Essay Sample on Child Abuse and Conduct Disorder in Children

Posted on September 7, 2011

According to Sadock B., Sadock V. &Sadock V.A.(2008, P.96) in their book, Kaplan and Sadock concise textbook of child and adolescent psychiatry, there in a common consensus on the fact that those children that chronically experience sexual or physical abuse when they are young are at a risk of developing aggressive behavior at later years. They also assert that the onset of aggressive behavior in children with a history of maltreatment manifests early in boys than in girls. That is to say that, conduct disorder reaches diagnostic criteria at the age between 14 and 16 for girls and at the age of between 10 and 12 years old in boys (Sadock B., Sadock V. &Sadock V.A., 2008, P.96). For instance, McCabe, et al (2005,p.575) conducted an experiment with an aim of testing the hypothesis that those children who are exposed to violent behavior end up developing conduct problems during their adolescence. This was a two years study that used a sample of 423 adolescents between the ages of 12 to 17 years old. This was a random sample of high risk youths being treated in public psychiatric hospitals. The information needed was collected from studying the adolescents’ pattern of treatment and care (Mc Cabe, et al 2005, p.575). The results put in their article titled, The Relation between Violence Exposure and Conduct Problems among Adolescents: a Prospective Study indicated that those children who had been exposed to community violence had a higher chance of developing conduct disorder which would manifest in external symptoms. On the other hand, child maltreatment predicted psychiatric disorder that manifested without externalizing the symptoms. However a child’s exposure to violence between intimate partners did not predict either of the two outcomes. Even where child maltreatment and exposure to violence between intimate partners were controlled, a child’s exposure to violence was a great contributing factor to adolescent misconduct. It is therefore imperative to form treatment solutions that address the internalizing and externalizing symptoms, in the treatment of socially deviant adolescent with a history of child maltreatment. The study also gives significant pointers towards the prevention of psychiatric disorders in young people. Romano, Zoccolilo & Paquette (2006, p. 329) did a study that investigated the relationship between child maltreatment and behavior disorder in a sample of pregnant adolescents. Cross-sectional information was collected from a sample of 252 pregnant adolescents from a home group setting, hospitals and high schools in Canada. The girls filled up a questionnaire and underwent an interview on their history of psychiatric disorder. The study used latent class analysis to associate child maltreatment and behavioral disorder. The results in their article, Histories of child maltreatment and psychiatric disorder in pregnant adolescents showed that 79% of the pregnant adolescents had not experienced child maltreatment while 21% undergone some kind of mistreatment at a young age. The study also showed that the child maltreatment latent variables had no connection with psychiatric disorder. Instead, aggressive behavior was associated with only the sexual form of child maltreatment. The results also showed a significant association between depression and psychiatric disorder in the pregnant adolescents at the ratio of 3.70.In addition and compared to the non maltreated girls, those girls who had experienced multiple forms of maltreatment were four times more likely to develop conduct disorder. In conclusion, the study proved that prior experience of sexual or multiple form of child maltreatment was a factor that predisposed adolescents to behavior misconduct (Zoccolilo &Paquette 2006, p. 329).More studies of the maltreatment history of a child will help to form better understand adolescent misconduct and come up with remedies that can help to prevent such outcomes. Relationship between depression and conduct disorder in children with child abuse Rutter & Taylor argue in their book (2002) argue in their book, child and adolescent psychiatry that, one of the identifiable causal factor for conduct disorder is child abuse. This is because child abuse leads to concurrent alterations in various emotional, cognitive, neuroendocrinological and neurohumoral regulatory processes. It is the variation in either of this processes that charged with causing depression that leads to behavior disorder in young people. Mash (2003) in his book child psychopathology argues that, the maltreatment of a child can lead to negative psychological consequences that persist into ones adulthood. This means that most of the adult psychiatric patients are victims of childhood maltreatment. He further asserts that those adolescents with a history of physical abuse are at a higher risk of developing chronic problems in self concept, self esteem, behavior and emotional self regulation and psychological outcomes like dissociative behavior, depression and PSTD. This can later in life cause more serious problems including sexual problems anxiety disorders, or depression. According to the American Psychiatric Association diagnostic manual (1987), the relationship between adolescent depression and conduct disorder is not random. This argument is supported by Kovacs, Paulauskas, Gatsonis &Richards(1988) who argue that the estimated prevalence of comorbidity for conduct disorder and depression in children and adolescence was from their study found to be at 23%.This number has risen up to between 32 t0 37% in other separate investigations.Benamos & Bathsheva (1992) argued in his article, depression and conduct disorder in children and adolescent: A review of the literature, that the