The Developmental Aspect of Antisocial Personality Disorder:                     A Psychosocial Perspective               ...
INTRODUCTION       Is there a way to detect earlier and treat lifelong adult delinquency known asAntisocial Personality Di...
Personality Disorder may help in both diagnosis and treatment of this very serious andenduring condition.        This pape...
intense reactions to ones environment (Rothbart & Bates, 1998; Eisenberg, Damon, &Lerner, 2006).       An infant’s ability...
relationships and usually are unable and unwilling to share their feelings with others(McDevitt & Ormrob, 2007).       Inf...
also develop antisocial tendencies, including increased aggression and noncompliantbehaviors (DSM-IV-TR; Breiling, Maser, ...
Multiple studies have found parental factors, such as abuse and neglect andparental separation, divorce or loss, as potent...
child’s behavior. Glueck & Glueck (1968) and West & Farrington (1973) found that verystrict and authoritarian parenting st...
requires adjustment. Hetherington, Cox, & Cox (1978) found that months after a divorceadjusting can be difficult to both t...
MacKinnon-Lewis, 1994; Mason, Cauce, Gonzales, & Hiraga, 1996). Parents, who raisetheir children to focus on academics, wi...
Children begin school at the age of five or six. Children must adjust to meetingnew teachers and peers, as well as adapt t...
are more likely to commit more violent crimes as adults than there peers (Anderson,Gentile, & Buckley, 2007). Although jus...
more likely to use drugs and alcohol and engage in other risky activities, compared totheir same-aged peers (Wichstrom, 20...
found that, besides deficits in executive functioning, antisocial adolescents also have lowlevels of arousal and increased...
Steinberg, 2006). Adolescents with antisocial friends, who become more antisocial, willbecome more delinquent (Werner & Si...
(Campbell & Schwarz, 1996; Gorman-Smith & Tolan, 1998; Youngstrom, Weist, &Albus, 2003; Ozer, 2005; Steinberg, 2008). Bing...
Changes in family life also can influence antisocial development. As statedearlier, divorcing parents increases the likeli...
extracurricular activities and resources (Lee & Smith, 1995). Small schools increaseadolescent’s involvement in a classroo...
adolescent works, the less satisfied they feel about life (Fine, Mortimer, & Roberts,1990).         Most of an adolescent’...
A lack of structure, absence of adult supervision, and socializing with peers increased thelikelihood of delinquency and o...
Oppositional Defiant Disorder as well as Attention-Deficit/Hyperactivity Disorder are thedisorders mostly noted to precede...
and Attention-Deficit/ Hyperactivity Disorder (ADHD) may predispose youths todevelop Antisocial Personality Disorder. In a...
continuously interrupting and having difficulty waiting one’s turn (DSM-IV-TR). Thereare three subtypes of this disorder: ...
(Lahey, Loeber, Burke, Rathouz & McBurnett, 2002; Lahey, Loeber, Burke, &Applegate, 2005; Washburn, Romero, Welty, Abram, ...
and child abuse). Individuals with Antisocial Personality Disorder may engage in sexualbehavior or substance use that has ...
According to the DSM-IV-TR (2000) individuals with Antisocial PersonalityDisorder are more likely to       “receive dishon...
and research demonstrate that that the development of Antisocial Personality Disordercan be diminished.       Research has...
behavior by directly reinforcing positive behaviors with tokens and punishingmaladaptive behaviors (i.e., taking tokens aw...
also reduce problematic behaviors (Connell, Dishion, Yasui, & Kavanagh, 2007;Breiling, Maser, & Stoff, 1997). Connell, Dis...
individual as someone who lived by maladaptive lifestyle of wanting to attain power asmeans of avoiding an inferiority com...
CONCLUSION       Antisocial Personality Disorder has enduring symptoms that begin to exhibitduring infancy and through adu...
ReferencesAdler, A. (1964). Superiority and Social Interest. London, England: Fletcher and Sons       Ltd., Norwhich.Ainsw...
adolescents’ distress: Supportive parenting, stressors outside the family, and       deviant peers. Journal of Community P...
Bullock, B., & Dishion, T.J. (2002). Sibling collusion and problem behavior in early       adolescence: Toward a process m...
behaviors, peer deviance, and delinquency among serious juvenile offenders.     Developmental Psychology, Vol 42(2). 319-3...
Crittenden, P., Claussen, A., & Sugarman, D. (1994). Physical and psychological       maltreatment in middle childhood and...
Eisenberg, N., Damon, W., & Lerner, R.M. (2008). Handbook of Child Psychology. (6th       ed. Vol. 3: Social, Emotional an...
Freidenfelt, J., & af Klinteberg, B. (2007). Exploring adult personality and psychopathy       tendencies in former childh...
Hawker, D., & Boulton, M. (2000). Twenty years’ research on peer victimization and       psychosocial maladjustment: A met...
Johnson, J.G., Cohen, P., Kotler, L., Kasen, S., & Brook, J.S. (2002). Television viewing       and aggressive behavior du...
Kupersmidt, J., DeRosier, M. & Patters, C. (1995). Similarity as the basis of children’s       friendships: The roles of s...
Levy, T. M. & Orlans, M. (2000). Attachment disorder as an antecedent to violence       and antisocial patterns in childre...
Maker, A.H., & Buttenheim, M. (2000). Parenting difficulties in sexual-abuse survivors:       A theoretical framework with...
McLanahan, S., & Bumpass, L. (1988). Intergenerational consequences of family       disruption. American Journal of Sociol...
Osgood, D.W., & Anderson, A. (2004). Unstructured socializing and rates of       delinquency. Criminology, 42, 519-549.Osg...
Prinstein, M.J., & Greca, A.M. (2002). Peer crowd affiliations and internalizing distress       in childhood and adolescen...
Sadeh, N., & Verona, E. (2008). Psychopathic personality traits associated with abnormal       selective attention and imp...
Stanford, M., Helfritz, L., Conklin, S., Villemarette-Pittman, N.R., Greve, K., Adams, D.,       & Houston, R.J. (2005). A...
Underwood, M. (2003). Social aggression among girls. New York: Guilford.Vitaro, F., Tremblay, R., Kerr, M., Pagani, L., & ...
Widiger. T.A., & Corbitt, E.M. (1995). Are personality disorders well classified in the       DSM-IV? In W.J. Livesley (Ed...
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The Development of Antisocial Personality Disorder Over the Lifespan: A Psychosocial Perspective

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The Development of Antisocial Personality Disorder Over the Lifespan: A Psychosocial Perspective

  1. 1. The Developmental Aspect of Antisocial Personality Disorder: A Psychosocial Perspective By Rachel Siehs AbstractIndividuals diagnosed with Antisocial Personality Disorder show an enduring pattern ofdisregard for and violation of the rights of others. Antisocial Personality Disorder adultstend to have substance abuse problems, spend years in prison, have interpersonal andemployment problems and are more likely to die prematurely due to violence. Researchhas shown that this pattern of conduct begins in infancy and continues into adulthood.Antisocial Personality Disorder individuals show symptoms that are similar to those ofother disorders such as Conduct Disorder, Oppositional Defiant Disorder and AttentionDeficit/Hyperactivity Disorder throughout their childhood and adolescence.Environmental factors can lead to the development of antisocial behavior in childhoodand adolescence. A review of developmental literature and early intervention treatmentscould suggest ways for the early diagnosis and treatment of Antisocial PersonalityDisorder.
