Description of Conduct Problems

• Age-inappropriate actions and attitudes

that violate family expectations, societal
norms, and personal or property rights of
others
• These disruptive and rule-violating
behaviors range from:
– Annoying minor behaviors (e.g., temper
tantrums) to serious antisocial behaviors (e.g.,
vandalism, theft, and assault)

© Cengage Learning 2016

 Description of Conduct Problems (cont’d.)

• We must consider many types, pathways,

causes, and outcomes of conduct
problems
• Are associated with unfortunate family and
neighborhood circumstances
– Circumstances do not excuse the behavior,
but help us understand and prevent it

© Cengage Learning 2016

 Context

• Antisocial behaviors appear and decline

during normal development
– Behaviors vary in severity, from minor
disobedience to fighting
– Some may decrease with age; others
increase with age and opportunity
– Are more common in boys in childhood
– Children who are the most physically
aggressive in early childhood maintain relative
standing over time
© Cengage Learning 2016
 Frequencies for Common Antisocial
Behavior

© Cengage Learning 2016

 Social and Economic Costs

• Conduct problems are the most costly

mental health problem in North America
• Early, persistent, and extreme antisocial
behavior occurs in about 5% of children
– These children account 50% of all crime in the
U.S. and approximately 30-50% of clinic
referrals
– Annual public costs (healthcare, juvenile
justice, and educational systems) are $10,000
per child
© Cengage Learning 2016
 Psychological Perspectives
• Conduct problems fall on a continuous dimension
– Externalizing dimension: Impulsive and overactive
• “Rule-breaking behavior”: running away, setting fires,
stealing, dugs, vandalism, skipping school
• “Aggressive behavior” : Fighting , destructiveness,
disobedience, defiance, threatening
– Overt (visible) –covert (hidden) dimension
– (Most children with CD display both)
– Destructive-nondestructive dimension
– Crossing the overt-covert with the destructive-nondestructive
• Yields four categories of conduct problems

© Cengage Learning 2016

 Four Categories of Conduct Problems

© Cengage Learning 2016

 Perspectives

• Conduct problems are viewed as distinct

mental disorders based on DSM
symptoms
– Disruptive behaviors are described as
persistent patterns of antisocial behavior
– Represented by the categories of Conduct Disorder (CD) and
Oppositional Defiant Disorders (ODD)

• The diagnosis of antisocial personality

disorder (APD) is relevant to
understanding childhood conduct and their
adult outcomes
© Cengage Learning 2016
 Public Health Perspectives

• Blends the legal, psychological, and

psychiatric perspectives with public health
concepts of prevention and intervention
– Goal
• To reduce injuries, deaths, personal suffering, and
economic costs associated with youth violence
• Cut across disciplines to:
– Understand conduct problems in youths
– Determine how these problems can be
treated and prevented
© Cengage Learning 2016
 DSM-5 Defining Features

• Two DSM-5 disruptive behavior disorders

– Oppositional defiant disorder (ODD)
– Conduct disorder (CD)
– Both have been found to predict future
psychopathology and enduring impairment in
life functioning

© Cengage Learning 2016

 Oppositional Defiant Disorder

• Age-inappropriate recurrent pattern of

stubborn, hostile, disobedient, and defiant
behaviors
• Usually appears by age 8
• Severe ODD behaviors can have negative
effects on parent-child interactions
• Symptoms can be grouped into
• 1)Negative affect ( angry, irritable mood)
• 2) Defiance (defiant/strong-head behavior
© Cengage Learning 2016
 Diagnostic criteria for Oppositional Defiant
Disorder

© Cengage Learning 2016

 Diagnostic criteria for Oppositional Defiant
Disorder (cont’d.)

© Cengage Learning 2016

 Conduct Disorder

• Repetitive, persistent pattern of severe

aggressive and antisocial acts
– May have co-occurring problems, e.g.,
ADHD, academic deficiencies, and poor peer
relations
– Family child-rearing practices may contribute
to problems
– Parents feel the children are out of control
and feel helpless to do anything about it

© Cengage Learning 2016

 Diagnostic Criteria for Conduct Disorder

© Cengage Learning 2016

 Diagnostic Criteria for Conduct Disorder
(cont’d.)

© Cengage Learning 2016

 Diagnostic Criteria for Conduct Disorder
(cont’d.)

© Cengage Learning 2016

 Conduct Disorder Age of Onset

• Children with childhood-onset CD display

at least one symptom before age 10
– More likely to be boys
– Show more aggressive symptoms
– Account for disproportionate amount of illegal
activity
– Persist in antisocial behavior over time

© Cengage Learning 2016

 Conduct Disorder Age of Onset (cont’d.)

