PARENTAL ANTISOCIAL BEHAVIOUR AND CHILDREN’S …



PARENTAL ANTISOCIAL BEHAVIOUR AND CHILDREN’S OUTCOMES

INTRO ANTISOCIAL BEHAVIOUR

Personality disorders -more risk than axis 1 –if parent defined as ill –hospitalization- PD parent will neither evoke nor accept help offered by their social network. Distance themselves from family and friends so child has no alternative, stable, adult , attachment figures . worst risk if P.D characterized by hostility (Berg-Nielsen,2002).

Antisocial personality disorder Lying,Physical assault,Stealing,Duplicity,Manipulating others,Indifference to victim

The lifetime prevalence of antisocial behaviours in the general population is 12.3%

Men are more likely than women to engage in antisocial behaviours .Are the mechanisms the same for men and women? externalizing disorder. -gender differences – genetic-> women internalize more (that’s why more in women) and men externalize. Maybe diagnostic criteria a bit biased (men more likely to lash out and be obviously aggressive- maybe disorder expressed differently in each gender, different clinical presentation-women-relational aggression) Hormones.

Conduct Problems (CD)- Conduct Problems (CD) are a repetitive and persistent pattern of behaviour through which the basic rights of others and major age-appropriate social norms or rules are violated (e.g., aggressive, destructive, deceitful, and norm violating behaviours) . CD are preceded by Oppositional Defiant Disorder (ODD). - ODD is characterized by negativistic, argumentative, noncompliant behaviour towards authority figures

most common reason for referral of children to mental health services.

Conduct disorder (CD) is defined as a repetitive and persistent pattern of behavior which violates the rights of others or major age-appropriate societal rules (American Psychiatric Association, 2000).  While causal heterogeneity is common to all psychiatric disorders, the myriad of different etiological factors linked to CD is striking (e.g., genetic, neurocognitive, temperamental, peer, family).

Problems of aggression, oppositionality and impulsivity, with or without attention deficit or hyperactivity, constitute the most prevalent psychopathology in children and adolescents and are amongst the most common reasons for referral to mental health services, accounting for over 70 % of prepubertal and about 50 % of postpubertal referrals to clinics

CD and DSM-5-Presence of 3 out of 15 behavioural criteria ,Present in the past 12 months / 1 present in the past 6 months, 15 behavioural criteria fall into four behavioural subtypes:Aggression to people and animals,Destruction to property,Deceitfulness or theft, Violations of rules

Assessment Multi-informant approach, Parents / caregivers, Teachers, Patient. History and careful observation. Some symptoms might be underreported (for example some CD behaviours are covert and have low frequency)

Impairment - Significant burden on patient and family, Public health and societal concern, Economic costs, Poor academic performance , Risk taking behaviours , Difficult peer relationships , Addictive behaviours

Problems of conduct, that is to say, of persistent disruptive and aggressive behaviours, are the most common form of childhood psychiatric problem in the community and in referrals to child mental health facilities in the West (Loeber, 2000).

The infant is not the passive recipient of reinforcers but an active theoriser and agent, and throughout development there are mutual influences, between child and family and subsequently wider social systems

SUBTYPES

Childhood-onset CD

▪ Presence of one symptom of CD prior to age 10

▪ Childhood-onset is also called lifetime persistent antisocial behaviour

▪ It is associated with early problems in the family, difficult temperament, cognitive problems and genetic vulnerability

Adolescent-onset CD

▪ Adolescent-onset CD may occur because of poor parental monitoring and affiliation with deviant peers

▪ These adolescents are less likely to have neurological impairments and severe family problems

Recent studies suggest that these adolescents experience impairments in many domains of functioning in their adulthood Odjers et al. 2007 Adolescents that started at age of 7 with low CD, no increase. Life-course persisten although it decreases with age (from 26). Adolescent-onset- quite high. Childhood-limited (symptoms present between 7,9-12 but then disappear)

Life-course persistent (10.5%), Adolescent-onset (19.6%), Childhood-limited(24.3%), Low (54.6%).