  2. 2. INTRODUCTION Is there a way to detect earlier and treat lifelong adult delinquency known asAntisocial Personality Disorder? Antisocial Personality Disorder is a pervasive pattern ofdisregard for and violation of the rights of others (American Psychiatric Association,2000, DSM-IV-TR). Antisocial individuals tend to engage in behaviors that are groundsfor legal action (such as destroying property, harassing others, stealing or pursuing illegaloccupations) and show a lack of remorse or shame for harmful acts committed on others.Individuals tend to be deceitful and manipulative, irritable and/or aggressive, andconsistently and extremely irresponsible, impulsive by failing to plan ahead, and recklessin disregard for self or other’s safety (DSM-IV-TR). However, the most problematiccharacteristic of Antisocial Personality Disorder is that it is enduring. Approximatelythree percent of males and one percent of females exhibit characteristics of AntisocialPersonality Disorder, with an even greater percentage in substance abuse treatmentsettings, prisons and forensic settings (DSM-IV-TR). Development of AntisocialPersonality Disorder is more common when one’s first degree biological relatives havethis condition; adoption studies, however, have shown that one’s environment is also astrong factor in developing antisocial disorders (DSM-IV-TR). Antisocial Personality Disorder is usually not diagnosable until adulthood.However, because many of its symptoms overlap with those of other mental disorders,such as Conduct Disorder, Oppositional Defiant Disorder and Attention-Deficit/Hyperactivity Disorder, which are diagnosable in childhood and/or adolescence, earlyintervention when a client exhibits symptoms that overlap with those of Antisocial 2
  3. 3. Personality Disorder may help in both diagnosis and treatment of this very serious andenduring condition. This paper analyzes the symptomology of Antisocial Personality Disorder andother mental health conditions to explore whether and how early intervention can helptreat clients before Antisocial Personality Disorder can be diagnosed, thereby helpingthem to avoid this serious condition. INFANCY: UNDERSTANDING TEMPERAMENT AND ATTACHMENT Temperament and attachment both affect the development of lifelong antisocial(Damon, & Lerner, 2006) and is one of the first instances of individual expression(McDevitt & Ormrob, 2008). Attachment is the parent-child relationship that helps formbonds later in life. Temperament is a characteristic describing the reactivity level and self-regulationof an infant. Temperament becomes stable over time and some researchers believe thattemperament actually develops into ones personality (Caspi, 1998; Rothbart & Bates,1998; Eisenberg, Damon, & Lerner, 2006). behavior. Temperament is known to be stablethroughout one’s life (Eisenberg, There are six dimensions of temperament: sociability,sensitivity, adaptability, persistence, emotion intensity, and activity level. An infant withan “easy temperament” is categorized as approachable, adaptable, mild to moderateemotional intensity, and socialable. An infant with “difficult temperament” is withdrawn,emotionally intense, unable to adapt, with negative emotions. Children with difficulttemperament are more likely to be aggressive or withdrawn (Caspi, 1998; Patterson,2008). An infant who is categorized as having a “slow to warm up temperament” tends tobe predominantly in a negative mood, slow to adapt to new stimuli, and have mildly 3
  4. 4. intense reactions to ones environment (Rothbart & Bates, 1998; Eisenberg, Damon, &Lerner, 2006). An infant’s ability to communicate and move around independently is extremelylimited. Infants rely heavily on their parents for all their basic needs to be met. Becausethey are unable to use words to communicate and cannot acquire their physical needs andwants on their own, they rely on support and attention from their caregivers. This bondbetween the caregiver and infant is called attachment. Attachment has an enormous effecton how the infant perceives people in the world. All infants form attachment relationships with their primary caregivers (Bowlby,1969; Ainsworth, Blehar, Waters, & Wall, 1978; Sroufe, 1979). An infant with secureattachment to his or her primary caregivers learns trust. Individuals with secureattachment styles tend to be socially and psychologically skilled as they grow up (Matas,Arend, & Sroufe, 1978; Sroufe, 1979). An infant develops an insecure-ambivalentattachment style when a primary caregiver is unavailable when the individual has needsto be met. Infants who have an insecure-ambivalent attachment display considerabledistress when separated from a parent or caregiver and do not seem comforted by thereturn of the parent. At the reunion, the child passively rejects the parent by refusingcomfort, or may openly display direct aggression toward the parent (Ainsworth, Blehar,Waters, & Wall, 1978; Shorey & Snyder, 2006). Infants with insecure-avoidantattachment tend to avoid parents and caregivers. Insecure-avoidant infants neither seekcomfort nor contact from primary caregiver, instead they tend to be more independent(Ainsworth, Blehar, Waters, & Wall, 1978; McDevitt & Ormrob, 2007). Individuals withinsecure-avoidant attachment styles tend to show little investment in social and romantic 4
  5. 5. relationships and usually are unable and unwilling to share their feelings with others(McDevitt & Ormrob, 2007). Infants who develop an insecure-disorganized attachment style have a primarycaregiver who is inconsistent in meeting the needs of the infant (Main & Solomon, 1986,1990; Shorey & Snyder, 2006). They tend to lack a consistent way of responding tostressful events (Main & Solomon, 1986, 1990; McDevitt & Ormrob, 2007). Theiractions and responses to caregivers are often a mix of behaviors, including avoidance orresistance. These children are described as displaying dazed behavior, sometimesseeming either confused or apprehensive in the presence of a caregiver. In some extremecases of insecure-disorganized attachment style children show fear towards theircaregivers (Main & Solomon, 1986, 1990; McDevitt & Ormrob, 2007). Levy & Orlans(1999, 2000) found that disruptions in attachment during the first 3 years can lead to“affectionless psychopathy,” which is the inability to form meaningful emotionalrelationships, coupled with chronic anger, poor impulse control, and a lack of remorse.Disorganized attachment styles lead the developing child to behave in ways that areconsistent with how he or she expects to be treated by others (Bowlby, 1969; Shorey &Snyder, 2006). Children with insecure attachment styles are more likely to be rejected bypeers and have a wide range of emotional and behavioral problems in their future(Steinberg, 2008). Regardless of whether the infant had a secure attachment or insecureattachment with his primary caregiver, these styles help the infant know how to perceiveand what to expect from the world (Bowlby, 1969; Shorey & Snyder, 2006). It is clear that development of an insecure attachment to one’s parents will affectone’s later attachment with others later in life. If one has a difficult temperament one may 5
