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Transcript
Andrews University
Digital Commons @ Andrews University
Dissertations
Graduate Research
1988
A Profile Analysis of the SCL-90-R for Aggressive
and Nonaggressive Adolescents with Conduct
Disorder : a Comparison of Aggression and
Nonaggression in Relationship to Psychoticism
and Depression, Hostility and Anxiety
Janet M. Rice
Andrews University
Follow this and additional works at: http://digitalcommons.andrews.edu/dissertations
Part of the Clinical Psychology Commons, and the Other Psychology Commons
Recommended Citation
Rice, Janet M., "A Profile Analysis of the SCL-90-R for Aggressive and Nonaggressive Adolescents with Conduct Disorder : a
Comparison of Aggression and Nonaggression in Relationship to Psychoticism and Depression, Hostility and Anxiety" (1988).
Dissertations. Paper 656.
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Order N u m b e r 8919896
A profile an alysis o f th e SC L -90-R fo r aggressive a n d
nonaggressive adolescents w ith c o n d u ct d iso rd er: A com parison
o f aggression a n d n o n aggression in re la tio n sh ip to psychoticism
a n d d epression, h o stility a n d an x iety
Rice, Janet Mildred, Ph.D.
Andrews University, 1988
C op yrigh t © 1 9 8 9 by R ic e , J a n e t M ild red . A ll rig h ts reserved .
UMI
300 N. Zeeb Rd.
Ann Arbor. MI 48106
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Andrews University
School of Education
A PROFILE ANALYSIS OF THE SCL-90-R FOR AGGRESSIVE AND
NONAGGRESSIVE ADOLESCENTS WITH CONDUCT DISORDER:
A COMPARISON OF AGGRESSION AND NONAGGRESSION IN
RELATIONSHIP TO PSYCHOTICISM AND DEPRESSION,
HOSTILITY AND ANXIETY
A Dissertation
Presented in Partial Fulfillment
of the Requirements for the Degree
Doctor of Philosophy
by
Janet M. Rice
July 1988
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A PROFILE ANALYSIS OF THE SCL-90-R FOR AGGRESSIVE AND
NONAGGRESSIVE CONDUCT DISORDERED ADOLESCENTS:
A COMPARISON OF AGGRESSION AND NONAGGRESSION
IN RELATIONSHIP TO PSYCHOTICISM AND
DEPRESSION, HOSTILITY AND ANXIETY
A d is s e rta tio n
presented in p a r t i a l f u l f i l l m e n t
o f the requirm ents f o r th e degree
Doctor o f Philosophy
by
Janet M. Rice
APPROVAL BY THE COMMITTEE:
JThe rman :
Mar ion j'. Merci
,jl_______
Oi r e e f q r , B jiefo ral
Programs
OearT, S c h o o t o f E ^ u c a t i o n
Member:
Thesba N. Johnston
E x te rn a l
Examiner:
ÔâtëApprôvëd
Conrad A. R e ic h e rt
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©
C opyright by Janet M. Rice
1988
All Rights Reserved
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ABSTRACT
A PROFILE ANALYSIS OF THE SCL-90-R FOR AGGRESSIVE AND
NONAGGRESSIVE ADOLESCENTS WITH CONDUCT DISORDER:
A COMPARISON OF AGGRESSION AND NONAGGRESSION IN
RELATIONSHIP TO PSYCHOTICISM AND DEPRESSION,
HOSTILITY AND ANXIETY
by
Janet M. Rice
Chair:
Marion J. Merchant
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
ABSTRACT OF GRADUATE STUDENT RESEARCH
Dissertation
Andrews Univeristy
School of Education
Title:
A PROFILE ANALYSIS OF THE SCL-90-R FOR AGGRESSIVE AND
NONAGGRESSIVE ADOLESCENTS WITH CONDUCT DISORDER: A
COMPARISON OF AGGRESSION AND NONAGGRESSION IN
RELATIONSHIP TO PSYCHOTICISM AND DEPRESSION,
HOSTILITY, AND ANXIETY
Name of researcher:
Janet M. Rice
Name and degree of faculty adviser:
Date completed:
Marion J. Merchant, Ph.D.
