The document discusses the development of antisocial personality disorder from infancy through childhood. It notes that infants who develop insecure attachments with caregivers, especially disorganized attachments, are more likely to exhibit antisocial behaviors later in life. Childhood factors that can contribute to antisocial personality disorder include abusive or neglectful parenting, parental divorce, negative influences from siblings, rejection from peers, and affiliating with deviant peer groups. Early detection and treatment of antisocial behaviors during childhood may help prevent the development of antisocial personality disorder.

1. The Developmental Aspect of Antisocial Personality Disorder:
A Psychosocial Perspective
By Rachel Siehs
Abstract
Individuals diagnosed with Antisocial Personality Disorder show an enduring pattern of
disregard for and violation of the rights of others. Antisocial Personality Disorder adults
tend to have substance abuse problems, spend years in prison, have interpersonal and
employment problems and are more likely to die prematurely due to violence. Research
has shown that this pattern of conduct begins in infancy and continues into adulthood.
Antisocial Personality Disorder individuals show symptoms that are similar to those of
other disorders such as Conduct Disorder, Oppositional Defiant Disorder and Attention
Deficit/Hyperactivity Disorder throughout their childhood and adolescence.
Environmental factors can lead to the development of antisocial behavior in childhood
and adolescence. A review of developmental literature and early intervention treatments
could suggest ways for the early diagnosis and treatment of Antisocial Personality
Disorder.

2. INTRODUCTION
Is there a way to detect earlier and treat lifelong adult delinquency known as
Antisocial Personality Disorder? Antisocial Personality Disorder is a pervasive pattern of
disregard for and violation of the rights of others (American Psychiatric Association,
2000, DSM-IV-TR). Antisocial individuals tend to engage in behaviors that are grounds
for legal action (such as destroying property, harassing others, stealing or pursuing illegal
occupations) and show a lack of remorse or shame for harmful acts committed on others.
Individuals tend to be deceitful and manipulative, irritable and/or aggressive, and
consistently and extremely irresponsible, impulsive by failing to plan ahead, and reckless
in disregard for self or other’s safety (DSM-IV-TR). However, the most problematic
characteristic of Antisocial Personality Disorder is that it is enduring. Approximately
three percent of males and one percent of females exhibit characteristics of Antisocial
Personality Disorder, with an even greater percentage in substance abuse treatment
settings, prisons and forensic settings (DSM-IV-TR). Development of Antisocial
Personality Disorder is more common when one’s first degree biological relatives have
this condition; adoption studies, however, have shown that one’s environment is also a
strong factor in developing antisocial disorders (DSM-IV-TR).
Antisocial Personality Disorder is usually not diagnosable until adulthood.
However, because many of its symptoms overlap with those of other mental disorders,
such as Conduct Disorder, Oppositional Defiant Disorder and Attention-Deficit/
Hyperactivity Disorder, which are diagnosable in childhood and/or adolescence, early
intervention when a client exhibits symptoms that overlap with those of Antisocial
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3. Personality Disorder may help in both diagnosis and treatment of this very serious and
enduring condition.
This paper analyzes the symptomology of Antisocial Personality Disorder and
other mental health conditions to explore whether and how early intervention can help
treat clients before Antisocial Personality Disorder can be diagnosed, thereby helping
them to avoid this serious condition.
INFANCY: UNDERSTANDING TEMPERAMENT AND ATTACHMENT
Temperament and attachment both affect the development of lifelong antisocial
(Damon, & Lerner, 2006) and is one of the first instances of individual expression
(McDevitt & Ormrob, 2008). Attachment is the parent-child relationship that helps form
bonds later in life.
Temperament is a characteristic describing the reactivity level and self-regulation
of an infant. Temperament becomes stable over time and some researchers believe that
temperament actually develops into ones personality (Caspi, 1998; Rothbart & Bates,
1998; Eisenberg, Damon, & Lerner, 2006). behavior. Temperament is known to be stable
throughout one’s life (Eisenberg, There are six dimensions of temperament: sociability,
sensitivity, adaptability, persistence, emotion intensity, and activity level. An infant with
an “easy temperament” is categorized as approachable, adaptable, mild to moderate
emotional intensity, and socialable. An infant with “difficult temperament” is withdrawn,
emotionally intense, unable to adapt, with negative emotions. Children with difficult
temperament are more likely to be aggressive or withdrawn (Caspi, 1998; Patterson,
2008). An infant who is categorized as having a “slow to warm up temperament” tends to
be predominantly in a negative mood, slow to adapt to new stimuli, and have mildly
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4. intense reactions to ones environment (Rothbart & Bates, 1998; Eisenberg, Damon, &
Lerner, 2006).
An infant’s ability to communicate and move around independently is extremely
limited. Infants rely heavily on their parents for all their basic needs to be met. Because
they are unable to use words to communicate and cannot acquire their physical needs and
wants on their own, they rely on support and attention from their caregivers. This bond
between the caregiver and infant is called attachment. Attachment has an enormous effect
on how the infant perceives people in the world.
All infants form attachment relationships with their primary caregivers (Bowlby,
1969; Ainsworth, Blehar, Waters, & Wall, 1978; Sroufe, 1979). An infant with secure
attachment to his or her primary caregivers learns trust. Individuals with secure
attachment styles tend to be socially and psychologically skilled as they grow up (Matas,
Arend, & Sroufe, 1978; Sroufe, 1979). An infant develops an insecure-ambivalent
attachment style when a primary caregiver is unavailable when the individual has needs
to be met. Infants who have an insecure-ambivalent attachment display considerable
distress when separated from a parent or caregiver and do not seem comforted by the
return of the parent. At the reunion, the child passively rejects the parent by refusing
comfort, or may openly display direct aggression toward the parent (Ainsworth, Blehar,
Waters, & Wall, 1978; Shorey & Snyder, 2006). Infants with insecure-avoidant
attachment tend to avoid parents and caregivers. Insecure-avoidant infants neither seek
comfort nor contact from primary caregiver, instead they tend to be more independent
(Ainsworth, Blehar, Waters, & Wall, 1978; McDevitt & Ormrob, 2007). Individuals with
insecure-avoidant attachment styles tend to show little investment in social and romantic
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5. relationships and usually are unable and unwilling to share their feelings with others
(McDevitt & Ormrob, 2007).
Infants who develop an insecure-disorganized attachment style have a primary
caregiver who is inconsistent in meeting the needs of the infant (Main & Solomon, 1986,
1990; Shorey & Snyder, 2006). They tend to lack a consistent way of responding to
stressful events (Main & Solomon, 1986, 1990; McDevitt & Ormrob, 2007). Their
actions and responses to caregivers are often a mix of behaviors, including avoidance or
resistance. These children are described as displaying dazed behavior, sometimes
seeming either confused or apprehensive in the presence of a caregiver. In some extreme
cases of insecure-disorganized attachment style children show fear towards their
caregivers (Main & Solomon, 1986, 1990; McDevitt & Ormrob, 2007). Levy & Orlans
(1999, 2000) found that disruptions in attachment during the first 3 years can lead to
“affectionless psychopathy,” which is the inability to form meaningful emotional
relationships, coupled with chronic anger, poor impulse control, and a lack of remorse.
Disorganized attachment styles lead the developing child to behave in ways that are
consistent with how he or she expects to be treated by others (Bowlby, 1969; Shorey &
Snyder, 2006). Children with insecure attachment styles are more likely to be rejected by
peers and have a wide range of emotional and behavioral problems in their future
(Steinberg, 2008). Regardless of whether the infant had a secure attachment or insecure
attachment with his primary caregiver, these styles help the infant know how to perceive
and what to expect from the world (Bowlby, 1969; Shorey & Snyder, 2006).
It is clear that development of an insecure attachment to one’s parents will affect
one’s later attachment with others later in life. If one has a difficult temperament one may
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6. also develop antisocial tendencies, including increased aggression and noncompliant
behaviors (DSM-IV-TR; Breiling, Maser, & Stoff, 1997).
CHILDHOOD DEVELOPMENT
Childhood is the period before sexual maturation, beginning at the age of two and
lasting until about the age of ten. During this period, one develops language that enables
communication with others. Increased motor development allows one to engage in
organized sports. The child’s increased cognitive abilities allow him or her to think about
concrete objects and begin academic learning. All of these events take place during
childhood and influence one’s development into adolescence.
During childhood, one’s neurological pathways strengthen and become more
efficient. Enhanced motor skills allow the child to move throughout his environment and
explore. Fine motor skills (i.e., writing and manipulation of small objects) allow the child
to communicate with others in newer forms. Language skills explode during childhood.
Children are now able to express thought and receive information from others. The
increase in vocabulary provides labels that enable children to think about objects and
events even when they are not directly in sight. Language acquisition provides children
the ability to communicate and socialize with others (McDevitt & Ormrob, 2008;
Patterson, 2008). Parents who provided a home that supports educational and language
growth have a positive effect on child development; with encouragement, children are
able to flourish. However, in homes where parent-child relationships are poor and parents
lack educational support and motivation, problems may occur in learning and cognitive
development. This is especially the case in families with low economic circumstances
(Hart & Risley, 1995, 1999).
6

