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Conduct problems (Child factors (Temperament = key aspect of child…
Conduct problems
Child factors
Temperament = key aspect of child development and when it is associated with negative emotionality, inflexibility and reactive responding, can predict externalizing behaviours seen in those with CPs
- a facet shown to evoke more negative aspects of parenting = may play a vital role in contributing to the coercive cycle.
- Thought to be an innate, biological characteristic --> a twin study found that the strongest temperamental predictor of CPs was emotionality and that this was significantly influenced by genetics (Gjone & Stevenson, 1997) = temperament may be critically important if a genetic predisposition to potentially later develop CPs can be assumed.
- has implications for preparing parents to avoid maladaptive techniques if they know their child is a potential risk for developing CPs
- Barker et al. (2011) 7,000 p's- fearless temperament at age 2 predicted both CU traits and CP at age 13 --> follow-back analyses shows had less fearful responses to punishment cues at age 2 = important link between temperament and cognition (punishment insensitivity) and elevated CU traits
Academic performance:
- Low intelligence often been considered an antecedent of CPs, with low IQ being associated with school failure and antisocial behaviour later in life (Farrington, 1995)
- poor verbal IQ and reading disorders have also been demonstrated to be related to increased CPs (Sanson et al. 1996) = intuitively understandable as it infers a poorer ability to communicate with others, which may in turn result in antisocial behavioural responses.
- BUT, like with parenting, gender differences also exist with regards to the relationship between IQ and CP’s
-Maughan et al. (1996) boys with CPs are at risk of later developing reading problems, whilst with girls, reading problems during childhood are predictive of CPs in teenage years
= gender differences are a confounding factor for both parenting and child factors when considering their role in causing CPs.
- link to SES --> more likely to receive worse education
Biological role in producing CPs:
- Viding et al. (2007; 2008) Both CU traits and CP were highly hereditable in both boys and girls = . shared genetic influences account for a large proportion, but not all, of the correlation between CU traits and conduct problems.
-Also CP in children high on CU traits showed stronger genetic influence than those low on CU traits, even controlling for presence of ADHD symptoms.
- Blonigen et al. (2006) substantial additive genetic effects on CU traits at both age 17 and 24 = stable variance in CU traits largely due to genetic effects.
- Fontaine et al. (2010) Highest heritability estimates found for boys in a stable-high trajectory of CU traits; membership in stable-high trajectory for girls was largely accounted for by shared environmental factors = different again for boys and girls
- If there is a biological role resulting in CPs then it follows that parents may have more of a role in producing CPs in children than simply that caused by bad parenting e.g. antisocial behaviour tends to cluster in families, with antisocial behaviour in parents predicting childhood onset of CD (Elkins et al. 1997).
- Specifically with girls, antisocial behaviour in the mother is associated with antisocial behaviour in the daughter, and this is largely influenced by parental psychological distress rather than parenting behaviour (Kaplan & Liu, 1999).
Parental behaviour prior to childbirth has also been found to play a role in causing CPs in children
- e.g. smoking and substance abuse during pregnancy have been associated with CPs in offspring - Loukas et al. (2001)
= there is a biological role associated with CPs, yet this also suggests that the role parents play in causing CPs in their children is larger than them simply engaging in bad parenting behaviours.
Social impairment:
- ASD people thought to have impaired ToM (ability to attribute others beliefs) attributed to mentalising areas of the brain --> linked to impaired social interaction. BUT, O'Nians (2014) found that despite CP children having impaired social difficulties, only ASD children show abnormal neural processing associated with ToM.
- Cervantes et al. (2014) children with ASD do however show higher rates of challenging behaviours (e.g. tantrums, aggression)- cog abilities in 263 children --> ASD severity linked with CP behaviours- regardless of cog ability, more severe symptoms = engage in higher rates of CP behaviours.
- Oliver et al. (2011) looked at socio emotional and pragmatic language competencies in over 6,000 children with no ASD --> all CP, relative to low CP, had difficulties in these domains. Early-onset CP in particular: 40.6% boys, 24.3% girls with persistent CP met impairment criteria for one of these factors. Controled for demographic confounds (e.g. maternal age at birth and education, low SES), child verbal IQ and internalising symptoms.
-Don't know direction of this relationship. If socio cognitive problems are route then --> difficulties in social interaction --> externalising behaviours.
Developmental trajectories:
- consistent evidence for 2 developmental trajectories associated with different correlates with the disorder, different timings of symptom emergence and different long-term consequences of the problem.
1) childhood-onset pattern --> children show symptoms, and psychological vulnerabilities (e.g. neuropsychological impairments) prior to adolescence
2) adolescent-onset pattern --> emergence of symptoms happening abruptly with adolescence – these are less likely to have dysfunctional families and cognitive impairments, and tend to show greater social adjustment as adults compared to their counterparts.
- Frick (2001) the differences between the two onset patterns reflect the existence of different processes operating in the development of CD across the two groups.
