Temperament and personality as potential factors in the development and treatment of conduct disorders.

Temperament and personality as potential factors in the development and treatment of conduct disorders. Abstract The development of Conduct Disorder Conduct DisorderDefinitionConduct disorder (CD) is a behavioral and emotional disorder of childhood and adolescence. Children with conduct disorder act inappropriately, infringe on the rights of others, and violate the behavioral expectations of (CD) in children andadolescents is examined from the perspective of Hans Eysenck'sbiosocial theory Biosocial Theory is a theory in behavioral and social science that suggests the attribution of disorders of personality and conditions of mind to the reaction of biologically determined personality traits to environmental stimuli. of personality. The theory views personality as aproduct of the interaction of biologically based temperament sourcetraits and socialization socialization/so��cial��iza��tion/ (so?shal-i-za��shun) the process by which society integrates the individual and the individual learns to behave in socially acceptable ways. so��cial��i��za��tionn. experiences. Eysenck's antisocial antisocial/an��ti��so��cial/ (-so��sh'l)1. denoting behavior that violates the rights of others, societal mores, or the law.2. denoting the specific personality traits seen in antisocial personality disorder. behavior(ASB ASB AsbestosASB Arbeiter Samariter Bund (German medical help organisation)ASB Anti-Social BehaviourASB Accounting Standards Board (UK FRC)ASB Aarhus School of Business ) hypothesis about the development of antisocial behavior isdiscussed. Intervention suggestions for antisocial behavior based onEysenck's theory are presented. The possible interaction oftemperament based personality profiles with the interventions for CDidentified as well established or as probably efficacious using criteriadeveloped by the American Psychological Association are also discussed.Finally, the possible contribution of Eysenckian personality profiles toKazdin's proposal for the use of a chronic disease model whentreating CD is discussed. ********** There are many contributing factors in the development of conductproblems (McMahon & Wells, 1998), including a number of biologicalfactors (Niehoff, 1999). Temperament is a biologically based trait thatin some cases is a risk factor predisposing individuals to antisocialand aggressive behavior. One well known perspective on temperament isbased on the New York New York, state, United StatesNew York,Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of Longitudinal Study longitudinal studya chronological study in epidemiology which attempts to establish a relationship between an antecedent cause and a subsequent effect. See also cohort study. (Thomas, Chess & Birch,1968; Chess & Thomas, 1987). This longitudinal study identified atemperament pattern called the difficult child that represents a riskfactor for antisocial behavior. Another perspective on temperament as arisk factor in antisocial behavior is Eysenck's biosocial theory ofpersonality (Eysenck, 1995). In Eysenck's model, personality is theproduct of an interaction between temperament and social experience. Itis a model strongly supported by a very long and continuous history ofresearch and development (Eysenck, 1947,1967,1981, 1991a, 199Th, 1995;H. Eysenck & M. Eysenck, 1985). Eysenck's temperament based theory is sometimes referred to asa three-factor model of personality in which the three factors areExtroversion extroversion/ex��tro��ver��sion/ (eks?tro-ver��zhun)1. a turning inside out.2. direction of one's energies and attention outward from the self. (E), Neuroticism (N), and Psychoticism (P). Eysenck (1991a)points out that nearly all large-scale studies of personality find theequivalent of the three traits he proposes. Further, the traits arefound across cultures worldwide. Assessments of an individual on thetraits are relatively stable across time. Finally, research on thegenetics of personality supports the three traits (Eaves, Eysenck, &Martin, 1988). The development of the theory and related research has givenconsiderable attention to measurement. The Eysenck PersonalityQuestionnaire The Eysenck Personality Questionnaire (1975), or E.P.Q., is a reliable research tool that is validated by criterion analysis. Disadvantages of the questionnaire are that it asks yes/no questions which forces a sometimes innacurate response, and it can be psychometrically inferior. developed for research on the model includes both adultand child versions (H. Eysenck & S. Eysenck, 1975,1993). None of thescales are intended as a measure of psychopathology psychopathology/psy��cho��pa��thol��o��gy/ (-pah-thol��ah-je)1. the branch of medicine dealing with the causes and processes of mental disorders.2. abnormal, maladaptive behavior or mental activity. ; but rather they