Intermittent Explosive Disorder in Children

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Questions and Answers

What is a common characteristic of aggression in children with Intermittent Explosive Disorder (IED)?

  • They often show aggression towards teachers only.
  • They rarely feel remorse after aggressive acts.
  • Their aggression is typically directed towards family or friends. (correct)
  • They usually feel in control during aggressive outbursts.

Which behavior is not typically associated with Intermittent Explosive Disorder (IED)?

  • Bullying.
  • Physical assault.
  • Aggression towards family members.
  • Calm and cooperative interactions. (correct)

Which of the following is an example of covert symptoms of conduct problems?

  • Lying. (correct)
  • Robbery.
  • Breaking and entering.
  • Physical assault.

How do children typically feel after showing aggressive behavior during an outburst related to IED?

<p>Remorseful. (C)</p> Signup and view all the answers

What type of behaviors are not characteristic of children with IED?

<p>Planning and executing complex crimes. (B)</p> Signup and view all the answers

Which of the following best describes the nature of overt symptoms in conduct problems?

<p>They involve visible and confrontational antisocial acts. (D)</p> Signup and view all the answers

Which behavior is indicative of aggression directed at strangers in children with IED?

<p>Feeling threatened or wronged. (D)</p> Signup and view all the answers

Which of the following is an example of antisocial behavior that may not involve physical aggression?

<p>Lying. (D)</p> Signup and view all the answers

What behavioral characteristics are associated with children showing both conduct disorder (CD) and limited prosocial emotions?

<p>They are often less responsive and resistant to treatment (A)</p> Signup and view all the answers

What act did Cade commit that resulted in significant damage and led to his first arrest?

<p>Vandalizing school properties (A)</p> Signup and view all the answers

Cade's fascination with which of the following activities caused the most concern for his psychologist?

<p>Building bombs (A)</p> Signup and view all the answers

Which behavior demonstrates Cade's lack of empathy towards others?

<p>Deliberately provoking and hurting classmates (D)</p> Signup and view all the answers

What was the nature of Cade's behavior when he used a box cutter?

<p>He injured a classmate during a fight (B)</p> Signup and view all the answers

Which statement best describes Cade's relationships with peers by sixth grade?

<p>He had few friends his own age and preferred older boys (D)</p> Signup and view all the answers

What evidence is there that Cade showed early signs of antisocial behavior?

<p>He cut all the whiskers off a cat (B)</p> Signup and view all the answers

What is the approximate percentage of youths meeting the criteria for Oppositional Defiant Disorder (ODD)?

<p>3.3% (C)</p> Signup and view all the answers

How much more likely are boys to develop Conduct Disorder (CD) compared to girls across all ages?

<p>Thrice as likely (B), Twice as likely (D)</p> Signup and view all the answers

What is the lifetime prevalence of Conduct Disorder (CD) in boys?

<p>5% to 10% (A)</p> Signup and view all the answers

What condition is most commonly associated with Conduct Disorder in youths?

<p>Substance use problems (D)</p> Signup and view all the answers

Which gender is more likely to develop comorbid anxiety and depression?

<p>Girls (A)</p> Signup and view all the answers

What is the common set of genes believed to predispose children towards?

<p>ADHD and conduct problems (C)</p> Signup and view all the answers

Which factor is a strong predictor of anxiety and depression in children with ODD?

<p>Symptoms of anger and irritability (C)</p> Signup and view all the answers

What does the dual failure model posits concerning conduct problems?

<p>They lead to failure in important life areas (C)</p> Signup and view all the answers

What is a significant limitation of Parent Management Training (PMT)?

<p>It is often difficult to access trained therapists. (C)</p> Signup and view all the answers

Which type of parenting does Authoritative parenting emphasize?

<p>High demandingness and high responsiveness. (D)</p> Signup and view all the answers

Which group of families does Parent-Child Interaction Therapy (PCIT) specifically target?

