Chapter 6
Conduct Problems
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Description of Conduct Problems
 Conduct problems and antisocial behaviors describe ageinappropriate actions/attitudes that violate family expectations,
societal norms, or personal or property rights of others
 Diversity in disruptive/rule-violating behaviors ranges from
annoying minor behaviors (e.g., temper tantrums) to serious
antisocial behaviors (e.g., vandalism, theft, assault)
 Consider many types, pathways, causes, and outcomes
 Often associated with unfortunate family and neighborhood
circumstances; circumstances do not excuse the behavior, but
help us understand it
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Context, Costs, and Perspectives
 Context
 Antisocial behaviors appear and decline during “normal”
development
 they vary in severity, from minor disobedience to fighting
 some antisocial behaviors decrease with age
 some increase with age and opportunity
 more common in boys in childhood, but the difference
narrows in adolescence
 children who are the most physically aggressive in early
childhood maintain their relative standing over time
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Context, Costs, and Perspectives (cont.)
 Social and Economic Costs
 Conduct problems are the most costly mental health
problem in North America
 Early, persistent, extreme pattern of antisocial
behavior occurs in about 5% of children; these
children account for over 50% of crime in the U.S.
and 30-50% of clinic referrals
 20% of mental health expenditures in the U.S. are
attributable to crime
 Public costs across healthcare, juvenile justice, and
educational systems are at least $10,000 per child
 Lifetime cost to society per child who leaves high
school for life of crime/substance abuse: about $2
million
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Context, Costs, and Perspectives (cont.)
 Perspectives
 Legal
 Juvenile delinquency: children who have broken a law
 Legal definitions result from apprehension and court
contact, so they exclude antisocial behaviors of very
young children occurring in home or school
 Minimum age of responsibility is 12 in most states and
provinces
 Only a subgroup of children meeting legal definition of
delinquency also meet definition of a mental disorder
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Context, Costs, and Perspectives (cont.)
 Perspectives (cont.)
 Psychological
 Conduct problems seen as falling on a
continuous dimension of externalizing behavior
 1 or more SD above the mean: conduct
problems
 Externalizing behavior consisting of related
but independent subdimensions:
 “rule-breaking behavior”
 “aggressive behavior”
 overt-covert dimension
 destructive-nondestructive dimension
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Context, Costs, and Perspectives (cont.)
 Psychiatric
 Conduct problems viewed as distinct mental disorders based
on DSM symptoms
 In the DSM-IV-TR, conduct problems are described as
persistent patterns of antisocial behavior, represented by
categories of oppositional defiant disorder (ODD) and
conduct disorder (CD)
 Public Health
 Blends the legal, psychological, and psychiatric perspectives
with public health concepts of prevention and intervention
 Goal: reduce injuries, deaths, personal suffering, and
economic costs associated with youth violence
 Cuts across disciplines
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
DSM-IV-TR: Defining Features
 Oppositional Defiant Disorder (ODD)
 Age-inappropriate, stubborn, hostile, and defiant behaviors
 Usually appears by age 8
 Many behaviors (e.g., temper tantrums) are common in
young children, severe/age-inappropriate ODD behaviors
can have extremely negative effects on parent-child
interactions
 75% of clinic-referred preschoolers from low-income
families meet DSM criteria for ODD
 These children are at high risk for developing secondary
mood, anxiety, impulse-control disorders
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
DSM-IV-TR: Defining Features (cont.)
 Conduct Disorder (CD)
 Repetitive, persistent pattern of severe aggressive
and antisocial acts that involve inflicting pain on
others or interfering with rights of others through
physical/verbal aggression, stealing, or acts of
vandalism
 severe antisocial behaviors
 may have co-occurring problems: ADHD,
academic deficiencies, poor peer relations
 family child-rearing practices may contribute
 parents feel the children are out of control and
feel helpless to do anything about it
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
DSM-IV-TR: Defining Features (cont.)
 Conduct Disorder (cont.)
