Conduct Disorder Research Paper

1. Key Characteristics

1.1 Diagnosis And Prevalence

CD is the psychiatric diagnostic category for antisocial behavior among children and adolescents (American Psychiatric Association 1994). Table 1 lists the main symptoms. A diagnosis of CD is provided if (a) the individual shows at least three symptoms; (b) within the past 12 months; (c) with at least one of the symptoms evident in the last 6 months.

The prevalence of a disorder refers to the percentage of cases in the population at a given point in time. Among community samples of school-age samples, the prevalence of CD is ~ 2–6 percent. The estimate is conservative in representing the scope of the problem. Children who approach but do not quite meet the criteria are likely to have significant impairment in everyday lives. Boys show ~ 3–4 times higher rates of CD than girls. The sex differences may be explained by differences in predispositions toward responding in aggressive ways. Age variations reveal interesting patterns in prevalence rates. Rates of CD tend to be higher for adolescents ( ~7 percent for youths aged 12–16 years) than for children (~4 percent for children aged 4–11 years).

1.2 Correlates And Associated Features

Children who meet diagnostic criteria for CD are likely to show a number of other problem behaviors (Robins and Rutter 1990, Pepler and Rubin 1991). They are likely to argue with adults, lose their temper, actively defy and refuse to comply with requests, deliberately annoy others, and are angry and resentful. A large percentage of children (e.g., 40–70 opening) diagnosed with CD also evince hyperactive behavior and meet criteria for attention-deficit hyperactivity disorder (ADHD). The core symptoms of ADHD include inattention, impulsiveness, and hyperactivity. Children with CD are also likely to show academic deficiencies. They are more likely to repeat a grade, to show lower achievement levels, and to end their schooling sooner than their peers. Such children often are socially ineffective in their interactions with adults (e.g., parents, teachers, community members) and engage in behaviors that promote deleterious inter-personal consequences such as peer rejection. In general, CD is associated with a wide variety of other child characteristics that reflect maladjustment in everyday life.

Several parent and family characteristics are associated with CD, including parent psychopathology and maladjustment, criminal behavior, and alcoholism. Parents of children with CD are likely to show especially harsh, lax, erratic, and inconsistent discipline practices. Within the families, there are often less supportive and more defensive communications among family members, unhappy marital relations, and interpersonal conflict. Untoward living conditions are also associated with CD including overcrowding, poor housing, and high-crime neighborhoods.

1.3 Onset And Course Of Conduct Disorder

Research has identified subtypes in an effort to find meaningful ways of grouping various sets of symptoms and accounting for prevalence differences over the course of development. Two patterns are currently receiving major attention. Child-onset CD begins in early childhood and with such behaviors as stubbornness, noncompliance, and hyperactivity that can progress to conduct problems. Youths with child onset are more likely than those with adolescent onset to engage in aggressive and criminal behavior and are more likely to continue their dysfunction into adult-hood. Adolescent-onset CD is more common than child onset. During adolescence, many youths engage in criminal behavior. For many of these youths, the acts are isolated and short-lived (Ketterlinus and Lamb 1994). Both child- and adolescent-onset CD youths engage in illegal behavior during adolescence. However, those with child onset are more likely also to engage in aggressive acts and to be represented primarily by boys.

Longitudinal studies show that CD in childhood predicts aggressive and antisocial behavior up to 30 years later. Among CD youths identified in childhood, slightly less than 50 percent continue their CD into adulthood. If all diagnoses are considered, rather than continuation of CD alone, slightly over 80 percent are likely to show a psychiatric disorder as adults. A broad set of characteristics CD youths are likely to show when they become adults are highlighted in Table 2. As the table indicates, individuals with a history of CD evince a broad range of untoward outcomes.

2. Factors That Influence Onset Of Conduct Disorder

Risk factors refer to characteristics, events, or processes that increase the likelihood (risk) for the onset of a problem or dysfunction. Risk factors, as antecedents to the dysfunction, may provide clues as to development and progression of CD, possible mechanisms and processes through which the dysfunction comes about, and foci for possible intervention. Several factors that predispose children and adolescents to CD are highlighted in Table 3.

