Implications of Conduct Disorder

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Implications of Conduct Disorder Outline

Implications of Conduct Disorder Sarah Judge CEP 841 Dr. Troy Mariage July 30, 2004 1

Problem Statement for Conduct Disorder Why is it important for others to learn about conduct disorder? Why is this area of study important for me? 2

Why Is It Important to Learn About Conduct Disorder?  Aggression, according to experts, is a learned disorder. If that is the case, school-age kids are learning a lot about hitting, kicking, and other aggressive behaviors (Black, 2003. pg. 1 ).  Many students are learning to use their aggression, displaying traits that are increasingly dangerous. These traits have dire consequences for the safety of students and teachers alike.  When the aggressive behavior rises to the level of a psychiatric problem, students may be diagnosed with conduct disorder. 3

 Of concern is the significant increase in the number of already troubled and seriously at-risk students in our schools. No let-up is in sight, and there are now too many to accommodate in traditional special education.  With the increased number have come deeper and more profound difficulties for these students. More students are turning defiant, angry, violent, and homicidal.  Special education was never designed to include those at risk. Today, these students can be half the members of a given class (Jones and Jones, 2004, pg. 11). 4

Conduct Disorder Relevance to Personal Experience  I currently teach fifth grade in an urban district, where many of my students are considered at-risk youth. I will be entering my fifth year of teaching in this district. As my tenure progresses with the district, so do the incidences of behavioral problems.  The behavior problems seem to be increasing in severity as time goes by. Physical fighting, verbal assaults, defiance, destruction of property, and theft, are all behaviors that I have witnessed. These behaviors are some of the traits of conduct disorder.  As a classroom teacher, I continually seek to find answers to behaviors that are hurtful to others and impede personal and academic goals of students, families, and school staff 5 members.

What is Conduct Disorder? Definition of Conduct Disorder Description of Conduct Disorder 6

Definition of Conduct Disorder  The Diagnostic and Statistical Manual of Mental Disorders defines conduct disorder as follows:  A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months. (DSM-IV, 1994, pp. 90-91)  The criteria for diagnosing conduct disorder are aggression to people or animals, destruction of property, deceitfulness or theft, and serious violations of rules. 7

DSM-IV Specific Behaviors for Conduct Disorder Specifically, DSM-IV states the following behaviors for each criterion under its definition for conduct disorder:  Aggression to People and Animals Destruction of Property Deceitfulness or Theft Serious Violation of Rules 8

Aggression to People and Animals  Often bullies, threatens, or intimidates others.  Often initiates physical fights.  Has used a weapon that can cause serious physical harm to others.  Has been physically cruel to people.  Has been physically cruel to animals.  Has stolen while confronting a victim.  Has forced someone into sexual activity. 9

Destruction of Property  Has deliberately engaged in fire setting with the intention of causing serious damage.  Has deliberately destroyed others’ property, other than by setting fire. 10

Deceitfulness or Theft  Has broken into someone else’s house, building, or car.  Often lies to obtain goods or favors to avoid obligations.  Has stolen items of nontrivial value without confronting a victim. 11

Serious Violation of Rules  Often stays out at night despite parental prohibitions, beginning before age 13 years.  Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period).  Is often truant from school beginning before age 13. 12

Description of Conduct Disorder • Conduct disorder is marked by chronic conflict with parents, teachers, and peers • The patterns of behavior are constant over time. • Conduct disorder is described to have two major subtypes:  Childhood Onset Type Adolescent Onset Type 13

Childhood Onset Type  Childhood onset type conduct disorder is characterized by the presence of one DSM characteristic before the age of 10.  This type is more common in boys than girls.  Boys typically display high levels of aggressive behavior.  Poor peer and family relationships persist through adolescence and into adult years.  These children are more likely to develop adult antisocial personality disorders than those with adolescent type conduct disorder. 14