aremeasures of temperament based personality traits. The Extroversion (E) trait is represented by a bipolar scale thatis anchored at one end by sociability and stimulation seeking and at theother end by social reticence and stimulation avoidance. Extroversion ishypothesized to be dependent upon the baseline arousal level in anindividual's neocortex and mediated through the ascending reticularactivating system ascending reticular activating system (ARAS) (·senˑ·ding r (ARAS Aras(äräs`), Rus. Araks, river, c.600 mi (970 km) long, rising in the Transcaucasus Mts., NE Turkey. It flows generally east, forming parts of the Turkey-Armenia and Armenia-Iran borders, before entering Azerbaijan where it joins the ) (Eysenck, 1967,1977,1997). The difference inbasal arousal between introverts and extraverts is evident in researchon their differential response to drugs. Claridge (1995) reviews drugresponse studies that demonstrate introverts require more of a sedativedrug Noun 1. sedative drug - a drug that reduces excitability and calms a persondepressant, downer, sedativechloral hydrate - a colorless crystalline drug used as a sedative; irritates the stomach and can be addictive than do extraverts to reach a specified level of sedation SedationDefinitionSedation is the act of calming by administration of a sedative. A sedative is a medication that commonly induces the nervous system to calm.PurposeThe process of sedation has two primary intentions. . Thisfinding is explained by the higher basal level of cortical arousal inintroverts. The Neuroticism (N) trait is anchored at one end by emotionalinstability and spontaneity and by reflection and deliberateness at theother end. This trait's name is based on the susceptibility ofindividuals high on the N trait to anxiety-based problems. Neuroticismis hypothesized to be dependent upon an individual's emotionalarousability due to differences in ease of visceral brain activation,which is mediated by the hypothalamus hypothalamus(hī'pəthăl`əməs), an important supervisory center in the brain, rich in ganglia, nerve fibers, and synaptic connections. It is composed of several sections called nuclei, each of which controls a specific function. and limbic system limbic systemn.A group of deep brain structures, common to all mammals and including the hippocampus, amygdala, gyrus fornicatus, and connecting structures, associated with olfaction, emotion, motivation, behavior, and various autonomic functions. (Eysenck, 1977,1997). The Psychoticism (P) trait is anchored at one end by aggressivenessand divergent thinking Noun 1. divergent thinking - thinking that moves away in diverging directions so as to involve a variety of aspects and which sometimes lead to novel ideas and solutions; associated with creativityout-of-the-box thinking and at the other end by empathy and caution. Thelabel for this trait is based on the susceptibility of a significantsub-group of individuals high on the F trait to psychotic disorders (H.Eysenck, & S. Eysenck, 1976). Psychoticism is hypothesized to be apolygenic polygenic/poly��gen��ic/ (pol?e-jen��ik) pertaining to or determined by several different genes. pol��y��gen��icadj. trait (Eysenck, 1997). Polygenic refers to a large number ofgenes each of whose individual effect is small. Each of these"small effect" genes is additive, so that the total numberinherited determines the degree of the P trait in the personality. The P trait in personality is the one with the most direct link tothe problem of Conduct Disorder (CD). Research indicates a relationshipbetween high P and diagnoses such as Antisocial Personality Antisocial personalityA personality characterized by attitudes and behaviors at odds with society's customs and moral standards, including illegal acts.Mentioned in: Malingering Disorders,Schizotypal Personalities, Borderline Personalities, and Schizophrenia(Claridge, 1995; H. Eysenck & S. Eysenck, 1976; Monte, 1995). Therelationship between psychotic tendencies in high P individuals isindirectly supported by the follow-up research of Robins (1979). Robinsfound that approximately 25% of individuals with a diagnosis of CD inchildhood developed psychotic conditions in adulthood. Children and youth with CD are characterized as lacking empathy,being cruel, egocentric, and not compliant with rules (AmericanPsychological Association, 1994). This description is congruent with thedescription of many who score high on Eysenck's P Scale (H. Eysenck& S. Eysenck, 1976). The most easily identified groups that would beexpected to include a large number of individuals high on the P traitare delinquents and adult criminals. Thus, a number of studies haveexamined these populations for the presence of high P trait scores(e.g., Chico & Ferrando, 1995; Gabrys, 1983; Kemp & Center,2002). Eysenck's theory predicts that individuals high on the P traitwill be predisposed to developing antisocial behavior (Eysenck, 1997).Further, an individual high on both the P and E traits will bepredisposed to developing antisocial, aggressive behavior. Aggressivebehavior is associated with low cortical arousal (high E) because aperson with a relatively under reactive nervous system does not learnrestraints on behavior or rule-governed behavior as readily as doindividuals with a higher basal level of cortical arousal. Further, whensuch an individual is high on the N trait as well, this will add anemotional and irrational character to behavior under some circumstances. Finally, antisocial individuals typically score lower than otherson the Eysenck Personality Questionnaire's Lie (L) Scale. The LScale is a measure of the degree to which one is disposed to givesocially expected responses to certain types of questions. A high scoreon this scale suggests that the respondent is engaging in impressionmanagement A low score suggests indifference to social expectations andis usually interpreted as an indication of weak socialization. Thestrongest form of Eysenck's antisocial behavior (ASB) hypothesiswould be high P, E, and N with low L. In a review of research on the ASB hypothesis in children andadolescents, Kemp and Center (1998) found strong support forEysenck's ASB hypothesis. Ninety percent (18 of 20) of the studiesreviewed had a positive finding for the P Scale (see Table 1). None ofthe studies reported contrary findings for the P Scale prediction.Sixty-three percent (12 of 19) studies had a positive finding for the EScale. One study had a contrary finding for the E Scale. Sixty-fivepercent (11 of 17) studies had a positive finding for the N Scale. Twostudies had contrary findings for the N Scale. Seventy-six percent (13of 17) had a positive finding for the L Scale prediction. One study hada contrary finding for the L Scale. Variability in the base number ofstudies is due to a failure to evaluate or report data for one or ore ofthe scales in some studies. In summary, very strong support was found for the P Scaleprediction and strong support for the L Scale prediction in subjectswith verified, teacher-identified, or self-reported antisocial behavior.The most important component in the ASB hypothesis is the P Scale(Eysenck, 1977). The L Scale plays a confirmation role in thehypothesis. The review also found moderate support for elevated E and NScale scores. The E and N Scales are contributing rather than primaryfactors in the hypothesis and one would expect weaker support for them.Thus, variability among children and adolescents with CD on the P, E andN Scales should be expected (Eysenck & Gudjonsson, 1989). Eysenck has emphasized the role of temperament in thepredisposition for antisocial and aggressive behavior, whileacknowledging the importance of socialization experiences in interactionwith temperament. Lykken (1995) attributes the alarming rise ofantisocial behavior largely to inadequate or inappropriatesocialization. However, Lykken distinguishes between antisocialindividuals who have a temperamental predisposition for antisocialbehavior and those that are purely the result of poor socialization. Herefers to the former as psychopaths and the latter as sociopaths. Lykkenargues that sociopaths are reared in environments with little structureand unpredictable or harsh parenting This is similar to the type ofenvironment identified by Patterson, Reid and Dishion (1992) in theirresearch on families of antisocial boys. The result of poorsocialization is an individual with a weak, underdeveloped conscienceand poorly developed rule-governed behavior (Lykken, 1995). Lykken (1995) discusses three different temperament genotypes andtheir relationship to socialization. The first genotype, the easilysocialized genotype, is somewhat rare. A child with this genotype oftenachieves good socialization even with socially inadequate parents. Thesecond genotype, the average genotype, is the most common and requiresparents of at least average competence for good socialization. Childrenwith the average genotype and socially inadequate parents are at riskfor developing sociopathic so��ci��o��path?n.One who is affected with a personality disorder marked by antisocial behavior.so behavior. The third genotype is thehard-to-socialize genotype. This genotype is the one from whichantisocial and aggressive behavior most easily evelops. It is also thegenotype from which psychopaths are most likely to arise. A child with ahard-to-socialize genotype will require highly competent parents toattain adequate socialization. Even with such parents, factors such asneighborhood conditions and peer influences may play a determining rolein the development of antisocial behavior. Accordin g to Flare (1993),psychopathic psy��cho��path��icadj.1. Of, relating to, or characterized by psychopathy.2. Relating to or affected with an antisocial personality disorder that is usually characterized by