Often an incorrect interpretation or prognosis of an abnormal or extraordinary behavior pattern can draw the line between what is normal and acceptable, and what can suddenly be classified as a disorder or a disease. This paper aims to study the similarities between certain behaviors, and what factors can acts as differentiators between the two. The paper also emphasized how critical correct assessment is for correct prognosis, and that a treatment may thus, vary greatly from one disorder to another.
Key concepts including “delinquency”, “antisocial behaviour”, “conduct disorder”, “conduct problems” and “externalising behaviour disorders” are often used interchangeably, however these concepts are far from identical (Connor, 2004). These are different definitions from different perspectives of psychology such as juvenile justice, clinical diagnostic/medical settings, psychometrics, and personality/social psychology in order to have a more complete understanding of antisocial behaviour and other related behaviours (Connor, 2004).
Disorders that bear similar symptoms Antisocial behaviors are any acts that violate social rules and the basic rights of others. They include conduct intended to injure people or damage property, illegal behavior, and defiance of generally accepted rules and authority, such as truancy from school. These antisocial behaviors exist along a severity continuum.
Disruptive Behaviour Disorder is used to describe a set of externalizing negative behaviour that co-occur during childhood; and which are collectively known as: “Attention-Deficit and Disruptive Behaviour Disorders” as outlined in the referred to collectively in the Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition (DSM-IV). The following are three subgroups of externalizing behaviors:
• Oppositional Defiant disorder (ODD) • Conduct Disorder (CD) • Attention Deficit Hyperactivity Disorder (ADHD)
Conduct Disorder is aggression toward people and animals, destruction of property, deceitfulness, theft, and other serious social rule violations. Oppositional Defiant Disorder is characterized by negativistic, hostile, and defiant behaviors, such as losing one’s temper, arguing, defying rules, deliberately annoying others, blaming others for one’s behavior, and displaying anger or vindictiveness (Childhood Antisocial Behavior and Adolescent Alcohol Use Disorders). ADHD A mental disorder of childhood is at least three times as common in boys as in girls, characterized by persistent inattention, hyperactivity, or impulsivity.
Brief History of Disorder classification In the medieval times, any deviation from norm was dealt with contempt, and any extraordinary behavior shown by people were said to be possessed by an evil spirit. Later, following Darwin’s theory of human evolution, Morel’s idea of degeneration was used to explain criminal behaviour. According to this concept, criminals were less evolved than normal human beings and that all psychopaths exhibited some degree of criminal behaviour. Physician and phrenologist Carl Otto (1824) was the one who initiated the evolvement of the term psychopathy.
Although his method was scientifically invalid, he started the trend of what would be called psychopathy as a set of personality traits. The term “psychopathic” was first used by J. L. Koch (1891) to describe personality disorders as a result of biological causes. K. Birnbaum (1909) first used the term “sociopathy”, because it was felt that environmental factors were causes of the personality. Now, psychopathy, as defined by Hare’s revised Psychopathy Checklist, is associated with both personality traits and overt behaviour. (Source: How Does Conduct Disorder correlate with Phsychopathy)
What are the factors in the patient’s history that will help determine whether the adolescent has a certain disorder or he is simply “acting out, and will eventually outgrow such behaviours Most of these disorders are generally and holistically classified as antisocial behavior. Antisocial behaviors tend to be consistent across social settings, such as school and home environments (Dishion et al. 1995). Although the inclination towards serious antisocial behaviors is quite steady across the lifespan, the manifestations of this propensity vary according to developmental stages.
This concept has been termed “heterotypic continuity” (Moffitt 1993, extracted from Childhood Antisocial Behavior and Adolescent Alcohol Use Disorders ). For example, antisocial behavior that is interpreted as irritability and impulsivity in younger children may become criminal behavior once these children reach adolescents or adulthood. Antisocial behaviour is a heterogeneous phenomenon and encompasses a wide variety of behaviours and definitions as mentioned above.
One way to distinguish subtypes of antisocial behavior is from the developmental perspective where current classification system (APA, 1994; Lahey et al. , 1998) and developmental pathways (Hinshaw, Lahey, & Hart, 1993; Loeber, 1990; Moffitt, 1993; Nagin, Farrington, & Moffitt, 1995; Patterson, Capaldi, & Bank, 1991; Shaw, Bell, & Gilliom, 2000) feature two different subtypes of antisocial behaviour: child-onset (also early-starter, aggressive-versatile) and adolescent-onset (late-onset, non-aggressive).