7. Multiple studies have found parental factors, such as abuse and neglect and
parental separation, divorce or loss, as potential contributors to later antisocial behavior
(Reti, Eaton, Bienvenu, Costa & Nestadt, 2002). Parenting styles and lack of parental
monitoring are also factors that influence a child’s development. According to Diane
Baumrind (1967, 1971, 1973, 1991) there are four types of parenting styles: authoritarian,
permissive, authoritative, and disengaged. Authoritarian parents tend to be very
demanding and not responsive. They tend to place a high value on obedience and control
and restrict their child’s autonomy. Children whose parents are Authoritarian tend to be
withdrawn and even seem uninterested in peer interaction. When faced with difficult
tasks, these children tend to become more angered and frustrated than their peers
(Baumrind, 1967; Baumrind & Black, 1967). Permissive parents are very accepting,
warm and more passive. Permissive parents are more concerned about raising a happy
child than an obedient one. Children whose parents are permissive appear to be less
mature than their peers (Baumrind,1967, 1971, 1973; Baumrind & Black, 1967).
Authoritative parents are warm and appreciative but controlling. Authoritative parents
place a high value on development of autonomy and self-direction (Baumrind,
1967,1971, 1973; Baumrind & Black, 1967). Disengaged parents are neither demanding
nor responsive. Disengaged parents care little about their child’s opinion or experiences.
Disengaged parents are more self-centered and primarily structure their lives around
themselves instead of their children (Baumrind, 1973, 1991). Children of disengaged
parents have difficulty relating to other people due to a lack of parental guidance and
encouragement. In some cases, disengaged parenting is a reflection of child maltreatment
and neglect (Baumrind, 1991). These parenting styles have many repercussions on the
7

