Patterns of relationships in children at risk of developing conduct disorder: parent/child risk factors and treatment implications

© 2012 Dr. Melissa Elizabeth DuncombeThis thesis explores the parent/child correlates and causative factors underlying the development of conduct disorder and associated treatment implications. Recent research has focussed on the role of emotional competence in child problem behaviour. The parent emotion socialisation literature seeks to provide a framework for understanding emotion-based pathways to child conduct disorder. Behaviour problems are of particular relevance during childhood, as difficulties during this period are likely to affect the degree to which young people become well-functioning adults with the capacity to successfully negotiate the challenges of adulthood. It is also a time of opportunity for positive re-direction in life course trajectories through implementation of early intervention parenting programs. This thesis draws on data from a randomised controlled study based in the community. Using a multidimensional model of risk processes that draws on behaviour and emotion theory, the current research aims to contribute to the understanding of child conduct disorder and how it can be averted in young children. The research includes four studies. Study 1 examined the psychometric properties of the new Conduct Problems Risk Screen (CPRS), a seven-item parent- and/or teacher-rated behavioural checklist designed to identify primary-school-age children at risk for conduct disorder. Accurate detection of those at risk can optimise the success of early intervention programs and the results suggest that the CPRS can be used as a valid and reliable screening tool. Studies 2 and 3 investigated the impact of multiple behaviour- and emotion-related parent (Study 2) and child (Study 3) characteristics on child disruptive behaviour among an at-risk sample. Overall findings indicated that inconsistent parental discipline, negative parent emotional expressiveness, and parent emotional wellbeing, in conjunction with problems with child emotional regulation and cognitive flexibility, demonstrated the strongest relations to disruptive behaviour problems. As such, they represent important foci for early intervention parenting programs. Study 4 explored the therapeutic importance of some of these components by examining the relative effectiveness of two early intervention parenting programs designed to reduce child disruptive behaviour. One program draws on behaviour theory and focusses on teaching parents behavioural strategies, and the other program draws on emotion theory and focusses on teaching parents emotion-based techniques. Multilevel modelling was used to assess intervention-related changes over time because children were nested within schools. Analyses followed an intent-to-treat model (which included data from all participants receiving any intervention). The results indicated that, despite different underlying mechanisms and different theoretical orientations, both interventions reduced child problem behaviour and improved facets of emotional competence. Tests of moderation identified groups of parents/children sharing similar characteristics and intervention outcomes. These analyses indicated that distinct strategies to address specific aspects of problem behaviour for certain children/parents may enhance intervention efforts. The four studies in this thesis have important implications for the development of models, theories, and interventions relating to conduct disorder, including the boundaries it shares with other important constructs, such as emotional competence, parent emotion socialisation, and effortful control. It provides a tool to identify at-risk primary-school-age children, identifies multiple parent and child behaviour- and emotion-focussed characteristics that may influence the trajectory of problem behaviour, and compares the outcomes and mechanisms of a behaviour- and emotion-focussed parenting early intervention program. Thus the results can help guide attempts to prevent the development of conduct disorder over this critically important developmental period