’s house or car,
conning, shoplifting).
D. Serious violation of rules (e.g., staying out at night before age 13 in
defiance of parental rules, truancy before age 13).
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**Significant impairment in social, academic, or occupational functioning.
**Person must be under 18 years of age.
II. Conduct Disorder & comorbidity:
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ADHD
Substance use disorders (alcohol, marijuana)
Note—CD & drug use occur concomitantly &
exacerbate each other.
Anxiety
Depression (15-45%)
Girls with CD are significantly more likely than
boys to develop these other disorders, suggesting
greater psychopathology in the girls than in the
boys.
III. What is prevalence of conduct
disorder?
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A review of several epidemiological studies indicates
that prevalence rates range from 4 to 16% for boys & 1.2
to 9% in girls (Loeber et al., 2000).
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Violent crimes (rape, assault) are largely crimes of male
adolescents.
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Incidence & prevalence of illegal activity peaks by age
17 & then drops precipitously in young adulthood.
IV. What is prognosis of Conduct
Disorder?
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Prognosis is mixed. More than half of
children with conduct disorder do not
become antisocial personalities in adulthood
(Loeber, 1991; Zoccolillo et al., 1992).
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However, research shows that most conduct
disordered boys do continue to demonstrate
some conduct problems into adulthood
(Lahey et al., 1995).
Do kids with conduct disorder become
antisocial adults?
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Yes, many children diagnosed with conduct
disorder meet criteria for antisocial
personality disorder into adulthood.
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Males with conduct disorder who had
fathers with antisocial behavior & poor
verbal intelligence, more likely to develop
APD.
V. Moffitt’s theory: Two courses of
conduct disorder:
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Moffitt argues that two different courses of
conduct problems should be distinguished.
1. Life-course persistent –Some individuals
show a pattern of antisocial behavior beginning
with problems by age 3 & continuing into
adulthood.
2. Adolescent-limited – Other conduct disorder
individuals started out with normal childhoods,
but produced high levels of antisocial behavior
during adolescence that does not continue into
adulthood.
VI. Etiological factors for Conduct
Disorder
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1. Biological Factors
Is conduct disorder heritable??
*There is some evidence that conduct disorder is
genetic.
Twin studies show a genetic link for conduct
disorder, although the extent of link varies with
the samples examined.
Adoption studies in Sweden, Denmark, & U.S.
show that criminal & aggressive behavior is
accounted for by both genetic & environmental
factors.
2. Neuropsychological deficits in
children with conduct disorder
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Poor verbal skills
Difficulty with executive function
Memory impairments
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Children who develop conduct disorder at an
earlier age have been shown to have an IQ score
of 1 standard deviation below age-matched peers
without conduct disorder.
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This IQ deficit is not attributable to lower SES,
race, or school failure (Lynam, Moffitt, &
Stouthamer-Loeber, 1993).
3. Psychological Factors
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A. Deficient moral awareness-- Children with
conduct disorder often lack guilt & remorse for
their antisocial & aggressive behaviors.
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B. Conduct behaviors are learned-1. Modeling– children learn aggressive
behaviors by observing parental aggression and/or
abuse in the home. Evidence supports both of
these factors.
2. Imitation- kids will imitate antisocial peers
C. Cognitive factors
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Cognitive processes of aggressive children had a
specific bias—children perceived ambiguous acts
as evidence of hostile intent.
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Children with these faulty perceptions may
retaliate to “perceived attacks” that were actually
not intended to be hostile.
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This may lead to aggressive behavior in response
to these attacks…. The vicious cycle then
continues.
D. Peer Influences
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Peers influence aggressive & antisocial behaviors
in others in 2 ways:
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1. Rejection by peers has been shown to be
causally related to increased aggressive
behavior (e.g., Dylan Klebold & Eric Harris—
Columbine High School massacre).
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2. Association with Deviant Peers—increases
frequency of deviant behavior in others (“Running
with the wrong crowd”).
E. Sociological Factors
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Increased incidence of antisocial & aggressive
behaviors linked to lower SES.
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Race is not a factor; previous research showing
African American children to have higher conduct
disorder rates was confound of living in poorer
community.
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--hyperactivity
--Lack of parental supervision
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VII. Treatment
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A. Family Interventions—treatment involves
parents & families of antisocial child.
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Using a behavioral program of parental
management training (PMT), Patterson &
coworkers have taught parents to modify their
responses to children so that positive social
behavior is rewarded.
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Parents use positive reinforcement (rewards) when
the child produces positive behaviors & timeout/loss of privileges for aggressive or antisocial
acts.
Does PMT work?
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Yes!!!, there is some evidence to support its,
efficacy.
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PMT—alters parent/child interactions, which is
associated with decreased antisocial behaviors. It
also improves the behavior of siblings & reduces
maternal depression.
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Both parent training & court-provided family
treatment significantly reduced rates of criminal
offense in one study (Bank et al., 1991).
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Long term effects—last for 1-3 years follow
training.
B. Multisystemic Treatment
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Henggeler’s MST has demonstrated reductions in
arrests 4 years following treatment (Borduin et al.,
1995).
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MST—is an intensive & comprehensive therapy
that provides services for the adolescent, his/her
community, the family, school, & peer group.
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Therapy targets not just child but all individuals in
the child’s life (hence, multisystemic).
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Treatment is provided in home, school, church,
community centers, etc.
Does MST work??
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Yes!!!! Compared with a control group who
received standard individual therapy, the MST
group demonstrated fewer antisocial behaviors &
arrests over the following 4 years.
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While 70% of adolescents receiving standard
therapy were arrested in the 4 years after
treatment, 22% of the subjects receiving MST
were arrested (Davison, Neale, & Kring, 2004).
C. Cognitive Therapies
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Individual therapy does show improvement.
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Children are taught to control their tempers, to
reduce aggressive behaviors.
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This is done by requiring kids with conduct
disorder to exert restraint when provoked.
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Kids are taught to distract themselves during a
perceived attack (humming, saying calm things to
themselves, turning away). They learn to do these
things when a peer provokes.
Cognitive therapists also focus on moral
beliefs of these youths.
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Children are taught moral-reasoning skills.
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They meet with therapists multiple times a
year in schools, to argue merits of morals
from stories posing moral dilemmas.
E.g., Moral dilemma story (taken from
Davison, Neale, & Kring, 2004)
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“Sharon and her best friend, Jill, are shopping in a
boutique. Jill finds a blouse she wants but cannot
afford. She takes it into a fitting room ad puts it
on underneath her jacket.l She shows it to Sharon
and, despite Sharon’s protests, leaves the store.
Sharon is stopped by a security guard. The
manager searches Sharon’s bag, but finding
nothing, concludes that Jill shoplifted the blouse.
The manager asks Sharon for Jill’s name,
threatening to call both Sharon’s parents and the
police if she doesn’t tell. Sharon’s dilemma is
whether or not to tell on her best friend.”
Students receiving “moral training” are
asked:
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To discuss the story, the characters, and
what the characters “should” do in this
situation.