<p>Families with disruptive preschoolers or young school-age children. (D)</p> Signup and view all the answers

According to Baumrind's developmental theory, which type of parenting leads to children's behavior problems?

<p>Indulgent parenting. (B), Uninvolved parenting. (D)</p> Signup and view all the answers

What aspect of PMT is less effective for certain parents?

<p>Single or low-income parents. (A)</p> Signup and view all the answers

What role do therapists play in Parent-Child Interaction Therapy (PCIT)?

<p>They coach parents and children in real-time interactions. (D)</p> Signup and view all the answers

What do low levels of both demandingness and responsiveness represent in Baumrind's parenting styles?

<p>Uninvolved parenting. (A)</p> Signup and view all the answers

Which parenting style sets high expectations and provides support to help children meet those expectations?

<p>Authoritative parenting. (A)</p> Signup and view all the answers

What is the primary goal of Problem-solving skills training (PSST)?

<p>To teach adaptive ways to problem-solve (D)</p> Signup and view all the answers

Which of the following is NOT a step in the problem-solving process of PSST?

<p>Choosing a random action (A)</p> Signup and view all the answers

How long do treatment effects from PSST typically last?

<p>For one year (A)</p> Signup and view all the answers

Which treatment shows better outcomes when combined with Problem-solving skills training?

<p>Parent Management Training (C)</p> Signup and view all the answers

What does Aggression Replacement Training aim to provide to adolescents?

<p>Skills needed for prosocial actions (A)</p> Signup and view all the answers

In problem-solving steps, what role does the therapist play during the practice?

<p>A coach (D)</p> Signup and view all the answers

Which of the following statements about PSST is true?

<p>PSST reduces symptoms more effectively than attention control. (B)</p> Signup and view all the answers

Which step immediately follows generating possible courses of action in PSST?

<p>Evaluating possible courses of action (A)</p> Signup and view all the answers

What is the main focus of the Anger Regulation Training (ART)?

<p>Enhancing social skills and moral reasoning (C)</p> Signup and view all the answers

What are the three main components of Anger Regulation Training?

<p>Skillstreaming, anger control training, and moral reasoning training (B)</p> Signup and view all the answers

Which of the following is a feature of Multisystemic Therapy (MST)?

<p>Family therapy and parental monitoring (B)</p> Signup and view all the answers

Based on Bronfenbrenner's ecological model, which factor is crucial in understanding a child's development?

<p>Socio-cultural factors like family income and ethnicity (A)</p> Signup and view all the answers

What can be a consequence of insufficient parental monitoring according to the content?

<p>Affiliations with deviant peers leading to antisocial behaviors (A)</p> Signup and view all the answers

How does the content describe the impact of community factors on children?

<p>They can contribute to academic difficulties and deviant behaviors (D)</p> Signup and view all the answers

What is a potential benefit for parents involved in the treatment programs mentioned?

<p>Improved techniques for better interactions with adolescents (A)</p> Signup and view all the answers

Which statement is true regarding the youths who undergo ART?

<p>They exhibit improved moral reasoning and anger control. (A)</p> Signup and view all the answers

Flashcards

Physical Aggression

Behavior that involves physical harm or aggression towards others, including hitting, kicking, punching, or threatening.

Covert Aggression

Acts that involve deception, manipulation, or dishonesty, such as lying, stealing, or cheating.

Family/Friend-Directed Aggression

Aggressive behavior that is directed towards family members or close friends.

Bullying and Robbery

Aggressive acts that are not typically seen in children with Intermittent Explosive Disorder (IED).

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Out-of-Control and Remorseful

An emotional state characterized by a feeling of losing control during aggression, often followed by remorse.

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Intermittent Explosive Disorder (IED)

A disorder characterized by episodes of intense anger and aggression that are out of proportion to the situation.

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Overt Symptoms in IED

A group of observable behaviors that are considered antisocial, including physical aggression, lying, and theft.

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Covert Symptoms in IED

A group of antisocial behaviors that are less obvious, usually involving deception and manipulation.

