,Conduct Disorder, Aggression and Delinquency DAVID P FARRINGTON Within the limits of a short chapter, it is obviously impossible to provide an exhaustive review of all aspects of conduct disorder, aggression, and delinquency in adolescence. There are many extensive reviews of these topics (Anderson & Huesmann, 2003; Coie & Dodge, 1998; Connor, 2002; Farrington & Welsh, 2007; Hill & Maughan, 200I; Rutter, Giller, & Hagel!, 1998). In this chapter, I will be very selective in focusing on what seem to me the most important findings obtained in the highest quality studies. I will particularly focus on risk factors discovered in prospective longitudinal surveys and on successful interventions demonstrated in randomized experiments. The major longitudinal surveys are detailed in Farrington and Welsh (2007, pp, 29-36) and Thornberry and Krohn (2003), while major experiments in criminology are reviewed by Fanington and Welsh (2006), My emphasis is mainly on young people aged 10-17 and on research carried out in North America, Great Britain, and similar Western democracies. Mostresearch has been carriedout with males, but studies offemales are included where applicable (Moffitt, Caspi, Rutter, & Silva, 2001; Moretti, Odgers, & Jackson, 2004; Pepler, Madsen, Webster, & Levine, 2(X)5; Zahn et aI., 2008). My focus is on substantive results rather than on methodological or theoretical issues. In general, all types of antisocial behavior tend to coexist and are intercorrelated. I have chosen to concentrate on conduct disorder, aggression, and delinquency because these are the most important types of adolescent antisocial behaviors studied in different fields: conduct disorder in clinical psychology and child/adolescent psychiatry, aggression in developmental psychology, and delinquency in criminology and sociology. While there is sometimes inadequate communication among different fields, it should be borne in mind that these behaviors are logically and empirically related, so that risk factors and successful interventions that apply to one of these types of antisocial behavior are also likely to apply to the other two types. Other types of antisocial behavior, such as drug use, will not be reviewed here. Although there is nowadays a great deal of interest in promotive and protective factors (e.g., Loeber, Farrington, Stouthamer-Loeber, & White, 20(8), I do not have space to discuss them here. Before reviewing risk factors and successful interventions, I will briefly review the definition, measurement, and epidemiology of each type of antisocial behavior. CONDUCT DISORDER Definition and Measurement Robins (1999) has traced the development of conduct disorder (CD) definitions over time, According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994, p. 85), the essential feature of CD is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms are violated. 683 6X4 Conduct Disorder. Aggn:~siHn and J)clilHlucnc~ Also. the di~turbance of hehavior must cause clinically significant impairment in social. academic or occupational functioning. According to the DSM-IV diagno:-.tic criteria. 3 or more out of 15 specified behavior,. including aggression to people or animab. propel1y destruction. stealing or lying. and violating rules (e.g" truancy. running away). must be prescnt for CD to be diagnosed. The prevalence of CD is lower if evidence of impairment is reyuired as well as specified behaviors (Romano. Tremblay. Vitaro. Zoccolillo. & Pagani. 20(1). Freyuent. serious. persistent behaviors that arc shown in several different setlings are most likely to be defined as symptoms of a disorder. Additions to the diagnostic protocol for CD in DSM-V were considered by Moffitt et al. (2001). including a childhood-limited subtype: callous-·unemotional traits; female-specific criteria; and biomarkers. Overall. Moffitt and colleagues concluded that the current CD protocol wa~ adequate and that the existing evidence base was not sufficiently compelling to justify alterations. CD can be diagnosed by a clinician in a psychiatric interview with a child and the parents, or it can be assessed using a structured interview administered by a nonclinician. such as the Diagnostic Interview Schedule for Children (DISC; Shaffer et al., 1996) or Child and Adolcscent Psychiatric Assessment (CAPA; Angold & Costello. 2000). Childhood antisocial behavior can also be assessed using rating scales or behavior problem checklists such as the Child Behavior Checklist (CBCL). typically completed by a parent. and its associated Teacher Report Form (TRF) and Youth Self-Report (YSR: Achenbach. 1(93). The~e yield broadband scales such as "externalizing behavior" and more specific scales of aggression. delinquency. and hyperactivity. with impressive cross-cultural replicability (Achenbach. Verhulst. Baron. & Althaus. 191)7). The aggression and delinljuency scales are highly correlated (Pakiz. ReinherL & Frost. 1(92). The dclillljuency scale of the CBCL is closely related to the diagnosis of CD on the DISC (Kasiu~. Ferdinand. \an den Berg. & Verhulst. 1997 J. Prevalence t\ottelmann and Jensen (1995) have usefull) summarized findings obtained in epidemiological studies of conduct disorder. One problem in interpreting prevalence re~lllt~ concerns the time period to which they refer. which may be .3 Il](lnths. 6 months. 12 month..,. or cumulatively over a period of year~. Prc\[llence rates are greater among male~ than female;. and vary at dilTerent ages. Also. prevalence rate~ change a~ the DSM definitions change (Lahey et al.. 19(0). In the Great Smoky Mountains Study of Youth. only 799i of conduct-disordered youths had functional impairment (Costello et al.. 1996). There is not space here to review mcasurement issue" or changes in prevalence over time (e.g., Achenbach. Dumenci. & Rescorla. 20m; Collishaw. Goodman. Pickles. & Maughan. 2(07). The instantaneou\ (as opposed to cumulative) prevalence of CD is about (}<;*-16% of adolescent boys and about 2°,i-91f( of adolescent girls (Mandel. 1(97). For example. in the Ontario Child Health Study in Canada. the 6-month prevalcnce of CD at age 12-16 was 10'1( for boys and 49( for girls (Offord et al.. 1(1)7). In the New "fork State longitudinal study. the 12-month prevalence of CD for boys was 16(7, at both ages 10-13 and 14-16 (Cohen et al.. 1993a). For girb. it was 4';i( at age 10-13 and 99c at age 14-16. Zoccolillo ( 1993) suggested that CD criteria may be less applicable to the behavior of girls than \0 the behavior of boys. and hence that gender-specific CD criteria should be developed. Gender differences in CD have been discussed by Lahey el al. (2006). It is not entirely clear how the prevalcnce or CD varies over the adolescent age range. and thi~ may depend on how CD i~ measured. For example. in the Methodology for Epidemiology of Mental Di"order~ in Children and Adolescents (MECA) study. which wa;. a cross~scctional ,mvel' of 1.21)5 adolescents Conduct Disorder 685 aged 9-17. the DISC was completed by parents and by adolescents (Lahey et aI., 2000). The prevalence of CD (in the previous 6 months) did not vary significantly over this age range according to parents. but it increased with age according to adolescent self-reports. According to adolescents, the prevalence of CD increased for boys from 1.3% at age 9-11 to 6% at age 12-14 and 1J% at age 15-17. For girls, prevalence increased from 0.5% at age 9-11 to 3% at age 12-14 and 4% at age 15-17. Hence, the male-to-female ratio for CO was greatest at age 15-17. In a large-scale study of over 10,000 British children aged 5-15, Maughan, Rowe, Messer, Goodman, and Meltzer (2004) found that the prevalence of CD increased with age for both boys and girls, and that the male preponderance in CD was most marked in childhood and early adolescence. The CO measure was derived from children, parents, and teachers. In the Great Smoky Mountains Study of Youth, Maughan. Pickles, Rowe, Costello, and Angold (2000) investigated developmental trajectories of aggressive and nonaggressive conduct problems. Between ages 9 and 16, they found that there were three categories of adolescents, with stable high conduct problems, stable low conduct problems, and decreasing conduct problems. Boys were more likely to have stable high or decreasing conduct problems over time, whereas girls were more likely to have stable low conduct problems over time. Similarly, Shaw, Lacourse, and Nagin (2005) investigated trajectories of conduct problems between ages 2 and 10, and van Lier, van der Ende, Koot, and Verhulst (2007) studied such trajectories between ages 4 and 18. Onset and Continuity DSM-IV classified CD into childhood-onset versus adolescent-onset types. Childhood-onset CD typically begins with the emergence of oppositional defiant disorder (ODD), characterized by temper tantrums and defiant irritable, argumentative. and annoying behavior (Hinshaw, Lahey. & Hart, 1993). Mean or median ages of onset for specific CD symptoms have been provided by various