7 – CONDUCT PROBLEMS
DESCRIPTION OF CONDUCT PROBLEMS
 Age-inappropriate actions and attitudes that violate family expectations, societal norms, and personal
property rights of others.
 Disruption and rule violating behaviours.
o Range from minor behaviour (e.g., temper tantrums) to serious forms of anti-social behaviour (e.g.,
vandalism, theft, or assault).
 Associated with unfortunate family and neighbourhood circumstances (e.g., physical abuse, neglect,
poverty, or exposure to criminal activity).
 There is some disparity between society’s concern for children who experience early abuse or adversity
and the tendency to criminalize youths who display violent behaviours.
o Mental health and juvenile justice system  protect at risk and provide rehabilitation.
o General public and criminal justice system  punishment-based system and emphasizes protecting
victims.
CONTEXT, COSTS, AND PERSPECTIVE
Context
 About 6% of adolescents refrain from anti-social behaviour entirely, and those who do describe themselves
as excessively conventional, anxious, and socially inhibited.
 Important features of antisocial behaviour:
o Vary in severity, from minor disobedience to fighting.
o Some decrease with age (e.g., disobeying), while others increase with age and opportunity (e.g.,
hanging around peers who get into trouble).
o More common in boys than in girls during childhood, but the difference narrows into adolescence.
Social and Economic Costs
 5% of children show early, persistent, extreme antisocial behaviour.
o These children account 50% of all crime in the US.
o Annual public cost is ~10,000 per child with conduct problems.
Perspectives
Legal
 Conduct problems are defined as delinquent or criminal acts.
o Property crimes (e.g., vandalism, theft, breaking, and entering).
o Violent crimes (e.g., robbery, aggravated assault, and homicide).
 Juvenile delinquency: describes children who broke the law, ranging from sneaking into a movie without
paying to homicide.
 Legal definitions depend on laws that change over time or differ across locations.
o Delinquency involves apprehension and court contact and excludes the antisocial behaviour of
young children that occur at home or school.
 Minimum age of criminal responsibility ranges from 7-12 years.
o A legal definition may result from one or two isolated acts.
o Mental health definition requires a child displaying persistent pattern of anti-social behaviour.
Psychological
o Falls along a continuous dimension of externalizing behaviour.
 Extreme end  one or more SA above the mean = conduct problems.
o Two related, but independent subdimensions:
1. Rule breaking behaviour (e.g., running away, skipping school, vandalism, etc.).
2. Aggressive behaviour (e.g., fighting, destructiveness, disobedience, etc.).
o Two additional independent dimensions:
1. Overt-covert dimension: range from overt visible acts (e.g., fighting) to covert hidden acts (e.g.,
stealing); at high risk for later psychiatric problems and impaired functioning.
2. Destructive-nondestructive dimension: range from acts, such as cruelty to animals or physical
assault, to non-destructive behaviours, such as arguing or irritability.
Psychiatric
o Categorical focus.
o DSM-5 contains the general category of Disruptive, Impulse-Control, and Conduct Disorders
o ODD and CD are often referred to as conduct problems or disruptive behaviour disorders.
Public Health
o Blends the legal, psychological, and psychiatric perspectives with public health concepts of
prevention and intervention.
o Goal: reduce the number of injuries, deaths, personal sufferings, and economic costs.
 Similar to other health concerns (e.g., automobile accidents).
o Cuts across disciples and brings together policy makers, scientists, professionals, communities,
families, and individuals with conduct problems.
CORE CHARACTERISTICS
Oppositional Defiant Disorder (ODD)
 Age-inappropriate recurrent pattern of stubborn, hostile, disobedient, and defiant behaviours.
 Usually appears by age 8.
 Three dimensions:
1. Negative affect: angry or irritable mood (e.g., loses temper or easily annoyed).
2. Defiance: defiant or headstrong behaviour (e.g., argues with or defies authority).
3. Hurtful behaviour: vindictiveness (e.g., vindictive).
DSM-5 Criteria for ODD
 For children younger than 5 years, the behaviour should occur on most days for a period of at leats 6
months.
 For children 5 years or older, the behaviour should occur at least once per week for 6 months.
