Conduct

Disorder
Overt
Aggression
How is Overt Conduct Disorder
Identified and Treated?
 Conduct Disorder
• Characterized by persistent
antisocial behavior that violates:
– The rights of others
– Age-appropriate social norms
• Includes:
– Aggression to people and animals
– Destruction of property
– Deceitfulness and theft
– Violation of rules
 Students with
Conduct Disorder
• Differ from peers in
– Rate of noxious behaviors
– Persistence of such conduct
beyond age at which most
children have adopted less
aggressive behaviors
How Do These Students Do
in School?
• Teachers see these students as:
– Uninterested
– Unenthusiastic
– Careless
• Students with Conduct Disorder have:
– Poor interpersonal relations
– Rejected by their peers
– Poor social skills
• Students with Conduct Disorder are most likely to
be:
– Left behind in grades
– Show lower achievement levels
– End school sooner than same-age peers
The Vile
Weed:
Stages
in the
Coercion
Model
 Conduct Disorder Case Study
• Tony is 13 and has conduct disorder and depression. He is living
with his Uncle and Aunt who have basically raised him since birth.
Occasionally his mom comes by, but not on a regular basis. The
father is unknown. Tony’s Uncle and Aunt adopted him. They are
the head of a “team” which cares for Tony. This includes respite
foster parent’s two weekends a month, Tony’s other Uncle one
weekend a month, and his grandparents or his adopted parents
the other weekend. At the moment, Tony is doing well. After the
last sentencing, they were able to get better cooperation from their
probation officer and a more workable probation agreement. Tony
is supervised more than his adopted parent’s four year old. Last
year he was hospitalized after he cut his wrist when he was
caught drinking. Tony is now part of a group at school who are
putting together a house. For once he is doing really well, expect
when he tried to steal an electric saw. But Tony’s parents had
warned the school to watch for this, and they did, and they caught
him. The punishment? No electric guitar for four days. Every week
or so while Tony is at school, his parents go through all his stuff.
They have told Tony they will do this. Tony now thinks it is mean
and unfair. On the other hand, their have been no knives in the
house for a month now. His parents call it “room service”.
 Conduct Disorder
• Is often comorbid with other
disorders
• Is one of the most prevalent
psychopathological disorders
• Affects:
– 6 – 16% of males
– 2 – 9% of females
– 1.3 to 3.8 million children have
conduct disorder
Conduct Disorder
• Males exhibit:
– Fighting
– Stealing
– Vandalism
• Overly aggressive
• Females exhibit:
– Lying
– Truancy
– Running away
– Substance abuse
– Prostitution
• Less aggressive
Conduct Disorder
• May be classified by age of
onset
• Earlier onset usually predicts
more serious impairment
 The
Causal
Wheel
 Classified As:
• Mild (resulting in only minor harm to
others)
• Moderate
• Severe (causing considerable harm to
others)
• Undersocialized (violent behavior)
• Socialized (more covert antisocial acts)
– Versatile (both overt and covert forms of
antisocial conduct)
Conduct Disorder
• Subtypes
–Overt Aggression
–Covert Antisocial
–Versatile
Causes of Aggression
• Learned through:
– Modeling
– Reinforcement
– Ineffective punishment
• Risk can be increased through these
factors:
– Personal
– Family
– School
– Peer
– Cultural
Preventing Aggression
• Consequences that deter
aggression
• Instruction in nonaggressive
responses
• Early intervention
• Restriction of tools of aggression
• Correction of living conditions
• More effective school options
Assessing Aggression
• Behavior rating scales, AND
• Direct observation
• Must include:
– Evaluation of a variety of domains
– Prosocial skills
– Social deficits
– Functional assessment of behavior
Interventions for
Aggression
• Interventions based on social learning
– Most reliable
– Include strategies such as:
• Rules
• Teacher praise
• Positive reinforcement
• Verbal feedback
• Stimulus change
• Contingency contracts
• Modeling and reinforcement
Uses and Misuses of Punishment
• Punishment should:
– Be reserved for serious misbehavior
– Be instituted in ongoing behavioral
management and instructional programs
– Be used only by people who are warm and
loving toward the individual