researchers. but they depend on the age of the child at measurement and the consequent cumulative prevalence ofthe symptoms. Retrospectively in the Epidemiological Catchment Area project, Robins (1989) reported that the mean age of onset (before 15) for stealing was 10 for males and females, while for vandalism it was 11 for male~ and females. However, ages of onset were generally later for girls than for boys. While exact onset ages varied, some CD symptoms consistently appeared before others. This observation led Loeber et a1. (1993) to postulate a model of three developmental pathways in disruptive childhood behavior. The overt pathway began with minor aggression (e.g., bullying) and progressed to physical fighting and eventually serious violence. The covert pathway began with minor nonviolent behavior (e.g., shoplifting) and progressed to vandalism and eventually serious property crime. The authority conflict pathway began with stubborn behavior and progressed to defiance and eventually authority avoidance (e.g., running away). Typically, progression in the overt pathway was accompanied by simultaneous progression in the covert pathway. Tolan and GormanSmith (1998) found that the hypothesized pathways were largely confirmed in the U.S. National Youth Survey and the Chicago Youth Development Study. The pathways model has also been replicated in Denver and Rochester (Loeber, Wei, Stouthamer-Loeber, Huizinga, & Thornberry, 1999), with African American and Hispanic adolescents (Tolan, GormanSmith, & Loeber, 2(00), and with antisocial girls (Gorman-Smith & Loeber. 2005). There is considerable continuity or stability in CD, at least over a few years. In the Ontario Child Health Study, 45% of children aged 4-12 who were CD in 1983 were still CD 4 years later, compared with only 5% of those who had no disorder in 1983 (Offord et aI., 1992). CD was more stable than attentiondeficitlhyperactivity disorder (AOHD) or emotional disorder. Also, stability was greater for , ..,~."'.'.• 6!1(, Conduct Dis()!·dcr. Aggrc~sinn and IklinqucllQ children aged X- 12 (CJ()',( pel's! ,ling) than for children aged 4-7 (25'/{ persisting I. However. the interprelutipll of results was complicated b\ comorhiCJily: 3YIr 01 [hose with CD in 10X3 had ADHD 4 years later. and. conversely. 34(i; of those \lith ADHD in 19H3 had CD 4 year;., later. In a Dutch follow-up study uSll1g the CBeL Verhulsl and van del' Ende (19Y5) found a significant correlation (0.54) between externalizing scores over an Hyear period spanning adole;.,cence. Similar resulh have been reported by other researchers. Jn their New York State study. Cohen. Cohen. and Brook (19lJ3b) found Ihal 43!1i of CD children aged 9--1 Hwere still CD 2.5 year;., laler (compared wilh I()c;i of nonCD chi ldren). There were no significant age or gender differences in stability. but stability increased with the severity of CD. In the Developmenlal Trends Study. Lahey et a!. (1995) reported that half of CD boys aged 7--12 were still CD 3 years later. Persistence was predicted by parental antisocial personality di~order (APD) and by low verbal 1Q. but nol by age, socioeconomic status (SES). or ethnicity. In the same study. CD in childhood and adolescem:e predicted APD in adulthood (Lahey. Loeber, Burke. & Applegate. 2005). AGGRESSION Definition and Measurement Aggression is detined a~ behavior that j" intended to. and actually does. harm another person (Coil' & Dodge. 1l)98). Many different type~ of aggression have been distinguished, including physical versus verbal aggre~sion. reactive versus proactive aggression. and hostile versus instrull1entul aggres'ijon (Raine el al.. 200(): Vuillancourt. Miller. Fagbemi. Cote. & Tremblay. 2(07). There i" not space here to review special types of aggression such a... soccer hooliganism (Farringtoll. 2006: Uise! & Bliescner. 200.h Instead. I will foclls on school bullying. which is one of the most clearly defined and 1110st resean.:hed types of ado\e,cenl aggres"ioll (Farrington. ILJ93b: Smith. Pepler. & Rigby. 20()'·1-), Its definition typically include... phy;.,ical. verhaL or pSYchoiogical attack or intimidation that is intended 10 call;,e fear. di;.,lre....s. or harm 10 a victim: an imbalance of power. with the more powerful child oppressing the less powerful one: and repcated incidents bel ween the ;.,ame children over a prolonged time period. Aggre.ssion is measured in a variety of ways, including sell-reports. parent reports. teaeher rating~. peer ratings. and school records. Solherg and Olweus (2003) argued that selfreports were the best method of measuring ,>chool bullying. Systematic observation is also used (e.g.. Pepler & Craig. 1(95). It i;, importalll to investigate the concordance of results obtained by these different methods, but these types of measurement issues will not generally be diseussed in this chapter. Many aggressive acts t:ommitted by adolescents are not witnessed by teachers. parent~, or peers. For example. in a Dublin study. O'Moore and Hillery (1989) found that teachers identified only 24o/r of self-reported bullies. In an observational study in Canada, Craig, Pepler. and Atlas (2000) discovered that the frequency of bullying was twice as high in the playground as in the classroom. However, Stephenson and Smith (19H9) in England reported that teacher and peer nominations about which children were involved in bullying were highly correlated (0.8). Prevalence The prevalence of physical aggression (hitting) increases up to age 2 and then decreases between ages 2 and 4. when verbal aggression increases (Coie & Dodge. 1(98). Most aggression al the preschool ages is directed against siblings or peers. The incidence of physical aggression continues to decrease in the elementary school years (Tremblay. 2000) as language and ahstract thinking improve, children increa;.,ingly use words rather than aggressive actions to resolve con1licts. and internal inhibitions and the ability to delay gratification al;,() improve. Research on the in a prevalence of physical aggression has been :reviewed by Lee. Baillargeon, Vermunt, Wu, jlJld Tremblay (2007). In a cross-sectional survey of a large representative sample of Canadian children, Tremblay et aL (1999)found that the prevalence of hitting. kicking, and biting (as reported by mothers) decreased steadily from age 2 to age 11. Furthermore, in the Montreal longitudinal study, the prevalence of teacher-rated physical aggression of boys decreased steadily from age 6 to age 15. Nagin and Tremblay (1999) identified four different trajectories of aggression the Montreal Longitudinal Experimental Study: consistently high, consistently low, high/decreasing, and moderate/decreasing. There have been many other studies of trajec. tories of physical aggression. Among the most important are the nationwide longitudinal study ofCanadian children (Cote. Vaillancourt, LeBlanc, Nagin, & Tremblay, 2006) and the analysis of data from six sites in three coun­ tries by Broidy et al. (2003). Interestingly, in a cross-sectional survey of large sample of American children (Fitzpatrick, 1997), the prevalence of selfreported physical fighting decreased from grade 3 (age 8) to grade 12 (age 17). Also, in the Pittsburgh Youth Study, the prevalence of parent-rated physical aggression of boys decreased between ages 10 and 17 (Loeber & Hay. 1997). Similarly, in the large-scale British survey of Maughan et aL (2004), the only CD symptom that decreased between ages 8 and 15 was physical fighting. Of course, it is possible that the seriousness of aggression according to injuries to participants) may increase between ages 10 and 17. Criminal violence will be discussed in the delinquency section. The prevalence of bullying is often very high. For example, in the Dublin study of 0' Moore and Hillery (1989), 58% of boys and 38% of girls said that they had ever bullied someone. The prevalence is lower when bullying is restricted to "sometimes or more often this term." With this definition, II % of boys and 2.59'( of girls were bullies in secondary Aggression 687 schools in Norway (Olweus. 