relationship between depression and conduct disorder in young people has been historically explained using either the theory of direct causal relationship, the theory of indirect causal relationship or the theory of the “final common pathway” hypothesis. According the direct causal relationship model, depression was viewed by early psychiatrists as a masked form of behavior in young people which manifested itself in either the form of antisocial behavior, general anxiety, school under achievement or psychomatic problems. Delinquency was considered to be a defense against parental deprivation or abuse and depression as the second defense option once the antisocial behavior failed to capture the attention of ones parents. This argument was however deemed invalid in the 1970s by later day explanations (Ben-Amos & Bathsheva 1992, p.188). The indirect causal relationship succeeded the above model. According to this model, depression was recognized as a disorder separate from conduct disorder. It explained the association between depression and conduct disorder in two ways. The first one presented depression as a result of abandonment where by a young person defended himself against his depression by either demonstrating rage, withdrawal or by acting out. The second explanation saw depression as a result of aggressive behavior in a manner that one is seen to condemn himself for carrying out deviant behavior. This behavior is presented as a result of expression of anger towards a needed individual who in this case might be dissociating himself from the young person either by sexually of physically abusing the minor. This argument is faulted for not showing how early depravation is more significant than a parents psychopathology in causing depression and antisocial behavior in young people (Ben-Amos &Bathsheva 1992, p.188). Finally, the final pathway model explains the relationship between depression and conduct behavior in maltreated children by seeking to find similar symptoms in the two disorders. This is done using a diagnostic spectrum of several borderline personality disorders. This model however fails in giving a clear explanation that may lead to the development of proper treatment options since it cannot provide distinct symptoms for each disorder. However it gives significant insights into further studies on how pharmacology can be applied in the treatment of both depressive disorder and conduct disorder in young people (Ben-Amos & Bathsheva 1992, p.188). Relationship between posttraumatic stress disorder and stress disorder in children with child abuse According to Myers (2005, p.205) in his book, Myers on evidence on child, Domestic and elder abuse cases, those child who experience physical abuse are at a higher risk of developing psychiatric disorders and adjustment problems. For instance physically abused children may end up becoming abusive parents towards their own children. However research has shown that the intergeneration transmission of this kind of abusive behavior is estimated at between 18 to 40%.Myers further argues that other than physical abuse, a child might be a victim of sexual abuse, psychological abuse or maltreatment in the form of neglect. He quotes research conducted by Vincent Felitti and his contemporaries to demonstrate the effects of child maltreatment. This research involved the analyzation of 8,506 questionnaires given to a sample of adults from the Kaiser Permanente health care at San Diego. The average age of the respondents was 56.They were supposed to answer whether they had experienced any of the 7 childhood traumas including, domestic violence, psychological trauma, sexual abuse, physical abuse, drugs or alcohol abuse by a household member, mental illness or whether the imprisonment of a household member. Over 6% of the respondents had experienced one or more of the traumas while 6% had experienced four or more childhood traumas. The experience of this trauma was associated with later day mental and behavior disorders. The research showed that improper handling of childhood trauma led to post traumatic tress disorder and behavior problems which manifested itself in behaviors like depressed mood, suicide attempts smoking, severe obesity, alcoholism, and drug abuse and multiplier sexual partners. This For instance 25 % of the respondents who were sexually abused as children, took up smoking at an early age compared to only the non sexually abused who only stood at 9%(Myers, 2005, pp. 206-207). Having seen the origin of both post trauma stress disorder and conduct disorder it is importance to show how they are related. Greenwald (2011, 304), asserts that although the effect of trauma borne out of child maltreatment can manifest in several ways trauma plays a major role in the development of conduct disorder. Improper handling of childhood trauma leads to post traumatic disorder where by the child basic trust is violated, his attachments are detached and his sense of empathy destroyed. At this point, the child’s sense of inhibition is reduced such that it becomes easy for the victim to commit crime against other people. Post traumatic stress disorder is such that the victim of abuse remains perpetually alert to potential danger to a point that this kind of sensitivity contributes to a sense of biased hostility. The child social competence is impaired by the internalization of anger which manifests itself in aggressive and sometimes violent acts. Post traumatic disorder also manifests itself in the form of intolerable emotions like intense sadness or fear which may lead to substance abuse or other high risk behaviors. The worst occurs when the effect of trauma manifested in post trauma stress disorder and conduct disorder lasts indefinitely and becomes part of the individual’s behavior and personality. Most