Conduct Disorder The Origin of Criminal Behavior

I. What is conduct disorder? A repetitive & persistent pattern of seriously antisocial behavior, usually criminal (illegal) in nature & marked by extreme callousness. Diagnosis is made in individuals under 18 Behaviors may include (but not limited to): Cruelty toward animals and/or people Vandalism Lying Theft Physical aggressiveness Behavior is often—vicious, callous, remorseless

DSM-IV TR Criteria for Conduct Disorder Repetitive & persistent behavior pattern that violates the basic rights of others or conventional social norms as manifested by the presence of 3 or more of the following in the previous 12 mos. & at least one of them in the previous 6 mos.: A. Aggression to people & animals (e.g., bullying, initiating physical fights, being physically cruel to people or animals, forcing someone into sexual activity). B. Destruction of property (e.g.,fire-setting, vandalism). C. Deceitfulness or theft (e.g., breaking into another’s house or car, conning, shoplifting). D. Serious violation of rules (e.g., staying out at night before age 13 in defiance of parental rules, truancy before age 13). **Significant impairment in social, academic, or occupational functioning. **Person must be under 18 years of age.

II. Conduct Disorder & comorbidity: ADHD Substance use disorders (alcohol, marijuana) Note—CD & drug use occur concomitantly & exacerbate each other. Anxiety Depression (15-45%) Girls with CD are significantly more likely than boys to develop these other disorders, suggesting greater psychopathology in the girls than in the boys.

III. What is prevalence of conduct disorder? A review of several epidemiological studies indicates that prevalence rates range from 4 to 16% for boys & 1.2 to 9% in girls (Loeber et al., 2000). Violent crimes (rape, assault) are largely crimes of male adolescents. Incidence & prevalence of illegal activity peaks by age 17 & then drops precipitously in young adulthood.

IV. What is prognosis of Conduct Disorder? Prognosis is mixed. More than half of children with conduct disorder do not become antisocial personalities in adulthood (Loeber, 1991; Zoccolillo et al., 1992). However, research shows that most conduct disordered boys do continue to demonstrate some conduct problems into adulthood (Lahey et al., 1995).

Do kids with conduct disorder become antisocial adults? Yes, many children diagnosed with conduct disorder meet criteria for antisocial personality disorder into adulthood. Males with conduct disorder who had fathers with antisocial behavior & poor verbal intelligence, more likely to develop APD.

V. Moffitt’s theory: Two courses of conduct disorder: Moffitt argues that two different courses of conduct problems should be distinguished. 1. Life-course persistent –Some individuals show a pattern of antisocial behavior beginning with problems by age 3 & continuing into adulthood. 2. Adolescent-limited – Other conduct disorder individuals started out with normal childhoods, but produced high levels of antisocial behavior during adolescence that does not continue into adulthood.

VI. Etiological factors for Conduct Disorder 1. Biological Factors Is conduct disorder heritable?? *There is some evidence that conduct disorder is genetic. Twin studies show a genetic link for conduct disorder, although the extent of link varies with the samples examined. Adoption studies in Sweden, Denmark, & U.S. show that criminal & aggressive behavior is accounted for by both genetic & environmental factors.

2. Neuropsychological deficits in children with conduct disorder Poor verbal skills Difficulty with executive function Memory impairments Children who develop conduct disorder at an earlier age have been shown to have an IQ score of 1 standard deviation below age-matched peers without conduct disorder. This IQ deficit is not attributable to lower SES, race, or school failure (Lynam, Moffitt, & Stouthamer-Loeber, 1993).

3. Psychological Factors A. Deficient moral awareness-- Children with conduct disorder often lack guilt & remorse for their antisocial & aggressive behaviors. B. Conduct behaviors are learned-- 1. Modeling– children learn aggressive behaviors by observing parental aggression and/or abuse in the home. Evidence supports both of these factors. 2. Imitation- kids will imitate antisocial peers

C. Cognitive factors Cognitive processes of aggressive children had a specific bias—children perceived ambiguous acts as evidence of hostile intent. Children with these faulty perceptions may retaliate to “perceived attacks” that were actually not intended to be hostile. This may lead to aggressive behavior in response to these attacks…. The vicious cycle then continues.

D. Peer Influences Peers influence aggressive & antisocial behaviors in others in 2 ways: 1. Rejection by peers has been shown to be causally related to increased aggressive behavior (e.g., Dylan Klebold & Eric Harris— Columbine High School massacre). 2. Association with Deviant Peers—increases frequency of deviant behavior in others (“Running with the wrong crowd”).

E. Sociological Factors Increased incidence of antisocial & aggressive behaviors linked to lower SES. Race is not a factor; previous research showing African American children to have higher conduct disorder rates was confound of living in poorer community. --hyperactivity --Lack of parental supervision

VII. Treatment A. Family Interventions—treatment involves parents & families of antisocial child. Using a behavioral program of parental management training (PMT), Patterson & coworkers have taught parents to modify their responses to children so that positive social behavior is rewarded. Parents use positive reinforcement (rewards) when the child produces positive behaviors & time- out/loss of privileges for aggressive or antisocial acts.

Does PMT work? Yes!!!, there is some evidence to support its, efficacy. PMT—alters parent/child interactions, which is associated with decreased antisocial behaviors. It also improves the behavior of siblings & reduces maternal depression. Both parent training & court-provided family treatment significantly reduced rates of criminal offense in one study (Bank et al., 1991). Long term effects—last for 1-3 years follow training.

B. Multisystemic Treatment Henggeler’s MST has demonstrated reductions in arrests 4 years following treatment (Borduin et al., 1995). MST—is an intensive & comprehensive therapy that provides services for the adolescent, his/her community, the family, school, & peer group. Therapy targets not just child but all individuals in the child’s life (hence, multisystemic). Treatment is provided in home, school, church, community centers, etc.

Does MST work?? Yes!!!! Compared with a control group who received standard individual therapy, the MST group demonstrated fewer antisocial behaviors & arrests over the following 4 years. While 70% of adolescents receiving standard therapy were arrested in the 4 years after treatment, 22% of the subjects receiving MST were arrested (Davison, Neale, & Kring, 2004).

C. Cognitive Therapies Individual therapy does show improvement. Children are taught to control their tempers, to reduce aggressive behaviors. This is done by requiring kids with conduct disorder to exert restraint when provoked. Kids are taught to distract themselves during a perceived attack (humming, saying calm things to themselves, turning away). They learn to do these things when a peer provokes.

Cognitive therapists also focus on moral beliefs of these youths. Children are taught moral-reasoning skills. They meet with therapists multiple times a year in schools, to argue merits of morals from stories posing moral dilemmas.

E.g., Moral dilemma story (taken from Davison, Neale, & Kring, 2004) “Sharon and her best friend, Jill, are shopping in a boutique. Jill finds a blouse she wants but cannot afford. She takes it into a fitting room ad puts it on underneath her jacket.l She shows it to Sharon and, despite Sharon’s protests, leaves the store. Sharon is stopped by a security guard. The manager searches Sharon’s bag, but finding nothing, concludes that Jill shoplifted the blouse. The manager asks Sharon for Jill’s name, threatening to call both Sharon’s parents and the police if she doesn’t tell. Sharon’s dilemma is whether or not to tell on her best friend.”

Students receiving “moral training” are asked: To discuss the story, the characters, and what the characters “should” do in this situation.