19911: and 89t of boys and 4% of girls were bullies in secondary schools in Sheffield, England (Whitney & Smith, 1991). The prevalence of bullying decreases with age from elementary to secondary schools, especially for girls. Cross-national comparisons of the prevalence of bullying have been published by Smith et al. (1999) and Due et al. (2005). Genderdifferences in aggression are not very great in infancy and toddlerhood (Loeber & Hay, 1997), but they increase from the preschool years onward. Boys use more physical and verbal aggression, both hostile and instrumental. However, indirect or relational aggression-spreading malicious rumors, not talking to other children, excluding peers from group activities-is more characteristic of girls (Bjorkvist, Lagerspetz, & Kaukiainen, 1992; Crick & Grotpeter, 1995). Gender differences in aggression tend to increase in adolescence, as female physical aggression decreases more than male physical aggression (Fontaine et aL, 2008). Continuity There is significant continuity in aggression over time. In a classic review, Olweus (] 979) found that the average stability coefficient (correlation) for male aggression was 0.68 in 16 surveys covering time periods of up to 21 years. Huesmann, Eron, Lefkowitz, and Walder (1984) in New York State reported that peer-rated aggression at age 8 significantly predicted peer-rated aggression at age 18 and self-reported aggression at age 30. Similarly, in Finland, Kokko and Pulkkinen (2005) found that aggression at ages 8 and 14 predicted aggression at ages 36 and 42. Female aggression is also significantly stable over time; stability coefficients were similar for males and females in the Carolina Longitudinal Study (Cairns & Cairns, 1994, p. 63). However. Loeber and StouthamerLoeber (1998) pointed out that a high (relative) stability of aggressiveness was not incompatible with high rates of desistance from physical i i 688 Conduct Disorder, Aggression and J)elinquellc~ aggression (ab,olute change) from childhood to adulthood. Olweus (1979) argued that aggression was a ;-.table personality trait. However. theories of aggression place most emphasIs on cognitive processes. For example. Huesmann and Eron (19159) put forward a cognitive script model. in which aggressi ve behavior depends on stored behavioral repertoires (cognitive scripts) that have been learned during early development. In response to environmental cues. possible cognitive scripts are retrieved and evaluated. The choice of aggressive scripts, which prescribe aggressive behavior. depends on the past history or rewards and punishments and on the extent to which adolescents are influenced by immediate gratification as opposed to long-term consequences. According to this theory. the persisting trait of aggressiveness is a collection of well-learned aggressive scripts that are resistant to change. A similar social information-processing theory was proposed by Dodge (199 1) and updated by Dodge (2003). There is not space here to discuss other cognitive or decision-making theories of antisocial behavior. DELINQUENCY Definition and Measurement Delinquency is defined according to acts prohibited by the criminal law, such as theft, burglary, robbery, violence. vandalism. and drug use. There are many problems in using legal definitions of delinquency. For example, the boundary between what is legal and what is illegal may be poorly defined and subjective. as when school bullying gradually escalate~ into criminal violence. Legal categories may be so wide that they include acts which are hehaviorally quite different. as when "robbery" ranges from armed bank holdups carried oUl by gangs of masked men to thefts of small amounts of money perpetrated by one :-choolchild on another. Legal definitions rely 0]] the concept of intent. which is difficult to measure reliably and validly, rather than the behavioral criteria preferred by social scientish. Also. legal definitions change over time. However. their main advantage is that. becau;.e they have been adopted by most delinquency researchers. their use makes it possible to compare and summanze results obtained in different projects. Delinquency is commonly measured using either official records of arresh or convictions or self-reports of offending. The advantages and disadvantages of official records and self-reports are to some extent complementary. In general. official records include the worst offenders and the worst offenses. while self-reports include more of the normal range of delinquent activity. In the Pittsburgh Youth Study, Farrington, Jolliffe, Loeber. and Homish (2007) found that there were 2.4 self-reported offenders per official court offender, and 80 self-reported offenses per officially recorded offense. The worst offenders may be missing from samples interviewed in ~elf-report studies was less than complete, At age 32, they continued to drink heavily, use drugs, get into fights. and commit criminal acts. Several researchers have investigated factors that predict early versus late onset offending (Carroll et a!., 2006). In the Cambridge Study, the strongest predictors were rarely spending leisure time with the father, troublesome school behavior, authoritarian parents and psychomotor impulsivity (Farrington & Hawkins, 1991). In contrast. late onset offenders tended to be nervous-withdrawn and anxiou~, suggesting that these factors may have protected children from offending at an early age (Zara & Farrington, 2007). In the Pittsburgh Youth Study, the strongest correlates of early onset were physical aggression, ODD, ADHD, truancy, peer delinquency, and poor parental supervision (Loeber, Stouthamer-Loeber, van Kammen, & Farrington, 1991). There is a great deal of criminological research on other criminal career features such as desistance, duration of careers, escalation and deescalation (Farrington, I997a), but there is not space to review this here. Generally, there is significant continuity between delinquency in one age range and delinquency in another. In theCambridge Study, nearly three-quarters (73%) of those convicted as juveniles at age 10-16 were reconvicted at age 17-24, in comparison with only 16% of those not convicted as juveniles (Farrington, 1992a). Nearly half (45%) of those convicted as juveniles were reconvicted at age 25-32, in comparison with only 8% of those not convicted as juveniles. Furthermore, this continuity over time did not merely renect continuity in police reaction to delinquency. For 10 specified offenses, the significant continuity between offending in one age range and offending in a later age range held for self-reports as well as official convictions (Farrington, 1989b). In the Seattle Social Development Project, there was Comorbidity and Versatility 691 also significant continuity in court referrals and self-reports (Farrington et aL 2003a). Other studies show similar continuity in delinquency. For example. in Sweden. Stattin and Magnusson (1991 )reported that nearly 70% of males registered (by police, social, or child welfare authorities) for committing a crime before age 15 were registered again between ages 15 and 20, and nearly 60% were registered between ages 21 and 29. Also. the number ofjuvenile offenses is an effective predictor of the number of adult offenses (Wolfgang, Thornberry. & Figlio, 1987). There was considerable continuity in offending between the ages of 10 and 25 in both London and Stockholm (Farrington & Wikstrom, 1994). COMORBIDITY AND VERSATILITY In general, CD adolescents tend also to be aggressive and del inquent. There is controversy about whether aggressive symptoms should be considered part of ODD or CD (Loeber, Burke, Lahey, Winters, & Zera, 2000). In the Christchurch Study in New Zealand, Fergusson and Horwood (1995) reported that 90% of children with three or more CD symptoms at age 15 were self-reported frequent offenders at age 16 (compared with only 17% of children with no CD symptoms). Fergusson, Horwood, and Ridder (2005) later showed that conduct problems at ages 7-9 predicted offending at ages 21-25. Similarly, in the Great Smoky Mountains Study, Copeland. Miller-Johnson, Keeler. Angold, and Costello (2007) found that CD under age 16 predicted serious and violent crimes between ages 16 and 21. In the Denver Youth Survey, Huizinga and lakobChien (1998) found that about half of male and female self-reported violent offenders had a large number of externalizing symptoms on the CBCL. In Cyprus, Kokkinos and Panayiotou (2004) reported that CD adolescents were likely to be bullies. Numerous studies show that aggression in childhood and adolescence predicts , 692 Conduct Disorder. Aggression and Delinquent·y later delinquency and crime. For example. Hamalainen and Pulkkinen ( LJ9S. 1996) in Finland followed up nearly .+00 c:hildren between age;, Hand 32 and found that early aggre;,~i()n and wnduet problem, predicted later criminal offense;,. [n the Cambridge Study. teacher ratings of aggression at age I 14 (disobedient. diffJc:ult to disc:ipJine. unduly rough. quarrebome and aggressive. (lvercompetitive) ~ignificant]y predicted self-reponed violence at age 16-1 g (physical righting) and c:onvictions for violence up to age 32 (Farrington. 19<1 IJ. Generally. delinquents are versatile rather than specialized in their offending. In the Cambridge Study. !56L y,. of violent offenders also had convictions for nonviolent offenses (Farrington, 1(,)91 J. Violent and nonviolent but equally frequent otfenders were very similar in their childhood and adolesc:ent features in the Oregon Youth Study (Capaldi & Patterson. 1(96) and in the Philadelphia Collaborative Perinatal Project (Piquero. 2000). Studies of transition matrices summarizing the probahility of one type of offense following another show that there is a small degree of spe<.:ificity superimposed on a great deal of generality in juvenile delinquency (Farrington. Snyder. & Finnegan. 