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Conduct Disorder (CD)

A pattern of behaviors characterized by aggression, defiance, and lack of concern for others. It often begins in early childhood and can persist into adulthood.

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Limited Prosocial Emotions (LPE)

A combination of behaviors that involve emotional callousness, lack of empathy, and a disregard for the feelings of others. These children often have a difficult time forming healthy relationships.

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Treatment Resistance in CD & LPE

The tendency for individuals with CD and LPE to resist treatment interventions. They may be unwilling to engage with therapists or respond to traditional punishment techniques.

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Pyromania in Children

A child's fascination with fire and explosives, often accompanied by a desire to set them off or cause damage.

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Lack of Remorse in CD & LPE

A lack of remorse or guilt for harmful actions, often seen as a core feature of limited prosocial emotions.

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Lying and Deceit in CD & LPE

A child's tendency to lie, steal, and engage in other deceitful behaviors, often without much concern for the consequences.

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Emotional Reactivity in CD & LPE

A child's propensity to be easily triggered by emotional states, often leading to aggressive outbursts and difficulty regulating emotions.

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Lack of Concern for Others in CD & LPE

A child's lack of concern for the impact of their actions on others, often stemming from a lack of empathy and understanding.

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What is PCIT?

Parent-Child Interaction Therapy (PCIT) is a form of therapy where parents and children are coached by therapists while interacting in real-time. It's designed for preschoolers or young school-age children with disruptive behavior.

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What is the foundation of PCIT?

PCIT is based on Diana Baumrind's theory that parenting styles can be understood in terms of two dimensions: demandingness (setting expectations) and responsiveness (providing affection and support).

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How do authoritative parents behave?

Authoritative parenting is characterized by high levels of both demandingness and responsiveness. Parents set clear expectations and are supportive of their children's efforts.

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What happens when parents are not authoritative?

Children's behavior problems often arise when parents exhibit low demandingness (indulgent parenting), low responsiveness (authoritarian parenting), or low levels of both (uninvolved parenting).

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How is PCIT related to PMT?

PCIT is a variation of Parent Management Training (PMT), a therapy focused on teaching parents effective parenting techniques.

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Who might PMT not work well for?

PMT is less effective for single parents, low-income families, parents facing marital conflicts, or those with substance use or mental health problems.

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Why is PMT less effective with teenagers?

PMT is less effective with adolescents who are more resistant to treatment due to developing independence and strong opinions.

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Why is PMT not always accessible?

Most clinicians are not formally trained in PMT, making it difficult for parents to find an experienced therapist. This limits the accessibility of effective parenting programs.

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Problem-solving skills training (PSST)

A treatment method teaching disruptive youth to better understand and manage interpersonal issues, focusing on changing their thought patterns and reactions.

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What are the steps of PSST?

A step-by-step process to help youth identify, analyze, and solve social problems in a constructive way.

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PSST: What is the goal?

This type of training focuses on teaching youth how to generate various solutions, evaluate their effectiveness, and choose the best response, ultimately improving their problem-solving abilities.

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Aggression Replacement Training (ART)

A multimodal treatment program designed for adolescents struggling with disruptive behavior, aggression, and antisocial tendencies.

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What is the core principle of ART?

ART acknowledges that youth engaging in antisocial behaviors often lack essential social skills.

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What does ART aim to develop?

This treatment supports the development of essential abilities for prosocial behavior, including behavioral, affective, and cognitive skills.

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What is the structure of ART?

The treatment involves various components to address behavioral, emotional, and cognitive aspects of disruptive behavior.

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What is the key focus of ART?

ART focuses on developing the underlying skills and abilities needed for prosocial behavior, aiming to address the root causes of disruptive behavior.

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Reciprocal Intervention Training (ART)

A treatment approach that aims to help children develop and use social skills effectively. It involves three components: Skillstreaming, Anger Control Training, and Moral Reasoning Training.