8. child’s behavior. Glueck & Glueck (1968) and West & Farrington (1973) found that very
strict and authoritarian parenting style to be associated with a child’s development of
Antisocial Personality Disorder.
Childhood abuse and neglect also have severe consequences in development.
Abuse and neglect may cause serious long-lasting problems in children’s behavior (i.e.
aggression towards others), peer relations, and self-esteem (Crittenden, Claussen, &
Sugarman, 1994; Strauss & Yodanis, 1996; Sheeber, Hops, Alpert, Davis, & Andrews,
1997; Pittman & Chase-Lansdale, 2001). Many social learning theorists, such as Bandura
(1973) and Feshbach (1980), suggest that witnessing violence in the home provides a
model for learning aggressive behavior and the appropriateness of such behavior and,
consequently, produces aggressive-antisocial behaviors in the child. Traumatic and
chaotic parent-child relationships also contribute to emotional and social instability and
underdevelopment, poor personality organization, incapability for self reflection and the
inability to self-reflect, all characteristics of Antisocial Personality Disorder (Martens,
2005). Cicchetti & Barnett (1991) found that children who are abused or neglected earlier
in life are more likely to develop insecure attachment relationships with their primary
caregivers, leading to emotion-regulation difficulties and problem-solving deficits.
Moreover, Celia (1994) pointed out that when a child is exposed to trauma, he or she
might show a lack of ability to form bonds as a consequence of neglectful family factors
and neighborhood aspects. It will be very difficult for him or her to cooperate with people
who want to help or to trust persons who want to give social support.
Approximately one in five marriages ends in divorce (Hetherington, Henderson,
& Reiss, 1999; McDevitt & Ormrob, 2008). During childhood, the parents’ divorce
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9. requires adjustment. Hetherington, Cox, & Cox (1978) found that months after a divorce
adjusting can be difficult to both the children and the parents. Divorce can be both
financially and emotionally difficult on the family. Monitoring children decreases and
some divorced parents emotionally withdraw from their children, which may lead to
externalizing behavioral problems to occur (Breiling, Maser, & Stoff, 1997). A child
repeatedly exposed to marital conflict – especially when it is unresolved, is more likely to
be aggressive and depressed (Cummings, Ballard, El-Sheikh, & Lake, 1991). When
children are recipients of aggressive parenting themselves, they are more likely to imitate
this behavior in their relationships with their siblings (Conger, Conger, & Elder, 1994).
Siblings provide companionship and support, can be surrogate parents, and
sometimes take on a teaching role. However, siblings also can be bullies or competitors
(Patterson, 2008). Older siblings can influence younger siblings through teaching and
nurture, although studied have shown antisocial conduct of siblings tends to have
negative consequences on the child’s development (Ardelt & Day, 2002; Bullock &
Dishion, 2002; Haynie & McHugh, 2003). Furman & Lanthier (2002) and Brody (1998)
found that siblings’ relationships are positive especially when the child’s relationship
with his parents is positive and the home environment is harmonious. Aggressive and
hostile interactions with siblings, however, provides future practice, observational
learning, and reinforcement of problem behaviors that consequently lead one to
experience failures at school, with peers, and in future relationship (Natsuaki, Ge, Reiss,
& Neiderhiser, 2009).
During childhood, peer groups begin to form. Parents play an important role in
choice of peer groups (Brown, Mounts, Lamborn, & Steinberg, 1993; Curtner-Smith &
9

10. MacKinnon-Lewis, 1994; Mason, Cauce, Gonzales, & Hiraga, 1996). Parents, who raise
their children to focus on academics, will have children who are more likely to socialize
with peers who are more academically inclined. This is also the case for children who
exhibit aggressive and antisocial behaviors (Dishion, Patterson, Stoolmiller & Skinner,
1991; Kim, Hetherington, & Reiss, 1999; Garneir & Stein, 2002; Scaramella, Conger,
Spoth, & Simmons, 2002; Tolan, Gorman-Smith, & Henry, 2003). Problem parent-child
relations, especially ones coercive and hostile, lead to the development of antisocial
disposition in the child. This disposition then contributes to both school failure and
rejection by peers (Dishion, Patterson, Stoolmiller, & Skinner, 1991; Pardini, Loeber, &
Stouthamer-Loeber, 2005). In childhood, peer groups tend to be gender-segregated (i.e.,
boys socialize more with boys, and girls with girls) (Martin & Fabes, 2001) and peers
tend to share similar characteristics (i.e., behavior, socioeconomic status, and other
demographics) with each other (Kupersmidt, DeRosier, & Patters, 1995; Cassidy, Aikins,
& Chernoff, 2003). Kupersmidt, DeRosier, & Patters (1995) found that well-behaved and
similar socioeconomic status children are likely to play together. Children who are more
socially skilled tend to have more friends.
Being rejected by peer groups has a negative impact on one’s development.
Children who are rejected by peer groups tend to be children who are feared or disliked
(such as bullies). Rejection in the peer groups predicts later behavior and mental health
outcomes, such as delinquency, drug abuse and depression (Bagwell, Newcomb, &
Bukowski, 1998; Hawker & Boulton, 2000; Kupersmidt & DeRosier, 2004). This occurs
because many rejected children befriend other rejected children (Breiling, Maser, &
Stoff, 1997; Vitaro, Tremblay, Kerr, Pagani, & Bukowski, 1997).
10

11. Children begin school at the age of five or six. Children must adjust to meeting
new teachers and peers, as well as adapt to a school environment. They must also adjust
to classroom and school rules. Children in smaller classes tend to form warmer, closer
relationships with their teachers, and those who form a more positive relationship with
their teachers are more likely to succeed in school (National Institute of
Child Health and Human Development: Early Childhood Research Network, 2004).
Participation in organized and structured extracurricular activities after school can also
benefit a child’s development (Osgood, Wilson, O’Malley, Bachman, & Johnston, 1996;
Osgood, Anderson, & Shafer, 2005).
If one is aggressive during childhood, then one is more likely to be aggressive in
adolescence and adulthood (Breiling, Maser, & Stoff, 1997; Schaeffer, Kellam, Petras,
Poduska, & Ialongo, 2003). Children living under stressful conditions (e.g., domestic
violence, child abuse/neglect, poor communities) are more likely to develop and model
aggressive behaviors through direct observation from a parent, family members, and, in
some cases, peers (Breiling, Maser, & Stoff, 1997). Children who are aggressive are more
likely to be rejected by there peers and have adjustment and interpersonal problems in the
future (Underwood, 2003; Tremblay et al., 2004; Dodge, Coie, & Lynam, 2006).
Most children are connected to the media through television, videogames and
internet usage, which have more negative than positive effects on a child’s development.
Children who watch more violent television are more likely to act out more aggressively,
than those who do not (Hopf, Huber, & Weiß, 2008). Elementary school children who
play more violent video games become more aggressive in their behavior over time
(Anderson, Gentile, & Buckley, 2007; Breiling, Maser, & Stoff, 1997). These children
11