July 1988
Problem
Dissatisfaction with the DSM-III classification of conduct
disorder has led the editors of the DSM-III-R to group the social­
ized and undersocialized, aggressive and the undersocialized, nonaggressive conduct-disorderd youth together in the same category
(Solitary Aggressive Type).
However, the symptoms and behavior of
aggressive and nonaggressive youth are so diverse, they should be
placed in totally separate categories.
The implications of mis­
diagnosis are serious for rehabilitation and treatment.
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Method
One hundred-thirty male adolescents labeled aggressive and
nonaggressive conduct-disordered were administered the SCL-90-R.
The Chi-square test determined what percentage in each group scored
at the 70th percentile or above in the category of Psychoticism.
The t-test determined if there was a significant difference between
the two groups in the categories of Depression, Hostility, Anxiety,
and on the Global Severity Index.
Stepwise and best subsets regres­
sion determined a model for predicting conduct disorder.
The corre­
lation between each of the 10 items and the total scores in the two
categories that made up the model was examined.
Results
Psychoticism and Obsessive-Compulsive made up the model for
predicting conduct disorder.
While 83.9% of the aggressive group
scored at the 70th percentile or above in the category of Psychot­
icism, only 17.6% of the nonaggressive group scored that high.
The
t-test showed a significant difference between the two groups in the
categories of Depression, Hostility, Anxiety, and on the Global
Severity Index.
Conclusions
The results of the SCL-90-R indicate that aggressive and
nonaggressive conduct-disordered youth are so diverse in frequency
and intensity of symptoms, they should not be placed in the same
diagnostic category, and treatment must vary to prevent recidivism.
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TABLE OF CONTENTS
LIST OF T A B L E S ..............................................
vi
ACKN0WLEDGH4ENTS.............................................. Tli
Chapter
I. INTRODUCTION AND STATEMENT OF THE PROBLEM
II.
.............
1
Introduction ..........................................
Background ............................................
DSM-III Criteria ...................................
DSM-III-R Criteria .................................
Discussion Over Criteria ...........................
Statement of the Problem...............................
Purpose of the S t u a y ...................................
Issues to Be Addressed . . . . . .......................
Degree of Psychoticism: A Comparison of
Aggressive and Nonaggressive Youth ...............
Hostility, Depression, and Anxiety: A Comparison
of Aggressive and Nonaggressive Youth ...........
H o s t i l i t y ......................................
Depression......................................
A n x i e t y ........................................
Psychoticism and Its Relationship to
Hostility, Depression, and Anxiety ...............
Definition of T e r m s ..................................
Limitations..........................................
Delimitations ........................................
S u m m a r y ..............................................
^
2
4
5
6
8
9
10
REVIEW OF RELATED LITERATURE ...........................
18
Introduction ..........................................
DSM-III Classifications .............................
O v e r v i e w ..........................................
Early Investigations: 1936-1959
Susaary............................................
Intermediate Phase: the 1960s
Summary............................................
Developmental Phase: the 1970s
Conduct Disorder ...................................
Schizophrenia and Conduct Disorder .................
Hyperactivity and Conduct Disorder .................
Environment and Conduct Disorder ...................
Summary............................................
18
19
20
20
22
23
24
24
25
27
29
30
31
iii
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11
12
12
13
13
14
15
16
16
17
III.
IV.
7.
Current Issues: the 1980s
Conduct Disorder ..................................
Schizophrenia emd Conduct Disorder .................
Hyperactivity and Conduct Disorder .................
Environment and Conduct D i s o r d e r ...................
Anxiety and Conduct Disorder .......................
Depression and Conduct Disorder .....................
Antisocial Personality and Conduct Disorder ..........
Summary............................................
Conclusion............................................
32
32
33
35
36
39
40
41
43
43
M E THOD................................................
45
Introduction..........................................
Instrument............................................