– Be administered matter-of-factly, without
anger, threats, or moralizing
– Be fair, consistent, and immediate
– Be of reasonable intensity
– Involve response cost
– Be related to the misbehavior
– Be discontinued if it is not quickly apparent
that it is effective
– Have written guidelines for using specific
punishment procedures
Behavior Cycle and Precorrection
1) Calm: Behaving in ways that are expected and
appropriate
2) Trigger: First stage in moving towards a major
blowup
3) Agitation: Overall behavior in unfocused and off
task
4) Acceleration: Student engages the teacher in a
coercive struggle
5) Peak: Student’s behavior is out of control
6) De-escalation: Student is beginning to disengage
from the struggle and is in a confused state
7) Recovery: Eager for busy work and a semblance
of ordinary glasswork
The Acting Out
Cycle
School-Wide Discipline
• School-wide discipline plans must:
– Focus on earlier phases in the acting out
cycle
– Focus efforts on positive attention to
appropriate behavior
– Provide clear expectations and monitoring of
student behavior
– Provide staff communication and support
– Provide consistent consequences
Covert
Aggression
How is Covert Conduct Disorder
Identified and Treated?
Definition
• Covert Antisocial Behavior includes:
– Untrustworthiness and manipulation of others;
– Running away; and
– Concealment of one’s acts.
• “Masculine” Antisocial Behaviors
– Vandalism, fighting, and stealing.
• “Feminine” Antisocial Behaviors
– Lying, running away, and substance abuse.
• Behaviors Clustered Together for Males
and Females
– Truancy, expulsion, underachievement, and
discipline
Casual Factors
and Prevention
Assessment
• Covert behaviors are difficult to
observe
• Involves:
– Long periods of observation
– Self reports
Definitions of Animal
Abuse
• Social Science: Socially unacceptable behavior
intentionally causes unnecessary pain, suffering,
distress, or death.
 Law: Unnecessarily overloads, overdrives, torments,
deprives of necessary sustenance or shelter, or
unnecessarily mutilates, or kills any animal
(misdemeanor); intentionally commits an act that
results in cruel death, or excessive infliction of
unnecessary pain or suffering (felony)
 Types of Animal Abuse
•Neglect - no satisfaction derived; due to
carelessness, callousness and
ignorance
• Abuse - satisfaction derived from dominance
or from behavioral response
•Sadistic- takes satisfaction from suffering
•Hoarding
•Sexual abuse: crush videos
•Subcultural abuse: socially acceptable
Animal Abuse and Adult Criminality
•MSPCA Study: 1975-1996
—80,000 complaints
—268 efforts to prosecute
—119 convictions
—91 fined
—28 served time (average of 4.5 months)
•Compared to “next door neighbors,” men prosecuted
for animal abuse were
• 5 X more likely to commit violent crimes
• 4 X more likely to commit property crime
• 3 X more likely to have record for drug or
disorderly conduct offense
Adult Criminality and Childhood
Animal Abuse
•Alan Felthous and Stephen Kellert Studies-
—Compared criminals to non-criminals and psychiatric
to “normal”
—Significant association between acts of cruelty to
animals in childhood and serious, recurrent aggression
against people as an adult; most aggressive criminals
committed more severe acts of animal cruelty
•Frank Ascione
—48% of individuals incarcerated for sexual homicide
abused animals as children
—46% of convicted rapists abused animals as children
 Child Abuse and Animal
Abuse
•New Jersey Study - 53 families met criteria for
child abuse or neglect. 60% had confirmed
instances of cruelty to animals; in families referred
for physical abuse, 88% had instances of animal
abuse: 2/3 by fathers; 1/3 by children.
•1980 study in England: Of 23 families with
history of animal abuse, 83% had children at risk
for abuse or neglect.
•Pennsylvania study corroborated that behavior
patterns toward children and pets are similar.
 Abused Children Abuse Animals
• In one study, 4.7% of “normal” children
acknowledged animal abuse, compared to
13% who were sexually abused
24.5% who were physically abused
34% who were both physically and sexually
abused
• Children who witness violence are at greater risk of
becoming abusers or victims
• 26% to 32% of children in abusive families cruel to
animals
Responses
• Primary Prevention
– Humane education