1988J. The Cambridge Study shows that delinquency is associated with many other types of antisocial behavior. The boys who were convkted before age 18 (most commonly for otlenses of dishonesty. such as burglary and theft) were significantly more antisocial than the nondelinquents on almost every fac:tor that was investigated at that age (West & Farrington, J 977). The <.:onvicted delinquents drank more bcer. got drunk more often. and were more likely to say that drinking made them violent. They smoked more c:igarettes. had started smoking at an earlier age. and were more likely to be heavy gamhlers. They were more likely 10 have been wmicted for minor motoring offenses. to have driven aftcr drinking at least 10 units of alcohol 5 pints of been. and to have heen injured in road accidents. Thc delinquent;., ,vcre morc likely to have taken prohibited drugs such as marijuana or LSD. although lew of them had comiuions for drug offen"e.", Also. they were morc likely to have had "exual Interc:ourse. espec:ially with a variety of diffcrent girl;,. and especially beginning at an early age. but they were les'> likely to use comrac:eptives. The delinquents were more likely to go out in the evenings. and were espec:ially likely to spend time hanging about 011 the street. They tended to go around in groups of four or more. and were more likely to be involved in group violence or vandalism, They were much more likely to have been involved in physic:al fights. to have stm1ed fights. to have carried weapons. and to have used weapons in fighb. They were also more likely to express aggressive and anti-establishment attitudes on a questionnaire (negati ve to polic:e, school. rich people. and civil servants). Bec:ause CD. aggression, and delinquency are overlapping problems. they tend to have the same risk factors. and interventions that are effective in redudng one of these types of antisocial behavior tend also to be effective in reducing the other two types. I will focus especially on risk factors for delinquency (for a review of risk factors for CD, see Burke. Loeber. & Birmaher. 2002). Less is known about early risk factors for aggression (Tremblay. 200R). Risk factors that are essentially measuring the same underlying constructs as CD. aggression. and delinquency anger: Colder & Stice. 1998) are not reviewed here. RISK FACTORS Longitudinal data are required to establish the time ordering of risk factors and antisocial behavior. As mentioned. in this review I focus especially on result" obtained in major prospective longitudinal studies. It is extremely difficult in c:orrelational or IT(),~,,-sccti()nal studies to draw valid conclusions about ouse and elTeet. Similarly, because of the diffic:ulty of establishing c:allsal effeC:h of fa<.:ton; that vary only hetween individuab (e.g.. gender and ethnic-it)'). and hec:all.~e slich factors have no Risk Factors 693 practical implications for intervention (e.g., it is not practicable to change male~ into females). unchanging variables will not be reviewed here. In any case. their effects on offending are usually explained by reference to other, modifiable, factors. For example, gender differences in offending have been explained on the basis of different socialization methods used by parents with boys and girls, or different opportunities for offending of males and females, According to Rowe, Vazsonyi, and Flannery (1995), risk factors for delinquency are similar for boys and girls. but boys are generally exposed to more risk factors or higher levels of risk factors. Risk factors will be discussed one by one; additive, interactive, independent. or sequential effects will notbeexhaustively reviewed, although these are important issues (Waschbusch & Willoughby, 2008). Because of limitations of space, and because of their limited relevance for psychosocial interventions, biological factors are not reviewed. For example, one of the most replicable findings in the literature is that antisocial and violent adolescents tend to have low resting heart rates (Raine, 1993, p, 167). In the Cambridge Study, resting heart rate at age 18 was significantly related to convictions for violence and to self-reported violence, independently of all other variables (Farrington, 1997b). There is also little space to review theories of the causal mechanisms by which risk factors might have their effects on antisocial behavior. It is plausible to suggest that risk factors influence the potential for aggression and antisocial behavior, and that whether this potential becomes the actuality in any situation depends on immediate situational factors such as opportunities and victims. In other words, antisocial acts depend on the interaction between the individual and the environment (Farrington, 1998). However. there is not space here to review immediate situational influences or situational crime prevention (Clarke, ]995), Temperament and Personality Personality traits such as sociability or impulsiveness describe broad predispositions to respond in certain ways, and temperament is basically the childhood equivalent of personality. Temperament is clearly in£1uenced by biological factors but is not itself a biological variable like heart rate. The modem study of child temperament began with the New York longitudinal study of Chess and Thomas (1984). Children in their first 5 years of life were rated on temperamental dimensions by their parents, and these dimensions were combined into three broad categories of easy, difficult and "slow to warm up" temperament. Having a difficult temperament at age 3-4 (frequent irritability. low amenability and adaptability, irregular habits) predicted poor psychiatric adjustment at age 17-24. Unfortunately, it was not very clear exactly what a "difficult" temperament meant in practice, and there was the danger of tautological conclusions (e.g., because the criteria for difficult temperament and ODD were overlapping). Later researchers have used more specific dimensions of temperament. For example, Kagan (1989) in Boston classified children as inhibited (shy or fearful) or uninhibited al age 21 months, and found that they remained significantly stable on this classification up to age 7 years. Furthermore, the children who were uninhibited at age 21 months were more likely to be identified as aggressive at age 13 years, according to self- and parent reports (Schwartz. Snidman, & Kagan, 1996). Important results on the link between childhood temperament and later offending have been obtained in the Dunedin longitudinal study in New Zealand (Caspi, 2000). Temperament at age 3 years was rated by observing the child's behavior during a testing session. The most important dimension of temperament was being undercontrolled (restless. impulsive. with poor attention), and this predicted aggression, self-reported delinquency and convictions at age 18-21. Studies using classic personality inventories such as the Minnesota Multiphasic Personality Inventory (MMPI) and the California Psychological Inventory (CPt Wilson & Herrnstein, , (,94 Conduct r>isorder. Aggression and Delinquency I~!S5. pp. I!S6~ I~!S I ollen seem to produce essentially tautological results. such as that deJinyuenh are lOlA on ,ociallzation. The Eysenck personality questionnaire has yielded more promising re;-,ults (Eysenck. JYY6). In the Cambridge Study. those high on both extraversion and neuroticism tended to be juvenile seJfreported delinyuents. adult official offenders. and adult self-reported offenders. but not juvenile official delinquents (Farrington. Biron, & LeBlanc. 1(132). Furthermore. these relationships held independently of other variable~ such as low family income. low intelligence. and poor parental child-rearing behavior. However, when individual items of the personality questionnaire were studied. il was clear that the significant relationships were caused by the items measuring impulsiveness (e.g.. doing things yuickly without stopping to think). Since 1990. the most widely accepted personality system has been the "Big Five" or fivefactor model (McCrae & Costa. 2003). This suggests that there are five key dimensions of personality: neuroticism (1\), extraversion (E). openness (0). agreeableness (A). and conscientiousness (e). Openness means originality and openness to new ideas, agreeableness includes nurturance and altruism. and conscientiousness includes planning and the will to achieve. It is commonly found that low levels of agreeableness and conscientiousness are related to offending (Heaven. 1996; John. Caspi, Robins, Moffitt. & Stouthamer-Loeber, 1(94). Impulsiveness Impulsi veness is the most crucial personality dimension that predicts antisocial behavior (Lipsey & Derwn. 