Description of the SCL-90-R.........................
Critique of the S C L - 9 0 - R ...........................
Pilot S t u d y ..........................................
Subjects..............................................
Data Collection Procedures.............................
Data H a n d l i n g ........................................
Data A n a l y s i s ........................................
Hypotheses Testing ................................
S u m m a r y ..............................................
45
45
46
48
49
50
51
52
53
53
54
PRESENTATION AND ANALYSIS OF D A T A .....................
55
Introduction ..........................................
Statistical Analysis of the Hypotheses .................
Hypothesis O n e ............................ . ' . . . .
Hypothesis......................................
Findings........................................
Hypothesis T w o ....................................
Hypothesis......................................
Findings........................................
Hypothesis Three ..................................
Hypothesis......................................
Findings........................................
Hypothesis F o u r ....................................
Hypothesis......................................
Findings........................................
Hypothesis F i v e ....................................
Hypothesis......................................
Findings........................................
Hypothesis S i x ....................................
Hypothesis......................................
Findings........................................
Conclusion............................................
55
55
55
55
55
56
56
57
57
57
57
58
58
58
59
59
59
60
60
60
65
SUMMARY, DISCUSSION, AND IMPLICATIONS.................
66
Introduction . . . . . . ...............................
Problems Addressed In This Study ...................
Methods and F i n d i n g s ...............................
66
66
68
Iv
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Hypotheses and Results
...........................
Discussion of the Hypotheses............................
Hypothesis O n e ....................................
Schizophrenia ....................................
Hypothesis T w o ....................................
Hypothesis Three ....................................
Hypothesis F o u r ......................................
Hypothesis F i v e ......................................
Hypothesis S i x ......................................
Psychoticism....................................
Obsessive-Compulsive
...........................
Profile of SCL-90-R for Conduct Disorder ...............
Nine Categories of the SCL-90-R.....................
Somatization ....................................
Obsessive-Compulsive.............................
Interpersonal Sensitivity .......................
Depression......................................
A n x i e t y ........................................
H o s t i l i t y ......................................
Phobic Anxiety ..................................
Paranoid Ideation ..............................
Psychoticism ....................................
Global Severity Index ...........................
Heed for a More Specific C r i t e r i a .....................
Characteristics of Conduct Disorder ...................
General Characteristics.. ...........................
Nonaggressive ......................................
A g g r e s s i v e ........................................
Implications for Diagnosis,Treatment, and Research. . . .
Diagnosis..........................................
Treatment..........................................
R e s e a r c h ..........................................
68
69
69
70
72
73
75
76
77
79
80
82
83
83
84
85
85
86
86
87
87
87
88
89
90
90
90
91
94
94
94
98
APPENDIX A .................................................... 100
APPENDIX B .................................................... 103
BIBLIOGRAPHY .................................................
106
V I T A ......................................................... 130
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LIST OP TABLES
1.
Chi-Square Teat for Psychoticism.....................
56
2.
Results of the T - T e s t ..............................
60
3.
Model for Conduct Disorder..........................
61
4.
Ranking of Ten Items in PsychoticismC a t e g o r y .........
63
5.
Ranking ofTen Items in Obsessive-CompulsuveCategory
64
6.
Aggressive
7.
Nonaggressive Profile Scores ........................
Profile Scores
.
.......................
Vi
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83
83
ACKNOWLEDGEMENTS
An expression of thanks is due several people for the
guidance and support that was given to see this project through to
completion.
First, thanks must go to Dr. Marion Merchant for the
time and energy she gave throughout this study.
Tue time and
suggestions contributed by Drs. Donald Gillespie and Thesba Johnston
are also greatly appreciated.
A special word of thanks must go to
Dr. Jerome Thayer for his encouragement and innovative ideas for
handling and processing the data, and to Dr. Conrad Reichert for his
willingness to take time out of his busy schedule to serve as the
external examiner.
Also, special thanks go to my husband who spent
so many hours typing this material into the computer.
