Veneta Callpani| Department of Applied Psychology, New York University| Human Growth and Development
The study of antisocial, criminal and aggressive behaviors has been long researched given that these behaviors often operate at a high cost to society (Frick et al., 2009). Antisocial behaviors (ASB) in children and adolescents include aggressive acts, theft, lying and a number of other symptoms that violate social rules (Kazdin et al., 1987). These behaviors have been studied from different perspectives such as anthropological, sociological, evolutionary, psychological and biological perspectives (Frick et al., 2009). However, there is limited research from a developmental psychopathology and neurodevelopmental perspective. Some level of antisocial and aggressive behavior is normal in children and adolescence (Frick et al., 2009), especially while they’re going through adolescence and identity formation (Berger, 2020). But when these behaviors persist, they might have a profound effect on their brain development, cognitive skills and social interactions. This is an issue that also affects parents who might get frustrated, angry and feeling helpless when facing their children’s behavior.
There are many challenges in finding the right treatment for this ASB, and this is mostly due to the heterogeneity of the behaviors. Sometimes children/adolescents who perform one type of antisocial behavior are likely to perform others as well and then this becomes a syndrome: a conduct disorder (Kazdin, 1987). In order to find a treatment or intervention that helps both the children and the parents, it is necessary to look into the mechanisms of ASB from a neurodevelopmental perspective and also know more about risk factors, and parenting. Current clinical practice tends not to acknowledge the individual neuropsychological risk factors or target them for intervention (vanGoozen et al., 2022), therefore the aim of this study is to review the literature and find possible solutions and future considerations for treatment options.
Keyword searching of the Google Scholar articles included two groups. First group related to child behavior and included terms: antisocial behavior, problems, externalizing, aggression, child mental health, child neurodevelopment. The second group was related to interventions and parenting. This included: parent training, CBT for antisocial behavior, interventions for antisocial behavior, etiology and prevention.
Results and Discussion
Antisocial Behavior and Antisocial Behavior Subtypes
Antisocial behavior, which includes aggressive acts, thefts, lying etc., has a relatively high prevalence and clinical referral rates (Kazdin et al., 1987). Bullying is also considered part of conducting problems, however there is limited research on this topic (Golmaryami et al., 2015). The clinical significance of antisocial behavior is related to the high prevalence, stability and poor prognosis over the course of development and their continuity within families across generations (Kazdin et al., 1987). Because of its heterogeneity, a multiple level analysis (e.g., neurological, cognitive, social) is important. One new perspective added to the multiple level analysis is the neurodevelopment to understand the psychopathological conditions. However, one broad question that is raised when taking a developmental psychopathology perspective on ASB is whether or not this should be considered a psychopathological condition, psychiatric or mental illness (Frick et al., 2009). While the psychopathological approach cannot completely address these questions, because it depends on how the “mental disorder” is defined, it can help to define various causal pathways that might lead to antisocial behavior (Frick et al., 2009). When trying to classify ASB, one can rely on behavior differences, personality traits or neurodevelopmental differences, which are caused by many different factors. Therefore, Frick et al., (2009) emphasizes the concept of equifinality and multifinality when talking about the ASB subgroups. A number of reviews described from Frick et., (2009) have shown a distinction based on the different patterns of the onset: childhood onset versus adolescent onset; showing that the childhood onset group is more likely to show aggressive behavior in childhood, adolescence and most likely to continue and show antisocial and criminal behaviors into adulthood. So, the childhood and adolescence subtypes of ASB show different patterns of the onset but also the trajectory over time.
