Chapter 9 – Conduct problems
Description of conduct problems
Conduct problems and antisocial behaviors: age-inappropriate actions and attitudes that violate
family expectations, societal norms, and the personal or property rights of others.
• Children with severe conduct problems frequently grow up in extremely unfortunate
family and neighborhood circumstances, where they experience physical abuse, neglect,
poverty or exposure to criminal activity. Thus, in many cases, aggressive behaviors are
an adaptation to home and neighborhood violence and neglect.
Description of Conduct Problems – Section Summary
- Conduct problems or antisocial behavior(s) are age-inappropriate actions and attitudes of a child
that violate family expectations, societal norms, and the personal or property rights of others.
These children display problems in the self-control of emotions and behaviors.
- The nature, causes, and outcomes of conduct problems in children are wide-ranging, requiring
that we consider several different types and pathways.
- Many children with severe conduct problems grow up in extremely unfortunate family and
neighborhood circumstances.
Context, costs, and perspectives
Context
Although most young people break rules, adolescents with conduct problems engage in more,
and more severe, antisocial and risk-taking behavior compared to their peers.
• Antisocial behaviors appear and then decline during normal development.
o Antisocial behaviors vary in severity, from minor disobedience to fighting.
o Some antisocial behaviors decrease with age, whereas others increase with age
and opportunity.
o Antisocial behaviors are more common in boys than in girls during childhood,
but this difference narrows in adolescence.
Children who are the most physically aggressive in early childhood maintain their relative
standing over time.
Social and economic costs
An early, persistent, and extreme pattern of antisocial behavior occurs in only about 5% of
children. These children cause considerable and disproportionate amounts of harm, accounting
for over 50% of all crime in the U.S., and about 30-50% of clinic referrals.
The lifetime costs to society for 1 youth to leave high school for a life of crime and substance
abuse have been estimated to be about $3.2 million-$5.5 million.
Perspectives
Juvenile delinquency: a broad term used to describe children who have broken a law, anything
from sneaking into a movie without a ticket to homicide.
• Only a subgroup of youths who meet a legal definition of delinquency will also meet the
definition for a mental disorder:
o Definition of delinquency may result from 1 or 2 isolated acts
o Definitions of mental health usually requires the child to display a variety and
persistent pattern of antisocial behaviors.
Externalizing behavior: a continuous dimension of behavior that includes a mixture of impulsive,
overactive, aggressive, and delinquent acts.
, Overt-covert dimension: an independent dimension consisting of a continuum of antisocial
behavior ranging from overt forms like physical aggression at one end, to covert form (e.g.,
hidden or sneaky acts) at the other.
• Overt forms: correspond roughly to those on the aggressive subdimension of the
externalizing dimension.
o These children tend to be negative, irritable and resentful.
• Covert behaviors correspond roughly to those on the delinquent subdimension of the
externalizing dimension.
o These children are less social, more anxious, and more suspicious of others and
come from homes that provide little family support.
Most children with conduct behavior display both overt and covert behaviors.
Destructive-nondestructive dimension: an independent dimension of antisocial behavior
consisting of a continuum ranging from acts such as cruelty to animals or destruction of
property at one end to nondestructive behaviors such as arguing or irritability at the other.
Conduct problems are defined as distinct mental disorders based on DSM-5 symptoms. The name
of this category is Disruptive, Impulse-Control, and Conduct Disorders.
Disruptive behavior disorders: a general term to describe repetitive and persistent patterns of
antisocial behavior such as oppositional defiant disorder (ODD) and conduct disorder (CD).
Context, Cost, and Perspectives – Section Summary
- For most children, antisocial behavior appear and decline during normal development, although
children who are most aggressive maintain their relative standing over time.
- Costs to the educational, health, social service, criminal justice, and mental health systems that
deal with youth make conduct problems one of the most costly mental health problems in North
America.
- From a legal perspective, conduct problems are defined as criminal acts that result in
apprehension and court contact and are referred to as ‘delinquency’.
- From a psychological perspective, conduct problems fall along a continuous dimension of
externalizing behavior, which includes a mix of impulsive, aggressive, and rule-breaking acts.
- From a psychiatric perspective, conduct problems are viewed as a distinct category of mental
disorder based on DSM-5 symptoms. The overall category is called Disruptive, Impulse-Control,
and Conduct Disorders, and includes ODD and CD.
- A public health perspective cuts across disciplines and blends the legal, psychological and
psychiatric perspectives with public health concepts of prevention and intervention.
DSM-5 defining features
Oppositional Defiant Disorder (ODD)
Oppositional defiant disorder (ODD): a pattern of angry/irritable mood, argumentative/defiant
behavior, or vindictiveness lasting at least 6 months and exhibited during interaction with at
least one individual who is not a sibling.
• Appear by the age of 8
• Children with ODD are at risk for impulse-control, substance-use and mood and anxiety
disorders.
3 dimensions of symptoms of ODD:
1. Negative affect (angry/irritable mood) à predicts later depression
2. Defiance (defiant/headstrong behavior) à predicts later behavior disorders
3. Hurtful behavior (vindictiveness) à related to callous and unemotional behavior
Description of conduct problems
Conduct problems and antisocial behaviors: age-inappropriate actions and attitudes that violate
family expectations, societal norms, and the personal or property rights of others.