 Age of onset: Childhood-onset versus adolescent-onset CD
 Children with childhood-onset CD display at least one
symptom before age 10
 more likely to be boys
 more aggressive symptoms
 account for disproportionate amount of illegal activity
 persist in antisocial behavior over time
 Children with adolescent-onset CD
 are as likely to be girls as boys
 do not show the severity or psychopathology of the earlyonset group
 less likely to commit violent offenses or persist in their
antisocial behavior over time
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
DSM-IV-TR: Defining Features (cont.)
 Conduct Disorder (cont.)
 CD and ODD have much overlap of symptoms
 Although most cases of CD are preceded by
ODD, and most children with CD continue to
display ODD symptoms, most children with
ODD do not progress to more severe CD
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
DSM-IV-TR: Defining Features (cont.)
 Conduct Disorder (cont.)
 CD and Antisocial Personality Disorder (APD)





APD: 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
Adults with APD may display psychopathy: a pattern of
callous, manipulative, deceitful, remorseless behavior
Signs of lack of conscience occur in some children as
young as 3-5 years
Subgroup of children with CD are at risk for extreme
antisocial and aggressive acts; display callous and
unemotional interpersonal style
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Associated Characteristics
 Cognitive and Verbal Deficits
 Although most children with conduct problems
have normal IQ, they score nearly 8 points lower
than peers
 Greater deficit for children with childhood-onset
 Verbal IQ consistently lower than performance IQ
 Deficits present before conduct problems and may
increase risk
 Deficits in executive functioning related to failure
to consider future implications of their behavior
and its impact on others
 may be due to co-occurring ADHD
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Associated Characteristics (cont.)
 School and learning problems
 Underachievement, grade retention, special
education placement, dropout, suspension, and
expulsion
 Common factor (e.g., neuropsychological,
language deficit, socioeconomic disadvantage)
may underlie both conduct problems and school
difficulties
 Early language deficits may cause communication
difficulties, which may increase conduct problems
in school
 Relationship between conduct problems and
underachievement is firmly established by
adolescence
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Associated Characteristics (cont.)
 Self-Esteem Deficits
 Low self-esteem is not the primary cause of
conduct problems
 Instead, problems are related to inflated and
unstable, and/or tentative view of self
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Associated Characteristics (cont.)
 Peer problems
 Verbal and physical aggression toward peers; poor social
skills
 Often rejected by peers although some are popular
 children rejected in primary grades are 5 times more
likely to display conduct problems as teens
 some become bullies
 often form friendships with other antisocial peers
 underestimate own aggression, overestimate others’
aggression toward them;
 reactive-aggressive children display hostile attributional
bias: attribute negative intent to others
 proactive-aggressive view their aggressive actions as
positive
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Associated Characteristics (cont.)
 Family Problems
 General family disturbances (e.g., parental mental health
problems, family history of antisocial behavior, marital
discord, etc.)
 Specific disturbances in parenting practices and family
functioning (e.g., excessive use of harsh discipline, lack of
supervision, lack of emotional support/involvement, etc.)
 High levels of conflict in the family, especially between
siblings
 Lack of family cohesion and emotional support
 Deficient parenting practices
 Parental social-cognitive deficits
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Associated Characteristics (cont.)
 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 3-4 times higher in boys
with conduct problems
 Early onset of sexual activity, higher sex-related
risks
 Illicit drug use associated with antisocial and
delinquent behavior
 Conduct problems in childhood are a risk factor for
adolescent and adult substance abuse
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Accompanying Disorders and Symptoms
 Attention-Deficit/Hyperactivity Disorder (ADHD)
 About 50% of children with CD also have ADHD
 Possible reasons: common underlying factors, ADHD may be a
catalyst for CD, or ADHD may lead to childhood onset of CD
 Depression and Anxiety
 About 50% of children with conduct problems also have a
diagnosis of depression or anxiety
 Poor adult outcomes for boys with combined conduct and
internalizing problems
 Girls with CD develop depressive or anxiety disorder by
early adulthood
 Males and females: increasing severity of antisocial
behavior is associated with increasing severity of
depression and anxiety
 Anxiety may serve as protective factor to inhibit aggression
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevalence, Gender, and Course


Prevalence
 ODD more prevalent than CD during childhood; by adolescence
prevalence is equal
 Lifetime prevalence rates
 10% for ODD (11% for males, 9% for females)
 9% for CD (12% for males, 7% for females)
Gender differences are evident by 2-3 years of age
 2-4 times more common in boys; boys have earlier age of onset
 Gender disparity increases through middle childhood, narrows in
early adolescence, and increases again in late adolescence, when
male delinquent behavior peaks
 Early symptoms for boys are aggression and theft; early symptoms
for girls are sexual misbehaviors
 Boys remain more violence-prone
 Sex differences in antisocial behavior have decreased by more
than 50% over the past 50 years
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevalence, Gender, and Course (cont.)