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Multisystemic Therapy (MST)

A therapy approach that focuses on addressing conduct problems in adolescents by working with the entire environment surrounding the child

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Bronfenbrenner's Ecological Systems Model

A theory that emphasizes the interconnectedness of various systems that influence a child's development, including family, school, and community.

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Anger Control

The ability to understand and control one's emotions, particularly anger, in a healthy way.

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Moral Reasoning

The ability to make sound judgments about what is right and wrong, based on moral principles.

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Social Skills

A set of learned actions and behaviors that help individuals navigate social situations successfully.

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Social Problem-Solving

Strategies for solving interpersonal conflicts in a constructive and positive way.

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Parental Monitoring

The involvement and supervision of a child's activities by parents or guardians.

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Prevalence of IED in youths

The prevalence of Intermittent Explosive Disorder (IED) in youths, including boys and girls, approximates 2.5%. This signifies that approximately 2.5% of young people experience the symptoms of IED.

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Gender Difference in IED Prevalence

Boys are more likely to experience Intermittent Explosive Disorder (IED) than girls, indicating a higher prevalence among males.

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Outward vs. Concealed Symptoms in IED

The symptoms of Intermittent Explosive Disorder (IED) can include both outward and concealed behaviors. Outward behaviors are easily seen, like physical aggression, while concealed behaviors involve deceit and manipulation.

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Academic Challenges in CD

Academic performance may be negatively affected in children experiencing Conduct Disorder (CD). This can lead to difficulties in school and learning.

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Link between CD and ADHD

Co-occurrence of Conduct Disorder (CD) and Attention-Deficit/Hyperactivity Disorder (ADHD) is common. Approximately 41% of children with CD also have ADHD. This suggests a shared underlying factor, potentially genetic, causing both conditions.

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Substance Use and Academic Difficulties in CD

Children with Conduct Disorder (CD) may be more likely to engage in substance use and experience academic difficulties. This suggests a correlation between these behaviors and CD.

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Genetic Link to Substance Use and Conduct Problems

A genetic predisposition may play a role in both substance use and conduct problems. This suggests a shared genetic susceptibility could lead to both of these behaviors.

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Study Notes

Conduct Problems in Children and Adolescents

  • Conduct problems are a significant concern, affecting up to 50% of children referred for mental health treatment.
  • DSM-5 categorizes conduct problems into three types: conduct disorder, oppositional defiant disorder, and intermittent explosive disorder.

Types of Conduct Problems

  • Conduct disorder: A pattern of behavior violating the rights of others or societal norms.
  • Oppositional defiant disorder (ODD): Characterized by angry/irritable mood, argumentative/defiant behavior, and vindictiveness.
  • Intermittent explosive disorder (IED): Repetitive angry outbursts resulting in verbal or physical aggression.

Effects of Conduct Problems

  • Conflict with caregivers and authority figures
  • Impaired relations with parents and teachers
  • Actions that violate societal standards and rights of others.
  • Adverse effects on children's behavioral and socio-emotional development.
  • Increased risk for interpersonal and occupational problems.

Oppositional Defiant Disorder (ODD)

  • DSM-5 disorder characterized by a pattern of angry/irritable mood, argumentative or defiant behavior, and vindictive behavior toward others.
  • Causes distress to parents, teachers, and other caregivers.
  • Adversely affects parent-child interactions.
  • Leads to negative impacts on children's educational and social activities.

Distinction with Normative Child Behavior

  • Developmental increase of oppositional and defiant behavior is normal in toddlers and preschoolers.
  • Clinically significant ODD behaviors involve the number and frequency of disruptive behaviors, and the child's overall development context.
  • Children with ODD display increased problematic behaviors compared to children without it.
  • Children with ODD consistently exhibit tantrums, arguments, and mean behaviors.
  • A substantial percentage (approximately 70%) of clinic-referred children exhibit tantrums and denial of adult requests

Diagnostic Criteria for Oppositional Defiant Disorder

  • A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months, evidenced by at least 4 symptoms from the categories below and exhibited during interaction with at least one non-sibling.
  • This pattern causes significant distress to the individual or others in their immediate social context (e.g., family, peer group), or negatively impacts areas of functioning (e.g., social, education).
  • The behaviors don't occur solely during a psychotic, substance use, depressive, or bipolar disorder.