  6. 6. also develop antisocial tendencies, including increased aggression and noncompliantbehaviors (DSM-IV-TR; Breiling, Maser, & Stoff, 1997). CHILDHOOD DEVELOPMENT Childhood is the period before sexual maturation, beginning at the age of two andlasting until about the age of ten. During this period, one develops language that enablescommunication with others. Increased motor development allows one to engage inorganized sports. The child’s increased cognitive abilities allow him or her to think aboutconcrete objects and begin academic learning. All of these events take place duringchildhood and influence one’s development into adolescence. During childhood, one’s neurological pathways strengthen and become moreefficient. Enhanced motor skills allow the child to move throughout his environment andexplore. Fine motor skills (i.e., writing and manipulation of small objects) allow the childto communicate with others in newer forms. Language skills explode during childhood.Children are now able to express thought and receive information from others. Theincrease in vocabulary provides labels that enable children to think about objects andevents even when they are not directly in sight. Language acquisition provides childrenthe ability to communicate and socialize with others (McDevitt & Ormrob, 2008;Patterson, 2008). Parents who provided a home that supports educational and languagegrowth have a positive effect on child development; with encouragement, children areable to flourish. However, in homes where parent-child relationships are poor and parentslack educational support and motivation, problems may occur in learning and cognitivedevelopment. This is especially the case in families with low economic circumstances(Hart & Risley, 1995, 1999). 6
  7. 7. Multiple studies have found parental factors, such as abuse and neglect andparental separation, divorce or loss, as potential contributors to later antisocial behavior(Reti, Eaton, Bienvenu, Costa & Nestadt, 2002). Parenting styles and lack of parentalmonitoring are also factors that influence a child’s development. According to DianeBaumrind (1967, 1971, 1973, 1991) there are four types of parenting styles: authoritarian,permissive, authoritative, and disengaged. Authoritarian parents tend to be verydemanding and not responsive. They tend to place a high value on obedience and controland restrict their child’s autonomy. Children whose parents are Authoritarian tend to bewithdrawn and even seem uninterested in peer interaction. When faced with difficulttasks, these children tend to become more angered and frustrated than their peers(Baumrind, 1967; Baumrind & Black, 1967). Permissive parents are very accepting,warm and more passive. Permissive parents are more concerned about raising a happychild than an obedient one. Children whose parents are permissive appear to be lessmature than their peers (Baumrind,1967, 1971, 1973; Baumrind & Black, 1967).Authoritative parents are warm and appreciative but controlling. Authoritative parentsplace a high value on development of autonomy and self-direction (Baumrind,1967,1971, 1973; Baumrind & Black, 1967). Disengaged parents are neither demandingnor responsive. Disengaged parents care little about their child’s opinion or experiences.Disengaged parents are more self-centered and primarily structure their lives aroundthemselves instead of their children (Baumrind, 1973, 1991). Children of disengagedparents have difficulty relating to other people due to a lack of parental guidance andencouragement. In some cases, disengaged parenting is a reflection of child maltreatmentand neglect (Baumrind, 1991). These parenting styles have many repercussions on the 7
  8. 8. child’s behavior. Glueck & Glueck (1968) and West & Farrington (1973) found that verystrict and authoritarian parenting style to be associated with a child’s development ofAntisocial Personality Disorder. Childhood abuse and neglect also have severe consequences in development.Abuse and neglect may cause serious long-lasting problems in children’s behavior (i.e.aggression towards others), peer relations, and self-esteem (Crittenden, Claussen, &Sugarman, 1994; Strauss & Yodanis, 1996; Sheeber, Hops, Alpert, Davis, & Andrews,1997; Pittman & Chase-Lansdale, 2001). Many social learning theorists, such as Bandura(1973) and Feshbach (1980), suggest that witnessing violence in the home provides amodel for learning aggressive behavior and the appropriateness of such behavior and,consequently, produces aggressive-antisocial behaviors in the child. Traumatic andchaotic parent-child relationships also contribute to emotional and social instability andunderdevelopment, poor personality organization, incapability for self reflection and theinability to self-reflect, all characteristics of Antisocial Personality Disorder (Martens,2005). Cicchetti & Barnett (1991) found that children who are abused or neglected earlierin life are more likely to develop insecure attachment relationships with their primarycaregivers, leading to emotion-regulation difficulties and problem-solving deficits.Moreover, Celia (1994) pointed out that when a child is exposed to trauma, he or shemight show a lack of ability to form bonds as a consequence of neglectful family factorsand neighborhood aspects. It will be very difficult for him or her to cooperate with peoplewho want to help or to trust persons who want to give social support. Approximately one in five marriages ends in divorce (Hetherington, Henderson,& Reiss, 1999; McDevitt & Ormrob, 2008). During childhood, the parents’ divorce 8
  9. 9. requires adjustment. Hetherington, Cox, & Cox (1978) found that months after a divorceadjusting can be difficult to both the children and the parents. Divorce can be bothfinancially and emotionally difficult on the family. Monitoring children decreases andsome divorced parents emotionally withdraw from their children, which may lead toexternalizing behavioral problems to occur (Breiling, Maser, & Stoff, 1997). A childrepeatedly exposed to marital conflict – especially when it is unresolved, is more likely tobe aggressive and depressed (Cummings, Ballard, El-Sheikh, & Lake, 1991). Whenchildren are recipients of aggressive parenting themselves, they are more likely to imitatethis behavior in their relationships with their siblings (Conger, Conger, & Elder, 1994). Siblings provide companionship and support, can be surrogate parents, andsometimes take on a teaching role. However, siblings also can be bullies or competitors(Patterson, 2008). Older siblings can influence younger siblings through teaching andnurture, although studied have shown antisocial conduct of siblings tends to havenegative consequences on the child’s development (Ardelt & Day, 2002; Bullock &Dishion, 2002; Haynie & McHugh, 2003). Furman & Lanthier (2002) and Brody (1998)found that siblings’ relationships are positive especially when the child’s relationshipwith his parents is positive and the home environment is harmonious. Aggressive andhostile interactions with siblings, however, provides future practice, observationallearning, and reinforcement of problem behaviors that consequently lead one toexperience failures at school, with peers, and in future relationship (Natsuaki, Ge, Reiss,& Neiderhiser, 2009). During childhood, peer groups begin to form. Parents play an important role inchoice of peer groups (Brown, Mounts, Lamborn, & Steinberg, 1993; Curtner-Smith & 9