 Explaining Gender Differences
 Possible explanations: genetic, neurobiological,
environmental risk factors, definitions of conduct
problems to include physical violence
 girls tend to use indirect, relational forms of
aggression
 Clinically referred girls and boys are comparable in
externalizing behavior; referred girls are more deviant
than boys in relation to same-age, same-sex peers
 girls’ behavior is more covert
 Some girls with CD have early menarche
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevalence, Gender, and Course (cont.)
 Developmental Course and Pathways
 General Progression
 Earliest sign: usually difficult temperament in infancy
 Hyperactivity (possibly from neurodevelopmental
impairments)
 Oppositional/aggressive behaviors that peak during
preschool years
 Diversification: new forms of antisocial behavior develop
over time
 Across cultures, more frequent during adolescence
 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
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevalence, Gender, and Course (cont.)

Developmental Course and Pathways (cont.)
 Two Common Pathways across cultures
 Life-course-persistent (LCP) path begins early and persists into
adulthood; antisocial behavior begins early because neuropsychological deficits heighten vulnerability to antisocial
environments in social environment
 Complete, spontaneous recovery is rare after adolescence
 family history of externalizing disorders
 Adolescent-limited (AL) path begins around puberty and ends
in young adulthood (more common and less serious than LCP)
 50% decrease by early 20s, 85% decrease by late 20s
 Negative adult outcomes, especially for those on the LCP path
 Male: criminal behavior, work problems, substance abuse
 Females: depression, suicide, health problems
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes
 Historically viewed as result of inborn characteristics or
learned through poor socialization practices
 Early theories focused on child’s aggression and considered
one primary cause
 Today conduct problems are seen as resulting from the
interplay among predisposing child, family, community, and
cultural factors operating in a transactional fashion over time
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes (cont.)

Genetic Influences
 Aggressive and antisocial behavior in humans is universal
 Adoption and twin studies: 50% or more of variance in antisocial
behavior is hereditary, with contribution higher for children with LCP
versus AL pattern and for those with callous-unemotional traits
 Adoption and twin studies suggest contribution of genetic and
environmental factors
 Genetic factors:
 difficult temperament, impulsivity, tendency to seek rewards,
and insensitivity to punishment may create antisocial
“propensity”
 may increase likelihood for child’s exposure to environmental
risk factors
 genotype may moderate susceptibility to environmental insults
 Different pathways reflect the interaction between genetic and
environmental risk and protective factors
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes (cont.)
 Prenatal Factors and Birth Complications
 Pregnancy and birth factors
 low birthweight
 malnutrition (possible protein deficiency) during
pregnancy
 lead poisoning
 mother’s use of nicotine, marijuana, other substances
during pregnancy
 maternal alcohol use during pregnancy
 no direct biological link between biological factors and
conduct problems
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes (cont.)
 Neurobiological factors
 Overactive behavioral activation system (BAS) and
underactive behavioral inhibition system (BIS)
 Variations in stress-regulating mechanisms (e.g.,
hypothalamic-pituitary adrenal (HPA) axis and autonomic
nervous system (ANS), serotonergic functioning, and
structural and functional deficits in prefrontal cortex)
 Those with early-onset CD show low psychophysiological/
cortical arousal, and low reactivity of ANS, which may lead to
diminished avoidance learning so that punishment may
increase, rather than decrease, antisocial behavior
 Low levels of cortical arousal/low autonomic reactivity
 Neural, endocrine, psychophysiological influences interact
with negative environmental circumstances
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes (cont.)