12. are more likely to commit more violent crimes as adults than there peers (Anderson,
Gentile, & Buckley, 2007). Although just watching violence through the media does
increase the likelihood of violent behaviors, it is not an entirely causal factor (Breiling,
Maser, & Stoff, 1997).
The impact of parents, peer groups, and media exposure can be seen in a child’s
development. Marital conflict, maltreatment and disengaged parenting can influence the
child’s social and psychological development. Antisocial siblings and socializing with
antisocial peers can lead to more antisocial behaviors in the future.
ANTISOCIAL ADOLESCENT DEVELOPMENT
Adolescence is filled with biological changes, social transitions, and cognitive
improvements. During this stage, starting at the age of ten and ending in the early
twenties, adolescents discover who they are, form closer and more caring relationships,
establish a sense of independence, ultimately distance themselves from their parents, and
become members of society. All of these events take place during adolescence and
influence development into adulthood.
Puberty is the period during which an individual becomes capable of sexual
reproduction (Steinberg, 2008). Other biological changes include increases in height,
weight, muscle and strength. Puberty appearances may increase family conflict and
distance between parents and children. Laursen, Coy, & Collinsm (1998) and Ogletree,
Jones, & Coyle (2002) found that, as children mature from childhood into middle
adolescence, emotional distance between adolescents and their parent’s increases and
conflict intensifies, especially between the adolescents and their mothers. Those who
mature early tend to be more popular and socialize with older peers. Early maturers are
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13. more likely to use drugs and alcohol and engage in other risky activities, compared to
their same-aged peers (Wichstrom, 2001). Also, early maturers who use substances early
in adolescence are more likely to have substance abuse problems in the future and be
involved in other problematic behaviors (Dick, Rose, Viken, & Kaprio, 2000). Late-
maturing adolescents, on the other hand, tend to have better coping skills (Steinberg,
2008). The impact of early maturation on adolescents’ antisocial behavior is comparable
among African-American, Mexican-American and Caucasian boys (Cota-Robles, Neiss,
& Rowe, 2002).
During adolescence, children develop an “executive suite” of capabilities that
permit thinking that is more deliberate and more controlled (Keating, 2004). Adolescents
are better at thinking of what is possible; they think in the abstract, multidimensional, and
hypothetically. Adolescents’ conceptions of interpersonal relationships become more
mature; their understanding of human behavior becomes more advanced and their ideas
of social institutions and organizations become more complex. Adolescents’ ability to
understand what people are thinking is far more developed (Steinberg, 2008).
Adolescents are known to be risk takers. An individual’s susceptibility to peer pressure
increases during early and middle adolescence, and most adolescent risk-taking,
including delinquency, drinking, and reckless behavior, occurs when other teenagers are
present (Steinberg, 2004, 2008). Steinberg (2007) found that late maturation of the
prefrontal cortex (the area of the brain that controls executive functioning – planning,
decision-making, goal setting, etc.) increased the likelihood of risk taking during
adolescence. Individuals with deficits in executive functioning have conflicts in areas of
cognitive control and conflict monitoring (Sadeh & Verona 2008). Other studies have
13

14. found that, besides deficits in executive functioning, antisocial adolescents also have low
levels of arousal and increased filtering of environmental stimuli, which is linked to
sensation-seeking risk taking behaviors (Breiling, Maser, & Stoff, 1997). Stimulation
deprivation causes an increase in sensation seeking and risk-taking behaviors (Breiling,
Maser, & Stoff, 1997). Impulse control deficits combined with hyperactivity and
inattention dysfunctions are highly related predisposing factors for the presentation of
antisocial behavior (Holmes, Slaughter, & Kashani, 2001).
Being unable to understand another person’s perspective will hinder the ability to
understand another’s thoughts and feelings and therefore increase the likelihood of
antisocial behaviors such as destroying the property of others, bullying and harming
others and animals. An adolescent’s inability to understand social conventions and
societal norms also increases the chance of antisocial behaviors to form. An individual’s
inability to think about the consequences for their behavior also increases the likelihood
of violations to rules and antisocial behavior.
Peer groups become one of the most important features in an adolescent’s life;
crowd memberships contribute to one’s identity. Prinstein & Greca (2002) and Sussman,
Dent, McAdams, Stacy, Burton, & Flay (1994) found that the crowd with which an
adolescent affiliates has an important influence on his or her behavior, activities and self-
conception. If one’s crowd is uninterested in academics, one will be disengaged in school
and perhaps more focused on antisocial behaviors. The more substance-using friends an
adolescent has and the closer he or she feels to them, the more the adolescent is likely to
use alcohol and drugs (Hussong & Hicks, 2003). Peer influence is a dominant factor in
predicting whether that individual will be at risk for juvenile offending (Chung &
14

15. Steinberg, 2006). Adolescents with antisocial friends, who become more antisocial, will
become more delinquent (Werner & Silbereisen, 2003). Gang membership is also
associated with antisocial behavior. Adolescents who belong to gangs are at greater risk
for many types of problems in addition to antisocial behavior, including elevated levels of
psychological distress and exposure to violence (Li, Stanton, Pack, Harris, Cottrell, &
Burns, 2002).
The neighborhood in which one lives also influences adolescent development. For
most growing up in a poor neighborhood has negative effects on adolescent development
and mental health (McLoyd, 1990; Chung & Steinberg, 2006). Neighborhoods affect
adolescents by influencing norms to which an adolescent is exposed to (i.e., if they see
violence in the neighborhood, they will be believe it is “normal” for violence to occur)
and limited access to economic and institutional resources (Chung & Steinberg, 2006;
Steinberg, 2008). Adolescents who live in poor neighborhoods come into contact with
deviant peers more often, and by seeing nothing but poverty and unemployment in their
communities, they will have little reason to be hopeful about their own future; they may
feel that they have little to lose and therefore, drop out of school or become involved in
criminal activity (Steinberg, 2008). In poor neighborhoods the quality of schools, health
care, transportation, employment opportunities, and recreational services is lower and as
a result, adolescent have fewer chances to engage in activities that facilitate positive
development and fewer chances to receive services when they are having difficulty
(Leventhal & Brooks-Gunn, 2004). Exposure to violence, such as can be witnessed in
their own home, neighborhood, or at school, increase the likelihood that they themselves
will be involved in violent behavior, which could involve hurting themselves or others
15