• Children with severe conduct problems frequently grow up in extremely unfortunate
family and neighborhood circumstances, where they experience physical abuse, neglect,
poverty or exposure to criminal activity. Thus, in many cases, aggressive behaviors are
an adaptation to home and neighborhood violence and neglect.
Description of Conduct Problems – Section Summary
- Conduct problems or antisocial behavior(s) are age-inappropriate actions and attitudes of a child
that violate family expectations, societal norms, and the personal or property rights of others.
These children display problems in the self-control of emotions and behaviors.
- The nature, causes, and outcomes of conduct problems in children are wide-ranging, requiring
that we consider several different types and pathways.
- Many children with severe conduct problems grow up in extremely unfortunate family and
neighborhood circumstances.
Context, costs, and perspectives
Context
Although most young people break rules, adolescents with conduct problems engage in more,
and more severe, antisocial and risk-taking behavior compared to their peers.
• Antisocial behaviors appear and then decline during normal development.
o Antisocial behaviors vary in severity, from minor disobedience to fighting.
o Some antisocial behaviors decrease with age, whereas others increase with age
and opportunity.
o Antisocial behaviors are more common in boys than in girls during childhood,
but this difference narrows in adolescence.
Children who are the most physically aggressive in early childhood maintain their relative
standing over time.
Social and economic costs
An early, persistent, and extreme pattern of antisocial behavior occurs in only about 5% of
children. These children cause considerable and disproportionate amounts of harm, accounting
for over 50% of all crime in the U.S., and about 30-50% of clinic referrals.
The lifetime costs to society for 1 youth to leave high school for a life of crime and substance
abuse have been estimated to be about $3.2 million-$5.5 million.
Perspectives
Juvenile delinquency: a broad term used to describe children who have broken a law, anything
from sneaking into a movie without a ticket to homicide.
• Only a subgroup of youths who meet a legal definition of delinquency will also meet the
definition for a mental disorder:
o Definition of delinquency may result from 1 or 2 isolated acts
o Definitions of mental health usually requires the child to display a variety and
persistent pattern of antisocial behaviors.
Externalizing behavior: a continuous dimension of behavior that includes a mixture of impulsive,
overactive, aggressive, and delinquent acts.
, Overt-covert dimension: an independent dimension consisting of a continuum of antisocial
behavior ranging from overt forms like physical aggression at one end, to covert form (e.g.,
hidden or sneaky acts) at the other.
• Overt forms: correspond roughly to those on the aggressive subdimension of the
externalizing dimension.
o These children tend to be negative, irritable and resentful.
• Covert behaviors correspond roughly to those on the delinquent subdimension of the
externalizing dimension.
o These children are less social, more anxious, and more suspicious of others and
come from homes that provide little family support.
Most children with conduct behavior display both overt and covert behaviors.
Destructive-nondestructive dimension: an independent dimension of antisocial behavior
consisting of a continuum ranging from acts such as cruelty to animals or destruction of
property at one end to nondestructive behaviors such as arguing or irritability at the other.
Conduct problems are defined as distinct mental disorders based on DSM-5 symptoms. The name
of this category is Disruptive, Impulse-Control, and Conduct Disorders.
Disruptive behavior disorders: a general term to describe repetitive and persistent patterns of
antisocial behavior such as oppositional defiant disorder (ODD) and conduct disorder (CD).
Context, Cost, and Perspectives – Section Summary
- For most children, antisocial behavior appear and decline during normal development, although
children who are most aggressive maintain their relative standing over time.
- Costs to the educational, health, social service, criminal justice, and mental health systems that
deal with youth make conduct problems one of the most costly mental health problems in North
America.
- From a legal perspective, conduct problems are defined as criminal acts that result in
apprehension and court contact and are referred to as ‘delinquency’.
- From a psychological perspective, conduct problems fall along a continuous dimension of
externalizing behavior, which includes a mix of impulsive, aggressive, and rule-breaking acts.
- From a psychiatric perspective, conduct problems are viewed as a distinct category of mental
disorder based on DSM-5 symptoms. The overall category is called Disruptive, Impulse-Control,
and Conduct Disorders, and includes ODD and CD.
- A public health perspective cuts across disciplines and blends the legal, psychological and
psychiatric perspectives with public health concepts of prevention and intervention.
DSM-5 defining features
Oppositional Defiant Disorder (ODD)
Oppositional defiant disorder (ODD): a pattern of angry/irritable mood, argumentative/defiant
behavior, or vindictiveness lasting at least 6 months and exhibited during interaction with at
least one individual who is not a sibling.
• Appear by the age of 8
• Children with ODD are at risk for impulse-control, substance-use and mood and anxiety
disorders.
3 dimensions of symptoms of ODD:
1. Negative affect (angry/irritable mood) à predicts later depression
2. Defiance (defiant/headstrong behavior) à predicts later behavior disorders
3. Hurtful behavior (vindictiveness) à related to callous and unemotional behavior
