Podcast
Questions and Answers
What are the main components of the Anger Regulation Training (ART)?
What are the main components of the Anger Regulation Training (ART)?
Which of the following outcomes is associated with youths undergoing ART?
Which of the following outcomes is associated with youths undergoing ART?
What is a primary feature of Multisystemic Therapy (MST)?
What is a primary feature of Multisystemic Therapy (MST)?
Which ecological model supports the understanding of children's development as per MST?
Which ecological model supports the understanding of children's development as per MST?
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What effect does lack of family support have on a child's behavior in the context provided?
What effect does lack of family support have on a child's behavior in the context provided?
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What role do parents play in the context of adolescent welfare based on MST?
What role do parents play in the context of adolescent welfare based on MST?
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What is the primary aim of child-directed interaction?
What is the primary aim of child-directed interaction?
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Which of the following is NOT a component of child-directed interaction?
Which of the following is NOT a component of child-directed interaction?
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Which of the following factors is NOT considered essential in MST?
Which of the following factors is NOT considered essential in MST?
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Which behavior is most likely to increase when children experience greater academic difficulties?
Which behavior is most likely to increase when children experience greater academic difficulties?
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What should commands issued in parent-directed interaction be characterized by?
What should commands issued in parent-directed interaction be characterized by?
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What role do therapists play in parent-directed interaction?
What role do therapists play in parent-directed interaction?
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What is the primary focus of videotaped modeling in parent management training?
What is the primary focus of videotaped modeling in parent management training?
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In the Incredible Years program, parents are primarily engaged in what activity?
In the Incredible Years program, parents are primarily engaged in what activity?
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What is advised regarding the follow-up consequence of commands in parent-directed interaction?
What is advised regarding the follow-up consequence of commands in parent-directed interaction?
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What aspect of parenting does the BASIC parent training skills program emphasize?
What aspect of parenting does the BASIC parent training skills program emphasize?
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What is the primary role of the family in effective programs for at-risk youths?
What is the primary role of the family in effective programs for at-risk youths?
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How do effective treatments help youths avoid deviant peers?
How do effective treatments help youths avoid deviant peers?
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What is a common feature of evidence-based treatments for at-risk youths?
What is a common feature of evidence-based treatments for at-risk youths?
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Which factor is NOT identified as an environmental stressor that can be managed in effective programs?
Which factor is NOT identified as an environmental stressor that can be managed in effective programs?
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What is vital for the effectiveness of evidence-based treatments?
What is vital for the effectiveness of evidence-based treatments?
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What is the aim of the treatment delivery in effective programs for youths?
What is the aim of the treatment delivery in effective programs for youths?
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What is emphasized in the treatment of at-risk youths according to evidence-based programs?
What is emphasized in the treatment of at-risk youths according to evidence-based programs?
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What should occur periodically after treatment to ensure its ongoing effectiveness?
What should occur periodically after treatment to ensure its ongoing effectiveness?
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Study Notes
Conduct Problems in Children and Adolescents
- Conduct problems are a concern for many children and adolescents.
- A mental image of a child with conduct problems often involves disruptive or aggressive behavior.
Types of Conduct Problems
- DSM-5 categorizes conduct problems into three types:
- Conduct disorder
- Oppositional defiant disorder (ODD)
- Intermittent explosive disorder (IED)
Effects of Conduct Problems
- Conflict with caregivers and authority figures
- Disrupted relationships with parents and teachers
- Actions violating societal standards and the rights of others
- Negative effects on children's behavioral and socio-emotional development
- Increased risk of interpersonal and occupational problems
- An alarming 50% of children referred for mental health treatment also have conduct problems.
Oppositional Defiant Disorder (ODD)
- Characterized by a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months.
- Four symptoms from the categories below, and exhibited during interaction with at least one individual who is not a sibling.
- Angry/Irritable Mood
- Often loses temper
- Is often touchy or easily annoyed
- Is often angry and resentful
- Argumentative/Defiant Behavior
- Often argues with authority figures
- Actively defies or refuses to comply with requests from authority figures or with rules
- Often deliberately annoys others
- Often blames others for his or her mistakes or misbehavior
- Vindictiveness
- Has been spiteful or vindictive at least twice within the past 6 months
- Angry/Irritable Mood
Distinction with Normative Child Behavior
- Developmentally normative increase in oppositional and defiant behavior during toddler or preschool age is normal.