• Children with adolescent-onset CD

– As likely to be girls as boys
– Do not show the severity or psychopathology
characterizing the early-onset group
– Are less likely to commit violent offenses or
persist in their antisocial behavior over time

© Cengage Learning 2016

 Are CD and ODD Separate?

• Nearly half of all children with CD have no

prior ODD diagnosis
• Most children who display ODD do not
progress to more severe CD
• For most children, ODD:
– Is an extreme developmental variation
– Is a strong risk factor for later ODD
– Does not signal an escalation to more serious
conduct problems
© Cengage Learning 2016
 Antisocial Personality Disorder (ADP) and
Psychopathic Features
• Pervasive pattern of disregard for and
violation of the rights of others;
involvement in multiple illegal behaviors
– As many as 40% of children with CD later
develop APD
– Adolescents with APD may display
psychopathic features
– Signs of lack of conscience occur as young as
3-5 years

© Cengage Learning 2016

 Antisocial Personality Disorder (ADP) and
Psychopathic Features (cont’d.)
• A subgroup of children with CD are at risk
for extreme antisocial and aggressive acts
and for poor long-term outcomes
– Display callous and unemotional (CU)
interpersonal style
• Lack guilt and empathy; do not show emotions;
display narcissism and impulsivity; and lack
behavioral inhibition
– Different developmental processes may
underlie behavioral and emotional problems

© Cengage Learning 2016

 Associated Characteristics

• Many factors are associated with conduct

problems in youths
– Cognitive and verbal deficits
– School and learning problems
– Self-esteem deficits
– Peer problems
– Family problems
– Health-related problems

© Cengage Learning 2016

 Cognitive and Verbal Deficits

• Most children with conduct problems have

normal intelligence
• Verbal deficits are present in early
development: may interfere with self-control,
emotional regulation, receptive listening,
expressive speech
• Deficits in executive functioning
– Co-occurring ADHD may be a factor
– Types of executive function exhibited may differ - cool : attention,
working memory, planning and inhibition, (such as in ADHD) versus
hot executive functions: involve incentive and motivation (more often in
CD).
© Cengage Learning 2016
 Deficits in Executive Functions

• Rarely consider the consequences of their

behavior or the impact on others
• Fail to inhibit their impulsivity
• Fail to consider future rewards
• Fail to adapt their action to future
circumstances
• May be related to the comorbidity with
ADHD

© Cengage Learning 2016

 School and Learning Problems

• Underachievement, grade retention,

special education placement, dropout,
suspension, and expulsion
• Relationship between conduct problems
and underachievement is firmly
established by adolescence
– May lead to anxiety or depression in young
adulthood

© Cengage Learning 2016

 Family Problems

• General family disturbances

• Specific disturbances in parenting
practices and family functioning
• High levels of conflict are common in the
family, especially between siblings
• Lack of family cohesion and emotional
support
• Deficient parenting practices
• Parental social-cognitive deficits
© Cengage Learning 2016
 Peer Problems

• Young children with conduct problems

display poor social skills and verbal and
physical aggression toward peers
• Often rejected by peers, although some
are popular
– Children rejected in primary grades are five
times more likely to display conduct problems
as teens
– Some become bullies

© Cengage Learning 2016

 Peer Problems (cont’d.)

• Often form friendships with other antisocial

peers
– Predictive of conduct problems during
adolescence
• Underestimate own aggression and its
negative impact, and overestimate others’
aggression toward them

© Cengage Learning 2016

 Peer Problems (cont’d.)

• Reactive-aggressive children display

hostile attributional bias
• Proactive-aggressive view their aggressive
actions as positive

© Cengage Learning 2016

 Self-Esteem Deficits

• Low self-esteem is not the primary cause

of conduct problems
– Instead, problems are related to inflated,
unstable, and/or tentative view of self
• Youths with conduct problems may
experience high self-esteem
– Over time may permit them to rationalize their
antisocial conduct

© Cengage Learning 2016

 Health-Related Problems

• High risk for personal injury, illness, drug

overdose, sexually transmitted diseases,
substance abuse, and physical problems
as adults
• Rates of premature death (before age 30)
– Are 3 to 4 times higher in boys with conduct
problems

© Cengage Learning 2016

 Health-Related Problems (cont’d.)