  10. 10. MacKinnon-Lewis, 1994; Mason, Cauce, Gonzales, & Hiraga, 1996). Parents, who raisetheir children to focus on academics, will have children who are more likely to socializewith peers who are more academically inclined. This is also the case for children whoexhibit aggressive and antisocial behaviors (Dishion, Patterson, Stoolmiller & Skinner,1991; Kim, Hetherington, & Reiss, 1999; Garneir & Stein, 2002; Scaramella, Conger,Spoth, & Simmons, 2002; Tolan, Gorman-Smith, & Henry, 2003). Problem parent-childrelations, especially ones coercive and hostile, lead to the development of antisocialdisposition in the child. This disposition then contributes to both school failure andrejection by peers (Dishion, Patterson, Stoolmiller, & Skinner, 1991; Pardini, Loeber, &Stouthamer-Loeber, 2005). In childhood, peer groups tend to be gender-segregated (i.e.,boys socialize more with boys, and girls with girls) (Martin & Fabes, 2001) and peerstend to share similar characteristics (i.e., behavior, socioeconomic status, and otherdemographics) with each other (Kupersmidt, DeRosier, & Patters, 1995; Cassidy, Aikins,& Chernoff, 2003). Kupersmidt, DeRosier, & Patters (1995) found that well-behaved andsimilar socioeconomic status children are likely to play together. Children who are moresocially skilled tend to have more friends. Being rejected by peer groups has a negative impact on one’s development.Children who are rejected by peer groups tend to be children who are feared or disliked(such as bullies). Rejection in the peer groups predicts later behavior and mental healthoutcomes, such as delinquency, drug abuse and depression (Bagwell, Newcomb, &Bukowski, 1998; Hawker & Boulton, 2000; Kupersmidt & DeRosier, 2004). This occursbecause many rejected children befriend other rejected children (Breiling, Maser, &Stoff, 1997; Vitaro, Tremblay, Kerr, Pagani, & Bukowski, 1997). 10
  11. 11. Children begin school at the age of five or six. Children must adjust to meetingnew teachers and peers, as well as adapt to a school environment. They must also adjustto classroom and school rules. Children in smaller classes tend to form warmer, closerrelationships with their teachers, and those who form a more positive relationship withtheir teachers are more likely to succeed in school (National Institute ofChild Health and Human Development: Early Childhood Research Network, 2004).Participation in organized and structured extracurricular activities after school can alsobenefit a child’s development (Osgood, Wilson, O’Malley, Bachman, & Johnston, 1996;Osgood, Anderson, & Shafer, 2005). If one is aggressive during childhood, then one is more likely to be aggressive inadolescence and adulthood (Breiling, Maser, & Stoff, 1997; Schaeffer, Kellam, Petras,Poduska, & Ialongo, 2003). Children living under stressful conditions (e.g., domesticviolence, child abuse/neglect, poor communities) are more likely to develop and modelaggressive behaviors through direct observation from a parent, family members, and, insome cases, peers (Breiling, Maser, & Stoff, 1997). Children who are aggressive are morelikely to be rejected by there peers and have adjustment and interpersonal problems in thefuture (Underwood, 2003; Tremblay et al., 2004; Dodge, Coie, & Lynam, 2006). Most children are connected to the media through television, videogames andinternet usage, which have more negative than positive effects on a child’s development.Children who watch more violent television are more likely to act out more aggressively,than those who do not (Hopf, Huber, & Weiß, 2008). Elementary school children whoplay more violent video games become more aggressive in their behavior over time(Anderson, Gentile, & Buckley, 2007; Breiling, Maser, & Stoff, 1997). These children 11
  12. 12. are more likely to commit more violent crimes as adults than there peers (Anderson,Gentile, & Buckley, 2007). Although just watching violence through the media doesincrease the likelihood of violent behaviors, it is not an entirely causal factor (Breiling,Maser, & Stoff, 1997). The impact of parents, peer groups, and media exposure can be seen in a child’sdevelopment. Marital conflict, maltreatment and disengaged parenting can influence thechild’s social and psychological development. Antisocial siblings and socializing withantisocial peers can lead to more antisocial behaviors in the future. ANTISOCIAL ADOLESCENT DEVELOPMENT Adolescence is filled with biological changes, social transitions, and cognitiveimprovements. During this stage, starting at the age of ten and ending in the earlytwenties, adolescents discover who they are, form closer and more caring relationships,establish a sense of independence, ultimately distance themselves from their parents, andbecome members of society. All of these events take place during adolescence andinfluence development into adulthood. Puberty is the period during which an individual becomes capable of sexualreproduction (Steinberg, 2008). Other biological changes include increases in height,weight, muscle and strength. Puberty appearances may increase family conflict anddistance between parents and children. Laursen, Coy, & Collinsm (1998) and Ogletree,Jones, & Coyle (2002) found that, as children mature from childhood into middleadolescence, emotional distance between adolescents and their parent’s increases andconflict intensifies, especially between the adolescents and their mothers. Those whomature early tend to be more popular and socialize with older peers. Early maturers are 12
  13. 13. more likely to use drugs and alcohol and engage in other risky activities, compared totheir same-aged peers (Wichstrom, 2001). Also, early maturers who use substances earlyin adolescence are more likely to have substance abuse problems in the future and beinvolved in other problematic behaviors (Dick, Rose, Viken, & Kaprio, 2000). Late-maturing adolescents, on the other hand, tend to have better coping skills (Steinberg,2008). The impact of early maturation on adolescents’ antisocial behavior is comparableamong African-American, Mexican-American and Caucasian boys (Cota-Robles, Neiss,& Rowe, 2002). During adolescence, children develop an “executive suite” of capabilities thatpermit thinking that is more deliberate and more controlled (Keating, 2004). Adolescentsare better at thinking of what is possible; they think in the abstract, multidimensional, andhypothetically. Adolescents’ conceptions of interpersonal relationships become moremature; their understanding of human behavior becomes more advanced and their ideasof social institutions and organizations become more complex. Adolescents’ ability tounderstand what people are thinking is far more developed (Steinberg, 2008).Adolescents are known to be risk takers. An individual’s susceptibility to peer pressureincreases during early and middle adolescence, and most adolescent risk-taking,including delinquency, drinking, and reckless behavior, occurs when other teenagers arepresent (Steinberg, 2004, 2008). Steinberg (2007) found that late maturation of theprefrontal cortex (the area of the brain that controls executive functioning – planning,decision-making, goal setting, etc.) increased the likelihood of risk taking duringadolescence. Individuals with deficits in executive functioning have conflicts in areas ofcognitive control and conflict monitoring (Sadeh & Verona 2008). Other studies have 13
  14. 14. found that, besides deficits in executive functioning, antisocial adolescents also have lowlevels of arousal and increased filtering of environmental stimuli, which is linked tosensation-seeking risk taking behaviors (Breiling, Maser, & Stoff, 1997). Stimulationdeprivation causes an increase in sensation seeking and risk-taking behaviors (Breiling,Maser, & Stoff, 1997). Impulse control deficits combined with hyperactivity andinattention dysfunctions are highly related predisposing factors for the presentation ofantisocial behavior (Holmes, Slaughter, & Kashani, 2001). Being unable to understand another person’s perspective will hinder the ability tounderstand another’s thoughts and feelings and therefore increase the likelihood ofantisocial behaviors such as destroying the property of others, bullying and harmingothers and animals. An adolescent’s inability to understand social conventions andsocietal norms also increases the chance of antisocial behaviors to form. An individual’sinability to think about the consequences for their behavior also increases the likelihoodof violations to rules and antisocial behavior. Peer groups become one of the most important features in an adolescent’s life;crowd memberships contribute to one’s identity. Prinstein & Greca (2002) and Sussman,Dent, McAdams, Stacy, Burton, & Flay (1994) found that the crowd with which anadolescent affiliates has an important influence on his or her behavior, activities and self-conception. If one’s crowd is uninterested in academics, one will be disengaged in schooland perhaps more focused on antisocial behaviors. The more substance-using friends anadolescent has and the closer he or she feels to them, the more the adolescent is likely touse alcohol and drugs (Hussong & Hicks, 2003). Peer influence is a dominant factor inpredicting whether that individual will be at risk for juvenile offending (Chung & 14