- Examples of normal behavior include a 2-year-old insisting on choosing their own clothes or a 3-year-old having tantrums before bed.
- Children with ODD consistently throw tantrums, argue, and act meanly toward parents, teachers or other adults
- Clinically significant behaviors: number and frequency of disruptive behavior, and a child's overall developmental context.
- Children with ODD tend to exhibit problematic behaviors and more frequently than children without ODD.
- Only a small percentage of children without ODD show recurrent defiance beyond the typical normative age.
Diagnostic Criteria for ODD
- A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months.
- Evidence of at least four symptoms from any of the categories, and exhibited during interaction with at least one individual who is not a sibling.
Diagnosis
- DSM-5 guidelines to determine the recurrence and enough disruptive symptoms to merit a diagnosis of ODD in children.
- Most ODD symptoms must occur daily in preschoolers or weekly in adolescents.
- Children must display mean or vindictive behavior at least twice over 6 months.
- Elevated norm-referenced ratings signify severe ODD symptoms.
- Distinct categories for:
- Angry or irritable mood (referring to problems with regulating emotions).
- Argumentative or defiant behaviors (referring to problems with regulating actions).
- Vindictiveness (referring to both emotions and actions).
- Predicts issues of depression later on in life.
- Correlates with ADHD.
- Can lead to serious conduct problems in adolescence.
- Diagnosis can occur even if behaviors are present only in a limited setting.
- 96% of ODD cases present mainly in the child's interactions with parents.
- 62% of ODD cases include home, school, and peer interactions.
- Severity is important in determining the most appropriate diagnosis:
- Mild symptoms in one setting.
- Moderate symptoms in two settings.
- Severe symptoms in three or more settings.
Case Study: Davidson's Escape
- Davidson, a 6-year-old, refused to cooperate, defied instructions, and left the office during an appointment visit with a therapist.
Conduct Disorder (CD)
- A repetitive and persistent pattern of behavior in which the basic rights of others or major societal norms are violated.
- Demonstrated by 3 or more criteria from any category within past 12 months, with at least one criterion present in the past 6 months:
- Aggression to people and animals
- Destruction of Property
- Deceitfulness or theft
- Serious rule violations
Diagnostic Criteria for CD
- Criteria to diagnose CD including aggressive behavior, destruction of property, deceitfulness or theft, and serious violations of rules.
CD Diagnosis
- Multiple symptoms in preceding 12 months
- Data collected includes elevated ratings or behaviors beyond 93rd or 95th percentiles.
ODD and CD
- Although qualitatively different, ODD and CD can co-occur. Many children with ODD may not display the more severe symptoms of CD.
- CD may be present but ODD isn't, and is a predictor for antisocial behavior and substance use in the future.
- ODD is a significant predictor for both behavioral and emotional problems.
Case Study: Making Mom Miserable
- Brandyn, a 10-year-old boy, exhibited defiant and aggressive behavior at school.
- Involved bullying, cruelty/assault, and theft.
- Behaviors were designed for attention from others.
- His mother noticed similar behavior patterns at home.
Intermittent Explosive Disorder (IED)
- A DSM-5 disorder characterized by repeated angry outbursts, resulting in verbal and/or physical aggression.
- Recurrent outbursts, occurring at least twice weekly over 3 months.
- Magnitude of the outburst is disproportionate or not premeditated.
- Results in physical injury to other individuals or damage to property.
- The outburst must have caused marked distress and impairment.
Case Study: Road Rage
- Lucas, a 17-year-old youth, experienced intense aggression in a particular situation, ultimately resulting in an outburst.
- Reported by the youth and his mother, demonstrating repeated problems with losing control.
- Several documented incidents of aggressive behavior to others at school.
Signs and Symptoms of IED
- Overreacting to minor hassles
- Aggression directed towards family or friends.
- Aggression may also be directed at strangers.
- May feel out of control after an outburst and feel remorse afterwards.
- Usually don't display behaviors like bullying or robbing others.