aggressive, perverted, criminal, or amoral behavior. behavior begins early, is more severe, and has a very poorprognosis. In fact, Cleckley (1988) suggests that psychopaths are as farremoved from normal human experience as the psychotic. The prognosis for children and adolescents with sociopathicbehavior varies depending on the age at which their behavioral symptomsbegan. Patterson and Yoerger (1993) characterize children with a historyof sociopathic behavior before the age of 14 as early starters andindicate a poor prognosis. Sociopathy so��ci��op��a��thyn.The behavioral pattern exhibited by sociopaths. that doesn't become evidentuntil after the age of 14 (i.e., late starters), according to according toprep.1. As stated or indicated by; on the authority of: according to historians.2. In keeping with: according to instructions.3. Pattersonand Yoerger, has a much better prognosis. Late starters who have had aperiod of appropriate socialization experiences will usually abandontheir antisocial behavior by late adolescence or early adulthood(Lykken, 1995). Intervention In a review of studies on interventions for antisocial behavior,Eysenck and Gudjonsson (1989) found support for the use of behaviormodification behavior modificationn.1. The use of basic learning techniques, such as conditioning, biofeedback, reinforcement, or aversion therapy, to teach simple skills or alter undesirable behavior.2. See behavior therapy. techniques in the treatment of antisocial behavior.Behavior modification techniques suggested as potentially useful fortreating delinquents included (a) differential reinforcement ofincompatible and alternative behaviors and (b) time-out and responsecost for problem behaviors. Eysenck and Gudjonsson (1989) also found support for the use ofcognitive-behavioral procedures employing social-learning principles.They suggested teaching (a) rational self-analysis, (b) self-controltechniques, (c) means-end reasoning, and (d) critical thinking skills. There are several differential effects predicted fromEysenck's model that could be important when planning anintervention. First, the high E delinquent will not respond well topunishment intended to inhibit behavior previously associated withreward. Second, the high N and high E delinquent will be most responsiveto interventions employing reinforcement. Third, the high N and low Edelinquent will be most responsive to interventions employingpunishment. Finally, the high P delinquent will be the least responsiveto behavioral interventions. Wakefield (1979) has worked out theintervention implications for Eysenck's theory in some detail. Hediscusses these implications for 12 personality patterns representingvariations of F, E, and N (see Figures 1 & 2). Antisocial and aggressive behaviors are the most common reason forstudents being placed in special education (Kauffman, 1997, P. 338), andearly aggression is the best predictor of subsequent maladjustment maladjustment/mal��ad��just��ment/ (mal?ah-just��ment) in psychiatry, defective adaptation to the environment. mal��ad��just��mentn.1. Faulty or inadequate adjustment.2. (Lerner, Hertzog, Hooker, Hassibi, & Thomas, 1988). Unfortunately,the majority of intervention strategies for antisocial behavior have metwith dismal failure (McMahon & Wells, 1998). In an effort toidentify empirically supported psychosocial interventions, Division 12(Clinical Psychology) of the American Psychological Association createda Task Force to establish criteria for identifying empirically validatedinterventions. Section 1 (Clinical Child Psychology) of Division 12subsequently employed these criteria (Lonigan, Elbert, & Johnson,1998, p. 141) to identify effective interventions for childhooddisorders. Efficacy of Interventions for Antisocial Behavior The review undertaken for conduct problems covered the years 1966through 1995. This review examined 82 separate studies that included atotal of 5,272 children and adolescents (Brestan & Eyberg, 1998).The review of published intervention studies intervention studies,n.pl the epidemiologic investigations designed to test a hypothesized cause and effect relation by modifying the supposed causal factor(s) in the study population. relative to the criteriaadopted identified only two well-established interventions,Patterson's parent training and Webster-Stratton's videotapedparent training (Patterson, 1974; Patterson, Chamberlain & Reid,1982; Webster-Stratton, 1984, 1990). The eview identified 10 probablyefficacious treatments. Two of the more promising probably efficacioustreatments included multisystemic treatment and rational- emotivetherapy. Well Established Treatments Patterson, Cobb, and Ray (1973) conducted the first evaluation ofPatterson's parent training program. The procedures employed inPatterson et al. have been replicated and evaluated numerous times byresearchers from within Patterson's group and by independentresearchers (e.g., Patterson, 1974; Weinrott, Bauske & Patterson,1979). Patterson's intervention model targets parenting practicesthat contribute to the development of antisocial behavior within acontext of coercive interchanges. A coercive interchange ischaracterized by aversive aversive/aver��sive/ (ah-ver��siv) characterized by or giving rise to avoidance; noxious. a��ver��siveadj. behavior in one person being contingent on Adj. 1. contingent on - determined by conditions or circumstances that follow; "arms sales contingent on the approval of congress"contingent upon, dependant on, dependant upon, dependent on, dependent upon, depending on, contingent thebehavior of another person (Patterson et al., 1992). For example, amother may demand that her son stop watching television and complete hishomework. The child may then become oppositional, and his motherwithdraws her demand. The parent's behavior has reinforced thelikelihood that the child will use coercive behavior in the future tocounter control. According to Patterson and his colleagues, the homes of boys withantisocial behavior differ from the homes of normal boys in several ways(Patterson, 1974; Weinrott, et al., 1979). First, the parents ofantisocial boys do not consistently reinforce prosocial behavior.Second, coercive behaviors are not effectively punished. Third, thefamilies of antisocial boys reinforce coercive behaviors (Patterson& Yoerger, 1993). As an antisocial child's coercive skillsincrease, parental monitoring of the child diminishes (Patterson et al.,1992). Patterson's model for the acquisition and use of coercivebehavior with children makes parent training a logical intervention forantisocial children. The parent training process developed by Patterson and hisassociates is clear and sequential. An intake conference focusing on achild's behavior is conducted followed by home observations of thefamily. After this introductory phase, parent training begins. Thetraining includes (a) teaching the basic principles of social learningand behavioral charting and (b) teaching parents to pinpoint, observe,and chart problem behaviors. After the initial training, parents areasked to collect three days of baseline data on a selected behavior,such as noncompliance. Parent progress is supervised through phoneconversations with a trainer. Following this phase, parents participatein a parent group. A parent training group is composed of three to four sets ofparents who meet one evening each week. Parents are taught to reinforceprosocial behaviors with both tangible and social reinforcers. Theparents are also taught to use behavioral contracting and point systems. Finally, parents learn strategies like time-out for handlingnoncompliant and aversive behavior. Training is typically complete aftera family has worked through three to four target behaviors. Thisgenerally takes from eight to 12 sessions. Intervention usingPatterson's model has been very effective for families withchildren 12 years of age and under, but the effect on adolescents hasbeen mixed (Bank, Marlowe, Reid, Patterson & Weinrott, 1991; McMahon& Wells, 1998). The second well-established intervention for conduct problems inchildren, Webster-Stratton's videotaped parent training, isdesigned for younger children. Webster-Stratton's program is anintervention that can be widely disseminated and is relativelyinexpensive (Webster-Stratton, 1984). The underlying objective forWebster-Stratton's program is to realign the parent-childrelationship by teaching parents operant operant/op��er��ant/ (op��er-ant) in psychology, any response that is not elicited by specific external stimuli but that recurs at a given rate in a particular set of circumstances. op��er��antadj. learning based techniques forbehavior management behavior managementPsychology Any nonpharmacologic maneuver–eg contingency reinforcement–that is intended to correct behavioral problems in a child with a mental disorder–eg, ADHD. See Attention-deficit-hyperactivity syndrome. (Webster-Stratton, 1984). A unique component ofWebster-Stratton's intervention is the use of videotapes to focusinstruction. The videotapes feature between 180 and 250 two minutevignettes that illustrate both desirable and undesirable parent-childinteractions. After each vignette, parents in small groups discuss thebehavioral dynamics in the vignette with a trainer (Webster-Stratton,1984; Webster-Stratton, Kolpacoff, & Hollinsworth, 1988). Homeworkis assigned to parents to give them experience with applying newlylearned strategies with their child (McMahon & Wells, 1998). The videotape parent training has been conducted with differentdelivery models such as self-administered (e.g., Webster-Stratton,Kolpacoff, & Hollinsworth, 1988) and self-administered with trainerconsultation (e.g., Webster-Stratton, 1990). Trainer led groups haveproduced slightly better results in comparison to other delivery