• Secondary Prevention
– Programs for at-risk children

• Tertiary Prevention
– The AniCare Model of Treatment for
Animal Abuse
– AniCare Child
Programs—Pairing At-Risk Children
and Families with Animals in Need

•“Forget Me Not Farm,” collaboration of Humane

Society of Sonoma County, the San Francisco Child
Abuse Council, and the YWCA of Sonoma County,
which includes the Women’s Emergency Shelter
and a therapeutic child care services program.
Teaching gentleness with gardens and animals
to children from violent homes and communities.

–
Safe Haven for Pets Programs

• Various arrangements, depending on local community

• Local vets provide shelter and medical care

• Fostering

• Negotiating extra kennel space off-site

•
AniCare Child
Practical, concrete tools for assessment,
prevention, and intervention
• Designed for all professionals working with
children--counselors, teachers, social service
workers, probation department officials, clergy
• Focuses on empathy development and self
management skills
• Includes case studies, projective materials, and
individual and group exercises
The AniCare Model of Treatment
for Animal Abuse

• Stresses accountability and empathy

development
• Cognitive-behavioral
• Active therapist, directly addresses problem
• Pre- and Post-Treatment Questionnaires
• Ten AniCare Exercises, with homework
– Becoming the Victim
– Fostering Flexibility
– Learning to Nurture
– Establishing Intergenerational Accountability
Responding to Stealing
• Define stealing
• Parents decide when theft has occurred
• Parents apply consequences
• Every instance of stealing receives consequences
• Parents “keep eyes open” and ask questions
• Consequences involve specified interval of work or
period of restriction
• No positive reinforcement for periods of non-
stealing
• Program remains in effect for at least 6 months
Responding to Lying
• Careful monitoring of verbal and written
products
• Providing reinforcement for honest
behavior
• Punishing occurrences of lying
• Determining if child can differentiate truth
from non-truth
• Avoiding getting caught up in arguments
about the veracity of statements
 Firesetting
• Children may be more likely to set
fires if:
– They do not understand the danger of fire
– They do not have the necessary social skills
to obtain gratification in other ways
– They engage in other antisocial behaviors
– They are motivated by anger and revenge
Vandalism
• Appears to be a reaction to aversive
environments:
– Vague rules
– Punitive discipline
– Rigid punishment
– School curriculum not matched with student
needs
– Little recognition for appropriate behavior or
achievement
Responding to Truancy
• Social Learning Principles
– Attendance is praised
– Systems where attendance earns
rewards
– School work that is interesting
– Connecting school and home
– Stopping harassment by peers
– Decreasing fun outside of school during
school hours
Problem
Behaviors of
Adolescence
How are problem behaviors
identified and treated in
adolescence?
Juvenile
Delinquency
• Delinquent acts
• Index crimes
• Status offenses
Types of Delinquents
• Those who commit a few delinquent
acts vs. repeat offenders
• Age at first offense
– Prognosis is worse for juveniles who
offend before the age of 12
Causes of
Delinquency
• History of child abuse
• Hyperactivity and impulsivity
• Low intelligence and achievement
• Lax parental supervision
• Family history of criminality
• Poverty and large family size
• Antisocial behavior or conduct disorder
Causes of Delinquency
Responding to
Delinquency
• Families
– Intervention is extremely difficult
• Juvenile Courts and Correction
– Harsher punishments seem
counterproductive
• Schooling
– Typical punishment is usually ineffective
Street Gangs
• The typical gang member has:
– A notable set of personal
deficiencies
– A notable tendency toward defiance
– A greater-than-normal desire for
status, identity, and companionship
– A boring, uninvolved lifestyle
 Substance Abuse
• Usually episodic for most adolescents
• Alcohol and tobacco are the largest problems
• Important Terms
– Intoxication
• Symptoms of a toxic amount of substance in the blood stream
– Tolerance
• Physiological adoption to a substance so that an increasing amount
is required to produce the same effects
– Addiction
• Compulsive use of a substance and that obtaining and using the
substance has become a central concern and pattern of behavior
– Dependence
• The need to continue using a substance to avoid physical or
emotional discomfort or both
– Withdrawal
• Physical or emotional discomfort associated with a period of
abstinence
Preventing
Substance Abuse
• Must be designed for the individual
case
• School based interventions must:
– Require clear school policies
– Require systematic efforts to provide
information
– Provide referral to other agencies
– Involve families and peers
 Preventing Substance Abuse
– con’t
• Skills for students to learn:
– Resist peer pressure
– Change attitudes, values, and behavioral
norms related to substance use
– Recognize and resist adult influences toward
substance use
– Use problem-solving strategies such as self-
control, stress management, and appropriate
assertiveness
– Set goals and improve self-esteem
– Communicate more effectively
Seven Possible Symptoms of
Drug Involvement
1) Change in school or work attendance or
performance
2) Alteration of personal appearance
3) Mood swings or attitude changes
4) Withdrawal from responsibilities / family
contacts
5) Association with drug-using peers
6) Unusual patterns of behavior
7) Defensive attitude concerning drugs
Early Sexual Activity
• Increases:
– Risk of pregnancy
– Sexually transmitted diseases
– Psychological and health problems
• Current school based
interventions may be ineffective
 Introduction to CD