How Can We Best Describe Children's Conduct Problems?
- Overt symptoms: Observable and confrontational antisocial acts. Examples are physical assault, robbery, bullying.
- Covert symptoms: Antisocial behaviors that don't involve physical aggression; e.g., breaking and entering, burglarizing, lying, skipping school, or running away
Factor Analysis
- Summarizes conduct problems into groups, using two dimensions of overtness versus covertness and destructiveness versus non-destructiveness.
Reactive Aggression
- Physical violence or property destruction in response to a threat or provocation.
- Associated with ADHD.
- Also exhibited in kids who have emotion regulation problems.
- Often used to solve interpersonal disputes.
Proactive Aggression
- Deliberate physical violence or property destruction to achieve personal goals.
- Often modeled by parents who yell at/spank children.
- Believed to be triggered by a desire for acquiring rewards for their acts.
Comparison of Reactive and Proactive Aggression
- Reactive aggression diminishes by late adolescence, while proactive aggression persists.
- Proactive aggression may associate with later antisocial behaviors or criminal activity.
Age of Onset
- Children exhibiting childhood-onset conduct problems display problems in preschool or early elementary school.
- Adolescents with adolescent-onset conduct problems often exhibit problems after puberty.
Limited Prosocial Emotions
- A specifier used in DSM-5 for ODD-presenting youths who display limited prosocial emotions.
- Shows lack of remorse, guilt, or empathy.
- Show shallow or deficient expressions of emotions.
Psychopathy
- Not in DSM-5.
- A syndrome characterized by antisocial behavior, impulsivity, shallow or deficient affect, narcissism, disregard for others' suffering.
- High risk for disruptive behaviors extending beyond childhood.
- More prone to serious criminal activity.
Case Study: Callous Cade
- 14-year-old boy exhibiting aggressive, oppositional, and disruptive behavior from toddlerhood
- Engaging in various destructive actions such as property destruction and verbal/physical aggression towards peers/teachers.
Prevalence
- Prevalence of ODD, CD, or IED in boys and girls.
Disorders Associated with Conduct Problems
- ADHD
- Academic difficulties
- Substance use
- Depression
Causes of Conduct Disorders
- Genetic risks (40%-50% variance attributed to conduct problems)
- Shared environmental factors (factors like healthcare, nutrition, housing, lesser role in conduct problems)
- Difficult temperament and emotion regulation problems
- Physiological underarousal and punishment insensitivity (low emotional arousal and reduced autonomic activity)
- Parenting behavior: hostile parenting, coercive family processes, and low parental monitoring
- Parents' cognitions and mental health
- Peers and neighborhoods; peer rejection, selective affiliation, and deviancy training
- Neighborhood risk factors (lack of educational resources, inadequate monitoring, high crime neighborhood).
- Family cohesion and parental monitoring
- Prosocial after-school activities
Evidence-Based Treatment: PMT
- Parent Management Training (PMT) is a behavioral intervention to improve parent-child interactions.
- Weekly participation of parents is necessary in sessions without their children.
- Aims at skills to apply at home.
- Programs to address family needs.
Evidence-Based Treatment: PCIT
- Parent-Child Interaction Therapy (PCIT): variation of PMT, where parents and children are coached in real-time.
Evidence-Based Treatment: Videotaped Modeling
- Uses videotaped vignettes of problematic parent-child interactions in training.
Evidence-Based Treatment: Problem-solving Skills Training
- Teaches more effective interpersonal problem-solving techniques through various steps.
- Aimed at correcting biases in information processing.
Evidence-Based Treatment: Aggression Replacement Training
- Multimodal treatment for adolescents with histories of disruptive, aggressive, and antisocial behavior.
- Consists of skillstreaming, anger control training, and moral reasoning training.
Evidence-Based Treatment: Multisystemic Therapy
- Intensive family- and community-based approach.
- Addresses family, school, and peer systems to foster appropriate behaviors/outcomes.
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Description
This quiz explores the various conduct problems affecting children and adolescents, including conduct disorder, oppositional defiant disorder, and intermittent explosive disorder. It also discusses the implications of these issues on relationships and socio-emotional development.