Even under very adverse conditions with multiple risk factors present, many individuals will not experience adverse outcomes. Protective factors refer to characteristics, events, or processes that decrease the impact of a risk factor and likelihood of an adverse outcome. Protective factors are identified by studying individuals known to be at risk show several risk factors and by delineating subgroups of those who do, versus those who do not, later show CD. Among a high risk sample, children are less likely to develop CD if they are first born, are perceived by their mothers as affectionate, show high self-esteem and locus of control, and have alternative caretakers in the family (than the parents) and a supportive same-sex model who played an important role in their development. Other factors that reduce or attenuate risk include above-average intelligence, competence in various skill areas, getting along with peers, and having friends.

It is not clear how risk and protective factors operate. As an exception, parenting practices (e.g., harsh punishment, attending to aggressive child behavior) have been well studied. These practices directly contribute to CD and altering these practices reduces aggressive and antisocial child behavior (Pepler and Rubin 1991, Patterson et al. 1992).

3. Interventions

3.1 Treatment

Conduct problem symptoms constitute the most frequent basis for which children and adolescents are referred for treatment. Consequently, there is a need for effective interventions. Many different treatments have been applied, including psychotherapy, pharmacotherapy (medications), home, school, and com-munity-based programs, residential and hospital treatment, and assorted social services. Few treatments have been carefully evaluated in controlled studies and shown to reduce CD problems and to improve functioning of the child in everyday life (Kazdin 2000). Three of the more well studied treatments are highlighted here.

Parent management training refers to a treatment in which parents are trained to interact with the child in ways that promote prosocial behavior. The treatment focuses on the use of reinforcement (e.g., praise, tokens), mild punishment (e.g., brief time out, response cost), and related techniques (e.g., prompting, shaping) to develop child behavior. Extensive research has shown that many parent–child interaction patterns in the home unwittingly foster and escalate child aggressive behavior. Parent management training teaches skills to the parent, develops interactions between parents and the child that promote positive parent and child behavior, and in the process decreases aggressive and antisocial behavior.

Cognitive problem-solving skills training is based on research showing that conduct problem youths often show distortions in various cognitive processes (e.g., how individuals perceive, code, and experience the world, as reflected in beliefs, attributions, and expectations). A variety of cognitive processes pertain to interactions with others, including the ability to generate solutions to interpersonal problems and consequences of action (e.g., what would happen after a particular behavior). Problem-solving skills therapy develops skills in approaching interpersonal situations and teaches ways to identify prosocial or adaptive solutions and alternative consequences of actions. Children practice using the approach in treatment sessions and at home with their parents.

Multisystemic therapy focuses on the child behavior within the context of various systems (e.g., the family, peer group, schools) that may contribute to the child’s problem behavior or could be used to help alter that behavior. A focus on the family as a system is designed to build better communication, to reduce negative interactions, and to improve the ability of the parents to function. Factors that can affect these interactions and the child’s problems, such as stress that the parent experiences, marital conflict, association of the child with a deviant peer group, are focused on also. Many different techniques are applied to address these areas. Parent management training and problem-solving skills training, mentioned previously, are often incorporated into treatment.

3.2 Prevention

Prevention programs come in many different forms (McCord and Tremblay 1992, Mrazek and Haggerty 1994). Early intervention programs with the family have been effective in reducing conduct problems. High-risk families are identified, usually by such factors as low socioeconomic status, low educational attainment, and high-stress living conditions. Intervention programs sometimes begin before the child is born to provide counseling regarding maternal care, to provide support in the home to reduce stress, and to prepare the parents for child-rearing demands. After the infant is born, the program may continue for a few years to help support parents, to develop cognitive skills of the child, and to enroll the child in a preschool program. Youths who have received such programs, as they become adolescents, show lower arrest rates, higher levels of educational attainment, and less substance use and abuse than other youths who did not receive early intervention.