methods(Webster-Stratton, Kolpacoff, & Hollinsworth, 1988). It is interesting that both of the intervention programs in thewell-established category are programs directed at better preparingparents for their role as socialization agents. Some (e.g., Wells, 1994)think that interventions like parent training are best suited forchildren with milder behavioral difficulties. The authors would rephrase re��phrase?tr.v. re��phrased, re��phras��ing, re��phras��esTo phrase again, especially to state in a new, clearer, or different way. this to say that parent training is an approach that will probably bethe most successful with parents of children with a typical Eysenckianpersonality profile (i.e., average E and low or average P and N).However, this approach addresses a critical need of parents of troubledchildren with either a typical or a difficult personality.Differentiating between parents of children with typical and difficultpersonality profiles could possibly enhance the effectiveness of theapproach. Parents of children with a difficult profile probably requireboth education about their child's predispositions and moreextensive training in child management techniques. Probably Efficacious Interventions Multisystemic treatment (MST See micro systems technology. ) approaches the problems ofadolescents with CD within the context of multiple systems including thefamily, school, and community (Henggeler et al., 1986; Henggeler, Melton& Smith, 1992). Studies evaluating the effectiveness of MST havebeen conducted almost exclusively with juvenile delinquents with ahistory of violent behavior (e.g., Bourdin et al., 1995). The therapeutic procedures used by MST are present oriented andproblem focused (Henggeler et al., 1986, 1992). The intervention mayinclude both a participant's parents and peers. MST is highlyindividualized for an individual participant's needs (e.g., weakand ineffective parents would be instructed on the use of anauthoritative parenting style) (Henggeler et al., 1986). Sessions areoften conducted in a participant's home and take from 15 to 90minutes. Treatment typically lasts for 13 weeks and the therapist is oncall seven days a week, 24 hours a day (Henggeler et al., 1992). MST was found to be significantly more effective than individualtherapy or supervised probation in deterring future arrests anddecreasing the seriousness of future offenses in the event of recidivism recidivism:see criminology. (Bourdin et al., 1995; Henggeler et al., 1992). The cost per participantfor MST was about $2,800 in contrast to the cost of incarceration Confinement in a jail or prison; imprisonment.Police officers and other law enforcement officers are authorized by federal, state, and local lawmakers to arrest and confine persons suspected of crimes. The judicial system is authorized to confine persons convicted of crimes. perindividual of $16,300 (Henggeler et al., 1992). These positive findingsfor MST make it a promising approach for future research on interventionwith juvenile offenders. MST is an individualized approach to treatment in which programmingwill vary significantly across clients. Wakefield (1979) discusses theuse of Eysenckian personality profiles (see Figure 2) forindividualizing instruction and discipline. These personality profilesmight also be profitably applied to the conduct of MST, which emphasizesindividualization individualization,n the process of tailoring remedies or treatments to cure a set of symptoms in an indiv-idual instead of basing treatment on the common features of the disease. . Knowledge of a client's personality basedpredispositions should improve any effort to work through strengths tocompensate for weaknesses. A second intervention classified as probably efficacious,rational-emotive therapy, employs a less intense intervention.Rational-emotive therapy (Ellis, 1962, 1971, 1983) focuses onidentifying irrational beliefs and modifying or replacing these beliefs.Rational-emotive therapy is a structured, goal-oriented intervention(Block, 1978). Block compared the efficacy of rational- emotive therapywith psychodynamic PsychodynamicA therapy technique that assumes improper or unwanted behavior is caused by unconscious, internal conflicts and focuses on gaining insight into these motivations.Mentioned in: Group Therapy, Suicide group therapy in a sample of 10th and 11th gradeadolescents characterized as having significant academic anddisciplinary problems (e.g., cutting class, being tardy tar��dy?adj. tar��di��er, tar��di��est1. Occurring, arriving, acting, or done after the scheduled, expected, or usual time; late.2. Moving slowly; sluggish. , low CPA (Computer Press Association, Landing, NJ) An earlier membership organization founded in 1983 that promoted excellence in computer journalism. Its annual awards honored outstanding examples in print, broadcast and electronic media. The CPA disbanded in 2000. , andreferrals to