Kk&s Ch.44 Disruptive Behav Ds

Front 1

? is characterized by enduring patterns of negativistic, disobedient, and hostile behavior toward authority figures, as well as an inability to take responsibility for mistakes, leading to placing blame on others

Back 1

Oppositional defiant disorder

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Conduct disorder has been divided into a childhood-onset subtype, in which at least one symptom has emerged repeatedly before age ? years, and adolescent-onset type, in which no characteristic persistent symptoms were seen until after age ? years.

Back 2

10

Front 3

Oppositional defiant disorder has been reported to occur at rates ranging from ? percent

Back 3

2 to 16%

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ODD and gender ratio?

Back 4

The disorder seems more prevalent in boys than in girls before puberty, and the sex ratio appears to be equal after puberty

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Behaviour theory of ODD?

Back 5

. Behaviorists have suggested that oppositionality is a reinforced, learned behavior through which a child exerts control over authority figures; for example, by having a temper tantrum when an undesired act is requested, a child coerces the parents to withdraw their request. In addition, increased parental attention—for example, long discussions about the behavior—can reinforce the behavior.

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ODD DSM Criterion A?

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A developmentally inappropriate pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:

1. often loses temper
2. often argues with adults
3. often actively defies or refuses to comply with adults' requests or rules
4. often deliberately annoys people
5. often blames others for his or her mistakes or misbehavior
6. is often touchy or easily annoyed by others
7. is often angry and resentful
8. is often spiteful or vindictive

Front 7

The subtype of oppositional defiant disorder that tends to progress to conduct disorder is one in which ? is prominent

Back 7

aggression

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Types of ODD?

Back 8

One type, which is likely to progress to conduct disorder, includes certain symptoms of conduct disorder (e.g., fighting, bullying). The other type, which is characterized by less aggression and fewer antisocial traits, does not progress to conduct disorder.

Front 9

Parental psychopathology, such as ?, appears to be more common in families with children who have oppositional defiant disorder than in the general population,

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antisocial personality disorder and substance abuse

Front 10

Tx of ODD

Back 10

Multi-modal:
Primary = train parents, encourage + behaviour, ignore/not reinforce negative behaviour (1, 2, 3, Magic)
decrease harsh parenting

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Children with conduct disorder are likely to demonstrate behaviors in the following four categories:

Back 11

physical aggression or threats of harm to people, destruction of their own property or that of others, theft or acts of deceit, and frequent violation of age-appropriate rules.

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Conduct disorder is associated with many other psychiatric disorders including

Back 12

ADHD, depression, and learning disorders

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Conduct psychosocial factors:

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psychosocial factors, such as harsh, punitive parenting; family discord; lack of appropriate parental supervision; lack of social competence; and low socioeconomic level

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Conduct ds sx usual onset?

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Avg boy age: 10 to 12
Girls meet criteria: 14 to 16

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Conduct disorder occurs with greater frequency in the children of parents with

Back 15

antisocial personality disorder and alcohol dependence than in the general populatio

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Conduct ds rate? gender

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5%, > in boys

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Etiological factors in Conduct?

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Parenting - harsh, ASPD, etoh
Sociocultural: poverty
Psychological: poor affect regulation/impulse control, abuse
Bio: low dopamine hydroxylase enzyme that converts DA to NE. NA system fxn,
low CSF 5-HIAA associated with agg/violence
EEG: high right frontal EEG activity during rest
ADHD/CNS Dysfxn

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Criterion A stem for conduct?

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A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:

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Criterion A conduct ds sx?

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Aggression to people and animals

1. often bullies, threatens, or intimidates others
2. often initiates physical fights
3. has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
4. has been physically cruel to people
5. has been physically cruel to animals
6. has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
7. has forced someone into sexual activity

Destruction of property

8. has deliberately engaged in fire setting with the intention of causing serious damage
9. has deliberately destroyed others' property (other than by fire setting)

Deceitfulness or theft

10. has broken into someone else's house, building, or car
11. often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)
12. has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

Serious violations of rules

13. often stays out at night despite parental prohibitions, beginning before age 13 years
14. has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
15. is often truant from school, beginning before age 13 years

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Can you dx older than age 18?

Back 20

yes
If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

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COnduct ds and neurotransmitter levels?

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serotonin may be low

Front 22

Can you dx ODD if occurs with Mood DS? how about Conduct?

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can't with ODD
yes with conduct

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Is multimodal tx more for conduct or ODD

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conduct, ODD can get away with mainly parental therapy

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Describe multimodal tx for CD

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Behavioural
Social Skills training
Family Ed and Therapy
Rx

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What is tx better at ... overt problems or covert (lying, stealing) in CD?

Back 25

overt

Front 26

How manage school threats?

Back 26

functioning security hierarchy,
peer-participant programs,
threat assessment, and
crisis response initiatives

Front 27

Besides antipsychotics, what agents used to decrease aggression?

Back 27

Lithium (Eskalith) has been reported to have efficacy for some aggressive children with or without comorbid bipolar disorders.
A recent pilot study found that clonidine (Catapres) may decrease aggression.
SSRI to target impulsivity, irritability, lability of mood

Front 28

Buzz words in conduct ds tx?

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Combo of 1&2 work better than alone
1. parent management training
2. problem-solving skills training
Therapeutic foster care
family+cbt+peer+school intervention
Parental engagement (helps to have home visits)

Front 29

Key features in parent management training?

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reinforcement of prosocial
rule negotiation (the explosive child)
behaviour contracting
works best for pre-elementary school kids

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Problem solving training?

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aggresive kids more likely to anticipate rejection and hostility from others
modelling, role play to help in situations