Adolescent Onset Type  Adolescent type conduct disorder is defined by the absence of any criterion characteristic before an individual is 10 years old.  Individuals tend to be less aggressive and have more normal peer relationships than those belonging to childhood onset type.  Less likely to have ADHD.  Less likely to have adult antisocial personality disorder.  Prognosis is better than for childhood onset type. 15

Why Does It Happen?  Certain children have a genetic vulnerability to conduct disorder. When that vulnerability is combined with specific high-risk family and social factors, chances of CD increase (Goodman and Gurian, 2001, pg. 1).  While some studies have shown that criminality in a biological parent increases the likelihood of CD, genetic factors alone do not account for the development of the disorder (Webster, Stratton, and Dahl, 1995,pg. 715 ) 16

Another Reason for CD  Some adolescents with conduct disorder have been found to have an impairment of the frontal lobe of the brain. This is the area that affects the ability to plan, avoid harm, and learn from negative consequences. 17

Facts, Statistics, and Incidence of Conduct Disorder Facts of Conduct Disorder Statistics and Incidence of Conduct Disorder 18

Facts of Conduct Disorder  The diagnosis of conduct disorder was not formalized until 1978. It specifies a clustering of antisocial behaviors that persist for at least six months.  Prior to 1978, adolescents with antisocial behavior were categorized as having a runaway reaction, group delinquency reaction, or unsocialized aggressive reaction (Pager, 1998, pg. 862).  Patterns of conduct disorder typically begin as a reaction to ineffective parenting. 19

Ineffective Parenting as it Relates to Conduct Disorder  Parents fail to articulate clear expectations.  Parents may fail to impose needed limits or impose limits in ways that are authoritarian and punitive rather than instructive.  Unclear expectations make children unsure as to how to please their parents.  Children begin to ignore parental wishes and exploit parental inconsistencies (Brophy, 2003, pg. 233). 20

Family and Social Characteristics  Research suggests that certain family and social characteristics put children at particular risk for developing conduct problems (Webster, 1998, pg. 715). 21

Family Risk Factors (as reported by the Surgeon General) F a m i l y R i s k F a c t o r s L o w I n c o mT ee e n a g e P r eM g a n r ai t na cl yD i s c o r d L o w E d u c aS t i on ng l e P a r e S n u t hb os ot a d n c e A b u s e M a t e r n a l R P ea j re e c n t it oa nl C r i m i n a l H i s t o r y P a r e n t a l P s y c h i a t r i c I l l n e s s 22

Social Risk Factors (as reported by the Surgeon General) S o c i a l R i s k F a c t o r s i s o l a t i o n s t r e s s n e g l e c t d e p r e s s i o e n a r l y i n s t i t u t i o n aa l bi z u a s t ie o n 23

More Risks  The risk of a child developing conduct disorder increases exponentially with exposure to each additional risk factor.  Children in Head Start are at an increased risk for developing conduct problems because the risk factors are present at much higher levels in these families.  Studies indicate that early academic difficulties such as reading deficits and cognitive language delays are associated with conduct problems (Webster, 1998, pg. 715). 24

School as a Risk Factor  Delinquency rates and academic performance have been shown to be related to characteristics of the school itself.  Such factors as physical attributes of the school, teacher availability, use of praise, emphasis placed on individual responsibility and academic work, as well as the student-teacher ratio have been implicated in promoting or reducing conduct disorder. 25

High-Risk Schools  In communities with a number of distressed families, high risk children may attend schools with a large number of other high risk children.  This environment creates a difficult learning climate and elicits further conduct problems. 26

Statistics and Incidence of Conduct Disorder  Conduct disorder is one of the most frequently diagnosed disorders in childhood and adolescence.  6 to 10% of boys are affected by CD.  2 to 9% of girls are affected by CD.  50-75% of children with CD also have comorbid ADHD.  About 50% of children with CD also have an internalizing disorder such as depression or 27 anxiety.

