Disruptive behaviour and the risk of developing an antisocial lifestyle Marianne Kristiansson MD PhD Professor Emerita Karolinska Institutet Stockholm Sweden mariannekristianssonkise ID: 1045697
Download Presentation The PPT/PDF document "Children and adolescents" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1. Children and adolescentsDisruptive behaviour – and the risk of developing an antisocial lifestyleMarianne Kristiansson, M.D., Ph.D., Professor EmeritaKarolinska Institutet, Stockholm, Swedenmarianne.kristiansson@ki.se
2. Youth delinquencyA problem?Yes and No
3. Many children exhibit minor antisocial acts but most do not continue!!Note children starting before the age of 13!!!Farrington and Loeber, 2000
4. What has changed?Organized crime can be an important factor!The amount of drugs Between 2014 and 2019 the production of drugs from South America doubled (World drug report, UN)
5. Social services and National Board of Institutional Care (SIS, Governmental agency)The Social Services Act – measures mostly on a voluntary basis foster care homes, residential care homesLVU – Care of Young Persons (Special Provisions) Act institution, foster care homes, residential care homesLSU – Secure Youth Care Act institution no clear care chain!!!
6. What can you learn from Sweden?1. Sweden has been too late in detecting the inflow of organised crime and drugs as well as trafficking (children, women, sex, labour market)2. Sweden has been slow to react to disruptive behaviour in children and youths3. Lack of structure in the organisation for young persons with disruptive behaviour4. Lack of follow-up measures5. The educational system is not designed for vulnerable people6. Housing – significant segregation
7. Risk factors for antisocial behaviour – the big eight!Extremely well known! – Andrews and Bonta Antisocial family lack of schooling and work Antisocial Peers Substance Abuse Disorder History of antisocial behaviour, lack of social network Antisocial attitudes Antisocial temperament
8. Antisocial temperamentImpulsive behaviourLack of empathy Cognitive – reduced mentalisation Affective – not caring
9. “It takes a village to raise a child” Kathrin Thomas, HeadmistressMany different skills and functions need to be developed!Some need more support – Preventive social investmentsschool psychologist, school nurse, school doctor, school welfare officerphysiotherapist, occupational therapist, speech therapistchild and adolescent psychiatry, habilitation
10. Case Daniel is a 16-year-old boy who grew up in a family with five siblings. An older brother has been convicted of a crime, and a younger brother is taken into care with the support of LVU – Care of Young Persons (Special Provisions) Act. A sister has been visiting BUP (barn- och ungdomspsykiatrin – Child and adolescent psychiatry) for depression and anxiety. Until 8th grade, Daniel attended school regularly, but for a year or so, his school attendance has been a rare occurrence. When the teachers want to talk to him and his parents, he sometimes comes to school, and when he does come to school, he is rather pleasant and finds it easy to socialise with others. It is not believed that he uses drugs. For about 6 months, reports of concern have been received by the police; these have arrived several times a month. The police believe that he sells drugs in the town square and that he regularly meets people from a criminal network. The police also suspect that he sometimes handles weapons which he passes on to older criminals, but the police have not been able to prove this. On four occasions, he has been caught with cannabis and Tramadol in his possession. He states that the drugs belong to a friend. When the police talk to him, he mostly laughs off what is said and displays a lack of fear and concern. A year or so ago, he started a relationship with a girl from his class. Several friends of hers have said that he probably abuses his girlfriend, but she does not dare to report this. On a couple of occasions recently, the police have noted that he was driving with a criminal who is older than him and who lives in town.
