CONDUCT PROBLEMS
TODAY’S PLAN
Definitions
& Overview
Importance & Prevalence
Causes
Treatment
DEFINITIONS & OVERVIEW
OPPOSITIONAL DEFIANT DISORDER (ODD)
Pattern of minimum of 4 symptoms for at least 6
months
Angry/irritable mood
e.g., loses temper, touchy, resentful
Argumentative/defiant behavior
e.g., deliberately annoys others; blames others; refuses to
comply; argues with authority figures
Vindictiveness
e.g., spiteful
CONDUCT DISORDER (CD)
Pattern in which basic rights of others or societal
norms are violated; minimum of 3 of 15 symptoms
in the past year:
Aggression toward animals or people
e.g., initiates fights, uses weapon(s), physically cruel, stealing
while confronting a victim, forced sexual activity
Destruction of property
e.g., firesetting
Deceitfulness or theft
e.g., burglary, “cons” others, stealing items
Serious violations of rules
e.g., stays out past curfew before age 13; runs away overnight at
least twice; often truant before age 13
CD SPECIFIER (AGE OF ONSET)
Childhood-onset (at least 1 sx before age 10)
usually male
more aggressive acts
persist in antisocial behavior over time
often concurrent ODD and ADHD
CD SPECIFIER (AGE OF ONSET)
Adolescent-onset (sxs after age 10)
girl to boy ratio more balanced
Less severity/less psychopathology
less likely to commit violent offenses or
persist in antisocial behavior over time
More normal peer relationships
ANOTHER SPECIFIER FOR CONDUCT DISORDER
With limited prosocial emotions (also
called CU for callous-unemotional)
Must display at least 2 sx over at least 12
months in multiple relationships + settings
Lack of remorse or guilt
Callous – lack of empathy
Unconcerned about performance
Shallow or deficient affect
CD/ODD CONNECTION
Most cases of CD are preceded by ODD
Most children with CD continue to display
ODD symptoms
Most children with ODD do not progress to
CD
CONNECTIONS WITH OTHER DISORDERS
~40% of children with CD later develop
antisocial personality disorder
Signs of lack of conscience occur in some
children as young as 3-5 years (CU traits)
CONNECTIONS WITH OTHER DISORDERS
~50% of children with CD also have ADHD
~50% of children with conduct problems also
have a depression or anxiety disorder
IMPORTANCE
Most costly mental health problem in North
America
Public costs across healthcare, juvenile justice,
+ educational systems estimated to be at least
$10,000 per child
Lifetime cost to society per child who leaves
high school for life of crime/substance abuse: ~
$2 million
PREVALENCE
Lifetime prevalence rates
10% for ODD (11% for males, 9% for females)
9% for CD (12% for males, 7% for females)
CAUSES
CAUSES: BIOLOGICAL
Biological factors:
Adoption + twin studies: 50% or more of
variance in antisocial behavior is hereditary,
Difficult temperament, impulsivity, tendency
to seek rewards, learning difficulties, and
insensitivity to punishment may create
antisocial “propensity”
CAUSES: ENVIRONMENTAL
In children with CU traits, CD persists
regardless of parenting quality
Family instability and stress
Parental criminality and psychopathology (e.g.,
substance abuse)
CAUSES: ENVIRONMENTAL CONT’D
Physical or sexual abuse
Peer rejection
Delinquent peer group
Violent neighborhood
TREATMENT & PREVENTION
TREATMENT AND PREVENTION: OVERVIEW
• Typically begins w/school referral
• Most effective combine approaches across many
settings
• Not very effective:
• office-based
• group treatments
TREATMENT AND PREVENTION
Multisystemic Treatment (MST)
Sees adolescents as functioning within
interconnected social systems
Antisocial behavior results from/is maintained
by transactions within or between any of the
systems
http://mstservices.com/
TREATMENT AND PREVENTION
• Parent management training (PMT) (effective for
children under 12)
Treatment sessions cover: use of commands,
rules, praise, rewards, mild punishment,
behavioral contracts to change behavior of
child
Homework helps generalize skills
http://www.russellbarkley.org/
