Conduct Disorder University of Utah, Department of Educational Psychology - PowerPoint Presentation

1. Conduct DisorderUniversity of Utah, Department of Educational PsychologyTraining School Psychologists to be Experts in Evidence Based Practices for Tertiary Students with Serious Emotional Disturbance/Behavior Disorders US Office of Education 84.325KH325K080308Presented by Julia Hood5/5/09

2. Diagnostic Criteria of Conduct DisorderA. 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 last 6 months:

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

4. Diagnostic Criteria of Conduct DisorderDestruction of propertyhas deliberately engaged in fire setting with the intention of causing serious damagehas deliberately destroyed others’ property (other than by fire setting) Deceitfulness or thefthas broken into someone else’s house, building, or caroften lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)has stole items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

5. Diagnostic Criteria of Conduct DisorderSerious violations of rulesoften stays out at night despite parental prohibitions, beginning before age 13 yearshas run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)is often truant from school, beginning before age 13 yearsThe disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioningIf the individual is 18 years or older, criteria are not met for Antisocial Personality DisorderYou must specify age of onset and severity

6. Other Diagnostic ConsiderationsMust rule out Oppositional Defiant DisorderDetermine if behavior is “proactive” or “reactive”Determine “overt” or “covert” behaviorOvert behaviors are those that confront or disrupt the environment: aggression, temper tantrums, arguingCovert behaviors are those that may not be directly noticed by a caregiver: stealing, fire starting, lying

7. Comorbid Disorders and Other ConsiderationsADHDAnxietyDepressionSomatizationAcademic Achievement, Substance Abuse, Risky Sexual Behavior

8. History of Conduct Disorders(Mash & Barkley, 2006)How societies deal with “bad” children goes back in history to Plato 2,500Historical accounts from religious, medicine, and legal fieldCD has been in the DSM since the second edition, but has changed as to the diagnostic requirements over the yearsThere has been an increase of juvenile delinquency in the last 50 yearsMore femalesPeak age was mid-adolescence, but is now late adolescenceIncrease in proportion of violent crime to non-violent crime

9. Causes/Contributory Factors (Mash & Barkley, 2006; Frick, 2001)Multidimensional interaction among causal mechanismsIndividual vulnerabilitiesDifficult temperamentNeuropsychologicalProblems in child rearing (substance abuse, marital distress/divorce, parental antisocial behavior, low social support)Stressors in the general social ecology

10. Assessment of Conduct DisorderStructured interviewsBehavior rating scales (BASC, CBCL, ASEBA, ECBI, etc.)Functional behavior assessmentsPersonality tests (MMPI-A, MACI)Behavior observationsDevelopmental/medical historyUse multiple measures to get more comprehensive data

11. Treatment Options for Conduct Disorder (Mash & Barkley, 2006; Frick, 2001)Family-based interventions (parent training)Short-term effectsHelping the Non-compliant Child (HNC)Parent-Child Interaction Therapy (PCIT)Incredible Years Triple P- Positive Parenting ProgramOLSC Training ProgramMultisystemic Therapy (MST)Functional Family Therapy (FFT)

12. Treatment Options for Conduct Disorder (Mash & Barkley, 2006; Frick, 2001)Skill TrainingSocial SkillsCognitive Behavioral Skills TrainingProblem-Solving Skills TrainingAnger ManagementCoping-Competence ProgramsMulticomponent Skills Training

13. Treatment Options for Conduct Disorder (Mash & Barkley, 2006; Frick, 2001)Community-Based ProgramsThe Achievement Place Program (Teaching Family Model)Treatment Foster CareCase ManagementDay TreatmentSchool-Based TreatmentClassroom ManagementInvolvement in Multicomponent Treatments

14. Treatment Options for Conduct Disorder (Lilienfeld, 2005)“Get tough” approachesScared StraightBoot CampAttachment therapiesRebirthing, holding, reparentingPsychopharmacological TreatmentAntipsychoticsMood Stabilizers

15. Treatment Options for Conduct Disorder (Lilienfeld, 2005)Scientifically Questionable Treatments (SQT’s)Peer-group interventions“get tough” approachesAttachment therapiesPsychopharmacological as a stand-alone treatment

16. Recent Research Study for CDParent training for young Norwegian children with ODD and CD problems: Predictors and mediators of treatment outcome. Scandinavian Journal of Psychology, (2009), 50, 173-181.Authors: Fossum, S., Morch, W., Handegard, B., Drugli, M.B., & Larsson, B.