Without his
support and understanding, the completion of this dissertation
would not have been possible.
vii
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CHAPTER I
INTRODUCTION AND STATEMENT OF THE PROBLEM
Introduction
In the past, similar terms have been used to describe the
antisocial behavior of both adults and adolescents; more recently
the term conduct disorder has been applied particularly to antisocial
behavior in preadolescence and adolescence (DSM-III, 1980).
The
criteria for defining and diagnosing conduct disorder, however, have
long been questioned. The discussion revolves around the placement
of aggressive and nonaggressive youth in the same category.
Due to
the broad range of difference between aggressive and nonaggressive
behavior, there is a growing opinion among experts that these youth
must be placed in two separate categories and receive different
treatment.
Distinctions should be made among (1) youth who are aggres­
sive, (2) those who are nonaggressive, (3) those who are delinquent,
and (4) those who are both aggressive and delinquent.
Studies have
shown that aggression and delinquency are relatively independent of
each other.
There still remains, however, disagreement as to what
criteria constitute aggressive conduct disorder; therefore, further
study is needed.
This study is not concerned with delinquency per se; it is
restricted to an investigation of the differences between aggressive
1
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2
and nonaggressive conduct-disordered youth and of the factors
contributing to conduct disorder.
(Several issues relating to the
characteristics of conduct disorder are listed and addressed later
in Chapter 1).
Little research has been done on the differences
between aggressive and nonaggressive behavior.
The data described
in Chapter 4 should prove helpful in developing criteria for the
diagnosis of conduct disorder and planning for treatment, manage­
ment, rehabilitation, evaluation, and education of professionals.
Background
Hewitt and Jenkins (1946) were among the first to investi­
gate the psychopathology of children and to classify children's
symptoms into categories. They established groups of (1) unsocial­
ized youth that were also aggressive, (2) socialized delinquent
youth, and (3) a group that was withdrawn or overinhibited.
These
categories later developed into the four areas of conduct disorder
that exist in the Diagnostic and Statistical M a n u a l . third edition
(DSM-III, 1980) published by the American Psychiatric Association.
Other diagnostic systems include the World Health Organiza­
tion (WHO) and the International Classification of Disorders (ICD).
WHO has only one category for conduct disorder which includes illegal
activities such as theft or destruction of property, fighting, and
cruelty toward animals.
A wide range of delinquent acts are
referred to in a single category.
The ICD is a statistical classification of mental disorders,
other diseases, and morbid conditions.
Its principal use is for
keeping the records of mortality statistics; however, it has also
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3
been adapted for Indexing and retrieving aedical records.
There are definite limitations to the ICD.
It is not a
nomenclature of diseases; and, therefore, it does not attempt to
describe all clinical and pathological observations.
revised only every 10 years.
The ICD is
For these reasons the ICD proved
inadequate and the DSM series was developed for use in the mental
health field.
Clinicians needed something fully descriptive and
more current.
The DSM series has nomenclature that expands to
include new terms as they become
accepted, and this series has
already progressed through several modifications and revisions, the
most recent being the DSM-III-R (1987).
The ICD has been adapted for use in clinical situations and
for record-keeping in hospitals, where it is called H-ICD-A.
In
1977 a committee was formed to modify the ICD-9 to make it more
specific.
With input from many professional medical organizations,
the ICD-9-CM (Clinical Modification) was developed.
WHO developed
the ICD-9 while the American Psychiatric Association Task Force was
still working on DSM-III.
Attempts were made to promote compatibil­
ity between the two.
The ICD-9 has a category called Disturbance of Conduct Hot
Elsewhere Classified.
There are four subcategories under this
heading: (1) Onsoclalized Disturbance of Conduct such as disobedi­
ence, defiance, aggression, destruction, stealing, and lying;
(2)
Socialized Disturbance of Conduct which includes stealing as a
group, and identification with and loyalty to a group; (3) Coq>ulsive Conduct Disorder which may involve antisocial behavior such as
kleptomania; and (t) Mixed Disturbances of Conduct and Emotions
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4
which Includes antisocial behavior accompanied with anxiety or
apprehension.