Case Presentation
What is Conduct Disorder?
 Chronic pattern of behavior that causes harm to others
 Chronic pattern of behavior that violates societal rules
Conduct Disorder and antisocial behavior in
children.
 Actions and attitudes that are age-inappropriate.
 Violate expectations of family and society.
 Damage others’ personal or property rights.
 Issues in defining Conduct Problems

Historically, we have defined conduct problems:

 Legally
 Psychologically

 DSM-IV-TR includes:
 Oppositional Defiant Disorder
 Conduct Disorder

 Children with conduct disorders show a wide range of behaviors.

 Environmental Component

CD and ODD is associated with the person’s

environment
 Poverty / disorganized neighborhood
 Violence within the home / neighborhood
 Abuse/neglect / inadequate supervision
 poor quality schools
Community Factors
 The History of CD

The Boston boy fiend: 1874 Jesse Pomeroy, age 14.

Adolescent gangs in large cities during the 1700s and
1800s.
How should we handle juvenile delinquents?
If a minor is found guilty of an aggressive act, how
do we handle that in the court system?
 Conduct Disorder

CONDUCT DISORDER
Persistent pattern of behavior where rights of others/societal norms violated, shown by 3 or more of
following in last year, at least 1 in past 6 months:
Aggression to people and animals
____ ____ often bullies, threatens, or intimidates others
____ ____ often initiates fights
____ ____ used a weapon that can cause serious physical harm
____ ____ been physically cruel to people
____ ____ been physically cruel to animals
____ ____ stolen while confronting the victim
____ ____ forced sexual activity
Destruction of property
____ ____ deliberately fire set with intent of doing serious damage
____ ____ deliberately destroyed others' property other than by fire
Deceitfulness or theft
____ ____ break and entry into a car or house
____ ____ often lies to obtain things or avoid obligations ("cons others")
____ ____ stolen items without victim confrontation
Serious violations of rules
____ ____ often stays out at night despite parental prohibitions
____ ____ run away from home overnight at least twice (or 1 extended)
____ ____ often truant beginning before age 13
 Two Subtypes of CD

Childhood-Onset type:
 1 criterion of CD present before 10 years old
Adolescent-Onset type
 No evidence prior to 10 years old
Severity
 Mild, moderate, severe
 Cluster analysis of CD
Destructive
Property Violations Aggression
Cruelty to animals Assaults others
Lies Blames others for mistakes
Sets fires Bullies others
Steals Cruel to others
Vandalism Physical fights
Spiteful/vindictive

Oppositional Overt
Covert Status Offenses Angry-resentful
Breaks rules Annoys others
Runs away from home Argues with adults
Swears Defies adults’ requests
truancy Stubborn
Temper tantrums
Nondestructive Touchy-easily annoyed
Based on Frick et al. (1993)
 Oppositional Defiant Disorder

OPPOSITIONAL DEFIANT DISORDER

A. 6 month pattern of negativistic and defiant behavior during which at least 4 of
following present
(considered against what is normal for age level):
____ ____ often loses temper
____ ____ often argues with adults
____ ____ often actively defies or refuses adult requests or rules
____ ____ often deliberately annoys people
____ ____ often blames others for own mistakes
____ ____ often touchy/easily annoyed by others
____ ____ often angry and resentful
____ ____ often spiteful or vindictive
B. ____ ____ Does not meet criteria for Conduct Disorder, and does not occur
exclusively during
psychosis or depression
 Issues surrounding CD and ODD

1. Are ODD and CD distinct categories? Would a

dimensional view be more appropriate? How
might DSM-V handle this issue?
2. Does our culture help determine who is diagnosed
with ODD and CD? Are girls underdiagnosed?
3. Might an environment create ODD or CD?
 Associations with CD & ODD

Intelligence and underachievement in school

Lack of emotional intelligence
Personality factors: impulsive, callous, unemotional
Multiple problems in relationships: peers, family,
teachers, authority figures.
Co-occurring Disorders: ADHD, anxiety,
depression, substance abuse.
 Epidemiology

Prevalence: 5-8% for CD.