 DSM-5 uses severity ratings for ODD of mild, moderate, or severe.
 About 90% of clinically referred children with ODD display symptoms in two or more settings.
Conduct Disorder (CD)
 Repetitive, persistent pattern of severe aggressive and antisocial acts.
o Often involves inflicting pain on others or interfering with the rights of others through physical and
verbal aggression, stealing, or vandalism.
 Emerges in some before age 10 (child-onset) and some after (adolescent-onset).
DSM-5 Criteria for CD
 Presence of at least 3 of the following criteria in the past 12 months from any of the categories below, with
at least one criterion present in the past 6 months:
1. Aggression to people and animals.
2. Destruction of property
3. Deceitfulness or theft
4. Serious violations of rules
 Specifiy whether:
o Childhood-onset type or adolescent-onset type or unspecified onset.
 Specify if:
o Lack of remorse or guilt: do not feel guilty about wrongdoings.
o Callous lack of empathy: disregards feelings of others; cold and uncaring.
o Unconcerned about performance: does not show concern about poor performance at school, work,
or other important activities; blames others for poor performance.
o Shallow or deficient affect: does not express feelings or show emotions, except in ways that seem
shallow, insincere, or superficial.
The ODD and CD Connection
 Nearly half of all children with CD have no prior ODD diagnosis.
 Most children who display ODD do not progress to more severe CD.
o At least 50% maintain their ODD diagnosis without progressing.
o About 25% cease to display ODD problems entirely.
 ODD is an extreme developmental variation and a strong risk factor for later ODD and other problems.
Antisocial Personality Disorder (APD) and Psychopathic Features
 Pervasive pattern of disregard for and violation of the rights of others, involvement in multiple illegal
behaviours.
o 40% of children with CD develop APD as young adults.
o Psychopathic features (e.g., callous, manipulative, deceitful, and remorseless behaviour).
o Display callous and unemotional (CU) interpersonal style.
 Absence of guilt, lack of empathy, uncaring attitudes, shallow or deficient emotional
responses, and related traits of narcissism and impulsivity.
 High risk for extreme anti-social and aggressive acts and poor long-term outcome.
ASSOCIATED CHARACTERISTICS
Verbal and Cognitive Deficits
 Verbal deficits are present early in a child’s development before the emergence of conduct problems.
o May display an increase vulnerability to hostile family environment.
o Interferes with development of self-control, emotion regulation, or lack of empathy.
 Rarely consider the consequences of their behaviour and its impact on others.
o Fail to inhibit impulsive behaviour, to keep social values or rewards in mind, and adapt their action
to changing circumstances.
 Executive functioning deficits is divided into two categories:
1. Cool cognitive executive function (e.g., attention, WM, planning, and inhibition) are more characteristic
of children with ADHD.
2. Hot cognitive executive function (e.g., incentives and motivation) are more characteristic of children
with conduct problems.
School and Learning Problems
 Academic underachievement
o Early language deficits may lead to reading and communication problems, which heighten conduct
problems, associate with delinquent peers, and loss interest in school.
 Grade retention
 Special education placement
 Dropout, suspension, and expulsion
Family Problems
 General family disturbances: parental mental health problems, family history of anti-social behaviour,
marital discord, family instability, limited resources, and anti-social family values.
 Specific disturbances in parenting practices and family functioning: lack of supervision, harsh discipline,
lack of emotional support and involvement, and parent disagreement about discipline.
 These two types are interrelated  general family disturbances lead to poor parenting practices, resulting
in anti-social behaviour and feelings of parental incompetence.
Peer Problems
 Peer rejection
 Often form friendship with other antisocial peers
Self-Esteem Deficits
 Low self-esteem is not the primary cause of conduct problems.
 Instead, problems are often related to inflated, unstable, and/or tentative view of self.
 Aggressive children may overestimate their social competence and acceptance by other children.
 Any perceived threat to their biased view (e.g., rejection) may lead to aggressive behaviour, which provides
a way to avoid lowering of self-concept.
Health-Related Problems
 Rates of premature death (before age 30) are 3-4 times higher in boys with conduct problems.