199!S). Unfortunately. there are a bewildering number of constructs referring to a poor ability to control behavior. These include impUlsiveness, hyperactivity. restlessne~s. clumsiness, not considering conseyuences before acting. a poor ability to plan ahead. short time horizons. low self-control. sensation-seeking. risk-taking. and a poor ability 10 delay gratification. Pratt. Cullen. Blevins. Daigle. and Unnever (2002) carried out a mew-anulysi" of re,earch on ADHD and delinyuency. and concluded that they were strongly associated. Similar conclusions about impUlsiveness were drawn by Jolliffe and FalTington (in press). Many studies show that Ilyperactivity or ADHD predicts later offending. In the Copenhagen Perinatal project. hyperactivity (restlessness and poor concentration I at age II ~ 13 significantly predicted arrests for violence lip to age 22. especially among boys experiencing delivery complications (Brennan. Mednick. & Mednick. I~93). Similarly. in the Orebro longitudinal study in Sweden. hyperactivity at age 13 predicted police-recorded violence up to age 26. The highest rate of violence was among males with both motor restlessness and concentration difficulties (1ylt}). compared to 3% ofthe remainder (Klinteberg. Andersson. Magnusson. & Stattin. 19(3). In the Seattle Social Development Project. hyperactivity and risk taking in adolescence predicted violence in young adulthood tHerrenkohl et aL 2000). In the Cambridge Study, boys nominated by teachers as restless or lacking in concentration: those nominated by parents. peers. or teachers as the most daring or taking most risks: and those who were the most impulsive on psychomotor tests at age 8~ I0 all tended to become offenders later in life. Daring. poor concentration. and restlessness all predicted both official convictions and self-reported delinquency, and daring was consistently one of the best independent predictor" (Farrington 1992c). Interestingly. Farrington. Loeber. and van Kammen (19(0) found that hyperactivity predicted juvenile offending independently of conduct problems. Lynam (1996) proposed that boys with both hyperactivity and CD were most at risk of chronic offending and psychopathy. and Lynam ( 1998) presented evidence in favor of this hypothesis from the Pittsburgh Youth Study. The most extensive research on different measures of impulsiveness wa:-. carried out in the Pittsburgh Youth Study by White el al. (1994). The measures that were mosl strongly related to self-reported delinquency at ages 10 and 13 were teacher-rated impulsiveness (e.g., acts without thinking), self-reported impulsiveness, self-reported undercontrol (e.g., unable to delay gratificatioG), motor restlessnes~ (from videotaped observations), and psychomotor impulsiveness (on the Trail Making Test). Generally. the verbal behavior rating tests produced stronger relationships with offending than the psychomotor performance tests, suggesting that cognitive impulsiveness was more relevant than behavioral impulsiveness. Future time perception and delay-of-gratification test~ were only weakly related to self-reported delinquency. In the Developmental Trends Study, Burke, Loeber. Lahey, and Rathouz (2005) found that ADHD predicted ODD, which in turn predicted CD. Low IQ and Low Educational Achievement Low IQ and low school achievement are important predictors of CD, delinquency, and adolescent antisocial behavior (Moffitt, I993b). In an English epidemiological study of 13-year-old twins, low IQ of the child predicted conduct problems independently of social class and of the IQ of parents (Goodman, Simonoff, & Stevenson, 1995). Low school achievement was a strong correlate of CD in the Pittsburgh Youth Study (Loeber et a!., 1998). In both the Ontario Child Health Study (Offord, Boyle, & Racine, 1989) and the New York State longitudinal study (Velez, Johnson, & Cohen, 1989), failing a grade predicted CD. Underachievement, defined according to a discrepancy between IQ and school achievement, is also characteristic of CD children. as Frick et a!. (] 991) reported in the Developmental Trends Study. Low IQ and low school achievement also predict youth violence. In the Philadelphia Biosocial project (Denno, 1990), low verbal and peri'ormance IQ at ages 4 and 7 and low scores on the California Achievement test at age 13-14 (vocabulary, comprehension. maths, language, spelling) all predicted arrests for Risk Factors 695 violence up to age 22. In Project Metropolitan in Copenhagen, low IQ at age 12 significantly predicted police-recorded violence between ages 15 and 22. The link between low IQ and violence was strongest among lower class boys (Hogh & Wolf. 1983). Low lQ measured in the first few years of life predicts later delinquency. In a prospective longitudinal survey of about 120 Stockholm males, low IQ measured at age 3 significantly predicted officially recorded offending up to age 30 (Stattin & Klackenberg-Larsson, 1993). Frequent offenders (with 4 or more offenses) had an average IQ of 88 at age 3, whereas nonoffenders had an average IQ of 101. All of these results held up after controlling for social class. Similarly, low IQ at age 4 predicted arrests up to age 27 in the Perry Preschool Project (Schweinhart, Barnes, & Weikart, 1993) and court delinquency up to age 17 in the Collaborative Perinatal Project (Lipsitt, Buka, & Lipsitt, 1990). In the Cambridge Study, twice as many of the boys scoring 90 or less on a nonverbal IQ test (Raven's Progressive Matrices) at age 8-10 were convicted as juveniles as of those scoring above 90 (West & Fanington, 1973). However, it was difficult to disentangle low IQ from low school achievement, because they were highly intercorrelated and both predicted delinquency. Low nonverbal IQ predicted juvenile selfreported delinquency to almost exact!y the same degree as juvenile convictions (Farrington, 1992c), suggesting that the link between low IQ and delinquency was not caused by the less intelligent boys having a greater probability of being caught. Also, low IQ and low school achievement predicted offending independently of other variables such as low family income and large family size (Farrington, 1990), and were important predictors of bullying (Farrington. 1993b). Low IQ may lead to delinquency through the intervening factor of school failure. The association between school failure and delinquency has been demonstrated repeatedly in longitudinal surveys (Maguin & Loeber, 69(, Conduct Disorder, Aggression and Delinquency 1<)<)6). In the Pittsburgh Youth Study, Lynam, MoffitL and Stouthamer-Loeber (1993) <':011duded that low verbal IQ led to s<.:hool failure and "ubseqllently to self-reported delinquency. but only for Afriull1 Ameri<.:an boys. An alternative theory i~ that the link between low lQ and delinquency j" mediated by disinhibition (il1lpuisi veness. ADHD, low guilt lOlA empathy), and this wa" abo tested in the Pittsburgh Youth Study (Koolhof. Loeber. Wei, Pardini, & d·E,,<.:llry. 2007 l. A plausible explanatory factor underlying the link between low IQ and delinquency is the ability to manipulate abstract concepts. Children who are poor at this tend to do badly in IQ tests and in s<.:hool achievement, and they also tend to commit offenses, mainly because of their poor ability to foresee the <.:onsequences of theIr offending. Delinquents often do better on nonverbal performance IQ tests, such as object assembly and block design, than on verballQ tests (Moffitt. 1993b), suggesting that they find it easier to deal with concrete objects than with abstract concepts. Similarly. Rogeness ( 19<)4) concluded that CD children had deficit:, in verbal IQ but not in performance IQ. ImpUlsiveness, attention problems, low IQ, and low school achievement could all be linked to deficit~ in the executive functions of the brain, located in the frontal lobes. These executive fuiICtions include sustaining attention and concentration, abstract reasoning, concept formation. goal formulation, anticipation and planning, programming and initiation of purposive sequences of motor behavior, effective self-monitoring and self-awareness of behavior. and inhibition of inappropriate or impulsive behaviors (Moffitt & Henry, 199 L Morgan & Lilienfeld, 200()). Interestingly, in the Montreal longitudinal experimental study, a measure of executive functioning based on cognitive-neuropsychological tests at age 14 was the strongest neuropsychological discriminator between violent and nonviolent boys (Seguin. Pih\. Harden. Tremblay, & Boulerice. 1(95) This relatIonshIp held independently of a measure of family ad,er"ity (based on parental age at first birth. parental edu<.:alion level. broken family, and Inv-. SES) In the Pittsburgh Youth Study, the life-couf;,e-persistent offenders had marked neuro<.:ognitive impairmenh (Rai ne et aL 20(5) Other Individual Factors Numerou" other individual factOI';' have been related to CD, aggression. and delinquency. including low ;,elf-estecm (Kokkinos & Panayiotou, 2(04), depression were almost a~ likely to develop internalizing disorders. as they were to develop externalizing disorders (Johnson. Cohen. Kasen. & Brook. 