A research study done in England by Scott and colleagues was reported in the American Journal of Psychiatry 171:6, June 2014. In this study they attempted to find out if an intervention in children, ages 3 to 7 with conduct disorder would have a lower incidence of antisocial behaviors as teenagers. Conduct disorder is the childhood version of antisocial behavior seen in adults and is a necessary precursor.
The intervention consisted of a training program for the children's parents that taught them skills for reducing such behavior in their children. The program was provided by trained therapists using the basic "Incredible Years" videotape program, which has been extensively researched. The videos show right and wrong ways to interact with such children. In addition, the parents were asked to read with their children since it has been shown that literacy correlates with life success and less antisocial behaviors.
These children were followed for up to 10 years. The children whose parents had this training had a lower incidence of defiant behavior, antisocial personality traits, and better reading, and the parents showed better parenting. The parents demonstrated more warmth and did more supervision of their adolescent children.
This was an important study since "10% of children with antisocial behavior will develop antisocial personality disorder in adulthood" (all quotes are from the article noted at the beginning of this blog). As the authors point out, the treatment of antisocial personality disorder is very difficult so prevention is clearly preferred. This study demonstrated that prevention is possible, at least in children with conduct disorder bad enough to be referred to specialists by their family doctor.
The authors also describe the features of adult antisocial personality disorder, which demonstrate why prevention matters so much. Such individuals account for a disproportional amount of crime. The disorder is characterized by two sets of problems. First, they "persistently engage in antisocial behavior" such as "physical aggression, lying, rule-breaking, and crime." Second, they demonstrate "pervasive antisocial character traits across three domains": 1. "Emotional coldness, with callous-unemotional indifference to the distress of others;" 2. "Impulsiveness, including irresponsibility and irritability;" and 3. "Interpersonal problems, including manipulativeness and an inability to form enduring relationships."
The authors also note the interesting fact that studies show that such individuals have a decreased volume in parts of the gray matter of the brain that are involved in "empathic processing and moral reasoning." There is evidence that this disorder has a significant genetic component. Thus, it is all the more interesting that the program used in this study had the beneficial effects that were seen. Nurture can often provide some compensation for nature (genes in this case).
The "Incredible Years Program" is available in parts of the US. For example, it is available through the EPISCENTER (a collaborative effort between the Pennsylvania Commission on Crime and Delinquency and The Pennsylvania State University). You may be able to find a center near you via the internet.
Peter M. Hartmann, MD
