Developmental epidemiological courses leading to antisocial personality disorder and violent and criminal behavior: Effects by young adulthood of a universal preventive intervention in first- and second-grade classrooms

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Abstract

Background

Antisocial personality disorder (ASPD), violent and criminal behavior, and drug abuse disorders share the common antecedent of early aggressive, disruptive behavior. In the 1985–1986 school year teachers implemented the Good Behavior Game (GBG), a classroom behavior management strategy targeting aggressive, disruptive behavior and socializing children to the student role. From first through seventh grade the developmental trajectories of 2311 students from 19 Baltimore City Public Schools were examined. We report the GBG impact on these trajectories and ASPD and violent and criminal behavior by age 19–21.

Methods

In five urban, poor to lower middle class predominately African-American areas, three to four schools were matched and within each set randomly assigned to one of three conditions: (1) GBG, (2) a reading achievement program, or (3) the standard program. Classrooms and teachers were randomly assigned to intervention or control. Measures at 19–21 included self reports and juvenile court and adult incarceration records. GBG impact was assessed via General Growth Mixture Modeling based on repeated measures of aggressive, disruptive behavior.

Results

Three trajectories of aggressive, disruptive behavior were identified. By young adulthood, GBG significantly reduced the rates of ASPD and violent and criminal behavior among males in the persistent high aggressive, disruptive trajectory.

Replication

A replication was implemented with the following cohort of first-grade children using the same teachers, but with diminished mentoring and monitoring. Beneficial impact was found among persistent high males through seventh grade. By young adulthood GBG effects on ASPD and violent and criminal behavior were non-significant, but generally in the hypothesized direction.

Introduction

Antisocial personality disorder (ASPD) is one of the more common serious mental health problems presently faced in the U.S. (Kessler et al., 1994, Moran, 1999, Turner and Gil, 2002). It is associated with both economic costs and great suffering for individuals (e.g., involvement with the legal system, co-occurring substance use and other mental health problems) families (e.g., broken homes, non-support), the community (e.g., victims, crime and aggression) and the state (e.g., welfare, imprisonment) (Britt, 2000, Capaldi and Stoolmiller, 1999, Cohen and Miller, 1998, Krueger et al., 1998, Lambert et al., 2001, Loeber et al., 2000, New and Berliner, 2000, Robinson and Keithley, 2000). ASPD is frequently comorbid with virtually every drug abuse disorder (Compton et al., 2005), and it increases the morbidity and complicates the treatment for substance use disorders (Westermeyer and Thuras, 2005). Both ASPD and drug abuse disorders are also commonly associated with serious violent and criminal behavior. Importantly, heavy use of alcohol and other drugs appears to increase risk for both commission and victimization of violent acts (Chaiken and Chaiken, 1990). In addition, Fazel and Danesh (2002) report in a review of serious mental disorders in special populations that close to half (47%) of imprisoned individuals qualify for an antisocial personality disorder diagnosis. Importantly, all of the above-mentioned outcomes associated with ASPD, drug abuse, and violence require high levels of service use (Poduska et al., 2008, Webster-Stratton and Taylor, 2001).

Given these adverse effects and the difficulty in treating ASPD and its co-occurring antisocial outcomes once they are established (Reid and Thorne, 2006), there has been a growing consensus among social scientists and policy makers that early preventive interventions targeting the antecedents of antisocial behavior are preferable to treatment approaches (Bennett et al., 1998, Bennett et al., 1999, Mrazek and Haggerty, 1994, Offord and Bennett, 1997, Reiss and Price, 1996). In light of this strong evidence regarding the continuity between childhood and adult antisocial behavior, this preventive approach is especially pertinent (Farrington, 1995, Robins, 1966). Indeed, decades of research suggest that prevention is the most effective strategy available for reducing youth antisocial and violent behavior (Dodge, 1999, Hawkins et al., 2000b, Satcher, 2001).

