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Preventing Antisocial Personality Disorder

March 27, 2014

Preventing Antisocial Personality Disorder

  1. Joel Yager, MD

An evidence-based program directed at parents of young, highly disturbed children reduces antisocial behavior and traits several years later.

  1. Joel Yager, MD

Preventing the development of antisocial personality disorder before it fully develops is of considerable clinical interest, particularly because effective interventions for this disorder in adolescents and adults are lacking. To assess the effectiveness of an early prevention program, researchers conducted follow-ups of two controlled trials.

One study involved 120 children, aged 3 to 7 years, whose antisocial behaviors averaged above the 97th percentile and who were initially referred to a clinic by family physicians. Parents received 13 to 16 weeks of evidence-based parent-training group programming (mean sessions attended, 74%), waiting list, or treatment as usual. At an average of 8 years later, 78% of children were reassessed (mean age, 13).

The other study involved 109 students screened at eight schools whose behavior severity was above the 82nd percentile. Parents received the same program (mean sessions attended, 55%) or were offered a telephone helpline. At an average of 6 years later, 83% of children were reassessed (mean age, 11).

At follow-up, the clinic-referred program was associated with medium-to-large effects for improved oppositional-defiant symptoms, fewer antisocial traits, fewer parent-reported behavior problems, better reading, and (on some measures) improved parenting. However, teacher reports and adolescent self-reports of improvement were weaker or nonsignificant. In the school-screened group, no lasting effects were seen on any measure.

Comment

Initially, compared with school-screened subjects, clinic-referred children were more symptomatic, and their parents were more engaged in treatment, perhaps helping to account for differences in outcomes. These studies require additional follow-up because young teens remain at considerable risk for further antisocial behavior. Additionally, examining the potential impact of brain vulnerabilities on antisocial personality disorder would be important. Still, the effectiveness of the clinic-based intervention for these highly symptomatic children is encouraging.

  • Disclosures for Joel Yager, MD at time of publication Editorial boards Bulletin of the Menninger Clinic; Eating Disorders: Journal of Treatment and Research; Eating Disorders Review (Editor-in-Chief); Harvard Review of Psychiatry; International Journal of Eating Disorders; UpToDate Leadership positions in professional societies American Psychiatric Association (Chair, Steering Committee and Executive Committee on Practice Guidelines; Co-Chair, DSM5 Clinical and Public Health Committee; Chair, Council on Research and Quality Care)

Citation(s):

Reader Comments (2)

gamal boutros Physician, Neurology, NE TN neurology

the initial impression of improvement by the parent was not objective,they just want to fell they did their part--what counts is teacher,student opinion which did not show improvement--ii am afraid ,the studies really did not prove positive results--need much more in depth program,with additional assessments

ARNOLD KNEPFER

Interesting but hare-brained.

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