This paper focus on adolescent on-set behavior, from the perspective of developmental pathways. Despite the extent of information gathered on Psychopathy, little is known about its developmental nature. Presumable, there are certain risk factors or distinct developmental pathways which correlate them to other groups of delinquents. Knowledge of such developmental risk factors will greatly enable psychologists and researchers related to this field to deal with the serious problem of Psychopathy.
Some risk factors of psychopathy include a history of abuse, parental antisocial characteristics and related factors. It is also widely believed that phsychpathy is manifested at a young age (Hare 1991, Hart and Hare 1997, extracted from Individual and Familial risk factors for Adolescent physchopathy). However this does not mean that psychopathy manifested in adulthood has been developing in an early age. Certain risk factors are identified in the assessment and prognosis of a disorder.
Risk factors are generally associated with earlier events or conditions that are associated with a negative outcome which has been caused or influenced (McBride, Individual and Familial risk factors for Adolescent physchopathy 1998). This includes factors which act within the environment of the individual, and may be casually or indirectly linked to a negative outcome are also referred to as risk factors. Thus, serious assessment of anti-social behavior in an early and timely intervention may be able to mediate these risk factors.
Loeber and Stothamer Lober (1996) indicate that these conditions are cumulative and may lead to ‘stacking’, and may become resistant to change if not interrupted or mediated (Moffit 1990). It is important to understand that dynamic or changeable risk factors (such as knowledge about a childhood aggressive condition) are important in early identification of an adolescent disorder. Factors such as poor parenting or poor parental monitoring are important to be identified at an early age and thus can be monitored and treated, preventing it from becoming a an aggressive and adolescent delinquency in the future (Loeber and Stothamer Lober 1986).
These factors are mutable through treatment, and prevents the accumulation of antisocial behavior in aggressive adolescents (Kazdin 1987). Twentieth century theorists report that parental care is a key characteristic in the development of child behavior. Theorists have suggested that poor family attitudes and interactions fail to provide the attachments that could leverage children into socialized life-styles (e. g. , Hirschi, 1969). Poor home environments manifest antisocial characteristics in their children and associate them with disengaging themselves from their environment (e. g. , Sutherland and Cressey, 1974).
Reports based on two adolescents studies have addressed this issue. Both studies have used data collected by the Youth in Transition project from adolescents at ages 15 and 17 years (Bachman and O’Malley, 1984). Delinquency related to parent-adolescent interaction was studied by Liska and Reed (1985); their analyses suggest that attachment or interaction with parents inhibits delinquency, which in turn, promotes school attachment and stronger family ties.
Wells and Rankin (1988) considered the effectiveness of various dimensions of direct control on delinquency; their analyses suggest that restrictiveness, but not harshness, inhibits delinquency, however these studies do have their limitations as they were made using the same database, but none of the same parameters to conclude the relationship between the variables (adolescent studies from Youth in Transition project extracted from Mc Cord Family Relationships, Juvenile Delinquency, And Adult Criminality). Many suggest that psychopathy disorders, such as antisocial behavior, are also genetically inherited (Hare 1993. Forth and Burke 1998, Lykken 1995, (source: Individual and Familial risk factors for Adolescent physchopathy 1998).
Parents who are psychopathic also behave violently towards their children, thus instilling seeds of similar behavior into them. Children who have displayed signs of aggressiveness also may not culminate into aggressive adolescents with disorders or psychopathy as suggested by studies done by White, Moffits, Earls, Robins and Silva, 1990 (Individual and Familial risk factors for Adolescent physchopathy 1998). Aggression in a proportion of boys emerges early in life and is usually accompanied by ODD symptoms (Loeber et al. , 2000, extracted from Oppositional Defiant and Conduct Disorder: A Review of the Past 10 Years, Part I).
DSM-IV prescribes that the diagnosis of CD should not be made when behaviors are in reaction to their immediate external environment or influences, an example would be of an aggressive adolescent living in a high-crime area (Oppositional Defiant and Conduct Disorder: A Review of the Past 10 Years, Part I). There is a consensus among delinquency studies of both official and self-report data, showing an increase from childhood through adolescence in the prevalence of nonaggressive CD behaviors (Achenbach et al. , 1991; Stanger et al. , 1997); these include behaviors such as theft, breaking-and-entering, and fraud (e. g. , Loeber and Farrington, 1998; Loeber et al. , 1998a).
