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  1. Home
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  3. Conduct Disorders in Childhood and Adolescence
  • Cited by 7
Publisher:
Cambridge University Press
Online publication date:
August 2009
Print publication year:
2000
Online ISBN:
9780511543852
DOI:
https://doi.org/10.1017/CBO9780511543852
Series:
Cambridge Child and Adolescent Psychiatry
Subjects:
Psychiatry and Clinical Psychology, Developmental Psychology, Medicine, Pediatrics and Child Health, Psychiatry
Information

Book description

Conduct disorders are very common and the most frequent reason for clinical referrals to child and adolescent mental health facilities. Aggression and oppositional behaviour in youth often becomes persistent, and substantially increases the likelihood of adult problems of criminality, unstable relationships, psychiatric disorder, and harsh parenting. This comprehensive book by leading clinicians and researchers reviews established and emerging aspects of conduct disorder. It highlights the complexity and probable heterogeneity of the condition, including the biological, neuropsychological, and cognitive factors, and the role of attachment and family influences. Preventive and treatment approaches and outcomes are reviewed, with developmental and gender-based variations emphasized throughout. Integrating findings from a wide range of research perspectives, this is a uniquely authoritative survey of a common clinical and social problem, and will be essential reading for mental health practitioners and others with clinical, sociological or medicolegal interests in child health and behaviour.

Reviews

‘This is an extremely interesting and informative book that does justice to the complexity of perspectives on child and adolescent conduct problems … It deserves to become a standard work, available widely to all clinicians and researchers interested in this field.’

Source: Journal of Neurological and Neurosurgical Psychiatry

‘This publication provides a comprehensive and up-to-date account of conduct disorder and it will be of interest to a wide range of mental health professionals. The editors are to be congratulated not only because they have assembled some of the best known researchers and academics in this field but also because they have encouraged them to produce some truly first-class work … This is one of the best current books on the topic and it deserves to be widely read.’

Source: British Journal of Psychiatry

‘This book is interesting to read and the topics were comprehensively presented … I am confident that this book will be utilized as a reference and guideline by many physicians and healthcare professionals.’

Source: Saudi Medical Journal

‘… two chapters I found particularly helpful: one on the relationship between attachment and conduct disorder and one on the relationship between friends, friendships and conduct disorder … For any professional working with children with conduct disorders it offers both a compelling read and a valuable resource.’

Source: The British Journal of Forensic Practice

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Contents

Contents
  • 1 - Bad behaviour: an historical perspective on disorders of conduct
    pp 1-31
  • View abstract

    Summary

    Conduct disorder is by many centuries the oldest of the diagnostic categories used in contemporary child psychiatry. Some of the earliest evidence about the control of undesirable behaviour, adult or child, presents a picture of the individual or family unit as the sole responsible agency, with little or no outside interference available or sought. The Platonic tradition that forms one of the threads of western attitudes to morality offers one of the earliest, and still one of the most sophisticated, analyses of the relationship between harmful actions and the development of criminal responsibility. The problem of conduct disorder is central to the concerns of evolutionary psychology, because a disorder defined in terms of 'violations of social norms' raises important evolutionary questions. In this chapter, the authors have presented examples of public responses to conduct disordered children over the centuries, concentrating on religious, philosophical, legal and psychiatric writings.
  • 2 - Can the study of ‘normal’ behaviour contribute to an understanding of conduct disorder?
    pp 32-48
  • View abstract

    Summary

    Conduct disorder embraces a wide spectrum of anti-social behaviours, only a proportion of which is necessary for diagnosis. This chapter covers some topics which have not received much attention with respect to aggressive children, yet may be important for understanding this symptomatic and etiological heterogeneity. Aggressive behaviour is phenomenologically diverse, and can be divided into a number of categories. Aggressive behaviour is a common characteristic of conduct disorder, and appears not only as straight aggression, but also as disruptive behaviour, annoying others and cruelty, and may be responsible for the dislike of conduct-disordered children often shown by other children. A motivational approach applied to the particular symptom of aggressiveness demonstrates the dangers of a simplistic approach to etiology, but beyond that has only limited usefulness. A cognitive approach is more likely to be relevant to the wide range of symptoms that normal individuals show.
  • 3 - The development of children's conflict and prosocial behaviour: lessons from research on social understanding and gender
    pp 49-66
  • View abstract

    Summary

    This chapter considers normal developmental patterns in children's handling of conflict, their prosocial behaviour and moral understanding in early childhood, and in particular, some of the questions and challenges to developmental accounts raised by recent research on children's social understanding. The first section of the chapter summarizes the key developmental changes that have been described in children's angry and aggressive behaviour, in their behaviour in conflict, their prosocial behaviour and moral sensibility. The second section considers the relation of individual differences in these aspects of development to children's growing social understanding. Gender differences have been described in children's conflict strategies in group situations. It seems that sex differences in aggressive or prosocial behaviour are most consistently found in 'public' settings, within classrooms, playgrounds, neighbourhood gangs, rather than within intimate or family relationships.
  • 4 - Neural mechanisms underlying aggressive behaviour
    pp 67-102
  • View abstract