administration). Both groups met five days a week, 45minutes a day for 12 consecutive weeks, Rational-emotive groupparticipants demonstrated a marked improvement in truancy, tardiness TardinessDagwoodcomic strip character; chronically late at the office. [Comics: “Blondie” in Horn, 118]ten o’clock scholarschoolboy who habitually arrives late. [Nurs. ,and office referrals in comparison to the psychodynamic group. Rational-emotive therapy, which focuses on the effects ofirrational thinking on behavior, should also profit from the use of aEysenckian perspective. Individuals high on the N trait appear to be themost susceptible to irrational thinking. Thus, one would expect thattroubled youth who are high on the N trait would benefit the most fromthis type of approach. Other probably efficacious treatments that focus on adolescentsexhibiting CD include assertiveness training assertiveness trainingPsychiatry A procedure in which subjects are taught appropriate interpersonal responses involving frank, honest, and direct expression of their feelings, both positive and negative (Huey & Rank, 1984) andanger control training with stress inoculation inoculation,in medicine, introduction of a preparation into the tissues or fluids of the body for the purpose of preventing or curing certain diseases. The preparation is usually a weakened culture of the agent causing the disease, as in vaccination against (Schlicter & Koran,1981). Huey and Rank's assertiveness training used peer andcounselor led groups to foster discussion of problem topics such asanger and rule compliance. Schlicter and Koran's anger controltraining attempted to help adolescents define anger and recognize recentangry episodes in their lives. Stress inoculation procedures such asself-prompting, positive imagery, and backward counting were alsoemployed. These interventions yielded moderate research support whencontrasted with a no-treatment control group. The interventions classified as probably efficacious providealternatives for practitioners working with older CD adolescents. Someof these interventions, such as MST, appear highly promising but areintensive and time-consuming. Interventions that are considered wellestablished or probably efficacious both need extensive monitoring andfollow-up due to the long history of failure for interventions forantisocial children and adolescents (Kazdin, 1987, 1993). The Chronic Disease Model and CD Kazdin (1987) suggested that practitioners involved in therapy withchildren or adolescents diagnosed with CD might need to conceptualize con��cep��tu��al��ize?v. con��cep��tu��al��ized, con��cep��tu��al��iz��ing, con��cep��tu��al��iz��esv.tr.To form a concept or concepts of, and especially to interpret in a conceptual way: CDfrom a medical perspective, namely the chronic disease model. Kazdincompares CD to diseases such as alcoholism and diabetes in whichlifelong monitoring and treatment are necessary to ensure a functionaloutcome. Kazdin points out that children and adolescents with CDsometimes show significant improvement following time-limitedintervention, but soon revert to antisocial behavior when the treatmentis removed. Thus, children and adolescents with CD may always requiresome form of monitoring and treatment. Such monitoring should probablytake place at least every six months and be followed by boostertreatments if indicated (Kazdin, 1993). It is doubtful that all children exhibiting antisocial behaviorneed the long-term monitoring and treatment implicit in Adj. 1. implicit in - in the nature of something though not readily apparent; "shortcomings inherent in our approach"; "an underlying meaning"underlying, inherent a chronicdisease model. Eysenckian personality profiles may provide a method foridentifying individuals most likely in need of treatment under a chronicdisease model. It is probable that most of the individuals that needlong-term monitoring and treatment will be those with a difficultpersonality profile. Conclusion The problem of antisocial behavior is a complex one with no certainsolution in sight. Effective treatment and prevention of antisocial andaggressive behavior will probably require careful consideration ofbiological, cognitive, and environmental factors. More considerationneeds to be given to biological factors, such as temperament, and theirrole in the development of antisocial behavior and its resistance totreatment. The review of treatment studies by Brestan and Eyberg (1998)illustrates the variety of programs and strategies available forchildren and adolescents with CD. What is certainly needed is a moresystematic effort to evaluate the efficacy of many of the interventionsbeing used in clinical settings. The number of approaches meeting thecriteria for well-established interventions was quite small in relationto the body of literature reviewed. On one hand, the scope of theproblem is certainly broader than can be addressed by the twointerventions identified as empirically established. On the other hand,we should feel ethically constrained about the use of interventions thathave not been adequately validated.Figure 1Eysenck's P,E, and N combinations with descriptive labels from Wakefield(1979).PEN Combinations Descriptive Labels 1. Low or Avg. P, Avg. E, Low or Typical, The majority of Avg. N children. 