anti social youths who have experienced some kind of child maltreatment have been found to suffer from posttraumatic stress disorder with the prevalence rates ranging from 24% to 65% (Greenwald, 2011, p. 304). While some studies have hypothesized conduct disorder as a direct symptom of post traumatic disorder other see both disorders as a direct result of trauma in which some symptoms are similar. For instance, a study of combat veterans discovered that war related trauma predisposed both Post trauma stress disorder and antisocial behavior (Greenwald, 2011, p. 305). Relationship between executive function and conduct disorder in children with child abuse Hyman (2001, p. 680), has stated in his book, the science of mental health: personality disorder that there is empherical evidence that those children who grow up to be persistently antisocial suffer from deficits in their neuropsychological abilities. Research has ruled child abuse and neglect as some of the possible causes of kind of brain damage that lead to anti social behavior and consequent neuropsychological impairment. The two major types of neuropsychological deficits in antisocial children are impairments in verbal and executive functions. The verbal functions affected in antisocial children are concentration in reading, listening, writing, expressive speech, problem solving and memory. The affected executive functions on the other hand are a form of compartmental learning deficiency whose symptoms include impulsivity and in attention. Hyman (2001, p. 680), continues to argues that both conduct disorder and deficiencies in executive functions share a variance that does not depend on ones social class, academic attainment, race or test motivation. This deficiency in cognitive skills can affect both slow-witted and undetected delinquents. He also adds that there is a strong research based evidence to show that in executive functions is associated with the kind of anti social behavior that starts in child hood and is sustained afterwards for a long period of time. In their book, Helping adolescents: prevention of multiple problem behavior, Biglan, Brennan, Foster & Holder (2005, p.77) argues that evidence has demonstrated that specific executive functions deficits are significant risk factors towards substance abuse, overt aggression and latent conduct disorder. These executive deficits may vary from problems in inhibiting negative behavior, poor ability to plan, problems in verbal processing and difficult in sustaining attention. Executive cognitive deficits have therefore been linked to alcohol or substance abuse in high risk youths. The significant association between the deficit in performance of executive functions and conduct disorder has been applied by some researchers to explain the increased rate of comorbidity attention deficit/hyperactive disorder (ADHD) and in conduct disorder. The diminishing arousal of the nervous system leads to ADHD and hyperactivity that specifically affects the brain area that is responsible for behavioral inhibitions and higher order cognitive skills. When the ADHD in a child with a history of maltreatment is accompanied by serious disruptive and aggressive behavior, there is an increased likelihood of future conduct disorder and substance abuse (Biglan 2005, p.77). To investigate the kind of relationship that exists between executive function and conduct disorder in maltreated children, Mezzacapa, Kindlon &Earls(2001, p. 104) carried out a study on 126 boys aged between 6 and 12 years old and who attended either a therapeutic school for children with behavioral of emotional problems or public schools. They were put into 3 categories of public schools, none abused and therapeutic all of which were based on either ones school of origin or his history of maltreatment. The study controlled the boys medical status and IQ then made comparison of the boys in the three categories based on, the experimenter observation of the children’s behavior during the research; the ratings given by the teacher on each boy’s behavior; on the boys performance of a task that tested the capacity to act in progress or inhibit and the capacity to passively avoid responding to questions that had adverse consequences. The test also examined the average group variances in behavior, symptoms and task performance. There was also an analysis of differential age based changes in the behavior, symptoms and task performances within each group. In their article, Child abuse and performance task assessments of executive functions in boys, Mezzacapa, Kindlon & Earls (2001, p.104) reported that those non abused children attending therapeutic schools showed comparatively significant higher levels of externalizing and internalizing symptoms and those of redirecting to a given task in comparison to those children who attended public schools. Compared to public school boys, both therapeutic abused and therapeutic none abused children demonstrated capacities to inhibit an act in progress and ability to avoid giving a response with adverse consequence that was relatively poor. With increasing age, those children who had a history of maltreatment had lower improvements in their capacity to avoid responses with serious consequences compared to both non abused therapeutic children and those attending public schools (Mezzacapa, Kindlon & Earls (2001, p.104 This reported therefore collaborated previous hypothesis and researches conducted by behavioral scientists towards the argument that, child abuse contributes to the alteration of a child’s cognitive abilities especially in the executive functions. Such deficits are in turn linked to psychopathological behaviors manifested in poor self control and abusive aggression. The results of this investigation can however be best validated by