Early aggressive, disruptive behavior is widely recognized as an antecedent of later ASPD and violent and criminal behavior as well as drug abuse and school dropout (Dishion et al., 1996, Ensminger et al., 1983, Ensminger and Slusarcick, 1992, Farrington and Gunn, 1985, Hawkins et al., 2000a, Kellam et al., 1983, Kellam et al., 1991, Kellam et al., 1994, Kellam et al., 2008, Kershaw, 1992, McCord and Ensminger, 1997, Robins, 1978, Sameroff, 1994, Schwartzman et al., 1985). Given the importance of early aggressive, disruptive behavior as a precursor for an array of later problems, a number of universal (i.e., directed at the entire population) classroom preventive intervention trials have targeted this antecedent as a means of preventing later antisocial behavior and drug abuse. Examples of rigorous trials incorporating random assignment include The Seattle Social Development Project (Hawkins and Weiss, 1985), Linking the Interests of Families and Teachers (Eddy et al., 2000, Reid et al., 1999), Promoting Alternative Thinking Strategies (Greenberg and Kusche, 1998), Second Step (Grossman et al., 1997), Bullying Prevention (Olweus, 1991, Olweus, 1992, Olweus and Alsaker, 1991, Smith and Sharpe, 1994), and the three generations of developmental epidemiology-based field trials involving the Good Behavior Game (GBG) in the Baltimore City Public School System (BCPSS) (Kellam et al., 2008). These randomized trials are particularly important and powerful in determining the efficacy of interventions such as the GBG and in testing the etiologic model upon which the GBG is based (Brown and Liao, 1999, Brown et al., 2008, Farrington and Welsh, 2005, Kellam and Langevin, 2003, Kellam and Rebok, 1992, Kellam et al., 1999).

The Baltimore trials have a study design with two unique features that make it well suited for the study of long-term outcomes. First, study participants were followed into young adulthood, which gives these trials the capacity to inform the field about the long-term impact of the GBG on a range of outcomes including antisocial and violent and criminal behavior as the subjects move into adulthood. Although a number of the intervention programs targeting early aggressive, disruptive behavior cited above have demonstrated short-term impact, the Baltimore prevention intervention research is part of only a small set of programs that followed study participants into the young adult years (for a comprehensive review of school-based violence prevention programs, see Gottfredson, 2001, Gottfredson et al., 2002). Second, the Baltimore trials are part of only a few to employ a randomized block design to disentangle the effects of the school from the effects of the intervention itself (for more detail, see Kellam et al., 2008).

The GBG is a team-based behavior management strategy that promotes appropriate classroom behavior by rewarding teams of students that do not exceed maladaptive behavior standards (Barrish et al., 1969, Dolan et al., 1993, Kellam et al., 1994). The goal is to encourage students to manage their behavior through group reinforcement and mutual self-interest. Previous research has documented the effectiveness of the GBG in reducing the level and development of aggressive, disruptive behavior, particularly among aggressive, disruptive males (Brown, 1993, Dolan et al., 1993, Kellam and Anthony, 1998, Kellam et al., 1994, Kellam et al., 1998, Muthén et al., 2002, Rebok et al., 1996).

Life course/social field theory has guided the use of preventive interventions aimed at early antecedent of later problem outcomes as well as the conceptualization of normal and pathologic development in the Baltimore trials (Kellam et al., 1975, Kellam and Rebok, 1992). Central to life course/social field theory is the concept that individuals face specific social task demands in various social fields over the major stages of the life course. The specific social task demands the individual confronts through each stage of life are defined by individuals in each social field, whom we have termed the natural rater(s). The natural rater not only defines the tasks but also rates the adequacy of performance of the individual in that social field. Parents function as natural raters in the family, peers in the peer group, teachers in the classroom, and supervisors in the workplace. This interactive process of demand and response is termed social adaptation, and the judgment of adequacy of the individual's performance by natural raters is labeled social adaptational status (Kellam et al., 1975).

In line with the organizational approach to development (Cicchetti and Schneider-Rosen, 1984), normal development is viewed within the life course/social field theory as marked by the integration of earlier competencies into later modes of function, with the earlier competencies remaining accessible, ready to be activated and utilized during times of stress, crisis, novelty, and creativity. It follows then that early successful social adaptation in the face of prominent developmental challenges tends to promote later adaptation as the individual traverses the life course and encounters new and different social task demands across the main social fields (Cicchetti and Schneider-Rosen, 1984).

A critical developmental challenge early in the life course is entrance into the classroom social field, where the child is confronted with the teacher's demands for academic achievement, compliance, attention, and participation in classroom and peer activities. The transition into middle school and early adolescence provides another set of developmental tasks and challenges, which center on separation and individuation from parents and the growing demands of the family, classroom, and peer group social fields. Life course/social field theory posits that success in meeting these evolving and new task demands in middle school will depend, in part, on successful adaptation to the earlier developmental challenges encountered during the transition to elementary school. This key developmental principle, supported by a growing empirical literature, forms the basis for the focus in the Baltimore trials on successful adaptation to first grade as a means of improving social adaptational status over the life course.

Several researchers have worked on theoretical and empirical modeling of aggressive, disruptive behavior development (Loeber et al., 1998, Moffitt, 1993, Moffitt et al., 1996, Moffitt et al., 2002, Nagin and Tremblay, 1999, Nagin et al., 1995, Patterson et al., 1992, Patterson et al., 1998). Despite differences in terminology and emphasis, each model identifies two to five distinct groups of antisocial youth with different behavioral patterns, risk factors, and prognoses for desistence from antisocial behavior as adults. Each model proposes one to two chronic groups whose early and persistent aggressive, disruptive behavior is likely to be related to a biological or genetic vulnerability that is exacerbated by poor parenting and early school failure (i.e., the early starters, Patterson, 1982; life course persistent groups, Loeber and Stouthamer-Loeber, 1998, Moffitt, 1993). Each model also identifies one to two less severe groups whose antisocial behavior starts later, is less aggressive, disruptive, more sporadic, and stems from later socialization experiences such as deviant peer affiliations in early adolescence (i.e., the late starters, Patterson et al., 1992; adolescent-limited, Moffitt, 1993; and limited duration pathways, Loeber and Stouthamer-Loeber, 1998). Also implicit in each model is the assumption that there is at least one other group of youth who do not exhibit problems with antisocial behaviors. These models have helped to shift the study of youth antisocial behavior away from a variable-centered focus on describing broad predictors of behavior toward a more person-centered focus emphasizing individual differences in development (Magnusson, 1998). However, the empirical literature has focused primarily on the development of male aggression and has given little attention to the role of early aggression and other disruptive behaviors in the development of later female antisocial behavior (Keenan and Shaw, 1997, Silverthorn and Frick, 1999). Although some empirical studies examining pathways of antisocial behavior development among females are starting to emerge in the literature (e.g., Broidy et al., 2003, Cote et al., 2001, Schaeffer et al., 2006), research regarding gender differences in these pathways is limited.

The mechanisms by which the GBG intervention is hypothesized to reduce the risk for later antisocial behavior is consistent with the integration of the life course/social field theory and the early starter and late starter models of the development of antisocial behavior identified by Patterson et al. (1992). The early starter models of antisocial behavior build upon the theory of coercive family process developed by Patterson (1982). In the toddler years, parents’ failure to effectively punish noncompliant and aggressive, disruptive behavior comprises the first step in a process which serves to train the child to become progressively more coercive and antisocial. In the classroom setting, such children prove difficult for teachers, peers, or other natural raters to teach appropriate forms of social interaction and problem solving. Moreover, their coercive style may be further reinforced in the presence of inconsistent and punitive teacher disciplinary practices. Ultimately parents, teachers, and well-adjusted peers reject the coercive child, which results in the child's failure to develop academic, social, and occupational survival skills. Patterson et al. (1992) argues that a lack of adequate monitoring by parents in early adolescence and rejection by teachers and mainstream peers precipitates a child to drift into a deviant peer group, wherein a wide array of antisocial and delinquent behavior, including alcohol and drug use, may be reinforced, along with a rejection of mainstream norms and mores (Brook et al., 1989, Jessor and Jessor, 1978, Patterson et al., 1992).

A second commonly identified trajectory of aggressive, disruptive behavior involves late onset (i.e., in the pre- or early adolescent years) antisocial behavior and substance use. Patterson et al. (1992) argues that late starters typically exhibit marginal levels of social adaptation in the elementary school years in terms of aggressive, disruptive behavior, and their caregivers’ discipline and monitoring skills may be marginal at best. Consequently, these children are quite vulnerable to disruptions in parental monitoring and supervision, which may lead to rapid escalation of behavior and/or academic achievement problems. More specifically, Patterson et al. (1992) hypothesizes that the escalation in antisocial behavior seen in these late starters in early adolescence is the product of perturbations in parental monitoring and supervision brought on by serious family adversities that first surface in the middle school years. The disruptors may include a divorce, serious financial distress associated with the loss of a job, and/or the late onset of parental psychiatric distress or substance use, abuse, and/or dependence. Like the early starters, late starters may be rejected by their mainstream natural raters, as a result of their coercive and antisocial behavior. Their limited social skills and the rejection by their mainstream natural raters can precipitate an individual to drift into a deviant peer group, where antisocial behavior, substance use, and rejection of mainstream social values, mores, and institutions are reinforced.

In keeping with life course/social field theory and its integration with Patterson et al.'s (1992) early starter developmental model, the Baltimore GBG intervention is hypothesized to reduce the early aggressive, disruptive behavior and its distal correlates by improving teachers’ disciplinary practices. This improved classroom management will then result in a reduction of early aggressive, disruptive and coercive behavior at the individual and the classroom level, and as a result there will be fewer opportunities for youth to learn inappropriate behavior through modeling of their classmates’ aggressive, disruptive behavior. The youth will then be at decreased risk of being rejected by parents/caregivers, teachers, peers, and other natural raters and thus less likely to drift into a deviant peer group, where antisocial behavior and substance use may be reinforced and mainstream norms and mores rejected. Consequently, the youth will then be at reduced risk of serious antisocial behavior, violent and criminal behavior, and drug abuse in adolescence and adulthood.

