Child and Adolescent Psychopathology

1. Child and Adolescent Psychopathology Antisocial Personality Disorder andAlcohol & Drug Involvement during Childhood & Adolescence

2. Antisocial Personality Disorder • Historical Perspective • Antisocial personality is innate (Hobbes) • Antisocial personality is learned (Locke & Rousseau) • Both perspectives are probably valid • Multiple pathways to antisocial personality (equifinality) • Divergent outcomes for youth (multifinality)

3. Antisocial Personality Disorder • Definitions • Activities that violate societal norms, laws, or the rights of others • Criminal acts – theft, fraud, assault, DUI, drug use • Noncriminal acts – deceitfulness, irresponsibility • Person must be 18 or older; otherwise, consider Conduct Disorder (CD) • Antisocial behavior began before age 15 • Sociopathy – old name for antisocial personality

4. Antisocial Personality Disorder Definitions (cont’d) • Psychopathy – subtype of Antisocial Personality Disorder (APD) • Personality traits – callousness, shallow affect, lack of interpersonal connectedness, superficial charm • Chronic antisocial behavior • Assessed using the Psychopathy Checklist-Revised (PCL-R; Hare) • 80% of incarcerated persons meet ASPD criteria, but ASPD represents aheterogeneous group (which includespsychopathy)

5. Antisocial Personality Disorder • Prevalence • 3.63% lifetime in an epidemiological sample • Three times greater risk among men • Risk factors • Childhood conduct problems – 54% of CD boys were diagnosed with ASPD at age 18 or 19 • Minor physical anomalies (MPAs) – low-seated ears, adherent ear lobes, and furrowed tongues (prenatal/perinatal trauma) • Low autonomic arousal • Persistent antisocial behavior has a genetic component

6. Antisocial Personality Disorder • Developmental progression • Low parental involvement in middle childhood is associated with persistent antisocial behavior in adulthood • Peer rejection in childhood predicts ASPD because these children adapt by forming friendships that support deviance • Combination of well-organized peer interactions and high levels of deviancy training predict ASPD (e.g., gangs) • Substance abuse facilitates development of ASPD

7. Antisocial Personality Disorder • Protective factors • Age (> 45) • Attachment to social institutions (marriage, employment) • Decreased impulsivity and sensation seeking • Parenthood and increased family responsibilities • Academic success

8. Antisocial Personality Disorder • Etiological formulations • Individual differences • Psychopathy is primarily biological or temperamental, present at or near birth, persists throughout life course • Early starters versus late starters • Early starters – coercive parenting, school failure, early antisocial behavior • Late starters – poor parental monitoring, oppositionality, deviant peer involvement starting in adolescence

9. Antisocial Personality Disorder • Environmental and relationship factors • Coercive parenting – intrusive demands, compliance refusals, escalating distress, negative affect, withdrawal of demand • Peer influences • Antisocial behavior interferes with positive peer relations • Children act as models and a source of reinforcement for this behavior • Opportunity for this behavior within networks of deviant peers • Social bonding – job stability and marital attachment predict lower rates of crime and deviance • Transactional process – bidirectional effects between individuals and their social environments

10. Antisocial Personality Disorder • Comorbidity • ADHD – 30-50% meet criteria for ODD or CD • Substance abuse – ASPD men three times as likely to abuse alcohol and five times as likely to abuse drugs; ASPD women 10-13 times as likely to abuse alcohol and 12 times as likely to abuse drugs • Anxiety disorders and Depression

11. Antisocial Personality Disorder • Cultural considerations – amplified by SES and neighborhood risk factors • Physical spanking less problematic in African American community • African American children receive more negative feedback for school behavior and performance, more likely held back and placed in special-education • African Americans have higher arrest and re-arrest rates despite similar rates of antisocial behavior to European Americans

12. Antisocial Personality Disorder • Important moderators of antisocial behavior • Self-regulation – high effortful control • Less vulnerable to deviant peer influence • Need for cultural rituals and daily routine and chores • Biosocial factors – gene-environment interactions • Sociocultural factors – evaluate systems-level policies • Improve behavior-management practices of teachers • Improve academic instruction

