Conduct problems, antisocial behavior, and psychopathy

Types, developmental pathways, long-term outcomes

Conduct disorder

aggressiveness, conduct problems, and antisocial behaviors

most frequent cause of clinic referrals in children and adolescents -1/3 to 1/2 of all referrals

poor prognosis

Context of usual behavior

Age 6 - 53% of boys and 48% of girls reported to lie -

Age 12 - 10% of boys and 0% of girls (by age 11)

Gender

M:F rates equal by about age 15

Antisocial girls less aggressive than boys, but

More likely than non-antisocial girls to:

associate with antisocial boys

become pregnant early

develop mood & anxiety disorders

have poor relationships including poor parenting

engage in violence

Overt and relational aggression

DSM-IV-TR diagnosis

"Persistent pattern of conduct in which the basic rights of others and major age-appropriate norms and rules are violated”

At least 3 symptoms in the past 12 months (at least one past 6 months)

aggression toward others

Property destruction

Deceitfulness or theft

Serious rule violations

significant impairment

childhood & adolescent onset

Aggressiveness

Bullies, threatens intimidates others

Initiates fights

Has used a weapon that can cause serious harm (knife, gun, etc.)

Has been physically cruel to others

Has been physically cruel to animals

Has stolen while confronting a victim

Has forced someone into sex

Property destruction

Fire setting with intent of causing damage or harm

Other deliberate property destruction

Deceitfulness or theft

Broken into house, building, etc.

Stolen without confrontation to victim (non-trivial items)

Rule violations

Stays out at night without parental permission beginning before age 13

Run away from home overnight at least twice (or once for a long time)

Often truant, beginning before age 13

Developmental pathways to antisocial behavior

Adolescent-onset

Childhood-onset

Primarily impulsive type

Primarily callous-unemotional type

Developmental patterns of onset

Age of onset

childhood-onset (≤ 12-yrs-old) vs. adolescent-onset (Moffitt, 1993; Patterson et al., 1998)

early arrest (≤ 14) (Patterson et al., 1998)

chronic offending

Childhood-onset pattern

Developmental pathways

Adolescent-onset

Key characteristics

Potential causal mechanism

Childhood-Onset Conduct Disorder
AGE

Cruel to others, stealing, 14

running away from home, 13

Truancy, breaking and entering 12

Assault 11

10

Lies, physical fights, set fires, bullies 9

others, cruel to animals, breaks 8

rules 7

6

Stubborn, defies adults, non-compliant 5

Temper tantrums, 4

Argumentative, annoys others 3

Developmental pathways
Childhood-onset: primarily impulsive type

Key characteristics

Potential causal mechanism

Implications for treatment

Developmental pathways
Childhood-onset: callous unemotional type

Key characteristics

Potential causal mechanisms

Cleckley’s Psychopath
Cleckley, H. (1976) The Mask of Sanity

Psychopathy and crime
Hare, Hart, & Harpur, 1991

Psychopaths commit greater number and variety of criminal offenses

Psychopaths commit more violent and aggressive offenses

More callous and cold-blooded violence and fewer crimes of passion

More instrumental violence (for dominance and gain)

Higher risk for recidivism, especially violent recidivism

77% violent recidivism vs. 21% for nonpsychopaths

Youth with CU traits
Stickle & Frick, 2002

Childhood-onset – low levels of CU traits
Stickle & Frick, 2002

Correlates to Conduct Disorder
(contextual correlates)

Family dysfunction

Deficient socialization practices

Parental psychopathology

High rate of conflict

Peer rejection

Association with deviant peer group

Poverty

High levels of societal violence

Correlates to Conduct Disorder
(Dispositional correlates)

Neuropsychological deficits

Poor response inhibition and executive deficits

Abnormal ANS functional

Reward dominant response style

Deficits in verbal intelligence

Learning problems

Deficits in social cognition

Hostile attributional bias

Limited response repertoire

Families of CD youth

Parental psychopathology

Coercive family process

inadvertently reward aggressive behavior

Family risk factors

Genetic – conduct disorder in a parent

Psychopathology and antisocial behavior in family

Parent-child interactions

Separation and divorce (especially within first 4-5 years of child’s life)

Birth order and family size

Socioeconomic disadvantage

Amount of supervision

Lack of access to other significant adults/relatives

Contact with antisocial adults and relatives

Antisocial older siblings

Protective factors

above-average IQ

No antisocial parent

Affectionate

High self-esteem (real)

Alternative caretakers

Competence in skill areas

Good peer relationships

Having friends

Academic success

Good relationship with emotionally responsive adult

Outcomes

Oppositional defiant disorder

loses temper

argues with adults

Actively defies or refuses to comply with adults' requests or rules

Deliberately annoys people

Blames other for his or her mistakes or misbehavior

Touch or easily annoyed by others

angry and resentful

Spiteful or vindictive

Impairment

Not due to other disorders (psychotic or mood)

Not conduct disorder