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Antisocial Children Hurt Parents and Society

Study says early intervention is crucial

MONDAY, July 30, 2001 (HealthDayNews) -- Antisocial children are more than an emotional drain on their parents -- they cost society up to 10 times more than children without behavior problems, and they're more likely to wind up criminals, says a new study.

But the British researchers who present a disturbing portrait of conduct disorder in the July 28 issue of the British Medical Journal also suggest a solution that teaches parents to nip problematic behavior in the bud.

The researchers say persistent conduct disorder is the most common psychiatric problem of childhood and adolescence, affecting 7 percent of boys and 3 percent of girls. The disorder often is complicated by attention deficit-hyperactivity disorder and later by substance abuse and criminal behavior.

Dr. Stephen Scott, a pediatrician who studies behavioral problems in children, led the research. He says it's not difficult for parents and teachers to recognize which children have this problem.

"The teachers will say they're the one at the front, kicking and spitting and stabbing other people with their pencils," says Scott.

The disorder can leave a child with severe social and educational disadvantages. Studies have shown that 40 percent of 8-year-olds with conduct disorder are convicted of crimes, such as theft, vandalism and assault, when they become adolescents.

Scott followed 142 London children, who were 10 in 1970, into their late 20s.

Based on the children's performance on emotional, behavioral and learning tests, they were put in one of three groups: no problem, conduct problem or conduct disorder.

The researchers found that by the time the subjects reached age 28, the value of public services expended on an individual in the first group was $10,600, while a child with conduct problems cost about $34,700. But for a child with conduct disorder, the cost skyrocketed to $99,900, or nearly 10 times more than for a child without behavior problems.

Studies in the United States have found the crimes committed by the average juvenile delinquent cost between $80,000 and $325,000. That rises to $1.2 million for a typical adult criminal aged 19 to 24.

After working for years in a clinical setting with children, Scott says he concluded conventional therapies for conduct problems weren't working. While traveling in the United States, he looked into a therapy developed at the University of Washington Parenting Research Clinic.

Using videotaped examples, the approach encourages parents to reward children for positive behavior that would otherwise go unnoticed. This includes praise for simple things, such as playing quietly or eating all their food. "They're getting instruction and attention about when they're behaving well," says Scott.

The program also deals with effective discipline, trying to show children they won't get attention for misbehaving and there are consequences to bad behavior. "What these kids have got to learn is how to act socially and responsibly," says Scott.

Therapists deal solely with parents, teaching moms and dads new ways to deal with children who have learned to gain attention by misbehaving. Parents also get praised for making the effort, and Scott says some parents describe feeling more in control of their life once they adopt the new parenting tools.

Back in England, Scott started a trial on 141 children, ages 3 to 8, with antisocial behavior. Ninety were included in the program, while 51 children on a waiting list were used as a control. They eventually received help, too.

Observing how parents and children interacted and using information from interviews five to seven months after the lessons, Scott says parents in the group that received treatment were using praise three times more than criticism and inappropriate comments compared with those on the waiting list.

Moreover, most children in the intervention group had fewer emotional and behavioral problems and were less hyperactive. However, about 21 percent of the children failed to improve substantially.

Though most children in the study came from poor or disadvantaged families, Scott says the technique has worked with antisocial children from privileged families. He says most of the therapy involved working with mothers, and more needs to be done to get fathers involved in the program.

H. Russell Searight, director of behavioral medicine at the Forest Park Hospital Family Practice Residency Program in St. Louis, Miss., says if intervention doesn't occur fairly early, conduct disorder has a poor prognosis.

"At a psychological level, these children are not distressed about their behavior. … They tend to have little insight into their condition," he says.

The best solution are therapies that work with the parents of the problematic child, says Searight.

"The target is really not so much the child. It's working with the parents," he says. However, that approach can have its own challenges. "One of the prime risk factors for it is having parents who have had problems with the law. They may not have the internal resources or just be available enough to intervene."

Another positive intervention is for parents to involve their children with a positive peer group. Searight encourages parents of children at risk for conduct disorder to enroll their kids in "pro-social" activities, such as sports or scouting.

But most important, parents need to intervene early, a conclusion shared by Scott.

"Once you get to that stage when they're out-of-control adolescents, there's very little you can do," says Scott. "[It's really important to] nip it in the bud and catch them young."

What To Do: For more information on conduct disorder, check Internet Mental Health, the Center for Mental Health Services or the American Academy of Child & Adolescent Psychiatry.

SOURCES: Interviews with Stephen Scott, M.D., senior lecturer, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London; H. Russell Searight, Ph.D., director of Behavioral Medicine, Forest Park Hospital Family Practice Residency Program, St. Louis, Miss.; July 28, 2001, British Medical Journal
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