ODD.CD.APDdevelopment of APD in adulthood, all of whichmay serve as narrow, behavioural indicators of ageneral psychopathic personality. Examiningthese behavioural disorders from adevelopmental standpoint is important asseveral implications related to childdevelopment and the criminal justice system canbe drawn.The DSM-IV-TR describes ODD as apattern of “negativistic, defiant, disobedient, andhostile behaviour towards authority figures”(Rowe, Costello, Angold, Copeland, &Maughan, 2010, p. 726) lasting at least sixmonths and causing significant distress orimpairment in the child’s life. Some typicalbehaviours include irritability, frequently losinghis or her temper, arguing with adults,deliberately provoking people, and blamingothers for his or her own misbehaviour(American Psychiatric <strong>Association</strong>, 2000). Thisbehavioural disorder usually onsets early inchildhood, around two to four years of age, andis characterized by a display of oppositionalbehaviours and emotions in contexts involvingother people, particularly those in positions ofauthority (Hofvander, Ossowwki, Lundstrom, &Anckarsater, 2009). There has been somespeculation as to whether these behaviours areindicative of an actual disorder or are merelytypical childhood acts of rebellion (Hofvander etal., 2009). However, it is the persistence ofthese behaviours (i.e., lasting at least sixmonths) and their ability to cause significantdistress in a child’s life that distinguishesbetween such normal acts of rebellion andclinically-disordered behaviour (AmericanPsychiatric <strong>Association</strong>, 2000). Additionally,several longitudinal studies have noted strikingsimilarities between ODD and other childhooddisruptive behaviour disorders (e.g., ADHD,CD) and have proposed that they may reflectmanifestations of the same behavioural disorderat different stages in development (Burke et al.,2010).Rowe et al. (2010) assessed cohorts ofchildren aged three to seven to examine thepredictive validity of ODD to CD. They foundthat ODD was a significant predictor of childonsetCD with 79% of the children diagnosedwith CD meeting diagnostic criteria for ODDdirectly before, or at the same time as the CDdiagnosis. Other longitudinal evidence confirmsthat ODD typically has an earlier onset and ismore prevalent than CD, with ODD childrenbeing at greater risk of being diagnosed with CDlater in life (Burke et al., 2010).It is important to note that in order to bediagnosed with ODD, the child must not meetcriteria for CD (American Psychiatric<strong>Association</strong>, 2000). However, clinical studieshave demonstrated that 60 to 95% of CD casesinclude a comorbid ODD diagnosis (Rowe etal., 2010). Such a high rate of comorbidity inCD patients suggests that CD may be a moreserious form of ODD along the samebehavioural trajectory. It is also significant tonote that ODD has been shown to predict lateronset of CD, but there has been no confirmingevidence of a reciprocal relationship (i.e., CDleading to ODD), thereby lending more supportto the developmental pathway of thesedisruptive behavioural disorders.Since CD is often seen as a more seriousform of ODD, it is not surprising that many, ifnot all, of the features of ODD are usuallypresent in cases of CD. CD is characterized bygeneral violation of the basic rights of others,with other defining features includingaggression towards people and animals,destruction of property, deceitfulness, theft,rule-breaking, and serious violation of societalnorms (American Psychiatric <strong>Association</strong>,2000). CD has an age of onset similar to ODD,with symptoms emerging as young as four tofive years old, and can be diagnosed inchildhood, adolescence, or adulthood(Hofvander et al., 2009). Of course, not allchildren diagnosed with ODD go on to developCD (American Psychiatric <strong>Association</strong>, 2000);however, child-onset cases of CD are typicallypreceded by ODD and patterns of physicalviolence and family instability appear to beimportant factors in the transition (AmericanPsychiatric <strong>Association</strong>, 2000; Rowe et al.,2010).Milan and Pinderhughes (2006)examined the relationship between familyinstability and child development and suggested
ODD.CD.APDthat early patterns of instability are related toexternalizing behaviour problems (e.g.,outwardly defiant behaviour). The authors alsofound that:“high levels of family instabilityincreased the likelihood that a child would meetcriteria for diagnosis [of a disorder in the DSM-IV] in third grade, beyond the predictiveaccuracy attained through early measures ofbehaviour problems from teachers and mothers(p. 53)”.Furthermore, Campbell, Shaw, andGilliom (2000) found that an early childhoodenvironment with negative parenting and familystress combined with patterns of hyperactivityand aggression may exacerbate the progressionof externalizing behaviour problems. Finally,Skodol et al. (2007) determined that positivechildhood experiences (e.g., achievements,positive relationships, and competentcaretakers) were associated with betterprognoses and remission from certainpersonality disorders. The results of thesestudies lend support to the notion that anunstable family environment may be acontributing factor in the progression from ODDto child-onset CD. However, the relationshipbetween ODD and adolescent-onset CD is lessclear and further research is necessary tounderstand how they are related (Burke et al.,2010).The relationship between CD and APD,however, is quite well understood inpsychopathological literature. In fact, one of thediagnostic criteria for APD, as laid out in theDSM-IV-TR, is evidence of conduct disorderbefore the age of 15 (American Psychiatric<strong>Association</strong>, 2000). The fact that the DSMarranged these disorders in a hierarchicalfashion suggests that they are at the very leastrelated, if not variations of the same underlyingdisorder. Similar to the way ODD and CD arerelated, all of the behavioural manifestations ofCD are present in APD on a more extreme scale.Other diagnostic criteria of APD includeviolations of social norms with respect to thelaw, persistent deceitfulness, impulsivity,recklessness, irresponsibility, and lack ofremorse (Ogloff, 2006). Violence andcriminality are two defining features of thisdisorder, with a significant proportion of peoplewith APD engaging in a criminal lifestyle (Coid& Ullrich, 2010). The main theme underlyingAPD is a general disregard for the rights ofothers, often to the extent of manipulation forpersonal benefit. Both CD and APD arecharacterized by disruptive behaviour violatingthe rights of others, with APD beingdistinguished by a more encompassingantisocial lifestyle.Not all cases of CD progress to adiagnosis of APD; however, numerousempirical studies have demonstrated a stronglink between the two. Gelhorn, Sakai, Price, andCrowley (2007) noted that generally, around40% of people with CD move on to developAPD. They tested this figure by examining asample from the National Epidemiologic Surveyon Alcohol and Related Conditions (NESARC)and found the percentage to be significantlyhigher, with 75% of their sample of CD patientsalso meeting diagnostic criteria for APD at theage of 18 (Gelhorn et al.). Hofvander et al.(2009) suggested that approximately half ofchildren with CD develop APD in adulthood,while another longitudinal study demonstratedthat around one third of their sample of CDcases progressed to APD, which wasinterestingly around the same percentage ofchildren with ODD that went on to develop CD(Burke et al., 2010).Although many children and adolescentswith ODD or CD outgrow their disorder andhave symptoms that persist only at a subclinicallevel, the relationship of these two childhooddisorders to APD is pronounced. The significantoverlap in behavioural criteria needed todiagnose these three disorders and the fact thatthey are arranged hierarchically in the DSM-IV-TR suggests that they may be age-dependentmanifestations of the same behavioural disorderalong distinct points of a developmentaltrajectory ending in APD.That being said, as previously discussed,the DSM-IV-TR utilizes a behavioural approachin developing diagnostic criteria to eliminateconfusion and improve reliability of diagnosisbetween clinicians (Coid & Ullrich, 2010).
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