Prevention programs are often conducted in the schools because there are opportunities to provide programs to youths in larger numbers, in the context of peers, and on a regular basis for extended periods. Programs often focus on developing positive skills and success experiences at home and at school. The reason for this focus is that bonding to deviant peers and poor connections with the family are risk factors for such behaviors as delinquency and substance abuse. Developing such success experiences in the schools among elementary school children has increased bonding to families and decreased rates of antisocial behavior and substance abuse. To date, the evidence shows that preventive interventions can have a significant impact on CD.

3.3 Social Policy

Social policy refers to governmental and legislative efforts to implement changes to benefit society or a particular segment of society and, in this sense, is a social intervention. There are many influences on the levels of aggression and violence that are society wide, depending on the country and culture. For example, the use of corporal punishment in child-rearing and school discipline, violence in the media (television and films), and social practices that permit or facilitate violence (e.g., availability of hand guns) influence aggressive and antisocial child behavior.

There have been many promising large-scale pro-grams to curb influences on child conduct problems. For example, the use of corporal punishment (i.e., physical aggression against children) contributes to child aggression. Corporal punishment in child discipline at home and at school has been banned in a number of countries (e.g., Austria, Denmark, Finland, Norway, and Sweden) (Greven 1992). As another example, a large-scale effort was implemented in Norway to curb bullying among children. Parent, teachers, and peers were involved in a national effort that was effective in changing the ethos of interactions among youths. In the USA, preschool educational programs (Head Start) are designed to improve child development in disadvantaged families and to have a broad impact on child functioning. In general, social policy interventions are more difficult to implement and to evaluate than treatment and prevention. Policy practices are often subject to changes in laws, are often expensive, and require special monitoring procedures to ensure effective implementation (American Psycho-logical Association 1993).

4. Conclusions

Conduct disorder in children and adolescents is a very active area of research. Efforts focus on understanding the emergence and course of disorder and the many child, parent, family, contextual, and societal influences that may operate. Research also focuses on interventions. Although treatment, prevention, and social policy changes were distinguished, the general view among professionals is that interventions at each of these levels are required in order to have a marked impact on the problem. For many individuals, severe antisocial behavior and associated dysfunction in multiple spheres represent a life-long pattern. Because the disorder is often passed from parents to children, efforts to understand and intervene are critically important. Many questions remain about CD and its course. Even so, much of the available knowledge can have an impact on the problem.

Bibliography:

1. American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th edn. American Psychiatric Association, Washington, DC
2. American Psychological Association, Commission on Violence and Youth 1993 Violence and Youth: Psychology’s Response. American Psychological Association, Washington, DC, Vol. 1
3. Greven P 1992 Exploring the effects of corporal punishment. Child, Youth, and Family Services Quarterly 15(4): 4–5
4. Kazdin A E 1995 Conduct Disorder in Childhood and Adolescence, 2nd edn. Sage, Thousand Oaks, CA
5. Kazdin A E 2000 Psychotherapy for Children and Adolescents: Directions for Research and Practice. Oxford University Press, New York
6. Ketterlinus R D, Lamb M E (eds.) 1994 Adolescent Problem Behaviors: Issues and Research. Erlbaum, Hillsdale, NJ
7. McCord J, Tremblay R E (eds.) 1992 Preventing Antisocial Behavior. Guilford Press, New York
8. Mrazek P J, Haggerty R J (eds.) 1994 Reducing Risks for Mental Disorders: Frontiers of Preventive Intervention Research. National Academy Press, Washington, DC
9. Patterson G R, Reid J B, Dishion T J 1992 Antisocial Boys. Castalia, Eugene, OR
10. Pepler D J, Rubin K H (eds.) 1991 The Development and Treatment of Childhood Aggression. Erlbaum, Hillsdale, NJ
11. Peters R D, McMahon R J, Quinsey V L (eds.) 1992 Aggression and Violence Throughout the Life Span. Sage, Newbury Park, CA
12. Robins L N 1991 Conduct disorder. Journal of Child Psychology and Psychiatry 32: 193–212
13. Robins L N, Rutter M (eds.) 1990 Straight and Devious Path-ways from Childhood to Adulthood. Cambridge University Press, Cambridge, UK