Another subgroup division is based in Callous-unemotional traits, which supports both the equifinality and multifinality. Equifinality (equal in final form) proposes that one symptom can result from many different causes; versus multifinality is when one cause can have many final manifestations (Berger, 2020, p.948). The distinction is based on the presence of a callous and unemotional interpersonal style characterized by a lack of guilt and empathy and callous use of others (Frick et al., 2009). Youth with childhood onset of ABS tend to score higher on measures of CU traits than those who show adolescent onset (Frick et al., 2009). Furthermore, youth with CU traits (fearless, thrill seeking) show more severe and pervasive patterns of aggression, versus youth without CU traits tend to show less aggression overall, and when they do show it is largely reactive in nature (Frick et al., 2009). When it comes to multifinality, research has proposed that the same temperament of fearlessness can lead some children to become “bold” and others “mean” depending on presence of other traits or socializing environments (Frick et al., 2009).
Another subtype division is based on the development of a conduct disorder, which includes children and adolescents who show severe and impairing levels of antisocial behavior but do not display the CU traits which suggests that different developmental processes may be underlying their aggressive and antisocial behavior. Frick et al., (2003) conducted research where they predicted that conduct problems, irrespective of the presence of CU traits, would be associated with measures of emotional and behavioral dysregulation; thus, the main effect of conduct problem would not be modified by the presence or absence of CU traits. The total number of participants was 100 and they were separated into 5 groups: control (n=25), conduct problems only (n=23), Callous-unemotional (CU) only (n=25) and combined (n=25). The mean age of the participants was 12.4; the mean SES (Duncan’s socioeconomic index) was 46.6 and mean K-BIT (Composite Index from the Kaufman Brief Intelligence Test) was 104.8. For the independent variables an antisocial process screening device (APSD) was used for screening. APSD is a 20-item behavior rating scale that was completed by each child’s parent and teacher (Frank et al., 2003). For the dependent variables multiple measures were taken such as: thrill and adventure seeking, reward dominance computer task, emotional lexical decision task, behavioral assessment system for children, diagnostic interview schedule for children -version 4, and why kids do things (an instrument which is a hypothetical situation procedure used to assess tendencies to attribute to attribute hostile intent and to react angrily in social situations) (Frank et al., 2003). In correlations with demographic characteristics, of significance was the emotional reactivity to peer provocation which tended to show negative correlation with age, SES, and intelligence. In the summary figure representation, it was shown that both groups of children with conduct problems scored higher in emotional and behavioral dysregulation (i.e., measures of anxiety and impulsivity-hyperactivity). In contrast, only children with both conduct problems and CU traits showed low behavioral inhibition (distress in new situations). Their findings showed that children with conduct problems show evidence of emotional and behavioral dysregulations, regardless of the presence or absence of CU traits. However, the dysregulation was more severe in children with both conduct problems and CU traits (Frank et al., 2003).
There were some limitations of the study, such as methodological limitations; the sample was not clinically-referred, and that diagnoses were not clinical, rather based on parents and teacher ratings. Nevertheless, the study suggests the importance of considering multiple casual pathways in development of severe antisocial and aggressive behavior. So far the treatments for conduct problems have been focusing on processes involved in children without CU traits; but future interventions can become more individualized and also target the processes involved in children with CU traits such as enhancing empathic responses (Frank et al., 2003).