 Substance-use disorders
o 10% of adolescents who use multiple drugs commit ~50% of all felony assaults, felony theft, and
various other reported crimes.
o Strong predictor of subsequent violence in the 3-5 years following delinquent youth detention.
ACCOMPANYING DISORDERS
 ADHD
o More than 50% of children with CD also have ADHD.
 Depression and Anxiety
o About 50% of youth with conduct problems also receive a diagnosis of depression or anxiety.
o This relationship is driven by the negative mood symptoms of ODD (e.g., anger/irritability) rather
than by its behavioural symptoms of defiance.
PREVALENCE, GENDER, AND COURSE
Prevalence
 ODD is more prevalent than CD during childhood, but by adolescence, their prevalence is equal.
 Lifetime prevalence rates:
o 12% for ODD: 13% for males, 11% for females.
o 8% CD: 9% for males, 6% for females.
 Prevalence estimates for CD and ODD are similar across cultures, but most comparisons made are between
Western countries.
Gender
 Gender differences are evident by 2-3 years of age.
o Boys have earlier onset and greater persistence.
o Boys: physical aggression and theft and externalizing behaviours.
o Girls: sexual misbehaviours and relational aggression (e.g., gossip, insults, ostracism, etc.).
 Sex difference decrease by more than 50% of the past 60 years.
Developmental Course and Pathways
General Progression
 Infancy
o The earliest indications of conduct problems may be difficult temperament (e.g., fussiness,
irritability, fearfulness in response to novel events).
o Often precedes later conduct problems but may not be specific to these problems.
 Preschool
o Increase in hyperactivity and impulsivity with growing mobility, weak emotion-regulation skills, and
heightened risk for simple forms of oppositional and aggressive behaviours.
 Elementary school
o Most children with conduct problems show diversification – they add new forms of antisocial
behaviour over time rather than replacing old behaviours.
o Covert conduct problems (e.g., substance abuse) begin to appear during elementary school and
increase into early adolescence.
o From ages 8-12, behaviours such as bullying, fire setting, vandalism, cruelty to animals and people,
and stealing begin to emerge.
o We see a snowballing negative cycle over time, when one deficit or problem behaviour produces
indirect and direct changes in others (e.g., peer rejection  aggression or vice versa).




Adolescence
o Major conduct problems become more frequent.
o Delinquent behaviour increases around the age of 17, and is associated with growing association
with deviant peers, increasing rate of arrests, re-arrest, and criminal convictions.
About 50% of children with early conduct problems improve.
Some children may not display problems until adolescence, and not all children display the full range of
difficulties described.
Others may display a chronic low level of persistent anti-social behaviour from childhood or adolescence
through adulthood.
Two Common Pathways
1. Life-Course-Persistent (LCP): Children who engage in aggression and anti-social behaviour at an early age
and continue to do so into adulthood.
o Begins early and persists into adulthood (~10% of cases).
o Complete spontaneous recovery is rare after adolescence.
2. Adolescent-Limited (AL): Youths whose anti-social behaviour begins around puberty and continues into
adolescence, but who later cease these behaviours during young adulthood.
o Begins in puberty and ends in young adulthood.
o Their delinquent activity is often temporary and related to situational factors, esp. peer influences.
Adult Outcomes
 The number of active offenders decrease by 505 by early 20s, and 85% decrease by late 20s.
 Negative adult outcomes are often seen, especially for LCP path.
o Children with conduct problems go on to display criminal behaviour, psychiatric problems, social
maladjustments, lost productivity, and so on as adults.
 Males = higher rates of criminal and substance abuse.
 Females = depression, anxiety, and suicidal behaviour.
CAUSES
 Historical Views:
o Inborn characteristics.
o Poor socialization practices.
 Today, conduct problems are seem as resulting from:
o An interplay among a predisposing child, family, community, and cultural factors operating bidirectionally over time.
Genetic Influences
 Aggressive and antisocial behaviour in humans is universal.
o Runs in families within and across generations.
 Adoption and twin studies
o 50% or more of variance in antisocial behaviour is hereditary for both males and females.
 The strength of the genetic contribution is higher for children who display LCP versus the AL pattern and for
those with CU traits.
