Department of Child and Adolescent Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands.
Clin Child Fam Psychol Rev. 2012 Sep;15(3):234-46. doi: 10.1007/s10567-012-0118-7.
In this review, a conceptualization of oppositional defiant (ODD) and conduct disorder (CD) is presented according to which social learning processes in these disorders are affected by neurocognitive dysfunctions. Neurobiological studies in ODD and CD suggest that the ability to make associations between behaviors and negative and positive consequences is compromised in children and adolescents with these disorders due to reduced sensitivity to punishment and to reward. As a result, both learning of appropriate behavior and learning to refrain from inappropriate behavior may be affected. Likewise, problem solving is impaired due to deficiencies in inhibition, attention, cognitive flexibility, and decision making. Consequently, children and adolescents with ODD and CD may have difficulty learning to optimize their behavior in changeable environments. This conceptualization of ODD and CD is relevant for the improvement of the effect of psychological treatments. Behavioral and cognitive-behavioral interventions that have been shown to be modestly effective in ODD and CD are based on social learning. Limited effectiveness of these interventions may be caused by difficulties in social learning in children and adolescents with ODD and CD. However, although these impairments have been observed at a group level, the deficits in reward processing, punishment processing, and cognitive control mentioned above may not be present to the same extent in each individual with ODD and CD. Therefore, the neurocognitive characteristics in children and adolescents with ODD and CD should be assessed individually. Thus, instead of delivering interventions in a standardized way, these programs may benefit from an individualized approach that depends on the weaknesses and strengths of the neurocognitive characteristics of the child and the adolescent.
在这篇综述中，根据社会学习过程受到神经认知功能障碍影响的观点，对对立违抗性障碍（ODD）和品行障碍（CD）进行了概念化。ODD 和 CD 的神经生物学研究表明，由于对惩罚和奖励的敏感性降低，这些障碍儿童和青少年在将行为与负面和正面后果联系起来的能力上受到了损害。因此，适当行为的学习和避免不当行为的学习都可能受到影响。同样，由于抑制、注意、认知灵活性和决策方面的缺陷，问题解决也受到了损害。因此，ODD 和 CD 儿童和青少年可能难以学习在多变的环境中优化自己的行为。这种 ODD 和 CD 的概念化对于提高心理治疗的效果具有重要意义。已经证明在 ODD 和 CD 中具有中等效果的行为和认知行为干预措施都是基于社会学习的。这些干预措施效果有限的原因可能是 ODD 和 CD 儿童和青少年在社会学习方面存在困难。然而，尽管这些缺陷在群体水平上得到了观察，但上述的奖励处理、惩罚处理和认知控制缺陷在每个 ODD 和 CD 患者中可能并不相同程度地存在。因此，应该对 ODD 和 CD 儿童和青少年的神经认知特征进行个体化评估。因此，这些方案可能受益于个体化方法，而不是以标准化的方式提供干预措施，这种方法取决于儿童和青少年的神经认知特征的弱点和优势。