Several studies have shown that the conduct problems and aggression vary in the context of neighborhoods (Rossa et al., 2005). Exploring this relationship, Rossa et al., (2005) identified three variables that might be influenced by the neighborhood’s quality: child stressful experiences, association with deviant peers, and conflict within parent- child relationship. The purpose of the study is to determine whether these three variables mediate the relation between neighborhood risk and child externalizing behavior for a sample of children from predominantly low-income. Therefore, they conducted a study and measured different variables such as demographic variables, neighborhood risk, criminal events, neighborhood quality, life events, delinquent peers, parent-child conflict, child externalizing behavior and maternal depression. For the child’s externalizing behavior, mothers completed the Child Behavior Checklist (CBCL) and children completed the Youth Self-Report to assess child mental health (Rossa et al., 2005). The study confirmed that children in neighborhoods that mothers perceived as high risk experienced more stressful events than children in lower risk neighborhoods. In addition, children in lower quality neighborhoods reported greater association with deviant peers and more parent-child conflict than children in better quality neighborhoods (Rossa et al., 2005). These results confirm that high risk neighborhoods have the potential to affect children through multiple systems: individual, family and peer. From their study they found evidence that the relationship of neighborhood risk to child externalizing behavior differed by whether the mother was born in the U.S or Mexico. The difference between culture, values and beliefs, lifestyle of families in Mexico and the United States might alter the way neighborhood risk influences children (Rosse et al., 2005). An interesting finding was that the parent-child conflict was not related to child externalizing behavior in Mexican families, but it was significant for families of U.S born mothers. One explanation for this is that the conflict takes place in a safe, strong, and supporting atmosphere when it comes to traditional Mexican homes (Rosse et al., 2005). Future research is needed to better understand this, but an important point is that research should consider cultural background when studying the relationship between neighborhood risk and children’s adjustment. Some limitations of this study: small sample and being cross-sectional study. Longitudinal studies of neighborhood influences on development would provide information about developmental and causal processes that cross-sectional studies cannot (Rosse et al., 2005).
The significance of antisocial behaviors is heightened by the absence of a clear and effective treatment. The prevalence of childhood mental health in the US is estimated approximately 18% (Tully & Hunt, 2015). Research from the past 30 years has shown that parenting interventions based on social learning and cognitive-behavior theory have been effective, however there is a low participation rate due to the length of interventions (Tully & Hunt 2015). Given the need to try out some other type of intervention that might work, Tully & Hunt (2015) conducted a systematic review to assess the evidence for the efficacy and effectiveness of brief (<8 sessions) individual or group parenting interventions for reducing child externalizing behavior problems. They reviewed 64 articles and only 9 of them met the criteria for brief parenting intervention. This indicates that brief parenting intervention is a topic that requires more research. However, the findings of these articles suggested that brief parenting interventions may be effective in reducing child externalizing behaviors and dysfunctional parenting (Tully &Hunt, 2015). A key limitation to this study was the inability to conduct a meta-analysis due to heterogeneity of included study.
Parent management training (PMT) and cognitive-behavioral problem-solving skills training (PSST) are two other treatment approaches. These two approaches are applied separately, however, Kazdin et al., 1987 conducted a study to investigate the effectiveness of using these two approaches combined. The total subjects that participated in the study consisted of 40 children (9 girls and 31 boys) and their parent(s). The children were all in patient of a psychiatric facility admitted for acute disorders including highly aggressive and destructive behavior, suicidal or homicidal ideation, and detreating family conditions. Posttreatment assessment was conducted 1 month after the final treatment and one-year follow up. The results showed a significant improvement in child behavior such as decreased aggression, behavior problems and increase in social and school performance. Limitations of this study include biased assessments because the results relied upon parent and teacher ratings. The absence of direct observation in the home and at school delimits interpretation of the results ( Kazdin et al., 1987).
Other treatments such as group therapy, individual therapy, pharmacotherapy are used but there is limited research in the effective use of different techniques (Kazdin, 1987).
Conclusion and Future Research
Many characteristics of conduct behavior, or antisocial behavior present major challenges identifying an effective treatment. There is limited research of the mechanism or the cause of the antisocial behaviors especially in a neurodevelopmental aspect of it. Heterogeneity of behaviors is what makes this a very difficult study. Thus, treatment might focus on one specific conduct problem, leaving another part that might be essential in children’s success (Kazdin, 1987). There is limited evidence to show that the therapeutic techniques, as discussed, effectively alter antisocial behavior in children (Kazdin, 1987).
Future research is needed to create new models and ways to study children’s antisocial behaviors both at an individual level and community level. Workshops and training for both parents and teachers can also be helpful in identifying and better dealing with these problems. These children are the future of our society, therefore more research and more attention to this complicated but very important case will help them and the society to create a better future.
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