Prenatal Factors and Birth Complications
 Malnutrition (e.g., protein deficiency).
 Lead exposure before and after birth.
 Low birth weight.
 Substance abuse (e.g., nicotine, marijuana, and acetaminophen) during pregnancy.
 Stress during pregnancy.
Neurobiological Factors
 Two subsystems of the brain.
1. Behavioural activation system (BAS): stimulates behaviour in response to signals of reward or nonpunishment.
2. Behavioural inhibition system (BIS) produces anxiety and inhibits ongoing behaviour in the presence of
novel events, innate fear stimuli, and signals of non-reward or punishment.
 BAS is similar to a gas pedal, while BIS is similar to a brake pedal.


Antisocial patterns of behaviour result from an overactive BAS and an underactive BIS.
o Overactive BAS = heightened sensitivity to rewards.
o Underactive BIS = failure to respond to punishment and continue to respond under conditions of no
reward.
Neuroimaging studies have revealed structural and functional brain abnormalities in youth with conduct
disorders:
o Amygdala, prefrontal cortex, posterior and anterior cingulate, and insula.
o These brain regions are involved in social and emotional information.
o Several neural systems underlying cognitive, social, and emotional differences across different types
of conduct problems.
 Dysfunction in the amygdala.
 Prefrontal cortex = decision-making circuits and socioemotional information processing.
 Frontoparietal regions = regulating emotions and impulsive motivational urges.
 Reduced default mode network connectivity = deficits in self-referential cognitive processes,
including moral reasoning and empathy.
Social-Cognitive Factors
 Differences attending to, interpreting, and responding to social cues.
 Others emphasize cognitive deficiencies (e.g., child’s failure to use verbal mediators to regulate his or her
behaviour) or cognitive distortions (e.g., interpreting a neutral event as an intentionally hostile act).
 Steps in the thinking and behaviour of aggressive children in social situations:
1. Encoding: Use fewer cues before making a decision.
2. Interpretation: Attribute hostile intentions to ambiguous social events (e.g., hostile attributional bias).
3. Response Search: Generate fewer and more aggressive responses and have less knowledge about social
problem solving.
4. Response Decision: More likely to choose aggressive solutions.
5. Enactment: Use poor verbal communication and strike out physically.
Family Factors
 Early maternal age at childbearing, poor disciplinary practices, harsh discipline, a lack of parental
supervision, a lack of maternal affection, marital conflict, family isolation, and violence in the home.
 Reciprocal influence: The child’s behaviour is both influenced by and influences the behaviour of others.
 Child behaviours typically exert greater influence on parenting behaviours than the reverse, perhaps more
for mothers than fathers.
 Coercion Theory: Contends that parent-child interactions provide a training ground for the development of
anti-social behaviour.
o Occurs in 4-step escape-condition sequence where the child learns to use increasingly intense
forms of noxious behaviour to escape and avoid unwanted parental demands.
 Reinforcement trap: a made-up of well-practiced actions and reactions, which may occur
with little awareness.
 Attachment Theory: There is a relationship between insecure attachments (including disorganized
attachments) and the development of antisocial behaviour during childhood and adolescence.
 Other family problems:
o Family instability and stress
 Amplifier hypothesis: stress amplifies the maladaptive predispositions of parents (e.g., poor
mental health), thereby disrupting family management practices and compromising parents’
ability to supportive of their children.
o Parental criminality and psychopathology
 Parents of antisocial children have higher rates of arrests, motor vehicle violations, license
suspensions, and substance abuse.
Societal Factors
 Social disorganization theories: community structure  family processes  child maladjustment
 Neighbourhood and school
o Social selection hypothesis: people who move into different neighbourhoods differ from one
another before they arrive, and those who remain differ from those who leave.
o High-risk neighbourhoods and enrolment in poor-quality school is associated with anti-social and
delinquent behaviours.

Media
o Concerns about the possible impact of violence in TV, video games, movies, and the Internet on
children’s social development and aggressive behaviour.
o Exposure to media violence may reinforce pre-existing antisocial tendencies in some children.