16. (Campbell & Schwarz, 1996; Gorman-Smith & Tolan, 1998; Youngstrom, Weist, &
Albus, 2003; Ozer, 2005; Steinberg, 2008). Bingenheimer (2005) found that witnessing
gun violence doubles an adolescent’s risk for committing violence in the future.
Although it may appear that family is not as important in adolescence, parental
styles, siblings and family changes are shown to have a significant effect on the
adolescent and his or her behaviors. According to Collins & Steinberg (2006) adolescents
who are raised in an authoritative home are more responsible, more self-assured, more
adaptive, more creative, more socially skilled, and more successful in school.
Adolescents raised in an authoritarian homes are more dependent, more passive, less
socially adept, less self-assured, and less intellectually curious. Adolescents raised in an
indulgent households are often less mature, more irresponsible, more conforming to their
peers, and less able to assume positions of leadership. Adolescents raised in an indifferent
homes are often impulsive and more likely to be involved in delinquent behavior and in
precocious experiments with sex, drugs and alcohol. Studies such as Crittenden,
Claussen, & Sugarman (1994), Strauss & Yondanis (1996), Sheeber, Hops, Alpert,
Davis, & Andrews (1997) and Pittman & Chase-Lansdale (2001) have shown that
parenting that is indifferent, neglectful, or abusive has harmful effects on an adolescent’s
mental health and development, leading to depression and antisocial behavioral problems,
including cases of physical abuse and aggression toward others. Adolescents from single-
parent homes, as well as those from uninvolved or less supportive parents are more likely
to be peer oriented and be more susceptible to antisocial pressure (Farrell & White, 1998;
Erickson, Crosnoe, & Dornbusch, 2000; Steinberg, 2008).
16

17. Changes in family life also can influence antisocial development. As stated
earlier, divorcing parents increases the likelihood of decreased parental monitoring and
increased exposure to martial conflict, both of which can have a maladaptive outcome to
development (Dornbusch et al., 1985; McLanahan & Bumpass, 1988; Moore & Chase-
Landsdale, 2001). Divorce increases an adolescent’s risk of using drug and alcohol,
having more behavioral problems, performing poorer in school and of being more likely
to engage in sexual activity (Allison & Furstenberg, 1989; Astone & McLanahan, 1991;
Hetherington & Stanley-Hagan, 1995).
Families’ financial strain also can disrupt parenting function and increase
behavioral problems (McLoyd, 1990). Income loss tends to increase the likelihood for an
adolescent to have emotional, academic and interpersonal problems as well as diminish
ones sense of mastery (Lempers, Clark-Lempers, & Simmons 1989; Conger, Conger,
Matthews, & Elder, 1999; Barrera et al., 2002). Conger, Conger, Matthews, & Elder
(1999) found financial strain also affected an adolescent’s psychological development. In
addition, parents who are stressed economically tend to be less involved, less nurturing
and less consistent in their discipline (McLoyd, 1990). This gives rise to a wide range of
psychological and behavioral problems in adolescence.
Sibling relations can also influence an adolescent’s development. The effect of
sibling relationships in adolescence is similar to its effect in childhood. A positive sibling
relationship in adolescence contributes to positive school competency, sociability,
autonomy, and self-worth (Yeh & Lempers, 2004).
School has profound effects on an adolescent’s development and behavior
(Steinberg, 2008). Large schools tend to provide adolescents with more classes,
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18. extracurricular activities and resources (Lee & Smith, 1995). Small schools increase
adolescent’s involvement in a classroom and gives them a sense of involvement and
obligation (Steinberg, 2008). Although class size does not affect an adolescent’s
academic development, overcrowding in school does provoke potential problems. Over-
crowded schools can be stressful on both students and their teachers and are more likely
to have inadequate resources (Ready, Lee, & Welner, 2004). Educators who provide
opportunities for their students, engage and excite students, are not biased, and set
expectations that are reasonably related to a student’s ability, will promote positive
adolescent academic development (Eccles, 2004; Rosenbloom & Way, 2004). That is, a
good teacher resembles a good, authoritative parent (Wentzel, 2002; Pellerin, 2005).
Schmidt (2003) found students who are disengaged in school are more likely to
misbehave.
Overcrowding in schools increases stress not only in teachers and resources, but
for the students as well. Violence is more common in overcrowded school, especially in
poor urban neighborhoods (Khoury-Kassabri, Benbensihty, Astro & Zeira, 2004).
Students who have low achievement beliefs can also influence antisocial behavior. They
are more likely to drop out of school, which is correlated to living at or near poverty
level, to experience unemployment and be involved in delinquent and criminal activity
(Rumberger, 1995; Steinberg, 2008).
Most individuals work during adolescence. Often these jobs have very little to do
with future careers and range from fast-food workers to cashiers to manual or skilled
labor. Most adolescents’ salaries go towards needs and activities. The more hours an
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19. adolescent works, the less satisfied they feel about life (Fine, Mortimer, & Roberts,
1990).
Most of an adolescent’s leisure time is involved socializing with peers, playing
sports, watching television and using other forms of the technology (including computer,
cell phones, video games, shopping, playing a musical instrument, etc.). Most
extracurricular activities (i.e., structured activities) have positive influence on an
individual’s development. This is so because it increases contact with peers, teachers and
other school or neighborhood personnel who may reinforce the value of school or
neighborhood and because participation itself may improve students’ self-confidence and
self-esteem (Spreitzer, 1994; Gore, Farrell, & Gordon, 2001; Markstrom, Li, Blackshire,
& Wilfong, 2005; Steinberg, 2008). Unstructured activities, conversely, are associated
with more problem behavior. Simply spending more time with peer’s increases the
likelihood of alcohol and drug use and partying, as well as being more susceptible to peer
pressure (Caldwell & Darling, 1999). Unstructured leisure activities can increase an
adolescent’s exposure to antisocial peers and activities. According to Steinberg (2008)
“Because most adolescence is a time of heightened peer pressure, and
heightened susceptibility to peer influence, and because one of the
strongest deterrents against problem behavior is a presence of an adult, it
is hardly surprising that unstructured peer activity without adult
supervision is associated with all sorts of problems – delinquency, drug
and alcohol use, and precocious sexual activity.” (pp. 250)
19