More Statistics  Conduct disorder is reported more frequently in large urban areas and appears to be increasing.  In urban areas, 6-16% of males and 2-9% of females under the age of 18 are reported to have conduct disorder.  In these areas, households of conduct disorder children are often led by single mothers. 28

Application and Implications Application as it Relates to Treatment and Prevention Application and Implications for Parents Application and Implications for Schools 29

Treatment Options  There is no “cure” for conduct disorder.  Since other disorders often occur at the same time as CD, it is difficult to treat and contributes to a high rate of treatment failure (Children’s Mental Health, 2001, pg.1).  Pharmaceutical use is largely ineffective.  Indicators of CD appear as early as preschool. Treatment is more successful when begun early with medical, mental health, educational, and 30 family components.

Prevention Instead of Treatment  Prevention and treatment focus on skill development for the child, parents, and school.  Prevention addresses the onset of the disorder before the child manifests the disorder.  The goal is to develop adaptive functioning and competence in the child through positive parenting and education.  Facilitating competence is a useful preventative measure for children rather than treatment 31 (Webster, Stratton, and Dahl, 1995, pg. 716 )

What Does this Mean for Parents?  Because of the child’s temperamental difficulties, even parents with the best of intentions can become involved in a negative cycle.  In this cycle, children resist compliance with parental request. Parents either give in to the child or resort to more intensive punishment to gain compliance. 32

The Negative Cycle  In the beginning of this negative cycle, the child then reacts with physical aggressiveness as an immediate coping mechanism.  Parents then isolate themselves from outside support in their family and community.  By adolescence, the child is alienated from the family culture. 33

Help for Families and Children  Treatment includes teaching parents to be more authoritative and less authoritarian in discipline practices (Brophy, 2003, pg. 233).  Parent Management Training is the method demonstrated to have the most impact on the child’s coercive pattern of behavior.  Behavior modification from early parent involvement is the best alternative. 34

Parent Management Training  PMT is based on the idea that conduct problems are inadvertently developed and sustained by maladaptive child-parent interactions.  PMT says that ineffective parenting results from unclear, vague commands and harsh punishment.  Ineffective parenting results when appropriate behaviors are failed to be recognized.  PMT encourages positive, specific feedback for desirable behaviors.  Uses natural and logical consequences for misbehavior. 35

Implications for Schools  As children advance to elementary school, those with conduct problems continue to have aggressive tendencies with adults and peers.  Students with CD tend to miss social cues and misinterpret other children as being hostile.  Students with CD lack the ability to solve difficult social issues.  Cognitive deficits are the most common educational correlate of CD.  An association with CD and achievement deficits have been found as early as first grade. This is a predictor of 36 outcomes for elementary and middle school.

Middle and High School Implications  At the middle school level, additional non- compliance with adults creates continued child-teacher interaction problems. This can result in less cognitive stimulation.  Parents may have negative interactions with school staff, which leads parents to further reject the child.  Continued aggression makes CD students less attractive to peers at a time when peer relationships are critically important. 37

Continued Middle and High School Implications  Comorbidity with other factors such as ADHD and depression are enhanced.  May begin showing interest in deviant peer groups, such as gangs.  Untreated and without intervention, students are often failing by the time they reach middle school.  May come to the attention of the juvenile court system 38

What Can Educators Do?  Studies are showing that early intervention, particularly in parent education, is proving to be successful in improving the attitude and behavior of children with CD (Avery, 2000, pg. 15 ).  An effective treatment is a combination of behavioral, cognitive, and family based therapy. Therapy should focus on behavior contracting, modeling, and relaxation training. Peer group and parent training are also important (Halgin and Whitebourn, 1994 ). 39

Strategies for Teachers  Students with mild to moderate CD can be handled through effective behavior management strategies.  Students will need to work with the school counselor, psychologist, and parents.  Students with more extreme CD may be removed from the classroom for all or part of the school day for special education (Vaughn, 2003, pg. 107). 40

Specific Strategies for Teachers  Authoritative socialization practices should be used in the classroom.  Teachers should avoid focusing on the student’s inappropriate behavior and focus on appropriate replacement behaviors.  Teachers should build good personal relationships with these students.  Avoid power struggles and remain calm.  If possible, remove the student for a private conference. 41  Limits should be clear, consistent, and enforced.