2(06). In the Pittshurgh Youth Study. parent~ with behavior problems and substance use problems tended to have CD boy" (Loeber et al.. 19(8). In their classic longitudinal studies. McCord (1(77) and Robins. West. and He~ianic ( I(75) showed that criminal parents tended to have delinquent sons. In the Cambridge Study. the concentration of otlending in ume project. Samp,on. MorenofL and Raudenbush (2005) concluded thai most of the difference belween African Americans and Caucasian, in violen(;e could be explained racial difkrence, in exposure 10 risk factor" especially Jiving in had neighborhoods. Similar conclusion\ were drawn by Farrington. Loeber. and Stouthamer-Loeber (2003b) in the Pittsburgh Youth Study. It is dear that offender~ di~prorortiollutely live in inner-city urea" characterized by physical deterioration. neighborhood disorganization. and high residential mobility (Shaw & !V1cKay. I()6()). However. again. it i\ difficult to determine to what extent the area" themselves inlluencc anti\()cial behavior and to what extent it i" merely the case that antisocial people tend to Jive in cleprived area" because of their poverty or public housing allocation policies 1. Interestingly. both neighborhood re"earchers such a~ Gottfredson. McNeil. and Gottfredson (1991 i and developmental researchers such as Rutter ( 19x I) have argued that neighborhoods have only indirect effects on antisocial behavior through their effects on individuals and families. In the Chicago Youth Development Study. Tolan, Gorman-Smith, and Henry (2003) concluded that the relationship between community structural characteristics (concentrated poverty, racial heterogeneity. economic resources. violent crime rate) and individual violence was mediated by parenting practices. gang membership, and peer violence. In the Pittsburgh Youth Study. Wikstrom and Loeber (2000) found an interesting interaction between types of people and types of areas, Six individual. falllily. peer. and school variable~ were trichotomi/, watched videotapes demonstrating parenting skills, and then took part in focused group discussions. The topics included how to play with your child, helping your child learn. using praise and encouragement to bring out the best in your child, effective setting of limits, handling misbehavior, how to teach your child to solve problems, and how to give and get support. The program was successful. Observations in the home showed that the experimental children behaved better than the control children (see also WebsterStratton, 2000). Sanders, Markie-Dadds, Tully, and Bor (2000), in Brisbane, Australia, developed the Triple-P Parenting program. This can either be delivered to the whole community in primary prevention using the mass media or can it be used in secondary prevention with high-risk or clinic samples. The success of Triple-P was evaluated with high-risk children aged 3 by randomly assigning them either to receive Triple-P or to a control group. The Triple-P program involves teaching parents 17 child management strategies, including talking with children, giving physical affection, praising, giving attention, setting a good example, setting rules, giving clear instructions, and using appropriate penalties for misbehavior ("time-out," or sending the child to his or her room). The evaluation showed that the Triple-P program was successful in reducing children's antisocial behavior. Another parenting intervention, Functional Family Therapy, was evaluated in Utah by Alexander and Parsons (1973). This aimed to modify patterns of family interaction by modeling, prompting, and reinforcement; to encourage clear communication of requests and solutions between family members; and to minimize conflict. Essentially, all family members were trained to negotiate effectively, 708 Conduct Disorder. Aggre~sion and DelinquenQ tu ,et clear rule~ about pri\iJeges and respon~ sibilities. and to u:-.e tec:hnigue~ of reciproc:al reinforcement with each other. This technique halved the recidivism rate of minor delinquents in comparison with other approaches (cliem~ centered or psychodynamic therapy). Its effec~ tiveness with more '-.crious delinquents was confirmed in a replication study using malc:hed groups (Gordon. 1<)95: see also Sexton & Alexander. 2(00). The multidimensional treatment foster care (MTFC) program. evaluated in Oregon by Chamberlain and Reid (19<)8). also pro~ duced desirable results. In treatment foster care. families in the community were recruited and trained to provide a placement for delin~ quem youths. The MTFC youths were closely supervised at home. in the community. and in the school, and their contacts with delinquent peers were minimized. The foster parents provided a structured daily living environment with clear rules and limits. consistent discipline for rule violations and one-to-one monitoring. The youths were encouraged to develop aca~ demic skills and desirable work habits. In the evaluation. 79 chronic male delinquents were randomly assigned to treatment foster care or to regular group homes where they lived with other delinquents. A I-year follow-up showed that the MTFC boys had fewer criminal referrals and lower self-reported delinquency. Hence. this program seemed to be an effeetive treatment for delinquency. Skills Training The set of techniques variously termed cognitive beharioral interpersonal social skills Iminillg have proved to be successful (Lipsey & Wilson. I99SJ. For example, the "Reasoning and Rehabilitation" program developed by Ross and Ross (I <)95) in Ottawa. Canada. aimed to modify the impUlsive. egocentric thinking of delinguents, to teach them to stop and think before acting. to consider the consequences of their behavior. to conceptualize alternative ways of solving interpersonal problems. and to consider the impact of their behavior on other people. especially their vic~ tims. It included social skills training. lateral thinking (to teach creative problem ~olving). critical thinking (to teach logical reasoning). values education (to teach values and concern for others). asserti veness trai ni ng (to teach nonaggressive. socially appropriate ways to obtain desired outcomes). negotiation 'ikills training. interpersonal cognitive problem solving (to teach thinking skills for solving inter~ personal problems). social perspective training (to teach how to recognize and understand other people's feelings). role playing and mod~ eling (demonstration and practice of effective and acceptable interpersonal behavior). This program led to a large decrease in reoffending by a small sample of delinLjuents. Tong and Fan'ington (2008) completed a systematic review of the effectiveness of "Reasoning and Rehabilitation" in reducing offending. They located 32 comparisons of experimental and control groups in four countries. Their meta-analysis showed that. over~ alL there was a significant 14% decrease in offending for program participants compared with controls. Jones and Offord (I 9S9) implemented a skills training program in an experimental public housing complex in Ottawa and compared it with a control complex. The program centered on nonschool skilis. both athletic (e.g.. swimming and hockey) and nonathletic (e.g., guitar and ballet). The aim of developing skills was to increase self-esteem. to encourage children to use lime construc~ tively and to provide desirable role models. Participation rates were high; about threequarters of age-eligible children in the experi~ mental complex took at least one course in the first year. The program was successful: delin~ guency rates decreased significantly in the experimental complex compared to the control complex. The benefit-to-cost ratio. based on savings to taxpayers. was 2.5. Uisel and Seelman (2006) completed a systematic review of the effectiveness of skills training with children and adolescent.s. They located 89 comparisons of experimental and control groups. Their meta-analysis showed that, overall, there was a significant 10% decrease in delinquency in follow-up studies for children who received skills training compared with controls, The greatest effect was for cognitive-behavioral skills training, where there was an average 25% decrease in delinquency in seven follow-up studies. The most effective programs targeted children aged 13 or older and high-risk groups who were already exhibiting behavior problems. Peer Programs There are few outstanding examples of effective intervention programs for antisocial behavior targeted on peer risk factors. The most hopeful programs involve using highstatus conventional peers to teach children ways of resisting peer pressure; this is effective in reducing drug use (Tobler, Lessard, Marshall, Ochshom, & Roona, 1999). Also, in a randomized experiment in S1. Louis, Feldman, Caplinger, and Wodarski (1983) showed that placing antisocial adolescents in activity groups dominated by prosocial adolescents led to a reduction in their antisocial behavior (compared with antisocial adolescents placed in antisocial groups). This suggests that the influence of prosocial peers can be harnessed to reduce antisocial