CD with callous-unemotional traits

Unemotional and callous behaviour- Lack of empathy and guilt ,Flat affect, Grandiosity, Fearfulness and deficits in emotional stimuli make these children less responsive to danger and emotional distress of other people (Frick, 2008)

The four callous-unemotional traits are:

1. Lack or remorse or guilt - The individual doesn’t feel bad after wrongdoing/lack of concern about actions

2. Lack of empathy - No concerns about the feelings of others

3. Unconcerned about performance - No concerns about performance/doesn’t put effort

4. Shallow or deficient affect - Doesn’t show emotions

 lack of concern for others’ feelings, deficient guilt and remorse, and shallow affect. The estimated prevalence of high CU traits in youth with CD ranges from 10–46% in community samples to 21–59% in clinic-samples (Kahn, Frick, Youngstrom, Findling, & Youngstrom, 2012;

Maternal emotional responsiveness during infancy has been associated with higher levels of empathy (Kiang, Moreno, & Robinson, 2004) and guilt (Kochanska, Forman, Aksan, & Dunbar, 2005) in childhood. A warm and involved parent-child relationship has also been shown to protect aggressive children with low fear from experiencing increases in CU traits over time (Pardini, Lochman, & Powell, 2007) and seems to buffer children with high CU traits from developing more serious conduct problems (Kroneman, Hipwell, Loeber, Koot, & Pardini, 2011

CD with severe Anger dysregulation

▪ Children with early onset-CD display severe anger dysregulation and show negative emotionality

▪ They interpret ambiguous cues as threatening and as a result they are more likely to show aggressive behaviour

▪ They are exposed to harsh parenting and have deficits in emotion regulation

Brain abnormalities – prefrontal cortex and amygdale

ocial-cognitive research suggests that children with high levels of anger tend to over-interpret ambiguous social cues as threatening (Schultz, Izard, & Bear, 2004), which may lead them to engage in defensive forms of aggression in response to minor provocation (Orobio de Castro, Veerman, Koops, Bosch, & Monshouwer, 2002). 

While problems with dysregulated anger may be partially driven by neurobiological factors, exposure to harsh and abusive parental discipline can also play a role. Exposure to harsh disciple has been consistently linked to the development of antisocial behavior (Gershoff, 2002), particularly among children with low CU traits (Pasalich, 2011)

Additionally, children who are exposed to high levels of harsh discipline tend to have difficulties developing appropriate emotion regulation skills (Shields & Cicchetti, 1998), and exhibit an increased hypervigilance to cues of potential threat in others (Dodge, Bates, Pettit, & Valente, 1995;Pollak & Sinha, 2002).

MEDIATORS

Evidence suggests that the transition to early CD is caused in part by subtle neurological deficits (e.g., deficit inhibitory control, poor verbal abilities) that lead to difficulties managing peer conflicts, regulating emotions, and controlling impulses (Moffitt, 2006). In addition to these cognitive problems, youth with childhood-onset CD often come from families with a longstanding history of antisocial behavior that use harsh/inconsistent discipline practices (Odgers et al., 2008), which makes it difficult for these children to acquire appropriate social skills and internalize rules for appropriate conduct.

← Individual differences in temperament – Lack of control at ages 3 and 5 AND number of changes of parental figures by age 13 -> related to conviction for violent offence by age 18 in males. temperament is thought to be biologically determined (lack of control in preschool ages) -> associated with dissocial behaviour by 18.-> direct link

← but also interaction with family environment (exposed to changes of parental figures )

In the Dunedin Multidisciplinary Study observational assessments of `lack of control' were obtained at ages 3 and 5, reflecting an inability to modulate impulse expression, impersistence in problem solving, and reactivity to stress and challenge expressed in affectively charged negative reactions (Henry, Caspi, Moffitt, & Silva, 1996). In males the likelihood of conviction for a violent offence by age 18, compared to that of no offence, was predicted by lack of control and by number of changes of parental figures experienced up to the age of 13. T

Deficits in verbal abilities and executive functioning

Children with conduct problems, Adolescents with delinquent behaviour, Adults with antisocial behaviour -> HAVE poor performance in IQ tests, Poor verbal abilities, Poor executive functioning.

Also strong link between cognit abilities and emotional regulation (they would use internal speech to regulate emotion

Perinatal complications ->vulnerability-> Risk. = problems with birth or during pregnancy – create vulnerability (+environment risk factors) –predict risk later in life. Smoking during pregnancy -> independently predicted conduct problems in boys (Maughan et al. 2007) stanga sus -> number of cigarettes that mothers smoked and levels of children’s CD – even for light smoking-significant risk of CD for boys at age of 7. Controlled for other risk such as low SES,etc.