  15. 15. Steinberg, 2006). Adolescents with antisocial friends, who become more antisocial, willbecome more delinquent (Werner & Silbereisen, 2003). Gang membership is alsoassociated with antisocial behavior. Adolescents who belong to gangs are at greater riskfor many types of problems in addition to antisocial behavior, including elevated levels ofpsychological distress and exposure to violence (Li, Stanton, Pack, Harris, Cottrell, &Burns, 2002). The neighborhood in which one lives also influences adolescent development. Formost growing up in a poor neighborhood has negative effects on adolescent developmentand mental health (McLoyd, 1990; Chung & Steinberg, 2006). Neighborhoods affectadolescents by influencing norms to which an adolescent is exposed to (i.e., if they seeviolence in the neighborhood, they will be believe it is “normal” for violence to occur)and limited access to economic and institutional resources (Chung & Steinberg, 2006;Steinberg, 2008). Adolescents who live in poor neighborhoods come into contact withdeviant peers more often, and by seeing nothing but poverty and unemployment in theircommunities, they will have little reason to be hopeful about their own future; they mayfeel that they have little to lose and therefore, drop out of school or become involved incriminal activity (Steinberg, 2008). In poor neighborhoods the quality of schools, healthcare, transportation, employment opportunities, and recreational services is lower and asa result, adolescent have fewer chances to engage in activities that facilitate positivedevelopment and fewer chances to receive services when they are having difficulty(Leventhal & Brooks-Gunn, 2004). Exposure to violence, such as can be witnessed intheir own home, neighborhood, or at school, increase the likelihood that they themselveswill be involved in violent behavior, which could involve hurting themselves or others 15
  16. 16. (Campbell & Schwarz, 1996; Gorman-Smith & Tolan, 1998; Youngstrom, Weist, &Albus, 2003; Ozer, 2005; Steinberg, 2008). Bingenheimer (2005) found that witnessinggun violence doubles an adolescent’s risk for committing violence in the future. Although it may appear that family is not as important in adolescence, parentalstyles, siblings and family changes are shown to have a significant effect on theadolescent and his or her behaviors. According to Collins & Steinberg (2006) adolescentswho are raised in an authoritative home are more responsible, more self-assured, moreadaptive, more creative, more socially skilled, and more successful in school.Adolescents raised in an authoritarian homes are more dependent, more passive, lesssocially adept, less self-assured, and less intellectually curious. Adolescents raised in anindulgent households are often less mature, more irresponsible, more conforming to theirpeers, and less able to assume positions of leadership. Adolescents raised in an indifferenthomes are often impulsive and more likely to be involved in delinquent behavior and inprecocious experiments with sex, drugs and alcohol. Studies such as Crittenden,Claussen, & Sugarman (1994), Strauss & Yondanis (1996), Sheeber, Hops, Alpert,Davis, & Andrews (1997) and Pittman & Chase-Lansdale (2001) have shown thatparenting that is indifferent, neglectful, or abusive has harmful effects on an adolescent’smental health and development, leading to depression and antisocial behavioral problems,including cases of physical abuse and aggression toward others. Adolescents from single-parent homes, as well as those from uninvolved or less supportive parents are more likelyto be peer oriented and be more susceptible to antisocial pressure (Farrell & White, 1998;Erickson, Crosnoe, & Dornbusch, 2000; Steinberg, 2008). 16
  17. 17. Changes in family life also can influence antisocial development. As statedearlier, divorcing parents increases the likelihood of decreased parental monitoring andincreased exposure to martial conflict, both of which can have a maladaptive outcome todevelopment (Dornbusch et al., 1985; McLanahan & Bumpass, 1988; Moore & Chase-Landsdale, 2001). Divorce increases an adolescent’s risk of using drug and alcohol,having more behavioral problems, performing poorer in school and of being more likelyto engage in sexual activity (Allison & Furstenberg, 1989; Astone & McLanahan, 1991;Hetherington & Stanley-Hagan, 1995). Families’ financial strain also can disrupt parenting function and increasebehavioral problems (McLoyd, 1990). Income loss tends to increase the likelihood for anadolescent to have emotional, academic and interpersonal problems as well as diminishones sense of mastery (Lempers, Clark-Lempers, & Simmons 1989; Conger, Conger,Matthews, & Elder, 1999; Barrera et al., 2002). Conger, Conger, Matthews, & Elder(1999) found financial strain also affected an adolescent’s psychological development. Inaddition, parents who are stressed economically tend to be less involved, less nurturingand less consistent in their discipline (McLoyd, 1990). This gives rise to a wide range ofpsychological and behavioral problems in adolescence. Sibling relations can also influence an adolescent’s development. The effect ofsibling relationships in adolescence is similar to its effect in childhood. A positive siblingrelationship in adolescence contributes to positive school competency, sociability,autonomy, and self-worth (Yeh & Lempers, 2004). School has profound effects on an adolescent’s development and behavior(Steinberg, 2008). Large schools tend to provide adolescents with more classes, 17
  18. 18. extracurricular activities and resources (Lee & Smith, 1995). Small schools increaseadolescent’s involvement in a classroom and gives them a sense of involvement andobligation (Steinberg, 2008). Although class size does not affect an adolescent’sacademic development, overcrowding in school does provoke potential problems. Over-crowded schools can be stressful on both students and their teachers and are more likelyto have inadequate resources (Ready, Lee, & Welner, 2004). Educators who provideopportunities for their students, engage and excite students, are not biased, and setexpectations that are reasonably related to a student’s ability, will promote positiveadolescent academic development (Eccles, 2004; Rosenbloom & Way, 2004). That is, agood teacher resembles a good, authoritative parent (Wentzel, 2002; Pellerin, 2005).Schmidt (2003) found students who are disengaged in school are more likely tomisbehave. Overcrowding in schools increases stress not only in teachers and resources, butfor the students as well. Violence is more common in overcrowded school, especially inpoor urban neighborhoods (Khoury-Kassabri, Benbensihty, Astro & Zeira, 2004).Students who have low achievement beliefs can also influence antisocial behavior. Theyare more likely to drop out of school, which is correlated to living at or near povertylevel, to experience unemployment and be involved in delinquent and criminal activity(Rumberger, 1995; Steinberg, 2008). Most individuals work during adolescence. Often these jobs have very little to dowith future careers and range from fast-food workers to cashiers to manual or skilledlabor. Most adolescents’ salaries go towards needs and activities. The more hours an 18