behavior. However, putting antisocial peers together can have harmful effects (Dishion, McCord, & Poulin, 1999). The most important intervention program whose success seems to be based mainly on reducing peer risk factors is the Children at Risk program (Harrell, Cavanagh, Harmon, Koper, & Sridharan, 1997), which targeted high-risk adolescents (average age 12) in poor neighborhoods of five cities across the United States. Eligible youths were identified in schools, and randomly assigned to experimental or control groups. The program was a comprehensive community-based prevention strategy targeting risk factors for delinquency. including case management and family counseling, family skills training, Successful Interventions 709 tutoring, mentoring, after-school activities and community policing. The program was different in each neighborhood. The initial results of the program were disappointing, but a one-year follow-up showed that (according to self-reports) experimental youths were less likely to have committed violent crimes and used or sold drugs (Harrell, Cavanagh, & Sridharan, 1999). The process evaluation showed that the greatest change was in peer risk factors. Experimental youths associated less often with delinquent peers, felt less peer pressure to engage in delinquency, and had more positive peer support. In contrast, there were few changes in individual, family or community risk factors, possibly linked to the low participation of parents in parent training and of youths in mentoring and tutoring (Harrell et aI., 1997. p. 87). In other words, there were problems of implementation of the program, linked to the serious and multiple needs and problems of the families. Community-based mentoring programs usually involve nonprofessional adult volunteers spending time with young people at risk for delinquency, dropping out of schooL school failure, or other social problems. Mentors behave in a "supportive, nonjudgmental manner while acting as role models" (Howell, 1995. p. 90). Welsh and Hoshi (2006) identified seven community-based mentoring programs (of which six were of high quality) that evaluated the impact on delinquency. Since most programs found desirable effects, Welsh and Hoshi concluded that communitybased mentoring was a promising approach in preventing delinquency. Similarly, a metaanalysis by Jolliffe and Farrington (2008) concluded that mentoring was often effective in reducing reoffending. School Programs An important school-based prevention experiment was carried out in Seattle by Hawkins. von Cleve, and Catalano (1991). This combined parent training, teacher training, and skills training. About 500 first-grade children 710 Cunduct Disorder, Aggression and Delinquenc)' (aged 6) were randomly a~signed to be in experimental or control c1as~es, The children in the experimental classes received special treatment at horne and schooL which was designed to im:rea"e their attachment to their parent" and their bonding to the schooL on the assumption that delinquency was inhibited by the strength of social bonds. Their parents were trained to notice and reinforce socially desirable behavior in a program called "Catch Them Being Good." Their teachers were trained in classroom management for example. to provide clear instructions and expectations to children, to reward children for participation in desired behavior, and to teach children prosocial (socially desirable) methods orsolving problems. In an evaluation of this program 18 months later. when the children were in differentdasses, Hawkins et al. (1991) found that the boys who received the experimental program were significantly less aggressive than the control boys, according to teacher ratings. This difference was particularly marked for Caucasian boys rather than African American boys. The experimental girls were not significantly less aggressive. but they were less self-destructive, anxious, and depressed. In a later follow-up, Hawkins, Catalano, Kosterman. Abbott. and Hill (1999) found that. at age 18. the full intervention group (those receiving the intervention from grades I to 6) admitted less violence, less alcohol abuse and fewer sexual partners than the late intervention group (grades 5-6 only) or the controls. The benefit-to-cost ratio of this program according to Aos et al. (2001 a) wa~ 4.3. Other school-based programs have also been i>uccessful in reducing antisocial behavior (Catalano et al.. 1995). In Baltimore, Petras et al. (ZOOS) evaluated the "Good Behavior Game" (GBG). which aimed to n:duce aggressive and disruptive child behavior through contingent reinforcement of interdependent team behavior. First-grade classrooms and teachers were randomly assigned either to the GBG condition (N or to a control condition (N = 165). and the GBG was played repeatedly over :2 years. In trajectory analyses. the researchers found that the GBG decreased aggressive/disruptive behavior (according to teacher reports) up to grade 7 among the most aggressive boys. and also caused a decrease in APD at ages J9-21. However. effects on girls and on a second cohort of children were less marked. There have been anumberofcomprehensive. evidence-based reviews of the effectiveness of school-based programs (Gottfredson. WiIson. & Najaka, 2006; Wilson. Gottfredson, & Najaka, 200 I: Wilson & Lipsey, 2007). Meta-analyses identified four types of school-based programs that were effective in preventing delinquency: school and discipline management. classroom or instructional management. reorganization of grades or classes, and increasing self-control or social competency using cognitive behavioral instruction methods. Reorganization of grades or classes had the largest average effect size (d 0.34), corresponding to a significant 17% reduction in delinquency. After-school programs (e.g" recreationbased, drop-in clubs. dance groups, and tutoring services) are based on the belief that providing prosocial opportunities for young people in the after-school hours can reduce their involvement in delinquent behavior in the community. After-school programs target a range of risk factors for delinquency, including association with delinquent peers. Welsh and Hoshi (2006) identified three high-quality after-school programs with an evaluated impact on delinquency. Each had desirable effects 0/1 delinquency, and one program also reported lower rates of drug use for participants compared to controls. Anti-Bullying Programs Several school-based programs have been designed 10 decrease hullying. The most famous of these was implemented by Olweus (1994) in Norway. It aimed to increase aware· ness and knowledge of teachers. parents, and children about bullying and to dispel myths about it A 30-page hooklet was distributed to all schools in Norway describing what was known about bullying and recommending what steps schools and teachers could take to reduce it. Also, a 25-minute video about bullying was made available to schools. Simultaneously, the schools distributed to all parents a four-page folder containing information and advice about bullying. In addition, anonymous self-report questionnaires about bullying were completed by all children. The program was evaluated in Bergen. Each of the 42 participating schools received feedback information from the questionnaire, about the prevalence of bullies and victims, in a specially arranged school conference day. Also, teachers were encouraged to develop explicit rules about bullying (e.g., do not bully, tell someone when bullying happens, bullying will not be tolerated, try to help victims, try to include children who are being left out) and to discuss bullying in class, using the video and role-playing exercises. Also, teachers were encouraged to improve monitoring and supervision of children. especially on the playground. The program was successful in reducing the prevalence of bullying by half. A similar program was implemented in England in 23 Sheffield schools by Smith and Sharp (1994). The coreprogram involved establishing a "whole-school" anti-bullying policy, raising awareness of bullying and clearly defining roles and responsibilities of teachers and students, so that everyone knew what bullying was and what they should do about it. In addition. there were optional interventions tailored to particular schools: curriculum work (e.g., reading books, watching videos), direct work with students (e.g., assertiveness training for those who were bullied), and playground work (e.g., training lunchtime supervisors). This program was successful in reducing bullying (by 15%) in primary schools, but had relatively small effects (a 5% reduction) in secondary schools. Baldry and Farrington (2007) reviewed 16 major evaluations of programs to prevent school bullying, conducted in II different Successful Interventions 711 countries. Of these, eight yielded clearly desirable results and only two yielded undesirable negative effects on bullying. They concluded that the findings of existing