- Pickles et al. (2016)164 children with lang impairment at 7, 8, 11 and 16yrs --> CP always co-occurred with hyperactivity in children with lang impairment regardless of difference in onset of symptoms (childhood vs. adolescence) or persistence (persistent vs. childhood limited)
- Frick et al. (2013) review claims children and adolescents with both severe CP and callous-unemotional traits are at risk for more severe and persistent antisocial outcomes, even when controlling or age of onset and severity of CP --> role of CU traits
Treatments
Given the complexity of the aetiology of CP, not surprising that most treatment approaches are ineffective:
- Bakker et al. (2017) - meta-analysis found that psychological treatments have a small effect in reducing parent-, teacher- and observer-rated CD problems in children and adolescents with clinical CD problems/diagnosis. There's not enough evidence to support one specific psychological treatment over another
- Frick (2001) explained lack of efficacy by the fact that such treatments are often founded on broad theories designed for adult interventions, instead of utilising the current understanding of the dimensional nature of the causes of CD and of potential developmental issues associated with youths
Contingency management programs:
- The principle is to readdress the fact that most families of children with CD do not have a consistent environment, resulting in inability to modulate their behaviour. It also focuses on the notion that these children tend to have temperamental vulnerabilities, exacerbating the negative effects of a non-contingent environment (O’Brien & Frick, 1996).
- aims to establish behavioural goals and a system in order to achieve these goals that includes positive reinforcement for positive behaviours.
- These programmes are effective amongst children in residential treatment centres and at home, as well as in educational settings (Abramowitz & Leary, 1991).
- BUT, these programs are often used inefficiently, in that they are not manipulated to suit the individual and negative reinforcement is often used more than positive reinforcement as a method of behaviour control
= Both of these factors often result in a lack of motivation in the child (Frick, 2001)
Parent training:
- Focus on modifying parent behaviours --> implemented by aiming to improve parent-child interactions, helping parents to learn how to supervise their children and to learn efficient discipline techniques, and altering behavioural responses in order to promote prosocial behaviours
- Multiple sources of research have demonstrated that this treatment is effective (Kazdin, 1995).
- explicit treatment manuals have been developed for a wide range of settings and age groups in order to aid the parent in developing positive parenting techniques (Patterson & Forgatch, 1987).
- Limitation is that it is often not completed by the parents, particularly in the most severely dysfunctional families (Kazdin, 1995).
Cognitive behavioural skills training:
- CBT designed to help children with CD with decision-making, problem solving and other aspects of social cognition, since research has shown that individuals with CD often have deficits in processing social information (Crick & Dodge, 1996).
- e.g. when faced with an ambiguous situation they are more likely to act with aggression compared to healthy counterparts (Dodge et al. 1997)
- To improve their social cognition, the treatment usually involves recognizing situations in which they would usually react with antisocial behaviour, and providing alternative responses.
- Praise is utilized in this treatment in order to reinforce their positive behaviours, hence a positive relationship between the child and therapist is fundamental.
- Limitations = difficulty in getting the children to maintain the positive behaviour outside of a training setting and over an extended period of time.
- The treatment should be implemented in a wider range of settings and naturalistic environment, such as schools, in order to promote positive behaviour in these settings.
Stimulant medication:
- 60-90% of clinically referred children with CD also have Attention Deficit Hyperactive Disorder (ADHD, Abikoff & Klein, 1992) = reducing ADHD symptoms is an important goal in treating CD – this is often achieved through medication.
- Several controlled medication trials have shown that treating ADHD symptoms like this also reduces antisocial behaviours linked with CD, and increases positive relationships with parents, teachers and other children (Whalen et al. 1989)
- But there is minimal evidence that medical interventions are beneficial for children with CD who do not have ADHD, and medication needs monitoring as each individual requires a different dosage
- Whilst enhanced positive behavioural effects arise with higher dosages, this is associated with more side effects (Hinshaw, 1991).
Future directions for treatment:
- Because of complexity of interaction of CD risk factors, treatment should be multifaceted to be effective --> not likely that the use of one treatment can be effective in treating CD
- multisystemic therapy (MST) - gained increasing support over recent years --> able to get around the limitations of these treatments.
- Its theoretical basis is Bronfenbrenner's theory of social ecology (1979) --> children and youths live within different systems that have direct (e.g., parenting practices) and indirect (e.g., neighbourhood context affects parenting practices) effects on behaviour, and that CD is multidetermined, its key influences coming from the individual, family, school, peer and community levels.
- Takes into account the importance of reinforcement and of cognitive behavioural skills training in order to change behaviour.
- Considers each family differently and tailors the program to meet their unique needs
- Negative behaviours are targeted in a way that aims to improve the family dynamics.
- Much support: Schaeffer & Borduin (2005) used MST on group of juvenile offender and found improved family relations, reduced parental and youth psychiatric symptoms, rearrests and incarceration by more than 50% through a 14 year follow up period
- Letourneau et al. (2009) found evidence that MST can be transported effectively, resulting in the extension of learned positive behaviours in multiple settings.
