_disorder品行障碍课件

Conduct disorder Readings nWenar, C. & Kerig, P. (2000)“ Conduct disorder and the devlopment of antisocial behaviour” in Developmental Psychopathology (pp. 189-210). Singapore: McGraw-Hill Lecture Questions nWhat is Conduct Disorder and how does it affect children/adolescents lives? nWhat are the diagnostic issues related to Conduct Disorder? nWhat is the developmental picture and course in Conduct Disorder? nWhat are some of the social issues related to Conduct Disorder? Conduct Disorder in Popular Culture Overview nAnother externalising problem nImpacts on all rings of the social context web- young person, family, school, community nNZ prevalence 3.4% age 11, 7.3% age 15, 5.5% age 18 nMore prevalent in clinical samples, around a third to a half of all child and adolescent cases nComorbidity with ADHD, ODD, learning disorders, depression Gender issues nRatio 3:1, more diagnosed in boys nResearch biased to study of boys nDSM criteria differences and presentation differences nGirls CD patterns more likely to begin in adolescence nGirls comorbidity-depression, anxiety nInfluence of developmental factors nInfluence of how gender constructed Factors in drawing the line nContext for the behaviour, adaptation or mental disorder? nSeriousness of rule violations nFrequency, intensity, endurability, pervasiveness nAge appropriateness of rule violations Rule violation developmental picture nPre-school aggression to other children, disobedient to parents nSchool age classroom disruption, unco- operative in playground, defiant at home nAdolescence delinquent peers, violating the law, ignoring parental discipline, failing in school nRule violation normal in adolescence nChildhood behaviour better predictor of adult antisocial behaviour than adolescent behaviour DSM Criteria nAggression to people and animals (cruelty, bullying, fights, forced sex, mugging) nDestruction of property (fire-setting and other ways) nDeceitfulness or theft (breaking & entering, conning, stealing nSerious rule violations (staying out at night, running away, truanting) nRepetitive, persistent, violation of others rights or social norms, at least three in each category Types of Conduct Disorder Childhood onset nOvert aggression nPhysical violence nMultiple problems nMore common in males nPersistent nBetter predictor of antisocial behaviour in adulthood Types of Conduct Disorder Adolescent onset nLess severe behaviour problems nLess complex problems nLess violent crime nDifferent childhood temperaments (difficult for child type, emotional detachment for adolescent sub-types Two behavioural dimensions: nDestructiveness- (a)those that harm others and (b)those that violate rules nOvertness- (c) those that lie, steal (covert) and (d)those that bully, fight nSubtypes- oppositional (b&d), aggressive (a&d), property violations (a&c), status violations (b&c) Frick et al. (1993) Children who kill n1950s Heavenly Creatures nMark and Luke Reihana nBailey Junior Kurariki Children who kill-psychopaths? nAntisocial behaviour-associated with impulsivity and conduct problems nPsychopathy associated with callousness, lack of empathy and emotion nPsychopathy linked with violence of offending nDifferent pathways Developmental course nAt age 3, aggressive, temper tantrums, torturing the family cat, destroying property, no playmates nIn the school years, academic deficiencies nAs a teenager, poor interpersonal skills, high peer rejection n50% of children diagnosed with CD will develop anti-social personality as adults (Kazdin) Risk factors-child/adolescent nPrematurity, low birth weight, anoxia, medical stresses at birth (interact with family factors) nNo substantial evidence for genetic factors nTemperament (emotionality, activity level, sociability) difficult nFrontal lobe deficits-inability to plan or redirect potentially harmful behaviour and learn from negative consequences nProblems with self-control Risk factors-parents nAlcoholism/substance abuse nhistory of parent criminality npsychiatric problems, especially antisocial personality disorder Risk factors- family system nharsh parenting or lax parenting, poor supervision, inconsistency, coercion nlow attachment, warmth nless supportive and more defensive communication ndominance of one family member nlow stress threshold, stress related to significant other nexposure to violence, abuse, neglect- increase risk from 5% to 20% Risk factors-social nlarge family size, overcrowding, untoward living conditions npoor housing ndisadvantaged school setting nfinancial hardship nadversarial contact with an outside agency NZ data Fergusson et al. (Christchurch Development Study) social and material disadvantage nparental criminality, substance abuse and other adjustment problems nimpaired parenting and lower standards of child care nfamily instability, change and marital conflict One risk factor in itself not predictive, the greater the number, the more likely anti-social career from early age escalating in seriousness Peers factors nPeer rejection in early childhood nAssociation with deviant or antisocial peer group (especially adolescence) nGirls with older boyfriends Societal factors nMedia violence and tolerance for violence nNeighbourhood violence nSchool climates nConstructions of gender Buffers or protective factors nBeing a girl nBeing very intelligent nHaving a positive social orientation nHaving