evaluations were generally optimistic. Similarly optimistic conclusions were drawn in systematic reviews by Vreeman and Carroll (2007) and Ttofi, Farrington, and Baldry (2008). Multimodal Programs Multimodal programs including both skills training and parent training are more effective than either alone (Wasserman & Miller, 1998). An important multimodal program was implemented by Tremblay, Pagani-Kurtz, Vitaro, Masse, and Pihl (1995) in Montreal, Canada. They identified about 250 disruptive (aggressivelhyperactive) boys at age '6 for a prevention experiment. Between ages 7 and 9, the experimental group received training to foster social skills and self-control. Coaching, peer modeling, role playing, and reinforcement contingencies were used in small group sessions on such topics as "how to help," "what to do when you are angry," and "how to react to teasing." Also, their parents were trained using the parent management training techniques developed by Patterson (1982). This prevention program was successful. By age 12, the experimental boys committed less burglary and theft, were less likely to get drunk, and were less likely to be involved in fights than the controls. Also, the experimental boys had higher school achievement. At every age from to to 15, the experimental boys had lower self-reported delinquency scores than the control boys. Interestingly, the differences in antisocial behavior between experimental and control boys increased as the follow-up progressed. A later follow-up showed that fewer experimental boys had a criminal record by age 24 (Boisjoli, Vitaro, Lacourse, Barker, & Tremblay, 2007), intervention programs that tackle several of the major risk factors for CD and delinquency are likely to be particularly effective. Henggeler, Melton, Smith, Schoenwald, and 712 ConducllJisorder, Aggression and Dclinqucnc:,; Hanley (1993) in South Carolina evaluated multisystemic therapy (MST) for jU\enile offenders. tackling family. peer. and school risk factors simultaneously in individualized treatment plans tailored to the needs of each family. MST was compared with the usual Department of Youth Service" treatment. involving out-of-home placement in the majority of cases. In a randomized experiment with delinquents. MST was followed by fewer arrests. lower ...e1f-reported delinquency. and less peeroriented aggression. Borduin et al. (1995 j also showed that MST was more effective in decreasing arrests and antisocial hehavior than was individual therapy. According to Aos. Phipps. BarlloskL and Lieh (200 IbJ. MST had one of the highest benefit-to-cost ratios of any program. For every $1 spent on it. $13 was saved In victim and criminal justice costs. MST was the most effective intervention in the review by Farrington and Welsh (2003). However. since that review two later meta-analyses have reached dramatically opposite conclusions about the effectiveness of MST; Curtis. Ronan. and Borduin (2004) concluded that it was effective, but Littell (2005) concluded that it was not. Therefore. we cannot be contident about the effectiveness of MST until this controversy is resolved by more evaluations. CONCLUSIONS A great deal is known about adolescent antisocial behavior from high-quality longitudinal and experimental studies. First. males are more antisocial than females. Second, alJ types (including CD. aggression, and delinquency) tend to coexist and are intercorrelated. Third. the most antisocial adolescents at one age tend also to be the most antisocial at a later age. Fourth. an early onset of antisocial behavior predicts a long and serious antisoclal career. However. both the prevalence and the age of onset ofantisocial behavior ca!1 vary dramatically according to ih definition and how it is measured. Research is needed on a wider range of features of antisocial careers; not jusl prevalence and onset but also frequency. seriousness. duration. escalation. deescalation. desistance. remission. motivation and situational influences. More studies are needed with multiple informants and frequent measurements. How the prevalence and incidence of antisocial behavior varies between ages I() and 17 is less well understood. The existing evidence suggests that the incidence of phy"ical aggression decreases during adolescence but that the prevalence of CD and delinquency increase. More research is needed 011 the age distribution of different types of antisocial behaVIOr. in order to explain these lindings. Abo. more research is needed on different types of developmental pathways and trajectories dunng this age range, A great deal is known about the key risk factors for adolescent antisocial behavior. which include impulsiveness. low empathy. low IQ and low school achievement. poor parental supervision. child physical abuse. punitive or erratic parental discipline. cold parental atti· tude. parental conflict. disrupted families. antisocial parents. large family size, low family income. antisocial peers. high-delinqucncyrate schools. and high-crime neighborhoods. However. the causal mechanisms linking these risk factors with antisocial outcomes are less well established. Larger developmental theories that explain broader patterns of results need to be formulated and tested (Lahey. Moffitt. & Caspi, 2003; Farrington. 2005). More research is needed on risk factors for persistence or escalation of antisocial hehavior. To what extent risk factors are the same for males and females, for different ethnic groups. or at different ages need!:> to be investigated. More cross-national comparisons of risk factors. and more studies of promotive and protective factors. arc needed. The comorbidity and versatility of antisocial behavior poses a major challenge to scientific understanding. It is important to investigate to what extent research findings are driven by a minority of multiple-problem adolescents or chronic delinquents. Often. multiple risk factors lead to multiple-problem boys (Farrington. 2002; Loeber et aL 2001). To what extent any given risk factor generally predicts a variety of different outcomes (as opposed to specifically predicting one or two outcomes) and to what extent each outcome is generally predicted by a variety of different risk factors (as opposed to being specifically predicted by only one or two risk factors) is unclear. An increasing number ofrisk factors leads to an increasing probability of antisocial outcomes, almost irrespective of the particular risk factors included in the prediction measure, but more research is needed on this. There was insufficient space in this chapter to review theories explaining the links between risk factors and antisocial outcomes, but these have to be based on knowledge about the additive, independent, interactive, and sequential effects of risk factors. There are many examples of successful intervention programs, including general parent education in home visiting programs, preschool intellectual enrichment programs, parent management training, cognitive behavioral skills training, anti-bullying and other school programs, mentoring and after-school programs, and multimodal programs including individual and family interventions. The meta-analysis by Farrington and Welsh (2003) concluded that the average effect size of family-based programs on delinquency was d 0.32, corresponding to a decrease in the percentage convicted from 50% to 34%. However, many experiments are based on small samples and short follow-up periods. The challenge to researchers is to transport carefully monitored small-scale programs implemented by high-quality university personnel into routine large-scale use, without losing their effectiveness. Often, multimodal programs are the most successful, making it difficult to identify the active ingredient. Successful multimodal programs should be followed by more specific experiments targeting single risk factors, which could be very helpful in establishing which risk factors have causal effects. More efforts are needed to tailor types of interventions to types of adolescents. Ideally, an intervention should be preceded by a References 713 screening or needs assessment to determine which problems need to be rectified and which adolescents are most likely to be amenable to treatment. It is important to establish to what extent interventions are successful with the most antisocial adolescents, in order to identify where the benefits will be greatest in practice. Also, more cost-benefit analyses are needed, to show how much money is saved by successful programs. Saving money is a powerful argument to convince policy makers and practitioners to implement intervention programs. A great deal has been learned about adolescent antisocial behavior in the past 25 years, especially from longitudinal and experimental studies. More investment in these kinds of studies is needed in the next 25 years in order to advance knowledge about and decrease these troubling social problems. 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