11. What should be done?Is it too late?When should we have reacted?
12. Education Ritchie sj. Et al. How much does education improve intelligence? A meta-analysis. Psychological Science 2018;29(8) 1358-1369It is enormously important for the individual’s development, good health and to ensure a safe life!The importance of a cognitively enriched environment for a child’s development
13. 19 november 202313Behaviours The brain controls the hand, but the hand can shape the brain!!The importance of forming new pathways in the brain!!!The brain works in networks and adapts to the environmentMental models become behavioursThrough motor learning, we create more stable networksRepeat favourable things!Some things can be automatedBehaviours that are learned and practised in the sociocultural context
14. 19 november 202314The brain and shared networksLanguage and use of tools!Tool use and language share, syntactic processing, and neural patternsBasal gangliaThibault S et al (2021). Science https://doi.org/10.1126/science.abe0874
15. Anxiety – child and adolescent behaviourFor what?
16. Emotional callousnessCriminal activity ???? Basic emotions – impulses to action Emotional learning Reason and emotions – Slow and quick decisions Balance Amygdala, Insula and Frontal lobes
17. Risk assessment – always probabilitiesAntisocial background – for example in the familyThe environment can affect brain development (e.g., cognitive stimulation)Antisocial friendsAntisocial temperament – e.g. shortcomings with regard to impulse controlShortcomings with regard to education and workAbuse of drugs, alcohol and medicinesVulnerability to recruitment into criminal networksLack of order in the local environment/neighbourhood – many criminalsBeing involuntarily alone and alienated
18. Two types of emotional callousnessAffectiveExcitement, brave, boldExtremely fearlessNo apparent anxietyDifficult dealing with guilt and responsibilityA lack of careOwn gainVerbal, rather pleasantSurvivorCognitiveDoes not understand the thinking and intentions of othersExtremely sensitive to stressAutistic traitsLonely, isolatedOdd forms of communicationSecondary anxiety/depression19 november 202318
19. Risk assessment of young people in generalSAVRY – Structured Assessment of Violence Risk in YouthCentrum för psykiatriforskning (Centre for Psychiatry Research)Region Stockholm offers courses
20. In case of concernTalk to the child/adolescentTalk to the familySocial services (if needed)Various special initiativesThe police, in the case of an act that may be a criminal offenceStudent healthBUP – Barn- och ungdomspsykiatrin (Child and adolescent psychiatry)
21. The importance of being part of a group – “my group”When are we going to become extremely concerned????Missing school a lotDrugs – own abuse and/or saleContact with criminals
22. Structured plan???? Which concrete activities?*Social skills trainingCBT based programmesSupport parents*Follow up – revision?
23. Particularly vulnerable individualsViolence and crime in the familyMental and physical ill healthPovertyCrime in the local areaDeficiencies in language development
24. What is the most difficult? Especially in children and adolescentsDiscovering certain traits of the personality – linked to the driving forces that govern the individualEvery individual must be assessed in their environment!
25. PurposeTry to learn to distinguish between two groupsI will present two boys – completely different!!
26. Case AAnders is an 11-year-old boy, and his parents are clearly worried about him. He ignores what his parents say. At school, he bullies his classmates, often starts fights and shies away from planned interactions with teachers when his behaviour is up for discussion. He completely ignores the fact that because of his behaviour, he was not allowed to accompany the rest of the class on a school trip. He doesn’t seem to care what others think, never feels shame, and shows no signs of remorse or guilt. However, some teachers find him quite charming, even if it is sometimes obvious that he is lying. He constantly teases his younger sister and laughs when she becomes upset. Recently, his parents found him in the garden standing on the cat. The cat screamed but Anders thought it was extremely funny.
27. Case BErik is an 11-year-old boy. Both his parents and teachers noticed that he is very lonely and probably being bullied. He can sometimes stare a little strangely at others, but he rarely says anything. Sometimes he sits in the classroom and stares out the window for long periods of time and when this happens, it is almost impossible to get his attention. The parents state that he sits in his room, online, for many hours. He often talks about war and guns and knives. His parents have also found a knife under his bed.