13. Prevalence of Alcohol & Drug Involvement During Childhood & Adolescence • Prevalence • 12th grade – 80% have tried alcohol • Adolescents drink half as often as adults but consume 4.9 drinks per occasion compared to 2.6 drink per occasion for adults • 10% of 4th graders and 29% of 6th graders have had more than a sip of alcohol • Greatest escalation occurs between ages 12 and 15 • 12th grade – 60% have tried nicotine • 12th grade – 50% have tried marijuana • Problematic substance involvement predicts truancy, suspensions, and expulsions

14. Prevalence of Alcohol & Drug Involvement During Childhood & Adolescence • Abuse and dependence: Criteria and diagnostic issues (p. 410) • Psychological dependence – subjective feeling of needing the substance to function adequately • Physical dependence – physiological and psychological adaptations • Tolerance – need to ingest larger amounts to achieve same effect • Withdrawal – consumption ends abruptly • Abuse and dependence are non-overlapping diagnoses

15. Prevalence of Alcohol & Drug Involvement During Childhood & Adolescence Diagnostic criteria and issues (cont’d) • Withdrawal and physiological dependence less prevalent but cognitive and affective withdrawal more prevalent among children and adolescents • Criteria might mot be sensitive enough to identify adolescents with substance use problems

16. Prevalence of Alcohol & Drug Involvement During Childhood & Adolescence • Risk factors – nested in certain contexts • Temperament – high sensation seeking, behavioral disinhibition, impulsivity, aggression, lack of behavioral control, negative affectivity, antisocial patterns, trait anxiety, anxiety sensitivity • Childhood behavior problems – hyperactivity, aggression, CD, comorbid psychiatric disorders (self-medicating; 60%) • Externalizing disorders – CD, ADHD, ODD • Internalizing disorders – depression, anxiety

17. Prevalence of Alcohol & Drug Involvement During Childhood & Adolescence • Alcohol and drug expectancies • Peer and parental modeling and media exposure produces more expected global positive effects, increased social facilitation, enhancement of cognitive and motor performance • Mediational model = family history of SUD  expectancies  SUD • Age of onset – the earlier the age, the worse the prognosis • Family influences • Family history = four-to-nine-fold risk of SUDs in males, two-to-three-fold risk in females • Parental deviance and psychopathology

18. Prevalence of Alcohol & Drug Involvement During Childhood & Adolescence • Peers • Greater access to substances • Adoption of beliefs and values consistent with drug-use lifestyle • Mediating variable between family history and conflict and SUD • Stress • Moderator of economic adversity on development of SUD • Bidirectional association (physical, academic, legal, peer, familial, emotional) • Neurocognitive functioning – poor executive functioning, which causes reduced ability to appreciate abuse consequences • Sleep difficulties – between ages 3 and 5

19. Prevalence of Alcohol & Drug Involvement During Childhood & Adolescence • Protective factors – temperament, high intelligence, social support, involvement with conventional peers, religiosity, low-risk taking, competence skills, and psychological wellness.

20. Prevalence of Alcohol & Drug Involvement During Childhood & Adolescence • Developmental pathways to Substance Use Disorders • Deviance – prone pathway • Reduced ability to self-regulate emotional distress and inhibit behaviors • Emotional distress caused by family history, ineffective parenting • Negative affectivity pathway – deficient regulation of negative affect • Temperamental negative emotionality • Environmental stressors • Enhanced reinforcement pathway – less sensitive to substances’ effects • Genetically influenced • Based on physiological response differences to SUD effects

21. Prevalence of Alcohol & Drug Involvement During Childhood & Adolescence • Sex, race, and ethnic differences • Few sex differences • Native Americans most prone; Asian Americans least prone

22. Prevalence of Alcohol & Drug Involvement During Childhood & Adolescence • Developmentally dependent effects • Adolescent animals less sensitive to alcohol’s adverse effects than adults • Adolescent animal exposure causes greater social facilitation than adults • Adolescents have greater long-term behavioral and brain impairment than adults • Adolescent animals have more tolerance, craving, and motor impairment than adults • Adolescent frontal brain regions that control executive planning and reasoning processes continue to mature into adulthood