conducting a longitudinal study that will investigate the influence of age on behavior regulation in individuals with a history of child maltreatment and consequence cognitive and behavior disorders (Mezzacapa, Kindlon & Earls (2001, p.104). Relationship between conduct disorder and attachment disorder in children with child abuse Abel & Southwest Minnesota State University (2009, p.8) asserts in their book titled childhood trauma and attachment disorder in foster children that a child’s first lesson in trust comes from his parent. The kind of nurturing she gets at the youngest age helps to build either a healthy or unhealthy attachment behavior. In most cases, the process of attachment is inhibited by factors such as abuse, death, maltreatment, chronic trauma, violence, neglect and out of home placements. Such factor may leave a child with attachment deficits that make them develop trust issues, social insecurities and physical detachments. The above problems are accentuated by the statistics that, young children and infants are being taken and sustained in foster cares in numbers that are relatively higher than that of older children. The prevalence of domestic violence and child maltreatment occur in 30 t0 60 5 of families that experience any kind of violence. A majority of youth undergo multiple foster care placements with some undergoing up to 7 placements before reaching their adulthood. In addition, by 2006 118, 000 children in foster cares were still waiting to be adopted while according to a 2005 report from the children defense funds millions of children all over America are witnessing family violence every day. There is therefore a need for permanency, stability and proper role adoption in family life in order to avoid attachment disorder in children (Abel & South West Minnesota State University, 2009, pp.8-9). In essence, any kind of parental care that is characterized by parent child conflict, lack of involvement or warmth, poor supervision and harsh styles of disciplining are associated with disrupted behavior in a child. In their book, women’s mental health: a lifecycle approach Romans & Seeman attempt to demonstrate how poor or abusive parental care may contribute to aggressive behavior in a child. In fact, they are that the relationship between the behavior of a parent and that of a child are directly related to each other. Such that conduct disorder in a parent can be remedied using interventions that put their focus in the alteration of the parent’s behavior. However, Romans & Seeman(2006, p.102), go ahead to say that although most studies in the consequences on parental practice on a child mental and behavioral health has been conducted on boys, a few isolated studies on girls have indicated that the behavior outcomes for boys and girls in the same coercive family vary. For instance, a study conducted on boys and girls in Pre School indicated that maltreated boys in Pre School were at a higher risk of developing aggressive behavior at their school going age compared to girls. The level of attachment that a child has with his parents depends on how well or how poorly the child perceives parental response and availability. The quality of attachment that a child has with his parent influence the kid of relationships he has in the future. Family risk factors like parental separation or divorce, marital conflicts, large family size and intense family stress has been linked to later aggressive behavior violence and criminal convictions. On the other had, the attachment deficit associated with child abuse and neglect has been associated with conduct disorder in children (Romans & Seeman, 2006, p.102). In their book, Child Neuropsychology: Assessment and Interventions for Neurodevelopment Disorders Semrud-Clikeman &Ellison (2009, p.201) argue that familial factors like maternal depression, family aggression and conflicts are some of the causes of attachment disorder in children. On the other hand, children with conduct disorder come from families where there is frequent parental substance abuse, and parent’s capacity to be coercive towards their children. Consequently those parents with punitive, coercive and inconsistent management styles predict attachment disorder which is converted by anger to conduct disorder. It is therefore important for psychiatrist to come up with treatment intervention that has its roots in the quality of attachment that a child has with his parents or guardians (Semrud-Clikeman & Ellison, 2009, p.201). Conclusion In conclusion, children with experience of maltreatment are exposed to a high risk factor of developing conduct disorder as a way of dealing with their pain. Several models have been used to link depression to conduct disorder. However, only an integrated research approach towards finding a cure for both depression and conduct disorder in can help find their association. In addition, Post traumatic stress disorder alters a child’s ability to inhibit aggressive conduct and increases his capacity to give responses that have adverse consequences leading to the development of conduct disorder. Child abuse and neglects creates deficits in a child’s executive functions. Research has shown that such deficits are high risk factors towards the development of aggressive behavior and conduct disorder. Decreased child’s attachment to her parents due to neglect or coercive behavior of the parents causes attention deficit disorder. Those suffering from this deficit handle it through manifestation of aggressive, suicidal or violent behavior that are a symptoms of conduct disorder. In summary, child maltreatment can either directly or indirectly lead to conduct disorder in an adolescent. For some individuals, such a behavior extends into their adult life.

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