28. Case A and Case B – completely different individuals!Case A Possible incipient emotionally callous traits developingCase B Possible incipient autistic traits
29. Callous traits/Psychopathy – Fearless!“An extra dimension of personality”Failure of capacity for guilt, responsibility, remorse, compassion, empathy“ASSESSMENT OF EMOTIONS”
30. Why do we have feelings?Basic emotions – survivalImpulses to action – FastAnger, fear, sadness, joy, disgust, surpriseEmotionsMore tied to memoriesMoodMore continuous state
31. Key concepts for capacity for serious violent behaviourEmpathyLack of impulse control
32. Lack of empathy – different personality traitsEmotionally callous traits/Psychopathic traitsAutistic traits
33. EMPATHY – different conceptsMotor learningCognitive – don't understand but can careAffective – understands but doesn’t care
34. Uncaring/Emotionally callous traits/Autonomic nervous system/The body essential/Extremely fearlessDeficiencies in emotional learning! – AmygdalaEmotionally callous traits
35. Pronounced emotional callousnessMay be present in both cases, but due to completely different mechanisms
36. Autistic traitsDoes not understand the thinking and intentions of othersOwn fantasy world!While fantasies prepare us for reality, there are also risks involved if they are not grounded on reality.Sometimes severe anxiety when facing adversityConcrete communicationSudden outbursts of aggression
37. Emotionally callous/pre-antisocial traitsExtremely fearlessCharming, manipulativeDoesn't care – emotionally callousImplied sadistic traitsTwo groups Impulsive Controlled
38. Case Daniel is a 16-year-old boy who grew up in a family with five siblings. An older brother has been convicted of a crime, and a younger brother is taken into care with the support of LVU – Care of Young Persons (Special Provisions) Act. A sister has been visiting BUP (barn- och ungdomspsykiatrin – Child and adolescent psychiatry) for depression and anxiety. Until 8th grade, Daniel attended school regularly, but for a year or so, his school attendance has been a rare occurrence. When the teachers want to talk to him and his parents, he sometimes comes to school, and when he does come to school, he is rather pleasant and finds it easy to socialise with others. It is not believed that he uses drugs. For about 6 months, reports of concern have been received by the police; these have arrived several times a month. The police believe that he sells drugs in the town square and that he regularly meets people from a criminal network. The police also suspect that he sometimes handles weapons which he passes on to older criminals, but the police have not been able to prove this. On four occasions, he has been caught with cannabis and Tramadol in his possession. He states that the drugs belong to a friend. When the police talk to him, he mostly laughs off what is said and displays a lack of fear and concern. A year or so ago, he started a relationship with a girl from his class. Several friends of hers have said that he probably abuses his girlfriend, but she does not dare to report this. On a couple of occasions recently, the police have noted that he was driving with a criminal who is older than him and who lives in town.
39. Reflections? Comments?
40. Case Erik, who you met earlier when he was 11 years old, is now 17 years old. He is in his first year of upper-secondary school. He is very talented. He has no friends at school. Others bully him somewhat, even though things did get better in upper-secondary school. It has been established by BUP that he has Asperger's, and he has a contact person for this. His best subject is history, especially military history. He is extremely interested in this subject and the different types of weapons used in various wars. You have heard! That there have been several reports of concern from the police to Social Services because they have seen Erik talking to a serious criminal who does not live in the same residential area as Erik and his parents. The police have understood that Erik has never really committed any crimes, but that he is interested in weapons. At school, strange drawings with weapons have been found, and another student says that it is Erik who has done the drawings.
41. How should we think now?And what should we do?
42. Acting aloneLonely, bullied – dissatisfactionPsychiatric help needed sometimesOwn world of thought Virtual world onlineIncreasingly alienated and violatedHatred, Revenge – communicating discontentIsolate themselves almost completelyTrigger – Thoughts become concrete action
43. To conclude
44. Structured planDaily monitoring – school, drug monitoring, no antisocial peersSocial skills trainingCBT based programmesSupport parents*Follow up – revise
45. All stakeholdersThe brain and the sociocultural context of the individualThe brain is trained in different waysLearning from environment, beliefs, attitudes, values, moral conceptsEvery individual is unique!!!We must always see the individual in his/her contextFaster action is needed by all those involved when there are signs of criminal development