    Summary

    Inappropriate aggression and violence is a pervasive feature of contemporary society. The great advances in the authors' knowledge of brain function have helped our understanding of the neural mechanisms underlying behaviour. This chapter focuses on what the authors know of these as they apply to aggression. It is axiomatic that the brain plays a central role in aggression, both by recognizing aggression-provoking stimuli, and formulating aggressive responses. The regulation of aggression is a distributed function of the brain. There are many anatomical areas associated with aggression, though whether there are specific 'aggressive' nuclei remains doubtful. There are also a plethora of neurochemical systems implicated in aggression. The challenge to those studying aggression in children is to identify the interplay between specific genes and critical elements of the social and physical environment that, together, determine long-lasting patterns of aggressive behaviour.
  • 5 - Biosocial influences on antisocial behaviours in childhood and adolescence
    pp 103-125
  • View abstract

    Summary

    This chapter links some perspectives to the development of the brain and influences on it, and considers some findings on the psychobiology of conduct problems. Identification of early causes and indicators of altered neuronal function that might contribute to conduct problems requires an understanding of the development of normal structures. Sex differences in rates of aggression and disruptive behaviours within the normal range and at the extremes are very striking, and a biosocial model of conduct disorder will have to account for these. For instance, the long-term impact of maternal smoking in pregnancy on the risk of later anti-social behaviours appears to be stronger in males than in females. Considerable attention has been paid to the possibility that alterations in neurotransmitter levels underpin psychiatric conditions such as depression and attention deficit hyperactivity disorder (ADHD). The extent of environmental influences on brain development suggests potential both for vulnerability and plasticity.
  • 6 - The epidemiology of disorders of conduct: nosological issues and comorbidity
    pp 126-168
  • View abstract

    Summary

    This chapter reviews the epidemiological evidence for its status as a disease (or group of diseases) and identifies problems that call for further research. Four broad classes of research are identified: (1) early studies of individual behaviours, (2) factor analytic studies of problem behaviour, (3) studies of the diagnosis of conduct disorder or oppositional defiant disorder and (4) developmental studies of behavioural disturbance. There is unassailable evidence of 'comorbidity' between statistically derived syndromes. Given that high rates of comorbidity represent real associations among symptoms of supposedly different disorders, we have to ask what these associations might mean. One possibility is that apparent comorbidity results from the current diagnostic rules generating spurious multiple diagnoses in highly symptomatic individuals. Conduct disorder/oppositional defiant disorder can be regarded as being a group of diseases that constitute one of the greatest of all public health challenges for the twenty-first century.
  • 7 - Conduct disorder in context
    pp 169-201
  • View abstract

    Summary

    This chapter examines recent progress in understanding contextual risks for conduct problems, focusing on three central contexts for children's development: the family, the neighbourhood and the school. It focuses on risks for individual differences in conduct problems. As early as the preschool years, noncompliant child behaviours are associated with particular patterns of parenting and parent-child relationships. Many families of conduct-disordered children face high levels of social as well as interpersonal stressors. Recent evidence suggests that the effects of poverty and social disadvantage are most strongly associated with children's cognitive skills and educational achievements. The school constitutes a further important context for children's development. Criminological theories have long argued that academic failure, truancy and low bonding to school play a part in the genesis of delinquency, and school experiences constitute one obvious source of non-shared environmental effects on behavioural development.
  • 8 - Genetic influences on conduct disorder
    pp 202-234
  • View abstract

    Summary

    In the last decade, there has been an increasing appreciation of the role of genetic influences on many child behavioural traits and disorders. Most psychiatric disorders are considered genetically complex and conduct disorder is no exception. The astonishing rapidity of advances in molecular genetics is now being applied to child psychiatry. Early molecular genetic studies of adult psychiatric disorders used strategies designed to detect single genes whose individual effects accounted for a very substantial proportion of the phenotypic variance. Molecular genetic studies have relevance to conduct disorder both through the study of phenotypes in which aggression is a prominent feature and also through other psychiatric disorders such as hyperactivity and alcohol and drug abuse, which are frequently comorbid with conduct disorder or anti-social personality. A long-term goal of genetic research must be to aid in prevention and treatment of conduct disorder.
  • 9 - The role of neuropsychological deficits in conduct disorders
    pp 235-263
  • View abstract

