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Book Review   |    
Antisocial Behavior and Mental Health Problems: Explanatory Factors in Childhood and Adolescence
Elissa P. Benedek, M.D.
Psychiatric Services 1999; doi:
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by Rolf Loeber, David P. Farrington, Magda Stouthamer-Loeber, and Welmoet B. Van Kammen; Mahwah, New Jersey, Lawrence Erlbaum Associates, 1998, 330 pages, $79.95

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Undertaking longitudinal studies on the development of problem behavior in children and adolescents is a major and daunting task, but one that is critical if we wish to expand our knowledge in the area of prognosis. As professionals and citizens, we are confronted with daily news reports of serious antisocial behavior by our youth. We are frequently chastised as others look through the retrospectoscope and suggest that we could have, or should have, predicted the serious antisocial and destructive behavior by a particular youth.

This volume reports on the methodology, the results, and the implications of the first two risk assessments conducted in the Pittsburgh Youth Study. The first assessment was carried out in 1987–1988 with three samples of boys totaling 1,517 subjects, and it is continuing with two of the three samples, or 1,009 boys and their families. The stated purpose of the study is to examine the continuity of problem behaviors and investigate, among other issues, whether continuity is limited to the same problem behaviors over time.

The investigators are also studying the relationships between various problem behaviors and, in particular, serious problem behaviors of young children before the emergence of early-onset delinquency. They hope to be able to predict which children will become chronically and seriously delinquent adolescents, which problem behaviors are critical, and which parental problems solidify children's problem behavior into adolescents' delinquent behavior. This study is one of various important longitudinal sister studies, including the Rochester Youth Development Study.

I am tempted to suggest if one wants partial answers to the many critical questions about the development of child and adolescent antisocial behaviors, this is the book. However, the authors do conclude that interrelationships exist among problem behaviors that are early manifestations of later externalizing problems. For example, attention-deficit hyperactivity disorder (ADHD), physical aggression, and conduct problems are related to later delinquency. The authors see ADHD as a key element in young boys' progression to diverse problem behaviors as adolescents; they note an association between ADHD and a progression to delinquency to substance abuse.

The authors also report that certain problem behaviors, such as depressed mood, decrease with age. Other behaviors increase with age—for example, shy or withdrawn behavior, oppositional behavior, conduct disorder, serious delinquency, serious substance use, and premature sexual activity.

In the assessments, a variety of manifestations of parental deviance and problems, including parental substance abuse, the father's behavioral problems, and parental anxiety-depression, were associated with myriad problem behaviors of their boys at a young age, but were less associated with problem behaviors as the youths grew older. Other macrofactors, including bad neighborhoods, unemployed mothers, large families, and African-American ethnicity, were associated with unfavorable outcomes. The authors report three key elements as most relevant for the development of problem behaviors: poor impulse control, attention problems, and the lack of guilt feelings.

Finally, the implications of the study are stressed. The most important one is that early problem behaviors should be addressed by interventions in many arenas to try to prevent escalation to a more serious level. The authors identify physical fighting and chronic disobedience as particular factors for early intervention. They reflect on their findings that a proportion of boys with externalizing problems such as fighting are also likely to become depressed and should be treated for depression.

Antisocial Behavior and Mental Health Problems is a difficult book to read and absorb. The authors compress a wealth of data into a medium-sized volume; each paragraph needs to be digested thoroughly if the reader is to absorb the data and the implications of that data.

However, this highly complicated, longitudinal study sends one clear and simple message: early problem behavior without intervention leads to later, more serious delinquency. The standard perception that "boys will be boys" or that "he will just grow out of it" is not applicable. As clinicians, we must concern ourselves with the child who is a playground bully and who demonstrates early aggressive behavior, as these behaviors only escalate.

Dr. Benedek is clinical professor of psychiatry at the University of Michigan Medical School in Ann Arbor.

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