Cultural Factors
 Across cultures, socialization of children for aggression is one of the strongest predictors of aggressive acts.
o The homicide rate among Kapauku from 1953 to 1954 was estimated at 200 per 100,000; 40 times
the current murder rate in the US.
o Lepcha people revealed that the only authenticated murder in their culture occurred about 200
years ago.
 Rates of antisocial behaviour vary widely across and within cultures.
TREATMENT AND PREVENTION
 Most promising treatments use a combination of individual, family, school, and community settings.
 Often requires treatment for related family problems, such as parental depression, marital discord, abuse,
and other stressors.
 Some treatments are not very effective because they do not address underlying determinants of conduct
problems:
o Office-based individuals counseling and family therapy.
o Group treatments can worsen the problem.
 Bringing together antisocial youth often encourage antisocial behaviours.
o Restrictive approaches such as residential treatment, inpatient psychiatric hospitalization, and
incarceration.
 Worsen physical and mental health outcomes and are expensive.
 Incarceration may not even serve a community protection function, since youths who are
incarcerated and then released often commit more crimes than youths kept at home and
given treatment.
 Comprehensive 2-prolonged approach:
o Early intervention and prevention programs: For young children at risk for or just starting to display
problem behaviours.
o On-going interventions: Help older youths and their families to cope with many associated social,
emotional, and academic problems.
Parent Management Training (PMT)
 Teaches parents to change their child’s behavior at home and other settings.
 Underlying assumption:
o Maladaptive parent-child interactions are partly responsible for producing and sustaining a child’s
antisocial behaviour.
o Changing how parents interact with their child can lead to improvements in child behaviour.
 The avg child whose parents participate in PMT shows better adjustment after treatment than 805 of
referred children whose parents do not participate.
 Effective for children younger than 12 years of age.
Problem-Solving Skills Training (PSST)
 Form of CBT.
 Focuses on children ages 7-14.
 Focuses on the cognitive deficiencies and distortions displayed by children and adolescents with conduct
problems in interpersonal situations.
 Underlying assumption:
o Perceptions and appraisals of environmental events trigger aggressive and antisocial responses.
Correcting this faulty thinking can lead to changes in behaviour.
 Children learn to appraise situations, identify self-statements and reactions, and alter their attributions
about other children’s motivations.
 Children learn to be more sensitive to how others’ feel, to anticipate their reactions, and to generate
appropriate solutions to social problems.
Multisystemic Therapy (MST)




Intensive family- and community-based approach for teens with severe conduct problems.
Focuses on adolescence.
Underlying assumption:
o An interconnected web of social systems, including the family, school, neighbourhood, and court
and juvenile services interact to result in antisocial behaviour.
o Addressing these many determinants can reduce severe antisocial behaviour.
MST is an intensive approach that also draws on PMT and PSST.
Preventive Interventions
 Underlying assumptions:
o Conduct problems can be treated more effectively in younger children than older ones.
o Counteracting risk factors and strengthening protective factors at young age limits and prevents
escalation of problem behaviours.
o Costs to education, criminal justice, health, and mental health systems can be reduced.
 Incredible Years: intensive multifaceted early intervention program for parents and teachers for children
ages 2-10.
o Use interactive videotapes as a foundation for training, permitting a widespread use at a relatively
low cost.
o Teaches child management skills and addresses the associated individual, family, and school
difficulties.
o Children learn effective communication skills, strategies for coping with conflict at home and at
work, and ways to strengthen social support.
o Reduces later conduct problems and maintains positive outcomes in adolescents for two-thirds or
more of children whose parents are involved.
 Fast Track Program: Prevents development of antisocial behaviour in high-risk children, using five
components.
o Intervention begins in grade 1 to grade 10.
o Children are taught social-cognitive skills for effective interpersonal problem solving and emotion
regulation.
o The goal is to strengthen academic skills and improve quality of relationship with family and school
personnel.
o In adolescence, issues related to peer affiliation and peer influence, academic achievement and
orientation, social cognition and identity development, and parent family relations are addressed:
1. PMT
2. Home visiting/case management
3. Social-cognitive skills training
4. Academic tutoring
5. Teacher-based classroom intervention
o Prevented 75% of CD cases in HR children.