• Early onset and persistence of sexual

activity and sexual risk-taking by age 21
• Substance use disorders and adolescent
antisocial behavior are strongly associated
• Childhood conduct problems are a risk
factor for adolescent and adult substance
abuse
– Mediated by drug use and delinquency during
early and late adolescence

© Cengage Learning 2016

 Accompanying Disorders and Symptoms
• Attention-Deficit/Hyperactivity Disorder
– More than 50% of children with CD also have
ADHD
– Possible reasons for overlap
• A shared predisposing vulnerability may lead to
both ADHD and CD
• ADHD may be a catalyst for CD
• ADHD may lead to childhood onset of CD
– Research suggests that CD and ADHD are
distinct disorders
© Cengage Learning 2016
 Accompanying Disorders and Symptoms
(cont’d.)
• Depression and anxiety
– About 50% of children with conduct problems
also have depression or anxiety
• ODD best accounts for the connection between
conduct problems and depression
• Increasing severity of antisocial behavior is
associated with increasing severity of depression
and anxiety
• Anxiety may serve as a protective factor to inhibit
aggression

© Cengage Learning 2016

 Prevalence
• ODD is more prevalent than CD during
childhood; by adolescence, prevalence is
equal
• Lifetime prevalence rates
– 12% for ODD (13% for males, 11% for
females)
– 8% for CD (9% for males, 6% for females)
• Prevalence for CD and ODD across
cultures of Western countries are similar
© Cengage Learning 2016
 Gender

• Gender differences are evident by 2-3

years of age
– During childhood, rates of conduct problems
are about 2-4 times higher in boys
– Boys have earlier age of onset and greater
persistence
– Early symptoms for boys are aggression and
theft; early symptoms for girls are sexual
misbehaviors

© Cengage Learning 2016

 Explaining Gender Differences

• Possible explanations
– Genetic, neurobiological, environmental risk
factors, and definitions of conduct problems
that emphasize physical violence
• Girls use indirect, relational forms of
aggression
• Early maturing boys and girls are at risk
for recruitment into delinquent behavior by
peers
© Cengage Learning 2016
 General Progression

• Earliest sign is difficult temperament in

infancy
• Hyperactivity and impulsivity during
preschool ad early school years
• Oppositional and aggressive behaviors
peak during preschool years
• Diversification - new forms of antisocial
behavior develop over time

© Cengage Learning 2016

 General Progression (cont’d.)

• Covert conduct problems begin during

elementary school
• Problems become more frequent during
adolescence

© Cengage Learning 2016

 General Progression (cont’d.)

• Some children break from the traditional

progression
– About 50% of children with early conduct
problems improve
– Some don’t display problems until
adolescence
– Some display persistent low-level antisocial
behavior from childhood/adolescence through
adulthood

© Cengage Learning 2016

Different Forms of Disruptive And Antisocial
Behavior

© Cengage Learning 2016

 Two Common Pathways

• Life-course-persistent (LCP) path begins

early and persists into adulthood
– Antisocial behavior begins early
• Subtle neuropsychological deficits heighten
vulnerability to antisocial elements in social
environment
– Complete, spontaneous recovery is rare after
adolescence
– Associated with family history of externalizing
disorders
© Cengage Learning 2016
 Two Common Pathways (cont’d.)

• Adolescent-limited (AL) path begins at

puberty and ends in young adulthood
– Less extreme antisocial behavior, less likely to
drop out of school, and have stronger family
ties
– Delinquent activity is often related to
temporary situational factors, especially peer
influences

© Cengage Learning 2016

 The Changing Prevalence Of Participation
In Antisocial Behavior Across The Lifespan

© Cengage Learning 2016

 Adult Outcomes

• 50% of active offenders decrease by early

20s, and 85% decrease by late 20s
• Negative adult outcomes are seen,
especially for those on the LCP path
– Males - criminal behavior, work problems, and
substance abuse
– Females - depression, suicide, and health
problems

© Cengage Learning 2016

 Causes

• Early theories focused on a child’s

aggression
• No single theory explains all forms of
antisocial behavior
• Today conduct problems are seen as
resulting from:
– The interplay among a predisposing child,
family, community, and cultural factors
operating in a transactional fashion over time

© Cengage Learning 2016

 Genetic Influences

• Aggressive and antisocial behavior in

humans is universal
– Run in families within and across generations
• Adoption and twin studies
– Indicate 50% or more of variance in antisocial
behavior is hereditary
– Suggest contribution of genetic and
environmental factors

© Cengage Learning 2016

 Prenatal Factors and Birth Complications

• Pregnancy and birth factors

– Low birth weight
– Malnutrition (possible protein deficiency)
during pregnancy
– Lead poisoning
– Mother’s use of nicotine, marijuana, and other
substances during pregnancy
– Maternal alcohol use during pregnancy

© Cengage Learning 2016

 Neurobiological Factors

• Overactive behavioral activation system

(BAS) and underactive behavioral
inhibition system (BIS)
• Variations in stress-regulating
mechanisms
• Structural and functional brain
abnormalities in amygdala, prefrontal
cortex, anterior cingulate, and insula

© Cengage Learning 2016

 Neurobiological Factors (cont’d.)