17. Recent Research Study for CDMethod121 subjectsSubjects’ Inclusion CriteriaAges 4- 8Parent referral for conduct problemsChild does not have a debilitating physical impairmentChild’s behavior was within clinical range on the Eyberg Child Behavior Inventory (ECHI) based on Norwegian normsChild meets diagnostic criteria (DSM-IV) for ODD and/or CDIf children met one less criterion than that reqired for diagnosis and they displayed severe conduct problems, they were still included

18. Recent Research Study for CDTreatment conditionsRandom Assignment to one of three conditionsParent training (n=47)Parent training combined with child training (n=52)Waiting list condition (n=28)Subject characteristics in the two active treatment conditionsMean age was 6.6 years (SD=1.3)28 children (28.3%) lived in one-parent familiesStep parent involved in 18 families (18.2%)6 children (6.1%) living in foster careOf which, 2 (2%) were in kinship foster care2 families (2%) not native-speaking Norwegians

19. Recent Research Study for CDAssessmentsECBIKiddie-SADS diagnostic interview with motherTeacher questionnairesDyadic Parent-Child Interaction Coding System-Revised (DPICS-R) to observe parent-child interactionsPreschool Behavior Questionnaire (PBQ)Teacher Report Form (TRF)Parental Stress Index (PSI)Beck Depression Inventory (BDI)Parenting Practices Interview (PPI) (adapted version)

20. Recent Research Study for CDTreatment: IY intervention program (Webster-Stratton, C.)BASIC parent training conditionAim is to strengthen families and promote parent competencies by increasing their positive and self-confidence in parenting, reduce negative parenting practices, improve parents’ problem-solving skills and anger management, and improve school involvementDivided into groups of 10-12 parents (parents of approx. 6 children)Met weekly for 12-14 weeks for 2 hours with 2 accredited therapistsWatched 250 video vignettes of parent-child interactionsTherapists led discussions about aspects of vignettesParents received home tasks and and parents shared experiences at the beginning of next sessionOn average, parents attended 92% of meetings (M=11.2, SD=1.6)

21. Recent Research Study for CDTreatment (cont.) IY intervention program & the “Dinosaur School”Parent training and child training combinedMet simultaneously at clinic, but groups were held separatelyApproximately 6 children met for 2 hours weekly, 18-20 weeks2 therapistsVideo-based program with 100 video vignettes of children in multiple settingsFantasy play with life-size puppets (a boy, a girl, various animals)Exercises sent home with childrenAttendance in child sessions was an average of 91% (M=15.6, SD=1.9)

22. Recent Research Study for CD2 families (2%) dropped out Both males and from Parent Training condition15 therapists for PT, 9 therapists for childrenTrained in programsFollowed treatment manualCompleted standardized checklistsTracked group activitiesSessions videotaped for peer, self, and trainer evaluation

23. Recent Research Study for CDOutcome VariablesChild functioning at homeIndependent observation of negative parentingChild behaviors in day care or schoolResults37 (39.8%) rated responders and 56 (60.2%) non-responders, significant difference between mean scores30 mothers (34.1%) achieved 30% or greater reduction in observed negative parenting, 58 (65.9%) non-responders28 children (32.6%) scored below cut-off (rated by teacher) but difference was not significant

24. Recent Research Study for CDResults (cont.)Logistic regression analysesIndependent variables of ADHD, female, and maternal stress predicted worse outcomeTreatment effects lower than original study (not uncommon)Post-treatment: two-thirds of children scored within normsNo child or family variables predicted unfavorable outcomesLimitations of the studyParental factors not controlled forParents more neutral interactions when observed than U.S. parents

25. ReferencesAmerican Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn. Text Revision). Washington, DC: American Psychiatric Publishing. Fossum, S., Morch, W., Handegard, B., Drugli, M.B., & Larsson, B. (2009). Parent training for young Norwegian children with ODD and CD problems: Predictors and mediators of treatment outcome. Scandinavian Journal of Psychology, 50, 173-181.Frick, P.J., Kamphaus, R.W., Lahey, B.B., Loeber, R., Christ, M.A., Hart, E.L., & Tannenbaum, L.E. (1991). Academic underachievement and the disruptive behavior disorders. Journal of Consulting and Clinical Psychology; 59, 2, 289-294. Lilienfeld, S.O. (2005). Scientifically unsupported interventions for childhood psychopathology:A summary. Pediatrics, 115; 761-764.Mash, E.J. & Barkley, R.A. (2006). Treatment of Childhood Disorders (3rd edn). New York: The Guilford Press.