 Social-Cognitive Factors
 Immature forms of thinking (e.g., egocentrism and
lack of perspective taking)
 Cognitive deficiencies (e.g., inability to use verbal
mediators to regulate behavior)
 Cognitive distortions (e.g., interpreting neutral
events as hostile)
 Dodge and Pettit: comprehensive social-cognitive
framework model involving cognitive and
emotional processes as mediators
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes (cont.)
 Family Factors
 Combination of child risk factors and extreme deficits in
family management skills are associated with
persistent/severe forms of antisocial behavior
 Influence of family environment (e.g., physical abuse, marital
conflict) on child moderated by several factors; child’s
genotype moderates the link between maltreatment and
antisocial behavior
 Reciprocal influence: child’s behavior is influenced by and
influences the behavior of others
 Coercion theory: through a 4-step, escape-conditioning
sequence, the child learns to use increasingly intense forms
of noxious behavior to avoid unwanted parental demands
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes (cont.)
 Family Factors (cont.)
 In children with callous-unemotional traits, CD persists
regardless of parenting quality
 Insecure parent-child attachments
 Family instability and stress
 High family stress may be both a cause and an outcome
of child’s antisocial behavior
 Childhood-onset CD (not adolescent-onset CD) related
to unemployment, low SES (poverty), multiple family
transitions
 Amplifier hypothesis: stress amplifies parents’
maladaptive predispositions
 Parental criminality and psychopathology
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes (cont.)
 Societal Influences
 Individual/family factors interact with larger societal/cultural
context
 Social disorganization: community structures impact family
processes that affect child adjustment
 Adverse contextual factors associated with poor parenting
 Neighborhood and school: antisocial behavior in youth is
more common in neighborhoods with criminal subcultures
 social selection hypothesis
 Media: correlation between media violence and antisocial
behavior
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes (cont.)
 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., but this is likely due to low SES
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Treatment and Prevention
• Typically, treatment begins when severe antisocial behavior at
school leads to referral, although it may begin sooner
• The most promising treatment uses a combination of
approaches across many settings
• 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)
• Comprehensive two-pronged approach includes:
• early intervention/prevention programs
• ongoing interventions
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Treatment and Prevention (cont.)
• Interventions with some empirical support for success:
 Parent management training (PMT) (effective for children
under 12)
 minimal or no direct intervention by therapist
 parents learn to change parent-child interactions,
promote positive behavior, decrease antisocial behavior
 parents learn to identify, define, observe child’s problem
behaviors
 treatment sessions cover use of commands, rules,
praise, rewards, mild punishment, negotiation,
contingency contracting
 parents see/practice techniques
 homework helps generalize skills
 progress is monitored/adjusted as needed
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Treatment and Prevention (cont.)
 Problem-Solving Skills Training (PSST)
 Focuses on cognitive deficiencies and distortions in
interpersonal situations
 Used along and in combination with PMT, as necessary
 Underlying assumption: the child’s perceptions and
appraisals of environmental events trigger aggressive and
antisocial responses; changes in faulty thinking lead to
changes in behavior
 Therapist uses instruction, practice, and feedback
 Children learn to appraise the situation, identify selfstatements and reactions, alter their attributions about
others’ motivations, and learn to be more sensitive to
others
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Treatment and Prevention (cont.)
 Multisystemic Treatment (MST)
 Intensive family- and community-based approach for
adolescents with severe conduct problems who are at risk
for out-of-home placement
 Sees adolescents as functioning within interconnected
social systems
 Antisocial behavior results from/is maintained by
transactions within or between any of the systems
 Attempts to empower caregivers to improve youth and
family functioning
 Effective in reducing long-term rates of criminal behavior
in part by decreasing association with deviant peers
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Treatment and Prevention (cont.)
 Preventive Interventions
 Recognition that intensive home- and school-based
interventions help overcome negative developmental history,
poor family/community environment, and deviant peer
associations
 Main assumptions:
 problems treated more easily/effectively in younger than
older children
 counteracting risk factors/strengthening protective factors at
young age limits/prevents escalation of problem behaviors
 reduces costs to educational, criminal justice, health, and
mental health systems
 Fast Track: program to prevent problems in high-risk children
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Treatment and Prevention (cont.)
 Conclusion: The degree of success or failure in treating
antisocial behavior depends on the type and severity of
the child’s conduct problem and related risk and
protective factors
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning