Child Psychopathology

By Eric J. Mash; Russell A. Barkley | Go to book overview

CHAPTER
THREE
Conduct and Oppositional
Defiant Disorders

Stephen P. Hinshaw

Steve S. Lee

Problems related to delinquency and youth violence in our nation are entwined in a complex web of public concern, community fear and outrage, media attention, concerted research efforts, and multifaceted prevention and intervention programs. Even though official rates of antisocial behavior (ASB) among children, adolescents, and adults in the United States showed evidence of a leveling off or slight decline during the 1990s, following decades of steady increases (Snyder & Sickmund, 1995; Zimring, 1998; Fingerhut & Kleinman, 1990), few would contend that aggression and ASB have receded as salient, impairing, disturbing, and even (in some instances) lethal problems. Indeed, notorious instances of youth violence in middle-class, suburban settings in recent years have propelled national interest in the alarmingly high rates of aggression, acting out, and even murder among young people—rates that have long been salient in impoverished, urban neighborhoods. Furthermore, levels of violence in the United States continue to surpass those in other industrialized nations (Loeber & Hay, 1997: Rutter, Giller, & Hagell, 1998). Among youths in general, the highest rates of referral for mental health services involve aggressive, acting-out, and disruptive behavior patterns, which have shown a detectable increase over the period of time from the 1960s through the 1990s (Achenbach & Howell, 1993). In addition, the threat—or reality—of violence continues to create climates of fear, intimidation, and deprivation in many communities (Richters & Martinez, 1993). Overall, despite the ever-increasing amounts of research on this topic, the need for sound scientific efforts directed toward understanding the roots, classification, underlying mechanisms, and treatment of ASB has never been greater.

Although we base much of the organizational scheme of this chapter on the contents of the parallel chapter in the first edition of this volume (Hinshaw & Anderson, 1996), we not only update the huge literature in the field but also pursue several expanded directions. First, we pay even greater attention to the multiple causal pathways that may portend clinically significant oppositionality and aggression among children and adolescents, incorporating the constructs of equifinality (the presence of divergent etiological roots that lead to phenotypically similar behavior patterns) and multifinality (the developmental diversity of outcomes from similar initial states) (Cicchetti & Rogosch, 1996). It is clear that the behavior patterns under consideration are the products of influences at multiple levels (e.g., genetic, temperamental, family systemic, socioeconomic, school-related, community-wide), which interact and transact in complex ways. Second, given the maturation of several important prospective, longitudinal samples into adulthood, we present additional information on the extended developmental outcomes of children with both early-onset and adolescent-onset manifestations of aggression and ASB. Third, we more

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