Transcript October 26, 2011 - Myweb @ CW Post

Antisocial Personality Disorder and
Alcohol & Drug Involvement during Childhood & Adolescence
 Historical Perspective
 Antisocial personality is innate (Hobbes)
 Antisocial personality is learned (Locke & Rousseau)
 Both perspectives are probably valid
 Multiple pathways to antisocial
personality (equifinality)
 Divergent outcomes for youth
(multifinality)
 Definitions
 Activities that violate societal norms, laws, or the rights of
others
 Criminal acts – theft, fraud, assault, DUI, drug use
 Noncriminal acts – deceitfulness, irresponsibility
 Person must be 18 or older; otherwise, consider Conduct
Disorder (CD)
 Antisocial behavior began before age 15
 Sociopathy – old name for antisocial personality
Definitions (cont’d)
 Psychopathy – subtype of
Antisocial Personality Disorder (APD)
Personality traits – callousness, shallow
affect, lack of interpersonal
connectedness, superficial charm
Chronic antisocial behavior
Assessed using the Psychopathy
Checklist-Revised (PCL-R; Hare)
 80% of incarcerated persons meet
ASPD criteria, but ASPD represents a
heterogeneous group (which includes
psychopathy)
 Prevalence
 3.63% lifetime in an epidemiological sample
 Three times greater risk among men
 Risk factors
 Childhood conduct problems – 54% of CD boys were
diagnosed with ASPD at age 18 or 19
 Minor physical anomalies (MPAs) – low-seated ears,
adherent ear lobes, and furrowed tongues
(prenatal/perinatal trauma)
 Low autonomic arousal
 Persistent antisocial behavior has a genetic component
 Developmental progression
 Low parental involvement in middle childhood is
associated with persistent antisocial behavior in
adulthood
 Peer rejection in childhood predicts ASPD because these
children adapt by forming friendships that support
deviance
 Combination of well-organized
peer interactions and high levels
of deviancy training predict ASPD
(e.g., gangs)
 Substance abuse facilitates
development of ASPD
 Protective factors
 Age (> 45)
 Attachment to social institutions
(marriage, employment)
 Decreased impulsivity and sensation
seeking
 Parenthood and increased family
responsibilities
 Academic success
 Etiological formulations
 Individual differences
 Psychopathy is primarily biological or temperamental,
present at or near birth, persists throughout life course
 Early starters versus late starters
o Early starters – coercive parenting, school failure, early
antisocial behavior
o Late starters – poor parental monitoring, oppositionality,
deviant peer involvement starting in adolescence
 Environmental and relationship factors
Coercive parenting – intrusive demands, compliance refusals,
escalating distress, negative affect, withdrawal of demand
Peer influences
o Antisocial behavior interferes with positive peer relations
o Children act as models and a source of reinforcement for
this behavior
o Opportunity for this behavior within
networks of deviant peers
 Social bonding – job stability and
marital attachment predict lower
rates of crime and deviance
 Transactional process – bidirectional
effects between individuals and their
social environments
 Comorbidity
 ADHD – 30-50% meet criteria for ODD or CD
 Substance abuse – ASPD men three times as likely to
abuse alcohol and five times as likely to abuse drugs;
ASPD women 10-13 times as likely to abuse alcohol and
12 times as likely to abuse drugs
 Anxiety disorders and Depression
 Cultural considerations – amplified by SES and
neighborhood risk factors
 Physical spanking less problematic in African American
community
 African American children receive more negative
feedback for school behavior and performance, more
likely held back and placed in special-education
 African Americans have higher arrest and re-arrest rates
despite similar rates of antisocial behavior to European
Americans
 Important moderators of antisocial behavior
 Self-regulation – high effortful control
 Less vulnerable to deviant peer influence
 Need for cultural rituals and daily routine and chores
 Biosocial factors – gene-environment interactions
 Sociocultural factors – evaluate
systems-level policies
 Improve behavior-management
practices of teachers
 Improve academic instruction
 Prevalence
 12th grade – 80% have tried alcohol
 Adolescents drink half as often as adults but consume
4.9 drinks per occasion compared to 2.6 drink per
occasion for adults
 10% of 4th graders and 29% of 6th graders have had more
than a sip of alcohol
 Greatest escalation occurs between ages 12 and 15
 12th grade – 60% have tried nicotine
 12th grade – 50% have tried marijuana
 Problematic substance involvement predicts truancy,
suspensions, and expulsions
 Abuse and dependence: Criteria and diagnostic issues
(p. 410)
 Psychological dependence – subjective feeling of
needing the substance to function adequately
 Physical dependence – physiological and psychological
adaptations
 Tolerance – need to ingest larger
amounts to achieve same effect

 Withdrawal – consumption ends
abruptly
 Abuse and dependence are nonoverlapping diagnoses
Diagnostic criteria and issues (cont’d)
 Withdrawal and physiological dependence less
prevalent but cognitive and affective withdrawal more
prevalent among children and
adolescents
 Criteria might mot be sensitive enough
to identify adolescents with substance
use problems
 Risk factors – nested in certain contexts
 Temperament – high sensation seeking, behavioral
disinhibition, impulsivity, aggression, lack of behavioral
control, negative affectivity, antisocial patterns, trait
anxiety, anxiety sensitivity
 Childhood behavior problems – hyperactivity,
aggression, CD, comorbid psychiatric disorders (selfmedicating; 60%)
 Externalizing disorders – CD, ADHD, ODD
 Internalizing disorders – depression, anxiety
 Alcohol and drug expectancies
 Peer and parental modeling and media exposure produces
more expected global positive effects, increased social
facilitation, enhancement of cognitive and motor
performance
 Mediational model = family history of SUD 
expectancies  SUD
 Age of onset – the earlier the age, the
worse the prognosis
 Family influences
 Family history = four-to-nine-fold risk
of SUDs in males, two-to-three-fold
risk in females
 Parental deviance and
psychopathology
 Peers
 Greater access to substances
 Adoption of beliefs and values consistent with drug-use lifestyle
 Mediating variable between family history and conflict and SUD
 Stress
 Moderator of economic adversity on development of SUD
 Bidirectional association (physical, academic, legal, peer,
familial, emotional)
 Neurocognitive functioning – poor executive functioning,
which causes reduced ability to appreciate abuse consequences
 Sleep difficulties – between ages 3 and 5
 Protective factors – temperament, high intelligence,
social support, involvement with conventional peers,
religiosity, low-risk taking, competence skills, and
psychological wellness.
 Developmental pathways to Substance Use Disorders
 Deviance – prone pathway
 Reduced ability to self-regulate emotional distress and inhibit
behaviors
 Emotional distress caused by family history, ineffective parenting
 Negative affectivity pathway – deficient regulation of
negative affect
 Temperamental negative emotionality
 Environmental stressors
 Enhanced reinforcement pathway – less sensitive to
substances’ effects
Genetically influenced
Based on physiological response differences to SUD effects
 Sex, race, and ethnic differences
 Few sex differences
 Native Americans most prone;
Asian Americans least prone
 Developmentally dependent effects
 Adolescent animals less sensitive to alcohol’s adverse
effects than adults
 Adolescent animal exposure causes greater social
facilitation than adults
 Adolescents have greater long-term behavioral and brain
impairment than adults
 Adolescent animals have more tolerance, craving, and
motor impairment than adults
 Adolescent frontal brain regions that control executive
planning and reasoning processes continue to mature into
adulthood