    Summary

    This chapter examines the accumulated evidence for the relation between neuropsychology and conduct problems in children and adolescents. It provides evidence for a link between neuropsychological health and conduct disorder. One of the most robust correlates of severe conduct problems is impaired verbal ability. Verbal deficits have been found in conduct-disordered children, serious adolescent delinquents and adult criminals. Evidence of the relation between executive deficits and conduct problems has been found among incarcerated subjects, among non-conduct-disordered subjects in laboratory situations, and among general-population samples. The cumulative effect of the neuropsychological deficits and the consequent social and academic failures results in a pattern of undercontrolled, explosive behaviour which persists across the life course. The relations between poor neuropsychological functioning and conduct problems were robust across diverse samples, particularly strong for severely anti-social subgroups, and survived conservative controls for possible third variables.
  • 10 - A reinforcement model of conduct problems in children and adolescents: advances in theory and intervention
    pp 264-291
  • View abstract

    Summary

    In the history of clinical psychology and psychiatry, troublesome children and adolescents have been referred to with a variety of labels. This chapter focuses on the role of reinforcement in both the early- and late-starter pathways. According to reinforcement theory, anti-social behaviour is learned and practiced within the child's social environment. For many years, parenting practices have been recognized to be among the most powerful predictors of anti-social behavior. The reinforcement theory has also been tested in the context of intervention trials. From a reinforcement point of view, contextual factors, such as family stress and neighbourhood, all affect the microsocial interactions within relationships. Thus, the effects of the larger context on anti-social behaviour are hypothesized, at least in part, to be mediated through the microsocial interactions. A reinforcement model offers a strong tool with which we can address the problems of anti-social behavior.
  • 11 - Perceptual and attributional processes in aggression and conduct problems
    pp 292-319
  • View abstract

    Summary

    Social information-processing models are thought to reflect the more proximal mental operations that are associated with behavioural responding. Although many theoretical accounts of perceptual and attributional processes in social behaviour and adjustment hypothesize the existence of enduring latent structures, there is considerable variation in how these structures are described or conceptualized. A considerable amount of research has been devoted to the study of attributional processes. Such processes may be described broadly in terms of attributions of causality and attributions of intent. The causal and temporal nature of the relation between processing and behavioural outcome is in need of further study. In summary, emerging evidence suggests that social information-processing patterns, including perceptual and attributional processes, may provide clues as to why cumulative experiences with parents and peers may have enduring effects on children's behavioural and psychological adjustment.
  • 12 - Attachment and conduct disorder
    pp 320-345
  • View abstract

    Summary

    This chapter offers an overview of attachment theory, its basic tenets and measurement tools. The rationale for proposing a link between attachment and conduct disorder is then presented, along with a description of possible mechanisms of influence. Serious conduct problems frequently have their origins in early childhood and show considerable continuity over time. The attachment theory provides a unique framework for considering the development of conduct disorder in that it offers a macroanalytic, developmental and organizational perspective, incorporating behavioural, cognitive and affective aspects of the developing child's experience. Attachment insecurity may increase the risk of psychopathology, it is neither necessary nor sufficient to its expression: some secure individuals will show disorder, and some insecure individuals will not. The attachment theory enriches our thinking about the processes which might lead to disorder and ways of effectively intervening.
  • 13 - Friends, friendships and conduct disorders
    pp 346-378
  • View abstract

    Summary

    Friends have been recognized as a potent source of influence on children's social, cognitive and emotional development. This chapter adopts a developmental perspective to understand whether and how friends or peers might influence children's/adolescents' conduct disorder. Four theoretical models regarding the role of deviant friends on the development of delinquency have been proposed: Peer influence, Individual characteristics, Social interactional, and a Mixed model. Given the relative lack of positive features in friendships with deviant youth, it is not surprising that these friendships do not buffer children against internalizing problems. Features of friendship can also act as moderators of deviant friends' influence on externalizing problems. Prevention/intervention studies are a good strategy to manipulate risk or protective factors in order to test their causal links with delinquency. Indeed, a study aimed at improving friends' characteristics or friendship quality and using an experimental design offers a real possibility to test causal links.
  • 14 - Continuities and discontinuities of development, with particular emphasis on emotional and cognitive components of disruptive behaviour
    pp 379-407
  • View abstract

    Summary

    This chapter concerns continuities and discontinuities in disruptive behaviour disorder, including oppositional defiant disorder (ODD) and conduct disorder (CD). The continuity of disruptive behaviour can be interpreted in several ways, ranging from inherent differences among individuals in their criminal propensity, to continuities in risk (and protective) factors. The chapter presents a matrix of different types of disruptive behaviours, which is relevant for a better differentiation of emotional and cognitive aspects of disruptive behaviour. The interrelation between emotion and cognition can clearly be seen in the analysis of overt reactive disruptive behaviour. Several of the same cognitions and emotions implicated in overt disruptive behaviour may also apply to covert disruptive behaviours. The chapter argues that emotional and cognitive processes play important roles in the persistence of disruptive behavior. It explains knowledge of emotional and cognitive components of disruptive behaviour as a first step toward improving interventions to reduce disruptive behavior.
  • 15 - Treatment of conduct disorders
    pp 408-448
  • View abstract