• Early findings suggest three neural

systems are involved:
– Subcortical neural systems
• Aggressive behavior - dysfunction in the integrated
functioning of brain circuits involving the amygdala
– Prefrontal cortex
• Decision-making circuits and socioemotional
information processing circuits
– Frontoparietal regions
• Emotions and impulsive motivational urges
© Cengage Learning 2016
 Social-Cognitive Factors

• Immature forms of thinking

• Cognitive deficiencies
• Cognitive distortions
• Deficits in facial expression recognition
and eye contact
• Dodge and Pettit comprehensive social-
cognitive framework model
– Cognitive and emotional processes are
mediators
© Cengage Learning 2016
 Steps In The Thinking And Behavior Of
Aggressive Children In Social Situations

© Cengage Learning 2016

 Family Factors

• Severe forms of antisocial behavior

– Are associated with a combination of child risk
factors and extreme deficits in family
management skills
• Influence of family environment is complex
• Reciprocal influence
– Child’s behavior is influenced by and
influences the behavior of others
• Child behaviors exert greater influence on
parenting behavior than the reverse
© Cengage Learning 2016
 Family Factors (cont’d.)

• Coercion theory
– Parent-child interactions provide a training
ground for the development of antisocial
behavior
– Four-step escape-conditioning sequence
• The child learns to use increasingly intense forms
of noxious behavior to avoid unwanted parental
demands (coercive parent-child interaction)
– Children with callous-unemotional traits
display significant conduct problems
regardless of parenting quality
© Cengage Learning 2016
 Family Factors (cont’d.)

• Attachment theories
– Children with conduct problems have little
internalization of parent and societal
standards
– There is a relationship between insecure
attachments and the development of
antisocial behavior

© Cengage Learning 2016

 Other Family Problems

• Family instability and stress

– High family stress may be both a cause and
an outcome of child’s antisocial behavior
• Unemployment, low SES, multiple family
transitions, instability, and disruptions in parenting
practices are stressors
– Amplifier hypothesis
• Parental criminality and psychopathology
– Aggressive and antisocial tendencies run in
families within and across generations
© Cengage Learning 2016
 Societal Factors

• Individual and family factors interact with

the larger societal and cultural context in
determining conduct problems
• Social disorganization theories
• Adverse contextual factors are associated
with poor parenting
• Neighborhood and school
– Social selection hypothesis
• Media
© Cengage Learning 2016
 Cultural Factors

• Across cultures, socialization of children

for aggression is one of the strongest
predictors of aggressive acts
• Rates of antisocial behavior vary widely
across and within cultures
• Antisocial behavior is associated with
minority status in the U.S.
– Likely due to low SES

© Cengage Learning 2016

 Treatment and Prevention
• Some treatments are not very effective
– Office-based individual counseling and family
therapy
– Group treatments can worsen the problem
– Restrictive approaches (residential treatment,
inpatient hospitalization, incarceration)

© Cengage Learning 2016

 Treatment and Prevention (cont’d.)
• Comprehensive two-pronged approach
includes
– Early intervention/prevention programs
– Ongoing interventions

© Cengage Learning 2016

 Effective Treatments For Children With
Conduct Problems

© Cengage Learning 2016

 Parent Management Training (PMT)

• Teaches parents to change the child’s

behavior in the home and in other settings
using contingency management
techniques
• Focus is on:
– Improving parent-child interactions
– Promoting positive behavior
– Decreasing antisocial behavior
• Makes numerous demands on parents
© Cengage Learning 2016
 Problem-Solving Skills Training (PSST)

• Focuses on cognitive deficiencies and

distortions in interpersonal situations
• Five problem-solving steps are used to:
– Identify thoughts, feelings, and behaviors in
problem social situations

© Cengage Learning 2016

 Problem-Solving Skills Training (PSST)
(cont’d.)
• Children learn to:
– Appraise the situation
– Identify self-statements and reactions
– Alter their attributions about others’
motivations
– Learn to be more sensitive to others

© Cengage Learning 2016

 Multisystemic Therapy (MST)

• Intensive family- and community-based

approach
– For teens with severe conduct problems who
are at risk for out-of-home placement
• Attempts to empower caregivers to
improve youth and family functioning
• Effective in reducing long-term rates of
criminal behavior
– Reduces association with deviant peers
© Cengage Learning 2016
 Preventive Interventions

• Main assumptions
– Conduct problems can be treated more easily
and effectively in younger than older children
– Counteracting risk factors/strengthening
protective factors at young age limits/prevents
escalation of problem behaviors
– Costs to educational, criminal justice, health,
and mental health systems are reduced

© Cengage Learning 2016

 Preventive Interventions (cont’d.)

• Incredible Years intensive multifaceted

early-intervention program for parents and
teachers
– Support for effectiveness of early
interventions in reducing later conduct
problems and maintaining positive outcomes
• Fast Track program to prevent
development of antisocial behavior in high-
risk children, using five components

© Cengage Learning 2016