20. A lack of structure, absence of adult supervision, and socializing with peers increased the
likelihood of delinquency and other problematic behaviors (Mahoney & Stattin, 2000;
Mahoney, Stattin, & Lord, 2004; Osgood & Anderson, 2004).
Adolescents’ exposure to the media (such as television, computers, and
magazines) also has a negative influence on an adolescent’s development. Adolescents
spend on average at least seven hours each day using the media, and the time spent is
continuously increasing (Steinberg, 2008). Adolescents are exposed to sexual themes,
violence, the use of drugs and alcohol and misleading messages of beauty and power,
which can cause antisocial behavior, as well as external or internal problems (Cantor,
2000;Ward, 2003; Ward, & Friedman, 2006; Steinberg, 2008). Media can also influence
the development of conduct disorder and antisocial behaviors during adolescence.
Messages on television, websites, and magazines can influence one’s sexual behaviors;
alcohol and drug use, and desensitize adolescents to violence. Consequently, exposure to
these messages can influence one’s behavior (Cantor, 2000; Johnson, Cohen, Smailes,
Kasen, & Brook, 2002; Huesmann, Moise-Titus, Podolski, & Eron, 2003).
As the foregoing show, adolescence is a period of changes and transitions, growth
and development, as well as privileges and responsibilities. One’s parents, siblings,
environment, peers, and even the media are important factors that can contribute to
normal adult development.
MENTAL DISORDER HISTORY OF INDIVIDUALS DIAGNOSED WITH
ANTISOCIAL PERSONALITY DISORDER
Antisocial Personality Disorder develops from disorders that occur during
childhood and adolescence. These mental disorders impair an individual’s psychological,
academic and social development. Disruptive Behavioral Disorders such as Conduct and
20

21. Oppositional Defiant Disorder as well as Attention-Deficit/Hyperactivity Disorder are the
disorders mostly noted to precede the development of Antisocial Personality Disorder.
Thirty to forty percent of children diagnosed with Conduct Disorder develop
antisocial personality disorder (Robins, 1966, 1991; Robins, Tipp & Przyberk, 1991).
Individuals diagnosed with Antisocial Personality Disorder showed symptoms of
Conduct Disorder before the age of fifteen. Conduct Disorder is a disruptive behavior
disorder that occurs in either childhood or adolescence. They show a repetitive and
persistent pattern of behavior in which they violate social norms or the rights of others
(DSM-IV-TR). There are three types of this disorder: childhood-onset type (diagnosed
prior to age ten), adolescent-onset type (diagnosed after age ten), and unspecified onset
(age is unknown) (DSM-IV-TR). The symptoms of conduct disorder can be either mild
(i.e., lying), moderate (i.e., vandalism) or severe (i.e., physical cruelty)(DSM-IV-TR). To
be diagnosed with conduct disorder one must fall into three or more of the criteria in the
past twelve months with at least one criterion in the past six months (DSM-IV-TR). One
must have shown aggression toward people and/or animals (such as bullying or
intimidating others), deceitfulness and/or theft, and serious violation of the rules (i.e.,
breaking parental rules) and/or destroyed property (DSM-IV-TR). Individuals diagnosed
with Conduct Disorder tend to engage in aggressive behavior. They may display bullying,
threaten others, initiate physical fights, and deliberately damage others’ property. They
may be deceitful, steal, violate rules set by others or force someone into sexual activities.
Lahey, Loeber, Burke & Applegate (2005) found that Conduct Disorder is not
always a predictor of the development of Antisocial Personality Disorder. Other
disruptive behavior disorders in childhood, such as Oppositional Defiant disorder (ODD)
21

22. and Attention-Deficit/ Hyperactivity Disorder (ADHD) may predispose youths to
develop Antisocial Personality Disorder. In a significant percentage of cases,
Oppositional Defiant Disorder is a development antecedent to Conduct Disorder.
However, not all children diagnosed with Oppositional Defiant Disorder develop
Conduct Disorder(DSM-IV-TR). Children with Oppositional Defiant Disorder show
symptoms in recurrent pattern of negativistic, defiant, disobedient, and hostile behavior
toward authority figures. This behavior is evident before the age of eight and includes
frequent loss of temper, arguing with adults, and actively defying or refusing to comply
with the request or rules of others (DSM-IV-TR). Individuals diagnosed with
Oppositional Defiant Disorder tend to lose their temper, argue with adults, actively defy
rules set by adults, are spiteful, blame others for his or her mistakes, and show persistent
stubbornness, resistance to direction , and an unwillingness to compromise, give in or
negotiate with adults or peers (DSM-IV-TR).
Approximately half of children with Attention-Deficit/Hyperactivity Disorder
also have Oppositional Defiant Disorder or Conduct Disorder (DSM-IV-TR). Attention-
deficit/Hyperactivity Disorder is a disruptive behavioral disorder in which the individual
shows a persistent pattern of inattention and/or hyperactivity-impulsivity which results in
impairments at home and at school or work. This disruptive behavior must be present
before the age seven and there must be clear evidence of interference in the development
of appropriate social, academic, or occupational functioning (DSM-IV-TR). Failure to
complete tasks with detail and attention, difficulty to saying on tasks and being extremely
disorganized are indicators of inattention. Hyperactivity is evident when a child is unable
to sit still and talks excessively. Signs of impulsivity include being impatient,
22

23. continuously interrupting and having difficulty waiting one’s turn (DSM-IV-TR). There
are three subtypes of this disorder: Attention-Deficit/Hyperactivity Disorder: Combined
Type (six symptoms of hyperactivity, six symptoms of inattention), Attention-Deficit/
Hyperactivity disorder: Predominantly Inattentive (six or more symptoms of inattention,
fewer symptoms of hyperactivity), and Attention-Deficit/Hyperactivity Disorder:
Predominantly Hyperactivity –Impulsive Type (six or more symptoms of hyperactivity,
fewer symptoms of inattention)(DSM-IV-TR). According to the DSM-IV-TR (2000)
“The rates of co-occurrence of Attention-Deficit/Hyperactivity Disorder
with these other Disruptive Behavior Disorders are higher than with other
mental disorders, and this co-occurrence is more likely in the two subtypes
marked by hyperactivity-impulsivity: Hyperactivity-Impulsive and
Combined Type.” (pp. 88)
Increased hyperactivity in childhood leads to increase in the likelihood of antisocial
behavior in adulthood (Freidenfelt & af Klinteberg, 2007).
Oppositional Defiant Disorder co-morbid with Attention-Deficit/Hyperactivity
Disorder increases the risk for Antisocial Personality Disorder, indirectly by increasing
risk for early-onset and persistent Conduct Disorder. Yet, co-morbidity of Attention-
Deficit/ Hyperactivity Disorder and Conduct Disorder increases risk for severe Antisocial
Personality Disorder in adulthood beyond what either disorder contributes independently.
However, studies have shown on individuals diagnosed with Attention-
Deficit/Hyperactivity Disorder and Oppositional Defiant Disorder independently from
Conduct Disorder does not predict the development of Antisocial Personality over time
23