    Summary

    This chapter reviews and evaluates advances in the treatment of conduct disorder. From a treatment perspective, conduct disorder represents an array of child, parent, family and contextual conditions. Parent management training is one of the most well researched therapy techniques and has been evaluated in scores of randomized controlled outcome trials with children and adolescents varying in age (e.g. 2-17 years old) and severity of oppositional and conduct problems. Functional family therapy (FFT) reflects an integrative approach to treatment that has relied on systems, behavioural and cognitive views of dysfunction. Multisystemic therapy (MST) is a family-systems based approach to treatment. The children referred for treatment often experience dysfunction and impairment in multiple domains, including comorbid disorders, learning and academic difficulties, dysfunctional peer relations and deficits in prosocial activities. Family morbidity is no less significant for developing and evaluating treatment for conduct disorder.
  • 16 - The prevention of conduct disorder: a review of successful and unsuccessful experiments
    pp 449-477
  • View abstract

    Summary

    This chapter identifies well designed preventive trials, assesses their effectiveness and gives examples of successful and unsuccessful interventions in the prevention of conduct problems in children. Preventive interventions may reduce disruptive behaviour through their impact on associations with deviant peers. There are a number of ongoing, large-scale preventive interventions for conduct disorder presently being undertaken. One distinctive preventive intervention study is the Fast Track Project. This project combines a universal programme with an indicated intervention directed toward high-risk children. Another preventive intervention programme is the Better Beginnings, Better Futures project. In this project, universal preventive interventions are delivered by social services in high risk communities, and evaluated by a separate research unit. The available evidence to date, reviewed in the chapter, suggests that conduct disorder can be prevented: some interventions did have substantial positive effects on distal disruptive behaviour outcomes, including externalizing behaviour, aversive behaviour, and delinquency.
  • 17 - Economic evaluation and conduct disorders
    pp 478-506
  • View abstract

    Summary

    Conduct disorder in early childhood can be responsible for scholastic failure, poor peer relations and delinquency in adolescence. This chapter introduces different types of economic evaluation, and discusses their respective uses and advantages in the child and adolescent mental health field. It explores the principles of the main modes of economic evaluation (cost-benefit analysis and its near relatives) and some of the core practical tasks to be accomplished. The most commonly discussed and most useful modes of economic evaluation are cost-benefit and cost-effectiveness analyses, but in fact there are quite a few different approaches. The underlying aim of each mode of economic evaluation is to examine the efficiency with which resources are being utilized. The main modes of economic evaluation have a common aim in their approach to cost measurement, which, if a societal perspective is adopted, is to range widely across all direct and indirect costs.
  • 18 - Antisocial children grown up
    pp 507-552
  • View abstract

    Summary

    Diagnostic criteria for anti-social disorders have been much influenced by Robins's (1966) early findings that the central adult outcome of childhood conduct problems lies in the pattern of severe anti-social difficulties, evident across domains of functioning, typified by anti-social personality disorder (ASPD). Hyperactivity, impulsivity and attentional difficulties have consistently been identified as among the more important markers of poor long-term outcome for conduct problems, at least in males. For anti-social children and adolescents, new environmental demands, whether prompted by developmental transitions or situational stressors, may only go to reinforce deviant tendencies. For many anti-social children, adverse environments are likely to persist across development. Behaviour genetic analyses have begun to illuminate the interplay between heritable and experiential risks, and longitudinal studies are providing an increasingly detailed picture of the complex forces that shape lives through time.
  • 19 - Conduct disorder: future directions. An afterword
    pp 553-572
  • View abstract

    Summary

    Problems involving disruptive behaviour constitute one of the most frequent causes of clinical referral. One of the striking features of all studies of psychosocial stress and adversity is the wide diversity in people's responses. Kazdin provides a comparable service with respect to therapeutic interventions. He notes the lack of evidence for traditional counselling or relationship approaches but points to the modest efficacy of four, somewhat related, modes of intervention; parent management training (PMT), cognitive problem-solving skills training (PSST), functional family therapy (FFT) and multisystemic therapy (MST). Each focuses on interpersonal interactions and on means of coping with real life challenges and problems, but does so with somewhat different emphases and therapeutic techniques. In pointing to the demonstrated benefits of these forms of intervention, he also draws attention to some of the key challenges that remain.

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