  19. 19. adolescent works, the less satisfied they feel about life (Fine, Mortimer, & Roberts,1990). Most of an adolescent’s leisure time is involved socializing with peers, playingsports, watching television and using other forms of the technology (including computer,cell phones, video games, shopping, playing a musical instrument, etc.). Mostextracurricular activities (i.e., structured activities) have positive influence on anindividual’s development. This is so because it increases contact with peers, teachers andother school or neighborhood personnel who may reinforce the value of school orneighborhood and because participation itself may improve students’ self-confidence andself-esteem (Spreitzer, 1994; Gore, Farrell, & Gordon, 2001; Markstrom, Li, Blackshire,& Wilfong, 2005; Steinberg, 2008). Unstructured activities, conversely, are associatedwith more problem behavior. Simply spending more time with peer’s increases thelikelihood of alcohol and drug use and partying, as well as being more susceptible to peerpressure (Caldwell & Darling, 1999). Unstructured leisure activities can increase anadolescent’s exposure to antisocial peers and activities. According to Steinberg (2008) “Because most adolescence is a time of heightened peer pressure, and heightened susceptibility to peer influence, and because one of the strongest deterrents against problem behavior is a presence of an adult, it is hardly surprising that unstructured peer activity without adult supervision is associated with all sorts of problems – delinquency, drug and alcohol use, and precocious sexual activity.” (pp. 250) 19
  20. 20. A lack of structure, absence of adult supervision, and socializing with peers increased thelikelihood of delinquency and other problematic behaviors (Mahoney & Stattin, 2000;Mahoney, Stattin, & Lord, 2004; Osgood & Anderson, 2004). Adolescents’ exposure to the media (such as television, computers, andmagazines) also has a negative influence on an adolescent’s development. Adolescentsspend on average at least seven hours each day using the media, and the time spent iscontinuously increasing (Steinberg, 2008). Adolescents are exposed to sexual themes,violence, the use of drugs and alcohol and misleading messages of beauty and power,which can cause antisocial behavior, as well as external or internal problems (Cantor,2000;Ward, 2003; Ward, & Friedman, 2006; Steinberg, 2008). Media can also influencethe development of conduct disorder and antisocial behaviors during adolescence.Messages on television, websites, and magazines can influence one’s sexual behaviors;alcohol and drug use, and desensitize adolescents to violence. Consequently, exposure tothese messages can influence one’s behavior (Cantor, 2000; Johnson, Cohen, Smailes,Kasen, & Brook, 2002; Huesmann, Moise-Titus, Podolski, & Eron, 2003). As the foregoing show, adolescence is a period of changes and transitions, growthand development, as well as privileges and responsibilities. One’s parents, siblings,environment, peers, and even the media are important factors that can contribute tonormal adult development. MENTAL DISORDER HISTORY OF INDIVIDUALS DIAGNOSED WITH ANTISOCIAL PERSONALITY DISORDER Antisocial Personality Disorder develops from disorders that occur duringchildhood and adolescence. These mental disorders impair an individual’s psychological,academic and social development. Disruptive Behavioral Disorders such as Conduct and 20
  21. 21. Oppositional Defiant Disorder as well as Attention-Deficit/Hyperactivity Disorder are thedisorders mostly noted to precede the development of Antisocial Personality Disorder. Thirty to forty percent of children diagnosed with Conduct Disorder developantisocial personality disorder (Robins, 1966, 1991; Robins, Tipp & Przyberk, 1991).Individuals diagnosed with Antisocial Personality Disorder showed symptoms ofConduct Disorder before the age of fifteen. Conduct Disorder is a disruptive behaviordisorder that occurs in either childhood or adolescence. They show a repetitive andpersistent pattern of behavior in which they violate social norms or the rights of others(DSM-IV-TR). There are three types of this disorder: childhood-onset type (diagnosedprior to age ten), adolescent-onset type (diagnosed after age ten), and unspecified onset(age is unknown) (DSM-IV-TR). The symptoms of conduct disorder can be either mild(i.e., lying), moderate (i.e., vandalism) or severe (i.e., physical cruelty)(DSM-IV-TR). Tobe diagnosed with conduct disorder one must fall into three or more of the criteria in thepast twelve months with at least one criterion in the past six months (DSM-IV-TR). Onemust have shown aggression toward people and/or animals (such as bullying orintimidating others), deceitfulness and/or theft, and serious violation of the rules (i.e.,breaking parental rules) and/or destroyed property (DSM-IV-TR). Individuals diagnosedwith Conduct Disorder tend to engage in aggressive behavior. They may display bullying,threaten others, initiate physical fights, and deliberately damage others’ property. Theymay be deceitful, steal, violate rules set by others or force someone into sexual activities. Lahey, Loeber, Burke & Applegate (2005) found that Conduct Disorder is notalways a predictor of the development of Antisocial Personality Disorder. Otherdisruptive behavior disorders in childhood, such as Oppositional Defiant disorder (ODD) 21
  22. 22. and Attention-Deficit/ Hyperactivity Disorder (ADHD) may predispose youths todevelop Antisocial Personality Disorder. In a significant percentage of cases,Oppositional Defiant Disorder is a development antecedent to Conduct Disorder.However, not all children diagnosed with Oppositional Defiant Disorder developConduct Disorder(DSM-IV-TR). Children with Oppositional Defiant Disorder showsymptoms in recurrent pattern of negativistic, defiant, disobedient, and hostile behaviortoward authority figures. This behavior is evident before the age of eight and includesfrequent loss of temper, arguing with adults, and actively defying or refusing to complywith the request or rules of others (DSM-IV-TR). Individuals diagnosed withOppositional Defiant Disorder tend to lose their temper, argue with adults, actively defyrules set by adults, are spiteful, blame others for his or her mistakes, and show persistentstubbornness, resistance to direction , and an unwillingness to compromise, give in ornegotiate with adults or peers (DSM-IV-TR). Approximately half of children with Attention-Deficit/Hyperactivity Disorderalso have Oppositional Defiant Disorder or Conduct Disorder (DSM-IV-TR). Attention-deficit/Hyperactivity Disorder is a disruptive behavioral disorder in which the individualshows a persistent pattern of inattention and/or hyperactivity-impulsivity which results inimpairments at home and at school or work. This disruptive behavior must be presentbefore the age seven and there must be clear evidence of interference in the developmentof appropriate social, academic, or occupational functioning (DSM-IV-TR). Failure tocomplete tasks with detail and attention, difficulty to saying on tasks and being extremelydisorganized are indicators of inattention. Hyperactivity is evident when a child is unableto sit still and talks excessively. Signs of impulsivity include being impatient, 22