24. (Lahey, Loeber, Burke, Rathouz & McBurnett, 2002; Lahey, Loeber, Burke, &
Applegate, 2005; Washburn, Romero, Welty, Abram, Teplin, & McClelland, 2007).
ANTISOCIAL PERSONALITY DISORDER FEATURES
The development of antisocial behavior continues from childhood into
adolescence and even into adulthood. The more frequent and diverse the childhood
antisocial acts are, the more likely the individual is to develop a life-long pattern of
antisocial behavior (Lynam, 1997). If intervention does not occur, one has a higher
chance of becoming incarcerated. Approximately forty to seventy-five percent of prison
inmates have Antisocial Personality Disorder, although, not all individuals with
Antisocial Personality Disorder are criminals (Hare, 1993; Widiger & Corbitt, 1995).
To be diagnosed with Antisocial Personality Disorder, one must be at least 18
years old and exhibit some symptoms of Conduct Disorder in adolescence (or in some
cases childhood) (DSM-IV-TR). Individuals with Antisocial Personality Disorder fail to
adhere to social norms with respect to being law-abiding citizens and tending to perform
acts repeatedly that are grounds for arrest (DSM-IV-TR). These acts can involve
destroying or vandalizing property, stealing, or physically hurting superiors (e.g., a boss)
and/or animals. These individuals also tend to be deceitful and manipulative in order to
gain personal profit or pleasure (such as to obtain money, sex, or power)(DSM-IV-TR).
Individuals diagnosed with Antisocial Personality Disorder are predisposed to be
impulsive and disregard planning for future consequences, which can lead to changes in
jobs, residences, and interpersonal relationships (DSM-IV-TR). Many individuals with
Antisocial Personality Disorder are extremely aggressive and irritable and, therefore, get
into physical fights or even in some cases commit acts of physical assault (i.e., spousal
24

25. and child abuse). Individuals with Antisocial Personality Disorder may engage in sexual
behavior or substance use that has a high risk for harmful consequence [i.e. HIV] (DSM-
IV-TR).
Individuals diagnosed with Antisocial Personality Disorder are also characterized
as consistently and extremely irresponsible (DSM-IV-TR). They may show
irresponsibility at work by repeated absences from work or by abandoning jobs. They
may show financial irresponsibility by failing to provide child support or not paying
income taxes. These individuals with Antisocial Personality Disorder tend to show little
remorse when it comes the consequences for their actions. According to the DSM-IV-TR
(2000) “They may be indifferent to, or provide a superficial rationalization for, having
hurt, mistreated, or stolen from someone. They may blame their victim for being foolish,
helpless, or deserving their fate.” (pp. 702) Individuals with Antisocial Personality
Disorder tend to be substance abusers (Messina, Farabee, & Rawson, 2003). and have
other mental disorder, such as anxiety disorders, mood disorders, pathological gambling,
or impulse control disorders, as well as somatization disorders (DSM-IV-TR).
Interpersonally, individuals with Antisocial Personality Disorder often come
across as arrogant with a grandiose sense of self-worth. They tend to be callous, which
makes them unable to form strong emotional bonds with others. They tend to be conning
and manipulative through lying. These individuals tend to be irresponsible for not only
themselves but for their children as well (i.e., malnutrition, failure to monitor children).
These interpersonal qualities affect not only their interpersonal relationships but
educational and occupational careers as well.
25

26. According to the DSM-IV-TR (2000) individuals with Antisocial Personality
Disorder are more likely to
“receive dishonorable discharges from the armed services, may fail to be
self-supporting, may become impoverished, or even homeless, or may
spend many years in penal institutions. Individuals with Antisocial
personality Disorder are more likely than people in the general population
to die prematurely by violent means (e.g., suicide, accidents, and
homicides).” (pp. 703)
Antisocial Personality Disorder runs a persistent course, but may become less
evident in an individual’s fourth decade of life (DSM-IV-TR). Though this appears to be
the case, individuals diagnosed with this disorder are more likely to spend many years in
penal institutions, be homeless or become impoverished, and fail to be self-supporting
(DSM-IV-TR). Individuals diagnosed with Antisocial Personality Disorder are also more
likely to die prematurely through violence (DSM-IV-TR).
TREATMENT SUGGESTIONS
Individuals with Antisocial Personality Disorder usually seek treatment due to a
court order and, therefore, are extremely difficult to treat, as they have not sought
treatment voluntarily. For psychotherapy to work, one must want to change. Being forced
into therapy, one might miss appointments, not complete homework assignments or
devalue the therapist. However, knowing that Antisocial Personality Disorder is enduring
and develops over a lifespan, we can treat the antisocial behaviors early. Token
economies and family therapy, as well as integrative approaches and
psychopharmaceuticals, can help treat antisocial symptoms. Early intervention studies
26

27. and research demonstrate that that the development of Antisocial Personality Disorder
can be diminished.
Research has shown that early intervention is an effective way to reduce
problematic behaviors, especially in school settings (Farrell & Meyer, 1997; Flannery,
2000). A neglected child can learn proper social skills and feel more competent in social
situations by improving adult-child relations and through different teaching techniques
(Flannery, 2000; McDevitt & Ormrob, 2007). Teaching children social skills can prevent
peer rejection. Flannery (2000) saw a decrease in aggressive behavior when teachers
encouraged and rewarded prosocial behavior, which in turn decreased antisocial
behaviors. Teachers who promote and develop structured extracurricular activities after
school programs or summer school activities can also decrease antisocial behaviors (Zill,
Nord & Loomis, 1995; McDevitt & Ormrob, 2007). Academically oriented programs
promote positive feelings about school, improve classroom behavior, greater conflict
resolution skills, improve grades and achievement test scores and increase school
attendance in children (McDevitt & Ormrob, 2007). This may also influence with whom
the child associates, which indirectly promotes greater investment in school (Zill, Nord &
Loomis, 1995).
Contingency management theory suggests that human behavior is controlled by
its consequences (Harvey, Luiselli & Wong, 2009). If one’s response is positively
reinforced, one is more likely to repeat that behavior. If one’s response is punished, it is
not likely to happen again (Domjan, 2006). Therefore, contingency management theorists
would suggest that antisocial behavior was constantly positively reinforced early on in
life, and thus it will continue on into adulthood. Token economies target maladaptive
27

