Antisocial Personality Disorder and Alcohol & Drug Involvement during Childhood & Adolescence.

Antisocial Personality Disorder andAlcohol & Drug Involvement during Childhood &

Adolescence

Child and Adolescent Psychopathology

Historical Perspective

Antisocial personality is innate (Hobbes)

Antisocial personality is learned (Locke & Rousseau)

Both perspectives are probably valid

Multiple pathways to antisocial personality (equifinality)

Divergent outcomes for youth (multifinality)

Antisocial Personality Disorder

Definitions

Activities that violate societal norms, laws, or the rights of others Criminal acts – theft, fraud, assault, DUI, drug use Noncriminal acts – deceitfulness, irresponsibility

Person must be 18 or older; otherwise, consider Conduct Disorder (CD)

Antisocial behavior began before age 15

Sociopathy – old name for antisocial personality


Definitions (cont’d) Psychopathy – subtype of

Antisocial Personality Disorder (APD)Personality traits – callousness, shallow

affect, lack of interpersonal connectedness, superficial charm

Chronic antisocial behaviorAssessed using the Psychopathy

Checklist-Revised (PCL-R; Hare) 80% of incarcerated persons meet

ASPD criteria, but ASPD represents aheterogeneous group (which includespsychopathy)


Prevalence 3.63% lifetime in an epidemiological sample Three times greater risk among men

Risk factors Childhood conduct problems – 54% of CD boys

were diagnosed with ASPD at age 18 or 19Minor physical anomalies (MPAs) – low-seated

ears, adherent ear lobes, and furrowed tongues (prenatal/perinatal trauma)

Low autonomic arousalPersistent antisocial behavior has a genetic

component


Developmental progression Low parental involvement in middle childhood

is associated with persistent antisocial behavior in adulthood

Peer rejection in childhood predicts ASPD because these children adapt by forming friendships that support deviance

Combination of well-organized peer interactions and high levels of deviancy training predict ASPD (e.g., gangs)

Substance abuse facilitates development of ASPD



Protective factors

Age (> 45) Attachment to social

institutions (marriage, employment)

Decreased impulsivity and sensation seeking

Parenthood and increased family responsibilities

Academic success

Etiological formulations

Individual differences

Psychopathy is primarily biological or temperamental, present at or near birth, persists throughout life course

Early starters versus late starters

o Early starters – coercive parenting, school failure, early antisocial behavior

o Late starters – poor parental monitoring, oppositionality, deviant peer involvement starting in adolescence


Environmental and relationship factorsCoercive parenting – intrusive demands,

compliance refusals, escalating distress, negative affect, withdrawal of demand

Peer influenceso Antisocial behavior interferes with positive peer

relationso Children act as models and a source of

reinforcement for this behavior


o Opportunity for this behavior within networks of deviant peers

Social bonding – job stability and marital attachment predict lower rates of crime and deviance

Transactional process – bidirectional effects between individuals and their social environments

Comorbidity

ADHD – 30-50% meet criteria for ODD or CD

Substance abuse – ASPD men three times as likely to abuse alcohol and five times as likely to abuse drugs; ASPD women 10-13 times as likely to abuse alcohol and 12 times as likely to abuse drugs

Anxiety disorders and Depression


Cultural considerations – amplified by SES and neighborhood risk factorsPhysical spanking less problematic in African

American communityAfrican American children receive more

negative feedback for school behavior and performance, more likely held back and placed in special-education

African Americans have higher arrest and re-arrest rates despite similar rates of antisocial behavior to European Americans


Important moderators of antisocial behavior

Self-regulation – high effortful control Less vulnerable to deviant peer influence Need for cultural rituals and daily routine and chores

Biosocial factors – gene-environment interactions

Sociocultural factors – evaluate systems-level policies

Improve behavior-management practices of teachers

Improve academic instruction


Prevalence 12th grade – 80% have tried alcohol Adolescents drink half as often as adults but

consume 4.9 drinks per occasion compared to 2.6 drink per occasion for adults

10% of 4th graders and 29% of 6th graders have had more than a sip of alcohol

Greatest escalation occurs between ages 12 and 15

12th grade – 60% have tried nicotine 12th grade – 50% have tried marijuana Problematic substance involvement predicts

truancy, suspensions, and expulsions

Prevalence of Alcohol & Drug Involvement During Childhood &

Adolescence

Abuse and dependence: Criteria and diagnostic issues (p. 410) Psychological dependence – subjective feeling

of needing the substance to function adequately

Physical dependence – physiological and psychological adaptations

Prevalence of Alcohol & Drug Involvement During Childhood &

Adolescence

Tolerance – need to ingest larger amounts to achieve same effect

Withdrawal – consumption ends abruptly

Abuse and dependence are non-overlapping diagnoses

Diagnostic criteria and issues (cont’d)

Withdrawal and physiological dependence less prevalent but cognitive and affective withdrawal more prevalent among children and

adolescents

Criteria might mot be sensitive enough to identify adolescents with substance use problems

Prevalence of Alcohol & Drug Involvement During Childhood & Adolescence

Risk factors – nested in certain contexts

Temperament – high sensation seeking, behavioral disinhibition, impulsivity, aggression, lack of behavioral control, negative affectivity, antisocial patterns, trait anxiety, anxiety sensitivity

Childhood behavior problems – hyperactivity, aggression, CD, comorbid psychiatric disorders (self-medicating; 60%)

Externalizing disorders – CD, ADHD, ODD Internalizing disorders – depression, anxiety


Alcohol and drug expectancies Peer and parental modeling and media exposure

produces more expected global positive effects, increased social facilitation, enhancement of cognitive and motor performance

Mediational model = family history of SUD expectancies SUD


Age of onset – the earlier the age, the worse the prognosis

Family influences Family history = four-to-nine-

fold risk of SUDs in males, two-to-three-fold risk in females

Parental deviance and psychopathology

Peers Greater access to substances Adoption of beliefs and values consistent with drug-use

lifestyle Mediating variable between family history and conflict

and SUD Stress

Moderator of economic adversity on development of SUD Bidirectional association (physical, academic, legal, peer,

familial, emotional) Neurocognitive functioning – poor executive

functioning, which causes reduced ability to appreciate abuse consequences

Sleep difficulties – between ages 3 and 5


Protective factors – temperament, high intelligence, social support, involvement with conventional peers, religiosity, low-risk taking, competence skills, and psychological wellness.


Developmental pathways to Substance Use Disorders Deviance – prone pathway

Reduced ability to self-regulate emotional distress and inhibit behaviors

Emotional distress caused by family history, ineffective parenting

Negative affectivity pathway – deficient regulation of negative affect Temperamental negative emotionality Environmental stressors

Enhanced reinforcement pathway – less sensitive to substances’ effectsGenetically influencedBased on physiological response differences to SUD effects


Sex, race, and ethnic differences

Few sex differences

Native Americans most prone; Asian Americans least prone


Developmentally dependent effects Adolescent animals less sensitive to alcohol’s

adverse effects than adults Adolescent animal exposure causes greater

social facilitation than adults Adolescents have greater long-term behavioral

and brain impairment than adults Adolescent animals have more tolerance,

craving, and motor impairment than adults Adolescent frontal brain regions that control

executive planning and reasoning processes continue to mature into adulthood


Antisocial Personality Disorder and Alcohol & Drug Involvement during Childhood & Adolescence.

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