2. Low or Avg. P, High E, Low or Sociable and Uninhibited Avg. N 3. Low or Avg. P, Low E, Low or Shy and Inhibited Avg. N 4. Low or Avg. P, Avg. E, Emotionally Over-reactive High N 5. Low or Avg. P, High E, High N Hyperactive 6. Low or Avg. P, Low E, High N Anxious 7. High P, Avg. E, Low or Avg. N Disruptive and Aggressive 8. High P, High E, Low or Avg. N Extremely Impulsive 9. High P, Low E, Low or Avg. N Withdrawn and Hostile10. High P, Avg. E, High N Frequently Agitated11. High P, High E, High N Very Disruptive and Aggressive12. High P, Low E, High N Very Anxious and AgitatedFigure 2.A summary of Wakefield's (1979) recommendations in four areas forEysenck's three temperament based personality traits. Behavior Arousal LearningHigh E Works quickly Works well under Focus on major Careless stress from points. Needs Easily distracted external continuous Easily bored stimulation. reinforcement. Good short-term recall. Does best in elementary school.Low E Works slowly Works poorly Intermittent Careful under stress from reinforcement is Attentive extemal sufficient. Motivated stimulation. Good long-term recall. Does best in high school.High N Over reacts to Easy arousal Compulsive emotional interferes with approach to stimuli. performance, learning. Slow to calm especially on Can study for long down. Avoids difficult tasks. periods. emotional Susceptible to test Does best in high situations anxiety. school.Low N Under reacts to Hard to motivate Exploratory emotional and tends to learner. stimuli. underachieve. Short study Quick recovery Needs high periods are best. from emotional arousal to sustain Does best in arousal. effort on easy elementary school. tasks.High P Solitary Seeks stimulation Slow to learn from Disregard for for an arousal experience danger. high. Responds Defiant and Confrontation and impulsively. aggressive. punishment may Creative, ifbright stimulate.Low P Sociable Not a sensation Teachable Friendly seeker Can be Convergent Empathetic too "laid back." thinker. DisciplineHigh E Most responsive to rewards and prompts, but also responsive to punishment and admonitions.Low E Most responsive to punishment and admonitions, but also responsive to rewards and prompts.High N Similar to low E but high N in combination with low E requires a more subdued approach.Low N Similar to high E However, both reward and punishment need to be more intense.High P Stimulated by punishment and threats. Responds best to highiy structured settings.Low P Responsive to both reward and punishment. 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New York: New York University Press New York University Press (or NYU Press), founded in 1916, is a university press that is part of New York University. External linkNew York University Press . Wakefield, J. (1979). Using personality to individualize in��di��vid��u��al��ize?tr.v. in��di��vid��u��al��ized, in��di��vid��u��al��iz��ing, in��di��vid��u��al��iz��es1. To give individuality to.2. To consider or treat individually; particularize.3. instruction. San Diego: Educational and Industrial Testing Service. Webster-Stratton, C. (1984). Randomized trial of twoparent-training programs for families with conduct-disordered children.Journal of Consulting and Clinical Psychology, 52, 666-678. Webster-Stratton, C. (1990). Enhancing the effectiveness ofself-administered videotape parent training for families withconduct-problem children. Journal of Abnormal Child Psychology,18,479-492. Webster-Stratton, C., Kolpacoff, M., & Hoilinsworth, T. (1988).Self-administered videotape therapy for families with conduct-problemchildren; Comparison with two cost-effective treatments and a controlgroup. Journal of Consulting and Clinical Psychology, 56,558-566. Wells, K. C. (1994). Parent and family management training. In L.W. Craighead, W. E. Craighead, A. E. Kazdin, & M. J. Mahoney (Eds.),Cognitive and behavioral interventions; An empirical approach to mentalhealth problems (pp. 251-266). Boston Ailyn & Bacon. Weinrott, M. R., Bauske, B. W., & Patterson, G. R. (1979).Systematic replication of a social learning approach to parent training.In P.O. Sjoden (Ed.), Trends in behavior therapy (pp. 331-351). NewYork: Academic Press. Address all correspondence to: David Center, Department ofEducational Psychology and Special Education, Georgia State University HistoryGeorgia State University was founded in 1913 as the Georgia School of Technology's "School of Commerce." The school focused on what was called "the new science of business. ,Atlanta, GA 30303.