28. behavior by directly reinforcing positive behaviors with tokens and punishing
maladaptive behaviors (i.e., taking tokens away) (Harvey, Luiselli & Wong, 2009). This
type of treatment can be used to target maladaptive behaviors such as aggression and
anger (Flannery, 2000). Because most antisocial individuals are likely to be incarcerated
or in substance abuse programs, which are both controlled environments, the use of token
economies for treatment will be more effective and efficient for behavior change over
time (Harvey, Luiselli & Wong, 2009). Messina, Farabee & Rawson (2003) found
contingency management forms of therapy treatment were more effective for Antisocial
Personality Disorder (as well as Antisocial Personality Disorder individuals with
substance abuse problems) than “talk therapies” (i.e., Psychodynamic) and showed less
relapse rate.
Psychopharmaceuticals, drugs used in the treatment of mental health disorders,
can also be helpful for treating symptoms of Antisocial Personality Disorder.
Anticonvulsants: phenytoin, carbamazepine, and valproate in particular have been found
to be effective in treating impulsive aggression in Antisocial Personality Disorder
patients (Stanford et al., 2005). Cambell, Gonzales, & Silva (1992), Mattes (1990), and
Stewart, Myers, Burket, & Lyles (1990) found that beta blockers have also proven to
reduce impulsive symptoms found in Conduct Disorder, Attention-Deficit/Hyperactivity
Disorder and Explosive Disorder. Propranolol and Pindolo are common beta blockers
used and tend to have very few side effects (Breiling, Maser, & Stoff, 1997).
Because most individuals with Antisocial Personality Disorder had family issues
throughout life, family therapy is a way to intervene early. Family therapy is used to
improve parent-child communication (Knox, Care, Kim, & Marciniak, 2004) and can
28

29. also reduce problematic behaviors (Connell, Dishion, Yasui, & Kavanagh, 2007;
Breiling, Maser, & Stoff, 1997). Connell, Dishion, Yasui, & Kavanagh (2007) found
increasing parents’ degree of engagement and teaching them proper monitoring skills
decreased the onset of antisocial behaviors. Increase in parent monitoring also decreased
antisocial peer involvement. In addition, increased school involvement from a parent
decreased involvement in antisocial behaviors(Connell, Dishion, Yasui, & Kavanagh,
2007).
Using Integrative Psychotherapy, combining Cognitive– Behavioral and
relaxation techniques as well as Psychodynamic techniques, was also found effective in
treating symptoms of violence and antisocial behavior in Antisocial Personality Disorder
(Krampen, 2009). Therefore it can be a helpful way to intervene with early antisocial
children and adolescents. Cognitive behavioral therapy seeks to change behavior and
thinking patterns that contribute to an individual’s problems (Owen, 2009; Johnstone &
Dallos, 2006). Cognitive-behavioral techniques could help individuals decrease antisocial
behavior and reduce anger by teaching individuals skills such as problem identification,
problem solving, decision-making, relaxation techniques and negotiation. Impulse control
and focusing on outcome expectancies can help focus an individual to reduce aggressive
and impulsive tendencies (Breiling, Maser, & Stoff, 1997, Johnstone & Dallos, 2006;
Krampen, 2009).
Adler’s (1964) psychodynamic approach posits that individuals strive to be
superior. They are motivated by inevitable feeling of inferiority to become superior in
one’s environment. One develops lifestyles as means of determining how one lives. A
psychodynamic theorist, such as Adler, would view an Antisocial Personality Disorder
29

30. individual as someone who lived by maladaptive lifestyle of wanting to attain power as
means of avoiding an inferiority complex of feeling powerless and helpless in one’s
ability control ones environment. This particular approach involves analyzing cognitive
lifestyles (i.e., “nobody cares”) in order to help the client become more fully conscious of
how he or she is directing his or her own life towards a destructive style of life (Adler,
1964; Maker & Buttenheim, 2000; Johnstone & Dallos, 2006).
The therapeutic relationship in psychodynamic theory is extremely important in
the change process. A therapist’s willingness to relate as a genuine equal increases the
likelihood that the client’s ability to actively contribute to finding solutions to serious
problems (Luborsky, 1984). By a therapist actively listening and being empathetic, an
individual with Antisocial Personality Disorder might replace his or her old style of
thinking and see the world as a more caring and understanding place (Breiling, Maser, &
Stoff, 1997). A psychodynamic approach can also be helpful in treating past feelings of
neglect and help abandon past protective strategies. Krampen (2009) found long-term
outcomes after long-term integrative psychotherapy ended. Symptoms of acting out and
violent behaviors decreased, with only a few relapses. However, Krampen’s work
appears to only work in controlled (in-patient) settings (Krampen, 2009).
There are many techniques and tools in which we can help treat the early onset
development of Antisocial Personality Disorder. Whether or not we choose to medicate,
intervene in school settings or family therapy, or even try to treat individually through
psychotherapy or counseling, there needs to be more research on how to prevent the onset
of Antisocial Personality Disorder.
30

31. CONCLUSION
Antisocial Personality Disorder has enduring symptoms that begin to exhibit
during infancy and through adulthood. A difficult temperament and disengaged,
neglectful parenting influence a child’s development to future antisocial behaviors.
Environmental factors in one’s home, school (especially peer involvement) and
community contribute to how one perceives and becomes involved in the world.
Unsupervised antisocial peer groups and disengagement in school develops into adult
antisocial behaviors such as substance use, stealing and other delinquent acts. Therefore,
there needs to be new ways to intervene with these children and adolescents before the
condition limits their lives. Children with Oppositional Defiant Disorder or Attention-
Deficit/Hyperactivity Disorder and children or adolescents with Conduct Disorder need
to be treated before it turns into a life-long battle with society and consequently, the law.
Future research is important to find effective and long-lasting psychotherapeutic ways to
treat children and adolescents who exhibit symptoms and to treat adults diagnosed with
Antisocial Personality Disorder in order to help them live their lives in a more socially
responsible way.
31

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