Home-School Collaboration  Fostering a positive home-school relationship is vital to the improvement of a CD child.  Parents should learn through their parental education that limits supported by contingent rewards and punishments are effective for their child.  Daily or weekly behavior reports should be sent home, with parents following up by delivering or withholding reinforcements (Brophy, 2003, pg. 42 233).

Conclusion/Summary  Concluding Thoughts  The “Big Idea” 43

Concluding Thoughts  The appearance of behavioral disorders is increasing dramatically in K-12 classrooms. As a result, their presence restricts the ability of the school system to educate students effectively.  The most common behavioral disorder in schools today is conduct disorder.  Conduct disorder, with its attributes of aggression, destruction, deceitfulness, and violation of rules, is marked by chronic conflict with parents, teachers, and peers.  As conduct disorder is frequently seen combined with other disorders, such as ADHD and depression, it can represent great difficulties at home and in the classroom. 44

More Final Thoughts  With these disruptions comes interrupted learning opportunities.  The question becomes, “How can we prevent situations that produce these behaviors?”  Practicing strategies such as those found in Positive Behavioral Support may be helpful. 45

The Big Idea  Prevention is preferred to treatment.  Perhaps the system needs to be changed, not the child.  If poor parenting is a key factor in the development of characteristics of CD, communities need to become involved. 46

Community Involvement  Children, parents, schools, and cities are all part of what makes a community.  Education of community members is key in prevention. Community prevention measures could include:  parenting classes offered to expectant families. job skills training for the under educated and unemployed.  parent management training programs for those families having a child with CD.  Facilitating competence in the child prior to manifestation of CD.  Teaching adaptive functioning skills to the child who is showing characteristics of CD. Often these originally look like those found in ODD (oppositional defiant disorder). 47

Resources Book Resources Journal Articles Websites National Groups 48

Book Resources  American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: AmericanPsychiatric Association.  Brophy, Jere. 1996. Teaching Problem Students. New York: Guilford Press.  .Jones, Vern and Louise. 2004. Comprehensive Classroom Management. Boston: Allyn and Bacon.  Vaughn, Sharon. 2003. Teaching Exceptional, Diverse, and At-Risk Students. Boston: Allyn and Bacon. 49

Journal Articles  Black, Susan. (2003). Angry at the world. American School Board Journal. vol. 190, no. 6.  Hendren, Robert L. (1999). Disruptive behavior disorders in children and adolescents. Review of Psychiatry, vol. 18.  Payer, Kathleen (1998). What happens to “bad” girls? A review of the adult outcomes of antisocial adolescent girls. The American Journal of Psychiatry, vol. 155 (862-870).  Stratton, Carolyn Webster. (1998). Preventing conduct problems in head-start children: Strengthening parent competencies. Journal of Consulting and Clinical Psychology., vol. 66 (715-730). 50

Web Sites  Avery, Cynthia, Semlear. (August 2000). Well-being of parents raising children with learning and behavioral disorders.http://www.conductdisorders.com  Surgeon General. (2000). Surgeon general mental health: a report of the surgeon general.http://www.surgeongeneral.gov  Tynan, Douglas. (March, 1994). Conduct disorder. http://www.emedicine.com 51

National Groups  National Mental Health Association 2001 North Beauregard Street, 12th FloorAlexandria, VA 22311(703) 684-7722  American Academy of Child & Adolescent Psychology 3615 Wisconsin Avenue NWWashington, DC 2016-3007(202) 966-7300 52

More National Groups  National Institute of Mental Health Information Resources and Inquiries Branch 6001 Executive Boulevard Room 8184, MSC 9663 Bethesda, MD 20892-9663 (301) 443-4513 53