More studies show that the prevalence of clandestine conduct problems increases from childhood through adolescence (Loeber and Stouthamer-Loeber, 1998). However, studies also give evidence that certain forms of aggression (such as physical aggression) has shown to decrease during the same period (Lahey et al. , 1998; Loeber and Hay, 1997; Loeber et al., 1991).
However, more violent forms of aggression, such as robbery, rape, and attempted or completed homicide, tends to develop more during adolescence (Oppositional Defiant and Conduct Disorder: A Review of the Past 10 Years, Part I) What are the important factors that the clinician should assess? Often during clinical assessment, when investigation is conducted, external factors and information from parents and key influencers are extracted to determine the behavior of children and adolescents.
It is, however, important to understand that children and youth in subject are essential informants regarding CD because their covert acts are not always noticed by adults. It is essential to combine the important informants diagnosis and results to establish the correct diagnosis and assessment, however much of this is missing. Even minor changes or difference in diagnostic criteria can produce large variations in prognosis leading to incorrect assessment and treatment of disorders.
A comparison of DSM-1II and DS2v1-III-R diagnoses on the same sample showed that between DSM-III and DSM-III-R ODD became 25% less prevalent and CD became 44% less prevalent (Boyle et al. , 1996; Lahey et al. , 1990 extracted from: Oppositional Defiant and Conduct Disorder: A Review of the Past 10 Years, Part I). Diagnostic Assessment The assessment of Conduct Disorder, for example, requires collecting data from multiple informants, such as parents, teachers, colleagues, in different settings using varying methods over time, in order to develop more realistic assessment and information about the subject in question.
Contact with medical, school, social service, and juvenille justice personnel should be established to obtain more realistic informationd . A history of the patient should be gathered including the patient’s prenatal and birth history, substance abuse by the mother, maternal infections, and medications taken during as well as post-pregnancy. The adolescents’ history should cover problems of attachment, temperament, aggression, oppositional behavior, attention, and impulse control .
Complete investigation of any physical and sexual abuse, both as a victim and perpetrator, should be dealt with in detail. DSM-IV target symptoms, and the course of their development, should be reviewed. The quality and quantity of peer relationships should be assessed . Obtaining information about the patients’ performance at school is imperative. Data from intelligence testing, achievement test, academic performance, extra-curricular behavior, and interaction as well as other behavioral reports should be gathered and analyzed.
Referral for intelligence testing, speech and language assessment, testing for learning disability, and neuro-psychiatric testing may further help in establishing relevancy of the diagnosis and further prognosis and assessment. Family assessment is an essential part of the evaluation and should include details of the family’s stlye of coping and dealing with situations; socioeconomic status of the family as well as history of social and economic stressors, social support, rehabilitation etc should be obtained.
How the parent has been dealing with adolescent, managing his behavior, and addressing the disorder’s relevance to the adoloscents’ life should be investigated. Any sign of parent’s harshness towards the adoloscent, abuse/neglect, and any abnormal inconsistency should be noted. A history of family antisocial behaviors, including incarceration, violence and physical or sexual abuse of the patient or other family members should be investigated as all of these have effects on the adolescents’ ultimate behavior and development.
The family should be screened for any history of ADHD, CD, substance use disorders, specific developmental disorders (i. e. , learning disabilities), or any other personality disorders. Also included are any information on adoptions and placements in foster care and institutions and any behavior experienced there by the patient. An evidence of a physical evaluation specifically within the last twelve months is necessary for prognosis. Physical condition including pulse rate is useful or any medical history is important so that treatment can be planned accordingly.
Other medical and neurological conditions, with especial focus on central nervous system (CNS) pathology (head injury, seizure disorder, or other CNS illness), chronic illnesses, etc should be evaluated. Any other relevant medical examinations should be conducted during the assessment. As mentioned above an interview with the patient, which can precede the parental interview, should cover the same aspects that are covered in the interview with the family; these include family history, the patient’s personal substance use and sexual history (including sexual abuse of others).
DSM-IV target symptoms may be detected by interviewing parents and other informants, and perhaps not directly from the patients’ interview. A close observation of the patient’s capacity for attachment, trust, and empathy; tolerance, anger and expression should be conducted during the interview; the patient might convey his/her capacity to show restraint, accept responsibility for actions, and experience of guilt.
A close assessment of factors such as cognitive functioning; mood, affect, self-esteem, and suicidal potential; presence and quality of peer relationships (loner, popular, drug-, crime-, or gang-oriented friends); and disturbances of ideation (inappropriate reactions to the environment, paranoia, dissociative episodes) may be the factors which can differentiate the CD from other disorders .