10.2% ODD.
Gender differences: the ratio of boys to girls 10 to 1
in childhood; 1.5 to 1 in adolescence.
Gender differences in symptom expression.
Developmental pathways
 Early onset versus later onset
 Peer aggression
 Firesetting and cruelty to animals
 Precursors and Course of CD

General Developmental Course

Pg. 161
 Course of Child-onset

Patterson’s Vile
Weed

Two social
failures

Contingencies
train children to
be coercive to get
what they want
Developmental Progression of Conduct Problems Behaviors
(ASBs)- Probabilistic Progression

Oppostitional Offensive Delinquent

Argues Cruelty Sets fires
Braggging Disobeys at school Steals outside
Demands attention Screams Alcohol/Drug use
Disobeys at home Poor Peer relations Truancy
Impulsive Fights Runs away
Temper Tantrums Sulks Vandalism
Stubborn Swears
Teases Lying
Loud

PreSchool Adolescence
Overt (often in home) Becomes more Covert
 Etiology of Conduct Problems

Etiological Theories
 Family and twin studies
 Shared environmental factors
 Non-shared environmental factors
 Teratogen exposure prenatally
 Perinatal stressors
 Abnormal neurophysiological responding
 Temperament
 Ineffective parenting
 Problematic peers / environmental
 Treatment

Working with Parents

Problem-solving Training
Family Therapy
Prevention Issues
 Thompson House Rules

1. No setting each other up. This means no name calling, no

tripping, and no elbowing.
2. No violence against other people. This means no hitting, no
throwing things at others, and no grabbing others.
3. No property destruction.
Violating any of these rules results in no Nintendo, TV, or
Gameboy for the rest of the day.
Violating either rule after dinner means no Nintendo, TV, or
Gameboy for the rest of the day AND the next day.
Additional rules:
4. Morning Nintendo, TV, or GameBoy only after ready for school
(dressed, teeth brushed, bed made).
5. Afternoon and evening Nintendo, TV, or Gameboy only after
the bedroom is picked up and all homework is done.
Mom will inspect to make sure these rules are met and approve
before Tim or Tom plays Nintendo, TV, or GameBoy.
Reward contingencies and token economies

Susan’s Agreement with Staff

Each day I earn at least half (½) of my Community Participation points
(40 points total) , I will be given 15 minutes of extra phone time, or 15
minutes of extra Walkman time, whichever I choose. My extra 15
minutes can be used on day shift only, at a time determined by staff.

Things I can do to earn more points:

1. get up on time, after 2 prompts or less.
2. attend unit meetings on time, after 2 prompts or less.
3. attend school on time, after two prompts or less.
4. follow directions from staff.
5. actively participate in unit activities.

Things I should not do or I will not earn points:

1. refuse to get out of bed.
2. stay in my room during unit activities.
3. refuse to participate in unit activities.
If I earn 40 Community Participation points for 4 days out of 7, my
mother will be allowed to bring my dog in during visiting hours on
Saturday or Sunday. If I earn 50 points for 5 days out of 7, my mother
will also be allowed to bring pizza in for my dinner on Saturday or
Sunday.
 Parent behavioral training

Three parenting mistakes to avoid

Over-reacting/personalizing
Verbosity (Act, don't yak!)
Inconsistency
Inconsistency
Inconsistency
Inconsistency
Social Skills Training
 Multisystemic Therapy

 Targets multiple systems with a treatment "team"

 Family, including siblings
 School Personnel
 Peers
 Juvenile Justice System

Effective but very expensiveor is it?