Parent factors
- ‘Good parenting’ behaviours = the encouragement of desirable behaviours and strengths, sensitivity to the child’s needs and setting consistent and firm limits on behaviour (Laird et al. 2003).
- 'Bad parenting' behaviours = low involvement (i.e. low emotional support and communication), high monitoring and supervision of child activities and harsh (e.g. physical punishment) or inconsistent discipline
--> these are correlated with increased delinquent behaviour in childhood e.g. Barker (2011) harsh parenting at age 4 sig. predicted CU traits at age 13, accounting for 10% (boys) and 14% (girls) variance in these traits
- Stormshak et al. (2000) found that physically aggressive punishment was linked to increased child aggression, and low parental involvement was linked to resistant child behaviour
Problem: findings are only correlational and research has mainly focused on the development of child CPs in boys = limits generalisability of findings
- Dunn & Plomin (1990) siblings (so boys and girls) in the same family experience very different parental treatment = affect of bad parenting on girls may therefore have different consequences to the affect on boys.
- e.g. Deater-Deckard & Dodge (1997) state of mother-daughter relationships and differential treatment between siblings by parents has been found to be particularly important for girls at risk of developing CPs = suggests parenting is associated with CPs for both boys and girls, but the aspects of parenting that are influential may differ for each gender
BUT might be that boys and girls exhibit different traits that influence differential parenting.
- explained by Patterson’s (1970) coercion hypothesis, whereby parenting practices and child disruptive behaviours are reciprocally influential = follows the principle that aversive stimuli (child screams in response to parent’s command) control the behaviour of one person (parent shouting) and positive reinforcement (parent withdraws command or comforts the child) maintains the behaviour of the other (reinforces child’s screaming behaviour).
- Cycle has negative consequences as it means the parent has few positive interactions with their child, they punish their child frequently and ineffectively and the child learns that coercion is an effective strategy
- LINK TO CHILD FACTORS
Parenting and child factors interact:
- Wootton et al. (1997) found that bad parenting only had a negative effect on child behaviour when the child had high levels of callous and unemotional traits (i.e. lack of empathy) = influence of child factors on parenting behaviour
- Burke et al. (2008) investigated the bidirectional nature of CPs in a longitudinal sample by recording the subtle changes in their behaviour, parenting practices and communication techniques over the 5-10 year period. Found a reciprocal effect of child and parent behaviour, but the child’s disruptive symptoms influenced parental behaviour to a greater extent than parenting behaviour influenced child behaviour --> ODD resulted in reduced involvement and communication, and increased timid discipline, whilst CD predicted reduced parental supervision.
BUT regardless, parenting interventions (i.e. teach parents how to implement structured management programs at home) have been generally successful in reducing CPs in children
= suggests bad parenting is to some degree a cause, or at least that good parenting can be a protector against the behaviours exhibited by these children.
- Kazdin (1995) argued that the effectiveness of this treatment technique is the most consistently demonstrated for treating CD. Furthermore, such
- treatments have been successfully applied at various age groups, from preschool to adolescents
- However, successful intervention depends largely on parental competence (Kazdin, 1995) e.g. many parents do not complete the parenting programs, and so success largely relies on their motivation to change their maladaptive parenting.
= treating parenting does to some extent reduce CPs, suggesting that bad parenting is associated with increased CPs in childhood.
Intro
CPs = a pattern of behaviour characterised by a failure to conform to society’s rules and expectations (Rutter & Rutter, 1993).
- subjective depending on cultural expectations
- according to DSM-IV, CPs categorised into 2 types of disorder:
-Oppositional defiant disorder (ODD)= pattern of negativistic, hostile and defiant behaviour towards authority figures
-Conduct disorder (CD) essential feature = violation of the rights of others and a violation of age-appropriate norms and rules
- ODD typically considered less severe compared to CD, which is considered more difficult to control
- 2 conditions often conflated into the same construct --> specifically due to their high comorbidity (Maughan et al. 2004) and considering that ODD often precedes CD (Hill, 2002)
- Causes of CD are multifaceted: the role of bad parenting is very important in the development of CPs, but its effect is bidirectional (with child factors) and thus it is not a sole determinant of CPs in childhood
Why they are important:
- global prevalence in 2010 estimated to be 3.6% for males and 2.2% for females (Erskine et al., 2014).
- Predict many suboptimal outcomes: Carr (2004) adult outcomes for children with CD = criminality, mental and physical health issues, poor social and marital adjustment, poor education and occupation attainment
- Social and economic cost: Scott et al. (2001) cost to public services from 10-28yrs is more than £70,000
Social factors
Development of CPs is associated with poverty, social class and urban living
- Anomie theory (Cloward and Ohlin, 1960)
- Flouri et al. (2015) longitudinal study of socioeconomic disadvantage with 209 p's at age 3, 5 and 7. ASD and ADHD group had high CP across period, and although SED not a risk factors for these, it was associated with elevated emotional problems among these children