Diagnosis

  • DSM-5 guidelines determine if disruptive symptoms are recurring enough to warrant diagnosis.
  • Most ODD symptoms occur daily in preschoolers and weekly in adolescents.
  • Children should demonstrate mean or vindictive behavior at least twice over 6 months.
  • Elevated norm-referenced behavior ratings beyond 93rd and 95th percentiles signify severe ODD.
  • ODD symptom categories include angry/irritable mood, argumentative/defiant behavior, and vindictiveness.
  • The relationship between symptoms and negative effects on life (e.g., depression, ADHD) can potentially be predicted.
  • Severity of symptoms occurring in only one setting (mild), two settings (moderate), or three or more settings (severe).

Conduct Disorder (CD)

  • DSM-5 disorder with a repetitive and persistent pattern of behavior violating the rights of others or major societal norms.
  • At least three of 15 criteria must be present in the past 12 months (with at least one in the past six months).
  • Categories include aggression to people/animals, destruction of property, deceitfulness/theft, and serious rule violations.

ODD and CD

  • ODD and CD can coexist.
  • Many children with ODD do not display the more severe symptoms of CD.
  • CD can be present in youth displaying no significant ODD symptoms.
  • CD is a predictor for future antisocial and substance use problems.
  • ODD is a predictor for both behavioral (defying, arguing) and emotional issues.

Case Studies

  • Case studies illustrate individuals diagnosed with ODD or CD.
  • Illustrate specific behaviors and challenges experienced by individuals diagnosed with Conduct Disorder.
  • Demonstrate specific family dynamics and coping strategies.

Intermittent Explosive Disorder (IED)

  • A disorder marked by repeated outbursts of anger resulting in verbal or physical aggression.
  • Recurrent outbursts, lasting for 3+ months, occurring at least twice monthly.
  • Outbursts exhibit emotional intensity grossly disproportionate to the provocation or stressor.
  • Outbursts lack premeditation and cause significant impairment or distress in daily functioning.
  • Chronological age is at least 6 years.

Signs and Symptoms (across disorders)

  • Overreaction to minor annoyances
  • Aggression frequently directed toward family/friends
  • Lack of remorse or emotional empathy
  • Conduct can range from mild disobedience and defiance to severe aggression

Causes, including:

  • Genetic factors
  • Shared environmental factors
  • Difficult temperament or emotional regulation
  • Hostile parenting
  • Low parental monitoring
  • Peer rejection
  • Neighborhood risk factors such as educational resources, inadequate monitoring, and high crime neighborhoods.

Treatment

  • Parent Management Training (PMT)
  • Parent-Child Interaction Therapy (PCIT)
  • Videotaped modeling
  • Problem-solving skills training (PSST)
  • Aggression Replacement Training (ART)
  • Multisystemic therapy (MST)

Prevalence

  • Prevalence statistics for ODD, CD, and IED are provided (broken down by gender and age groups.)

Associated Disorders

  • Common co-occurring conditions like ADHD and substance use issues are discussed.

Medications

  • Medications (e.g., methylphenidate, risperidone) and their potential effectiveness and side effects in treating conduct problems are examined.

Developmental Pathways (3 pathways)

  • This section details the different trajectories toward conduct problems, highlighting childhood onset, adolescent onset, and an ODD-only pathway.

What Works and Doesn't

  • This section evaluates the efficacy and limitations of various interventions. Examples of methods that prove ineffective, like incarceration, and methods proven better, like multisystemic therapy are provided.
  • Explains why certain interventions may be ineffective for treating conduct problems.

General Summary

  • This chapter outlines the concepts of conduct problems in children and adolescents, including types, factors, diagnosis, and treatment approaches.
  • It also covers prevalence, associated disorders, developmental pathways, and common treatment approaches for these conditions.

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