 Additional Treatments

Prevention
Institutionalization
Medication
 Empirically Supported Treatments

According to Chambless & Hollon, ESTs are:

"...clearly specified psychological
treatments shown to be efficacious in
controlled research with a
delineated population.”
 Criteria for ESTs

These treatments are identified by asking the

following questions:
 Has the treatment been shown to be beneficial in controlled
research?
 Is the treatment useful in applied clinical settings,
 if so, with what patients under what circumstances?
 Is the treatment cost effective relative to alternative
interventions?
 Treating Conduct Problems

 In general, the further along a child is in the

progression of antisocial behavior, the greater the
need for intensive interventions and the poorer the
prognosis
 ESTs for ODD and CD

Parent Management Treatment

Multi-Systemic Treatment
Cognitive Problem Solving Skills Treatment
Preventative Interventions
 Multi-Systemic Therapy

 An intensive family and community approach for

adolescents with severe CPs
 Draws on a number of techniques and is carried
out with all family members, school personnel,
peers, juvenile justice staff, and other individuals
in the child’s life
 Cognitive Problem-Solving Skills Training

 Focuses on the cognitive deficiencies and

distortions in interpersonal situations
 Provides instruction, practice, and feedback to
teach new ways of interacting
 Preventative Interventions

 Recent efforts have focused on trying to prevent

CPs through intensive programs of early
intervention
 Example: Fast Track (The Conduct Problems
Prevention Research Group)
 Two Specific ESTs for CP

“The Incredible Years” – Webster-Stratton

Fast Track – The Conduct Problems Prevention
Research Group
 The Incredible Years

Group Parenting Skills Training

Group Teacher Classroom Management Training
Child Training
 The Incredible Years

Parent Skill Training

Focuses on:
 Increasing positive parent-child interactions
 Behavior tracking
Behavior Tracking
 The Incredible Years

Parent Skill Training

Focuses on:
 Increasing positive parent-child interactions
 Behavior tracking
 Using “time-out” to discourage problem behaviors
 Making household contingencies explicit
 Reward contingencies
Rewards: Sticker Chart
 The Incredible Years

 The Child Curriculum focuses on:

 emotional literacy

 empathy or perspective taking

 friendship skills

 anger management

 interpersonal problem solving

 school rules

 how to be successful at school

 Outcome Studies

Improves parent child interactions

Reduces parent reliance on violent or critical
discipline methods
Reduces child conduct problems
 At 3 year follow up, 2/3 of children continued to show
clinically significant behavioral improvements (Webster-Stratton,
1990b).
 Fast Track

Fast Track is a multi-site,

comprehensive, 10-year intervention
project designed to prevent serious
antisocial behavior.
Begins when children are in 1st grade
School-wide program with pull out
groups for children high in CD.
 Fast Track

Focuses on improving
 child competencies
 parenting effectiveness
 school context
 school-home communications
 Fast Track: Components

Teacher-led classroom curricula (called PATHS)

directed toward the development of:
 emotional concepts
 social understanding
 self-control (including weekly teacher consultation about
classroom management)
 Fast Track: Components

Parent training groups designed to promote the

development of positive family-school relationships
and to teach parents behavior management skills,
particularly in the use of praise, time-out, and self-
restraint
Home visits for the purpose of fostering parents'
problem-solving skills, self-efficacy, and life
management
 Fast Track: Components

Child social skill training groups (called Friendship

Groups)
Child tutoring in reading
Child friendship enhancement in the classroom
(called Peer Pairing).
 Fast Track: Outcomes

Compared with children in the control group,

children in the intervention group displayed
significantly less aggressive behavior at home, in the
classroom, and on the playground.
By the end of third grade, 37 percent of the
intervention group had become free of conduct
problems, in contrast with 27 percent of the control
group.
 Fast Track: Outcomes

Placement in special education by the end of

elementary school was about one-fourth lower in the
intervention group than in the control group.
Court records indicate that by eighth grade, 38
percent of the intervention group boys had been
arrested, in contrast with 42 percent of the control
group.
 Fast Track: Outcomes

Psychiatric interviews after ninth grade indicate that

The Fast Track program intervention has reduced
serious conduct disorder by over a third, from 27
percent to 17 percent.
 Summary

There ARE ESTs for Conduct Problems

Better to prevent or intervene early than to treat full
blown Conduct Disorder
Parent participation is integral to treatment success