Trauma is proposed as a key to understanding the development and persistence of conduct disorder in conjunction with other contributing factors. Trauma history is virtually universal in this population, and trauma effects can help to account for many features of the disorder including lack of empathy, impulsivity, anger, acting out, and resistance to treatment. The current standard of care fails to fully address trauma, which may partially explain the low success rate. A trauma-focused individual therapy approach is presented as one example of how this population might be more effectively treated. This approach features motivational interviewing, self-control training, and trauma resolution and integrates eye movement desensitization and reprocessing (EMDR). Two illustrative case examples are presented and discussed.
Get full access to this article
View all access options for this article.
References
1.
Atlas, J. A., DiScipio, W. J., Schwartz, R., &Sessoms, L. (1991). Symptom correlates among adolescents showing posttraumatic stress disorder versus conduct disorder. Psychological Reports, 69, 920-922.
2.
Bowers, L. B. (1990). Traumas precipitating female delinquency: Implications for assessment, practice, and policy. Child and Adolescent Social Work, 7, 389-402.
3.
Brom, D. (1991). The prevalence of posttraumatic psychopathology in the general and the clinical population. Israel Journal of Psychiatry and Related Sciences, 28, 53-63.
4.
Burton, D., Foy, D., Bwanausi, C., Johnson, J., & Moore, L. (1994). The relationship between traumatic exposure, family dysfunction, and post-traumatic stress symptoms in male juvenile offenders. Journal of Traumatic Stress, 7, 83-92.
5.
Chambless, D. L, Baker, M., Baucom, D., Beutler, L., Calhoun, K., Crits-Christoph, P., Daiuto, A., DeRubeis, R., Detweiler, J., Haaga, D., Bennett Johnson, S., McCurry, S., Mueser, K., Pope, K., Sanderson, W., Shoham, V., Stickle, T., Williams, D.,&Woody, S. (1998). Update on empirically validated therapies, II. The Clinical Psychologist, 51, 3-16.
6.
Chemtob, C. M., Novaco, R. W., Hamada, R. S., &Gross, D. M. (1997). Cognitive-behavioral treatment for severe anger in posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 65, 184-189.
7.
Chemtob, C. M., Novaco, R. W., Hamada, R. S., Gross, D. M.,&Smith, G. A. (1997). Anger regulation deficits in combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 10, 17-36.
8.
Chemtob, C. M., Roitblat, H. L., Hamada, R. S., Carlson, J., &Twentyman, C. (1988). A cognitive action theory of posttraumatic stress disorder. Journal of Anxiety Disorders, 2, 253-275.
9.
Christian, R. E., Frick, P. J., Hill, N. L., Tyler, L., &Frazer, D. R. (1997). Psychopathy and conduct problems in children: II. Implications for subtyping children with conduct problems. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 233-241.
10.
Clark, D. B., Lesnick, L., &Hegedus, A. M. (1997). Traumas and other adverse life events in adolescents with alcohol abuse and dependence. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1744-1751.
11.
Conaway, L. P., &Hansen, D. J. (1989). Social behavior of physically abused and neglected children: A critical review. Clinical Psychology Review, 9, 627-652.
12.
Cuffe, S. P., Addy, C. L., Garrison, C. Z., Waller, J. L., Jackson, K. L., McKeown, R. E., &Chilappagari, S. (1998). Prevalence of PTSD in a community sample of older adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 147-154.
13.
Datta, P. C.,&Wallace, J. (1996, June). Enhancement of victim empathy along with reduction in anxiety and increase of positive cognition of sex offenders after treatment withEMDR. Paper presented at the annual conference of the EMDR International Association, Denver, CO.
14.
Dembo, R., Williams, L., Wothke, W., Schmeidler, J., &Brown, C. H. (1992). The role of family factors, physical abuse, and sexual victimization experiences in high-risk youths’ alcohol and other drug use and delinquency: A longitudinal model. Violence and Victimization, 7, 245-265.
15.
Famularo, R., Kinscherff, R., &Fenton, T. (1992). Psychiatric diagnoses of maltreated children: Preliminary findings. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 863-867.
16.
Fletcher, K. E. (1996). Childhood posttraumatic stress disorder. In E. Mash& R. Barkley (Eds.), Child psychopathology(pp. 242-276). New York: Guilford.
17.
Flisher, A. J., Kramer, R. A., Hoven, C. W., Greenwald, S., Alegria, M., Bird, H. R., Canino, G., Connell, R., &Moore, R. E. (1997). Psychosocial characteristics of physically abused children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 123-131.
18.