With respect to the late starter model and mechanisms of GBG intervention impact, it is hypothesized that youth in the GBG classrooms will maintain higher levels of social adaptation in the face of disruptions in parent supervision, discipline, and reinforcement in the pre- to early adolescent years than their standard setting counterparts. As a result, these youth will be less likely to drift into a deviant peer group and engage in serious antisocial behavior and substance abuse in adolescence and adulthood. Finally, those youth who continually exhibited minimal aggressive, disruptive behavior have shown successful social adaptation and therefore are hypothesized not to be influenced by other students’ aggressive, disruptive behavior.

In this paper, we report on the impact of the GBG on the course of aggressive, disruptive behavior from first to seventh grade and on the young adult outcomes of ASPD and violent and criminal behavior in young adulthood (age 19–21) for both males and females from the first generation of the Baltimore trials. This is an extension of previously published reports (Dolan et al., 1993, Kellam et al., 1994), which documented the more proximal or shorter term, impact of the intervention. In Kellam et al. (2008) the impact of the GBG is briefly reported, taking into account baseline aggressive, disruptive behavior in the fall of first grade. In this paper we examine the developmental trajectories and variation in impact of the GBG along with extending the young adult outcomes to include violent and criminal behavior. Importantly, we compare the results obtained using the data from the effectiveness trial (i.e., Cohort 1) to the data from the sustainability trial (i.e., Cohort 2).

In accord with the existing evidence regarding the development of aggressive, disruptive behavior, we hypothesize that there will be three developmental trajectories of aggressive, disruptive behavior with varying risk for later antisocial and violent and criminal behavior (Muthén et al., 2002, Petras et al., 2004, Schaeffer et al., 2003, Schaeffer et al., 2006). We hypothesize that children, especially males who are highly aggressive, disruptive early in elementary school and who remain aggressive, disruptive over elementary and middle school years (i.e., a persistent high class), will be at greater risk for later ASPD and violent and criminal behavior than their less aggressive, disruptive counterparts. We also hypothesize a second group of children who enter school with lower levels of aggressive, disruptive behavior and then escalate by the end of elementary school/early middle school to a higher level of aggressive, disruptive behavior (i.e., an escalating medium class). We hypothesize this group will also be at an elevated risk for later ASPD and violent and criminal behavior compared with their less aggressive, disruptive counterparts. Lastly, we hypothesize a third group of children who display a consistent low level of aggressive, disruptive behavior from first to seventh grade (i.e., a stable low group) and who will show the lowest level of risk for later ASPD and violent and criminal behavior. In addition, we hypothesize a lesser GBG impact for females given their overall lower levels of aggressive, disruptive behavior (Ensminger et al., 1983, Kellam et al., 1983, Schaeffer et al., 2006, Wilcox et al., 2008).

Section snippets

Study design

Study participants were first-grade students from 19 Baltimore City Public Schools who were initially assessed in the fall of first grade as part of a randomized field trial of two classroom-based interventions targeting either early learning with mastery learning (ML) or aggressive, disruptive behavior with the GBG. The schools were drawn from five geographic areas within the eastern half of the city that were defined by census tract data and vital statistics obtained from the Baltimore City

Results

In this section, we present the results by cohort status separately by gender. In each instance we describe the intervention effect through seventh grade on the course of aggressive, disruptive behavior as well as the impact of the intervention into young adulthood on ASPD diagnosis and incidence of violent and criminal behavior.

Discussion

This paper reports on the developmental epidemiological trajectories from first grade through early adolescence of early aggressive, disruptive classroom behavior and the strength of the trajectories in predicting antisocial personality disorder (ASPD) and violent and criminal behavior in young adulthood. We then report the impact of the GBG on each of the three developmental trajectories found to best typify the variation in courses leading to the young adulthood outcomes of ASPD and violent

Conflict of interest

The author and all of the co-authors declare that they have no conflict of interest.

Acknowledgements

We would like to extend our deepest gratitude to our partners, the Baltimore City Public School System, and the youths and families who participated in this project. We would also like to thank Drs. Sharon Lambert and Cindy Schaeffer for their insightful comments on earlier drafts of this manuscript as well as Dr. Kimberly Kendziora for her work with later drafts. We also thank Dr. Wei Wang for his assistance in testing the time specific impact of the intervention. In addition, we are grateful

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