Deficits in info processing Aggressive children-> attend to threatening aspects of other’s behaviours, interpret neutral situations as hostile, give aggressive solutions in social challenges. (Hill,2002).

negative attributions – they will not attribute someone’s behaviour as “he has a bad day” but “he’s a horrible person”

Dodge (1993) has proposed an information processing model for the genesis of aggressive behaviours within social interactions. He hypothesises that children who are prone to aggression focus on threatening aspects of others' actions, interpret hostile intent in the neutral actions of others, and are more likely to select and to favour aggressive solutions to social challenges (Crick & Dodge, 1994; Pettit, Poloha, & Mize, 2001)

are the result of repeated exposure to physical maltreatment. In turn these biases will make the child more likely to respond to social challenges in an aggressive manner. Dodge et al. (1995) tested this prospectively over four years in a sample of 507 recruited from kindergarten. Physical abuse documented in kindergarten was strongly associated with conduct problems in grades 3 and 4. Twenty-eight per cent of the abused group had clinically significant conduct problems compared with 6% of the non-abused.

David & Kistner, 2000). Several studies have shown that aggressive children tend to overestimate their social, academic and behavioural capabilities. 

 (y contrast, information processing, in respect of one's own abilities and relationships, that downplays difficulties should be associated with an increased threshold for powerful emotions of distress or anger. It is hypothesised that aggressive outbursts will occur when an inflated but fragile self-appraisal is threatened (David & Kistner, 2000)

Peer relationships Problems with peer relationships –more likely to develop antisocial problems (bidirectional – also likely that there is a common cause for peer and conduct problems – Moss,2002). Dissocial indiv will choose friends who are also Dissocial -> they will engage in antisocial behaviour and so on. (vicious circle)

-affiliations with deviant peers- common factor

Children with conduct problems have poorer peer relationships than non-disordered children in that they tend to associate with children with similar antisocial behaviours, they have discordant interactions with other children, and experience rejection by non-deviant peers (Vitaro, Tremblay, & Bukowski, 2001). _> just parents- no other good examples?

Brendgen, and Tremblay (2000)- mong those with high attachment to parents, having a best friend who was deviant at age 10 was no longer associated with later delinquency whilst there remained a strong association among those with low attachment to parents. This may imply that an affective bond with parents can buffer teenagers against the influence of deviant peers.

PARENTING -Coercive interactions between the parent and child lead to escalation of child aggressive and oppositional behaviours

Intergenerational transmission of antisocial behaviours. Parental antisocial behaviours->Children’s outcomes.

Specificity of effect- children of depressed parents are at risk of several problems (depression but also anxiety etc) but antisocial->risk for antisocial

Murray, Farrington and Sekol (2012) They conducted a systematic review to examine the links between parental incarceration and children’s antisocial behaviour, mental health problems and performance at school . Examined 14,690 references ->used only 40 studies. need longitudinal studies –child of antisocial is born-follow up, or retrospective studies – look at antisocial children and study parents etc.

The results revealed that parental incarceration was associated with higher risk of antisocial behaviour in their children

Parents antisocial behaviour and children’s outcomes

▪ Children of antisocial parents are more likely to develop externalising problems themselves

▪ Some methodological issues...

Most studies examined parents history of antisocial behaviour (during their adolescence)

Some studies have focused on behavioural problems only (Moss, 2002)

-parental inconsistency and disruptive discipline practices, as well as overreactivity in the form of harsh, overcontrolling and negative discipline (O’Leary, 1999)

-lack of parental monitoring- strong predictor for early onset drug use and delinquency (Chilcoat, 96).

-warmth- early maternal rejection was the most consistent predictor of preschool externalizing problems (Shaw, 1998).

-marital conflict had a direct “spillover effect” on children, who behaved in a similar way towards siblings. (Berg-Nielsen,2002).