  23. 23. continuously interrupting and having difficulty waiting one’s turn (DSM-IV-TR). Thereare three subtypes of this disorder: Attention-Deficit/Hyperactivity Disorder: CombinedType (six symptoms of hyperactivity, six symptoms of inattention), Attention-Deficit/Hyperactivity disorder: Predominantly Inattentive (six or more symptoms of inattention,fewer symptoms of hyperactivity), and Attention-Deficit/Hyperactivity Disorder:Predominantly Hyperactivity –Impulsive Type (six or more symptoms of hyperactivity,fewer symptoms of inattention)(DSM-IV-TR). According to the DSM-IV-TR (2000) “The rates of co-occurrence of Attention-Deficit/Hyperactivity Disorder with these other Disruptive Behavior Disorders are higher than with other mental disorders, and this co-occurrence is more likely in the two subtypes marked by hyperactivity-impulsivity: Hyperactivity-Impulsive and Combined Type.” (pp. 88)Increased hyperactivity in childhood leads to increase in the likelihood of antisocialbehavior in adulthood (Freidenfelt & af Klinteberg, 2007). Oppositional Defiant Disorder co-morbid with Attention-Deficit/HyperactivityDisorder increases the risk for Antisocial Personality Disorder, indirectly by increasingrisk for early-onset and persistent Conduct Disorder. Yet, co-morbidity of Attention-Deficit/ Hyperactivity Disorder and Conduct Disorder increases risk for severe AntisocialPersonality Disorder in adulthood beyond what either disorder contributes independently.However, studies have shown on individuals diagnosed with Attention-Deficit/Hyperactivity Disorder and Oppositional Defiant Disorder independently fromConduct Disorder does not predict the development of Antisocial Personality over time 23
  24. 24. (Lahey, Loeber, Burke, Rathouz & McBurnett, 2002; Lahey, Loeber, Burke, &Applegate, 2005; Washburn, Romero, Welty, Abram, Teplin, & McClelland, 2007). ANTISOCIAL PERSONALITY DISORDER FEATURES The development of antisocial behavior continues from childhood intoadolescence and even into adulthood. The more frequent and diverse the childhoodantisocial acts are, the more likely the individual is to develop a life-long pattern ofantisocial behavior (Lynam, 1997). If intervention does not occur, one has a higherchance of becoming incarcerated. Approximately forty to seventy-five percent of prisoninmates have Antisocial Personality Disorder, although, not all individuals withAntisocial Personality Disorder are criminals (Hare, 1993; Widiger & Corbitt, 1995). To be diagnosed with Antisocial Personality Disorder, one must be at least 18years old and exhibit some symptoms of Conduct Disorder in adolescence (or in somecases childhood) (DSM-IV-TR). Individuals with Antisocial Personality Disorder fail toadhere to social norms with respect to being law-abiding citizens and tending to performacts repeatedly that are grounds for arrest (DSM-IV-TR). These acts can involvedestroying or vandalizing property, stealing, or physically hurting superiors (e.g., a boss)and/or animals. These individuals also tend to be deceitful and manipulative in order togain personal profit or pleasure (such as to obtain money, sex, or power)(DSM-IV-TR).Individuals diagnosed with Antisocial Personality Disorder are predisposed to beimpulsive and disregard planning for future consequences, which can lead to changes injobs, residences, and interpersonal relationships (DSM-IV-TR). Many individuals withAntisocial Personality Disorder are extremely aggressive and irritable and, therefore, getinto physical fights or even in some cases commit acts of physical assault (i.e., spousal 24
  25. 25. and child abuse). Individuals with Antisocial Personality Disorder may engage in sexualbehavior or substance use that has a high risk for harmful consequence [i.e. HIV] (DSM-IV-TR). Individuals diagnosed with Antisocial Personality Disorder are also characterizedas consistently and extremely irresponsible (DSM-IV-TR). They may showirresponsibility at work by repeated absences from work or by abandoning jobs. Theymay show financial irresponsibility by failing to provide child support or not payingincome taxes. These individuals with Antisocial Personality Disorder tend to show littleremorse when it comes the consequences for their actions. According to the DSM-IV-TR(2000) “They may be indifferent to, or provide a superficial rationalization for, havinghurt, mistreated, or stolen from someone. They may blame their victim for being foolish,helpless, or deserving their fate.” (pp. 702) Individuals with Antisocial PersonalityDisorder tend to be substance abusers (Messina, Farabee, & Rawson, 2003). and haveother mental disorder, such as anxiety disorders, mood disorders, pathological gambling,or impulse control disorders, as well as somatization disorders (DSM-IV-TR). Interpersonally, individuals with Antisocial Personality Disorder often comeacross as arrogant with a grandiose sense of self-worth. They tend to be callous, whichmakes them unable to form strong emotional bonds with others. They tend to be conningand manipulative through lying. These individuals tend to be irresponsible for not onlythemselves but for their children as well (i.e., malnutrition, failure to monitor children).These interpersonal qualities affect not only their interpersonal relationships buteducational and occupational careers as well. 25
  26. 26. According to the DSM-IV-TR (2000) individuals with Antisocial PersonalityDisorder are more likely to “receive dishonorable discharges from the armed services, may fail to be self-supporting, may become impoverished, or even homeless, or may spend many years in penal institutions. Individuals with Antisocial personality Disorder are more likely than people in the general population to die prematurely by violent means (e.g., suicide, accidents, and homicides).” (pp. 703) Antisocial Personality Disorder runs a persistent course, but may become lessevident in an individual’s fourth decade of life (DSM-IV-TR). Though this appears to bethe case, individuals diagnosed with this disorder are more likely to spend many years inpenal institutions, be homeless or become impoverished, and fail to be self-supporting(DSM-IV-TR). Individuals diagnosed with Antisocial Personality Disorder are also morelikely to die prematurely through violence (DSM-IV-TR). TREATMENT SUGGESTIONS Individuals with Antisocial Personality Disorder usually seek treatment due to acourt order and, therefore, are extremely difficult to treat, as they have not soughttreatment voluntarily. For psychotherapy to work, one must want to change. Being forcedinto therapy, one might miss appointments, not complete homework assignments ordevalue the therapist. However, knowing that Antisocial Personality Disorder is enduringand develops over a lifespan, we can treat the antisocial behaviors early. Tokeneconomies and family therapy, as well as integrative approaches andpsychopharmaceuticals, can help treat antisocial symptoms. Early intervention studies 26