Foster, S., &Lendl, H. (1996). Four case studies of a new tool for executive coaching and restoring employee performance after setbacks. Consulting Psychology Journal, 48, 155-161.
19.
Green, A. H. (1983). Child abuse: Dimension of psychological trauma in abused children. Journal of the American Academy of Child Psychiatry, 22, 231-237.
20.
Greenwald, R. (1993). Using EMDR with children. (Available from EMDR, P.O. Box 51010, Pacific Grove, CA 93950-6010, with formal training)
21.
Greenwald, R. (1995). Eye movement desensitization and reprocessing (EMDR): A new kind of dreamwork? Dreaming, 5, 51-55.
22.
Greenwald, R. (1996a, June). EMDR for adolescents with disruptive behavior disorders. Paper presented at the annual meeting of the EMDR International Association, Denver, CO.
23.
Greenwald, R. (1996b). The information gap in the EMDR controversy. Professional Psychology: Research and Practice, 27, 67-72.
24.
Greenwald, R. (1998). Eye movement desensitization and reprocessing (EMDR): New hope for children suffering from trauma and loss. Clinical Child Psychology and Psychiatry, 3, 279-287.
25.
Greenwald, R. (1999). Eye movement desensitization and reprocessing (EMDR) in child and adolescent psychotherapy. Northvale, NJ: Jason Aronson.
26.
Greenwood, P. W. (1994). What works with juvenile offenders: A synthesis of the literature and experience. Federal Probation, 58, 63-67.
27.
Hartman, C. R.,& Burgess, A. W. (1993). Information processing of trauma. Child Abuse and Neglect, 17, 47-58.
28.
Hernandez, J. T., Lodico, M.,& DiClemente, R. J. (1993). The effects of child abuse and race on risktaking in male adolescents. Journal of the National Medical Association, 85, 593-597.
29.
Herrenkohl, R. C., Egolf, B. P., & Herrenkohl, E. C. (1997). Preschool antecedents of adolescent assaultive behavior: A longitudinal study. American Journal of Orthopsychiatry, 67, 422-432.
30.
Hunter, J. A., & Santos, D. (1990). The use of specialized cognitive-behavioral therapies in the treatment of juvenile sexual offenders. International Journal of Offender Therapy and Comparative Criminology, 34, 239-248.
31.
Hyer, L.,& Brandsma, J. M. (1997). EMDR minus eyemovements equals good psychotherapy. Journal of Traumatic Stress, 10, 515-522.
32.
James, B. (1989). Treating traumatized children: New insights and creative interventions. Lexington, MA: Lexington Books.
33.
Jameson, M. (1998, July). Effects of EMDR in a male correctional facility. Paper presented at the annual meeting of the EMDR International Association, Baltimore.
34.
Kazdin, A. (1995). Conduct disorder in childhood and adolescence(2nd ed.). Thousand Oaks, CA: Sage.
35.
Kazdin, A. (1997). Practitioner review: Psychosocial treatments for conduct disorder in children. Journal of Child Psychology and Psychiatry, 38, 161-178.
36.
Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993). Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113, 164-180.
37.
Krystal, H. (1978). Trauma and affects. Psychoanalytic Study of the Child, 33, 81-116.
38.
Malinosky-Rummell, R., & Hansen, D. J. (1993). Long-term consequences of childhood physical abuse. Psychological Bulletin, 114, 68-79.
39.
Marlatt, G. A., & Gordon, J. R. (1985). Relapse prevention: Strategies in the treatment of addictive behaviors. New York: Guilford.
40.
Marshall, W. L. (1996). Assessment, treatment and theorizing about sex offenders: Developments during the past twenty years and future directions. Criminal Justice and Behavior, 23, 162-199.
41.
McMackin, R., Morrissey, C., Newman, E., Erwin, B., & Daley, M. (1998). Perpetrator and victim: Understanding and managing the traumatized young offender. Corrections Management Quarterly, 2, 36-45.
42.
Miller, W. R. (1996). Motivational interviewing: Research, practice, and puzzles. Addictive Behavior, 21, 835-842.
43.
Moffitt, T. (1993). Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxonomy. Psychological Review, 100, 674-701.
44.
Newcorn, J. H., & Strain, J. (1992). Adjustment disorder in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 318-327.
45.
Paperny, D. M.,& Deisher, R. W. (1983). Maltreatment of adolescents: The relationship to a predisposition toward violent behavior and delinquency. Adolescence, 18, 499-506.
46.
Patterson, G. R., DeBaryshe, B. D., & Ramsey, E. (1989). A developmental perspective on antisocial behavior. American Psychologist, 44, 329-335.
47.