Coercive Family Process(1982) and in many subsequent publications. In brief, parents of antisocial children were found to be more inconsistent in their use of rules, to issue more, and unclear, commands, to be more likely to respond to their children on the basis of mood rather than the characteristics of the child's behaviour, to be less likely to monitor their children's whereabouts, and to be unresponsive to their children's prosocial behaviour. Patterson

r. Gardner (1989) tested the model by examining the outcome of parent–child conflicts. She found that mothers of conduct problem children were eight times more likely to back off in the face of a child's opposition than parents of normal control

1) The first explanation is clearly a possibility as coercive, hostile parenting is associated with antisocial parents and therefore may be a correlate of a genetically mediated association between parental and child antisocial behaviours. Two adoption studies (Ge et al., 1996; O'Connor, Deater-Deckard, Fulker, Rutter, & Plomin, 1998) have shown that adoptees at genetic risk of antisocial disorders are more likely than low-risk children to receive negative parenting in their adoptive home

-> ATTACHMENT - Children with conduct disorder often show a pattern of pervasive malfunction in adult life, including problems in establishing intimate relationships, suggesting that persistent difficulties in social relationships may be a key to the persistence of conduct problems

ccording to attachment theory, the quality of early relationships with attachment figures (usually parents) provides the basis for the subsequent establishment of social relationships, and so attachment difficulties might be expected to be associated with conduct problems. Indeed attachment theory has its origins in Bowlby's study of adolescent thieves, and in particular an affectionless and detached subset (Bowlby, 1944).

Specifically, harsh and inconsistent parenting is associated with the development of aggression, delinquency, and conduct problems. In this “parent effects model” negative parenting style is believed to influence a child’s antisocial behavior (Collins et al., 2000, Maccoby, 2000 and Moffitt, 2005). 

Even though an increasing number of studies have examined psychopathic personality during early childhood (e.g., Viding, Blair, Moffitt, & Plomin, 2005), surprisingly few have focused on the relationship between conflictive/negative parent-child relationships and child and adolescent psychopathic tendencies. This is perhaps explained by the fact that many researchers have rejected the role of early environmental influences on the development of psychopathic personality (Marshall & Cooke, 1999)

That is, some parental aggression may be evoked or may be a reaction to-rather than a cause of-antisocial and aggressive behavior exhibited from their children (Moffitt, 2005

Understanding the direction and genetic and environmental etiology of the association between parenting style and psychopathic personality will advance our understanding of the development of psychopathic personality. This could ultimately have consequences for intervention and prevention strategies for reducing psychopathy and other externalizing behavior problems.(Tuvblad, 2013).

Heritability

40% of variance in children’s outcomes is due to genes.

-heredity and vulnerability to psychosocial adversity – so parenting that is good enough for a robust child may not be necessarily so for a child who is genetically susceptible to disruptive or antisocial behaviour.

-temperamental traits such as activity level and irritability tend to be inherited. Moffitt (1993)- children whose hyperactivity and angry outbursts might be curbed by firm discipline often had parents who were inconsistent disciplinarians – the parents tended to be like their children- irritable and inpatient. (Berg-Nielsen,2002).

Modelling

▪ Parents provide models of positive and negative behaviours

▪ Antisocial parents= Models of rule breaking and aggressive behaviour

▪ Some parenting dimensions that have been indentified as important in the transmission of antisocial behaviour are...Poor monitoring,Inconsistent discipline,Physical punishment and maltreatment,Lack of warmth (Jhaffee, 2006)

Context-Marital discord,Abuse and neglect,Socioeconomic disadvantage,Poverty (Murray,2010)

Public health approach –surveillance (what is the problem), risk factor identification (what is the cause), intervention evaluation (what works), implementation (how do you do it) .

Interventions- Stimulants have a medium to large effect on CD symptoms, Other interventions can focus on anger management, reducing harsh parenting, positive reinforcement to encourage prosocial behaviour, Interventions should be tailored to the unique characteristics of the child

Scott et al., 2005-> Effect of treatment on anti-social behaviour –n=110 children aged 3-8. works children who were treated-significant drop after the intervention->significant improvement.

Prevention efforts

Target the developmental trajectory of childhood-onset CD, Target groups of children who display oppositional defiant disorder, dysregulated anger and callous-unemotional traits, Target multiple risks, Offer individualized programmes (Buitelaar, 2013)

What types of research designs are necessary to examine the possible links between parent’s antisocial behaviour and children’s adverse outcomes?

Design preventive efforts:

1) educational approach – teachers, students, parents need to know what the disorder is and how to identify it.

2) Identify risk group – antisocial parents. and try to involve them and improve these. Challenge- they wouldn’t want to be involved into therapy.

3) support groups for parents with children with CD.

4) changes in policies and legislation -> rehabilitation in prison

5) targeting risk factors -> smoking in pregnancy, substance abuse, etc.

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