  27. 27. and research demonstrate that that the development of Antisocial Personality Disordercan be diminished. Research has shown that early intervention is an effective way to reduceproblematic behaviors, especially in school settings (Farrell & Meyer, 1997; Flannery,2000). A neglected child can learn proper social skills and feel more competent in socialsituations by improving adult-child relations and through different teaching techniques(Flannery, 2000; McDevitt & Ormrob, 2007). Teaching children social skills can preventpeer rejection. Flannery (2000) saw a decrease in aggressive behavior when teachersencouraged and rewarded prosocial behavior, which in turn decreased antisocialbehaviors. Teachers who promote and develop structured extracurricular activities afterschool programs or summer school activities can also decrease antisocial behaviors (Zill,Nord & Loomis, 1995; McDevitt & Ormrob, 2007). Academically oriented programspromote positive feelings about school, improve classroom behavior, greater conflictresolution skills, improve grades and achievement test scores and increase schoolattendance in children (McDevitt & Ormrob, 2007). This may also influence with whomthe child associates, which indirectly promotes greater investment in school (Zill, Nord &Loomis, 1995). Contingency management theory suggests that human behavior is controlled byits consequences (Harvey, Luiselli & Wong, 2009). If one’s response is positivelyreinforced, one is more likely to repeat that behavior. If one’s response is punished, it isnot likely to happen again (Domjan, 2006). Therefore, contingency management theoristswould suggest that antisocial behavior was constantly positively reinforced early on inlife, and thus it will continue on into adulthood. Token economies target maladaptive 27
  28. 28. behavior by directly reinforcing positive behaviors with tokens and punishingmaladaptive behaviors (i.e., taking tokens away) (Harvey, Luiselli & Wong, 2009). Thistype of treatment can be used to target maladaptive behaviors such as aggression andanger (Flannery, 2000). Because most antisocial individuals are likely to be incarceratedor in substance abuse programs, which are both controlled environments, the use of tokeneconomies for treatment will be more effective and efficient for behavior change overtime (Harvey, Luiselli & Wong, 2009). Messina, Farabee & Rawson (2003) foundcontingency management forms of therapy treatment were more effective for AntisocialPersonality Disorder (as well as Antisocial Personality Disorder individuals withsubstance abuse problems) than “talk therapies” (i.e., Psychodynamic) and showed lessrelapse rate. Psychopharmaceuticals, drugs used in the treatment of mental health disorders,can also be helpful for treating symptoms of Antisocial Personality Disorder.Anticonvulsants: phenytoin, carbamazepine, and valproate in particular have been foundto be effective in treating impulsive aggression in Antisocial Personality Disorderpatients (Stanford et al., 2005). Cambell, Gonzales, & Silva (1992), Mattes (1990), andStewart, Myers, Burket, & Lyles (1990) found that beta blockers have also proven toreduce impulsive symptoms found in Conduct Disorder, Attention-Deficit/HyperactivityDisorder and Explosive Disorder. Propranolol and Pindolo are common beta blockersused and tend to have very few side effects (Breiling, Maser, & Stoff, 1997). Because most individuals with Antisocial Personality Disorder had family issuesthroughout life, family therapy is a way to intervene early. Family therapy is used toimprove parent-child communication (Knox, Care, Kim, & Marciniak, 2004) and can 28
  29. 29. also reduce problematic behaviors (Connell, Dishion, Yasui, & Kavanagh, 2007;Breiling, Maser, & Stoff, 1997). Connell, Dishion, Yasui, & Kavanagh (2007) foundincreasing parents’ degree of engagement and teaching them proper monitoring skillsdecreased the onset of antisocial behaviors. Increase in parent monitoring also decreasedantisocial peer involvement. In addition, increased school involvement from a parentdecreased involvement in antisocial behaviors(Connell, Dishion, Yasui, & Kavanagh,2007). Using Integrative Psychotherapy, combining Cognitive– Behavioral andrelaxation techniques as well as Psychodynamic techniques, was also found effective intreating symptoms of violence and antisocial behavior in Antisocial Personality Disorder(Krampen, 2009). Therefore it can be a helpful way to intervene with early antisocialchildren and adolescents. Cognitive behavioral therapy seeks to change behavior andthinking patterns that contribute to an individual’s problems (Owen, 2009; Johnstone &Dallos, 2006). Cognitive-behavioral techniques could help individuals decrease antisocialbehavior and reduce anger by teaching individuals skills such as problem identification,problem solving, decision-making, relaxation techniques and negotiation. Impulse controland focusing on outcome expectancies can help focus an individual to reduce aggressiveand impulsive tendencies (Breiling, Maser, & Stoff, 1997, Johnstone & Dallos, 2006;Krampen, 2009). Adler’s (1964) psychodynamic approach posits that individuals strive to besuperior. They are motivated by inevitable feeling of inferiority to become superior inone’s environment. One develops lifestyles as means of determining how one lives. Apsychodynamic theorist, such as Adler, would view an Antisocial Personality Disorder 29
  30. 30. individual as someone who lived by maladaptive lifestyle of wanting to attain power asmeans of avoiding an inferiority complex of feeling powerless and helpless in one’sability control ones environment. This particular approach involves analyzing cognitivelifestyles (i.e., “nobody cares”) in order to help the client become more fully conscious ofhow he or she is directing his or her own life towards a destructive style of life (Adler,1964; Maker & Buttenheim, 2000; Johnstone & Dallos, 2006). The therapeutic relationship in psychodynamic theory is extremely important inthe change process. A therapist’s willingness to relate as a genuine equal increases thelikelihood that the client’s ability to actively contribute to finding solutions to seriousproblems (Luborsky, 1984). By a therapist actively listening and being empathetic, anindividual with Antisocial Personality Disorder might replace his or her old style ofthinking and see the world as a more caring and understanding place (Breiling, Maser, &Stoff, 1997). A psychodynamic approach can also be helpful in treating past feelings ofneglect and help abandon past protective strategies. Krampen (2009) found long-termoutcomes after long-term integrative psychotherapy ended. Symptoms of acting out andviolent behaviors decreased, with only a few relapses. However, Krampen’s workappears to only work in controlled (in-patient) settings (Krampen, 2009). There are many techniques and tools in which we can help treat the early onsetdevelopment of Antisocial Personality Disorder. Whether or not we choose to medicate,intervene in school settings or family therapy, or even try to treat individually throughpsychotherapy or counseling, there needs to be more research on how to prevent the onsetof Antisocial Personality Disorder. 30
  31. 31. CONCLUSION Antisocial Personality Disorder has enduring symptoms that begin to exhibitduring infancy and through adulthood. A difficult temperament and disengaged,neglectful parenting influence a child’s development to future antisocial behaviors.Environmental factors in one’s home, school (especially peer involvement) andcommunity contribute to how one perceives and becomes involved in the world.Unsupervised antisocial peer groups and disengagement in school develops into adultantisocial behaviors such as substance use, stealing and other delinquent acts. Therefore,there needs to be new ways to intervene with these children and adolescents before thecondition limits their lives. Children with Oppositional Defiant Disorder or Attention-Deficit/Hyperactivity Disorder and children or adolescents with Conduct Disorder needto be treated before it turns into a life-long battle with society and consequently, the law.Future research is important to find effective and long-lasting psychotherapeutic ways totreat children and adolescents who exhibit symptoms and to treat adults diagnosed withAntisocial Personality Disorder in order to help them live their lives in a more sociallyresponsible way. 31
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