Peterson, K. C., Prout, M. F., & Schwarz, R. A. (1991). Post-traumatic stress disorder: A clinician’s guide. New York: Plenum.
48.
Pynoos, R. S. (1990). Post-traumatic stress disorder in children and adolescents. In B. D. Garfinkel, G. A. Carlson, & E. B. Weller (Eds.), Psychiatric disorders in children and adolescents(pp. 48-63). Philadelphia: W. B. Saunders.
49.
Pynoos, R. S., & Eth, S. (1986). Witness to violence: The child interview. Journal of the American Academy of Child Psychiatry, 25, 306-319.
50.
Riise, K. S., Corrigan, S. A., Uddo, M.,& Sutker, P. B. (1994, November). Multiple traumatic experiences: Risk factors for PTSD. Poster session presented at the annual meeting of the International Society for Traumatic Stress Studies, Chicago.
51.
Rivera, B.,& Widom, C. S. (1990). Childhood victimization and violent offending. Violence and Victims, 5, 19-35.
52.
Robins, L. N. (1981). Epidemiological approaches to natural history research: Antisocial disorders in children. Journal of the American Academy of Child Psychiatry, 20, 566-580.
53.
Scheck, M. M., Schaeffer, J. A., & Gillette, C. S. (1998). Brief psychological intervention with traumatized young women: The efficacy of eye movement desensitization and reprocessing. Journal of Traumatic Stress, 11, 25-44.
54.
Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures. New York: Guilford.
55.
Shapiro, F. (1996). Eye movement desensitization and reprocessing (EMDR): Evaluation of controlledPTSDresearch. Journal of Behavior Therapy and Experimental Psychiatry, 27, 209-218.
56.
Soberman, G. S., Greenwald, R.,& Rule, D. L. (in press). A controlled study of eyemovement desensitization and reprocessing (EMDR) for boys with conduct problems. Journal of Aggression, Maltreatment, and Trauma.
57.
Solomon, S. D., Gerrity, E. T., & Muff, A. M. (1992). Efficacy of treatments for posttraumatic stress disorder. Journal of the American Medical Association, 268, 633-638.
58.
Sorensen, E., & Johnson, E. (1996). Subtypes of incarcerated delinquents constructed via cluster analysis. Journal of Child Psychology and Psychiatry, 37, 293-303.
59.
Steiner, H., Garcia, I. G.,& Matthews, Z. (1997). Posttraumatic stress disorder in incarcerated juvenile delinquents. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 357-365.
60.
Stewart, K. (1998, July). Incorporating EMDR in a residential setting for abused adolescent females. Paper presented at the annual meeting of the EMDR International Association, Baltimore.
61.
Stickgold, R. (1998). Sleep, memory, PTSD and EMDR. EMDRIA Newsletter, 3(3), 16-16.
62.
Sweet, A. (1995). Atheoretical perspective on the clinical use ofEMDR. Behavior Therapist, 18, 5-6.
63.
Taylor, S. E., Pham, L. B., Rivkin, I. D., & Armor, D. A. (1998). Harnessing the imagination: Mental simulation, self-regulation, and coping. American Psychologist, 53, 429-439.
64.
Terr, L. (1991). Childhood traumas: An outline and overview. American Journal of Psychiatry, 148, 10-20.
65.
vpan derKolk, B. A. (1987). The psychological consequences of overwhelming life experiences. In B. A. van derKolk (Ed.), Psychological trauma(pp. 1-30). Washington, DC: American Psychiatric Press.
66.
van derKolk, B. A., Pelcovitz, D., Roth, S., Mandel, F. S., McFarlane, A.,& Herman, J. L. (1996). Dissociation, somatization, and affect dysregulation: The complexity of adaptation to trauma. American Journal of Psychiatry, 153(Festschrift Supplement), 83-93.
67.
Vrana, S., & Lauterbach, D. (1994). Prevalence of traumatic events and post-traumatic psychological symptoms in a nonclinical sample of college students. Journal of Traumatic Stress, 7, 289-302.
68.
Watson, C. G., Kucala, T., Manifold, V., Juba, M., & Vassar, D. (1988). The relationship of posttraumatic stress disorder and adolescent illegal activities, drinking, and unemployment. Journal of Clinical Psychology, 44, 592-598.
69.
Widom, C. S. (1989). Does violence beget violence? A critical examination of the literature. Psychological Bulletin, 106, 3-28.
70.
Wierson, M., Forehand, R. L., & Frame, C. L. (1992). Epidemiology and treatment of mental health problems in juvenile delinquents. Advances in Behavior Research and Therapy, 14, 93-120.