The DSM-III outlines four types of conduct disorder: (1)
Dndersoclallzed, Aggressive; (2) Undersoclallzed, Nonaggressive;
(3) Socialized, Aggressive; and (4) Socialized, Nonaggressive.
The parallel between the first two categories of the ICD-9 and the
Dndersoclallzed and Socialized categories of conduct disorder In the
DSM-III are apparent.
DSM-III Criteria
The DSM-III criteria for classifying conduct disorder has
been challenged because the preliminary field statistical studies
used for the DSM-III appear to be problematic.
Stewart and de B i d s
(1985) point out that the one follow-up study (Henn, Bardwell, &
Jenkins, 1980) of socialized and undersoclallzed delinquents failed
to control for the severity of the subject's misconduct.
Their
criticism of the DSM-III Is based upon what they perceive to be a
lack of data that establishes the validity of these classifications.
Stewart and de B i d s believe there Is general agreement on a
definition of conduct disorder.
They speak of disorders Involving
aggressive and destructive behavior and disorders Involving delin­
quency.
But data necessary for defining specific syndromes within
conduct disorder are Incomplete.
Stewart and de Blols support a
distinction between aggressive and nonaggressive symptoms, and thus
on this point agree with the DSM-III.
However, they would refine
the DSM-III criteria for classifying conduct disorder.
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5
DSM-III-R Criteria
The DSM-III-R states that the three new categories presented
correspond to categories derived from empirical studies.
They refer
to conduot problems alone and not to coexisting mental disorders
which must be coded separately.
Any coexisting mental disorders
should also be diagnosed as mild, moderate, or severe since research
has demonstrated the significance of degree of impairment, espe­
cially regarding prognosis.
These new categories are (1) Solitary Aggressive Type, which
corresponds to the Ondersocialized, Aggressive, the Undersocialized,
Nonaggressive, and the Socialized, Aggressive types of the DSM-III;
(2) Group Type, which corresponds to the Socialized, Nonaggressive
type (however, in the revised edition physical aggression may be
present; these youth usually claim loyalty to group members); and
(3) Undifferentiated Type, which is a residual group and may be
more common than the other two types.
The DSM-III-R has grouped aggressives and undersoclallzed,
nonaggressives in the Solitary Aggressive Type, thus removing the
distinction found in the DSM-III.
The new criteria also allows for
aggression in the Group Type (formerly Socialized, Nonaggressive).
Researchers have urged a separation between aggressive and nonaggres­
sive types; however, they have not had enough time to react to these
new categories.
The revision appears to be an attempt to accommodate
more than one theory regarding aggressive and nonaggressive behavior.
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6
Discussion Over Criteria
Stewart and de Blois (1985) disouss the DSM-III criteria for
conduct-disordered aggressive and nonaggressive.
They state that
the American Psychiatric Association criteria for conduct disorders
are "thoroughly oontroversial" chiefly for want of data.
There is
increased belief that aggressive and nonaggressive conduct disorders
are relatively independent of each other.
Hewitt and Jenkins'
(1946) clusters of aggressive and delinquent behaviors found that
the two were separate dimensions of behavior.
Vest and Farrington
(1977) found that aggressive and delinquent boys overlapped but were
not identical.
Most professional articles appear to make a distinction
between the areas of conduct disorder and delinquency.
Eysenck
(1981) suggests that the severity of antisocial conduct among
juveniles may be correlated with the general personality dimensions
of psychoticism and extroversion.
Along similar lines, Paisey and
Paisey (1982) and Raine, Roger, and Venables (1982) report relation­
ships between psychoticism, impulsivity, and extroversion.
Findings
suggest the possibility that juvenile misconduct has a dimensional
structure parallel to that already established by adult offenders
(Eysenck, 1977; Eysenck & Eysenck, 1978).
Berman and Paisey (1984)
demonstrate a positive relationship between psychoticism scores and
crimes of violence.
They ran a comparative study of assaultive and
nonassaultive juvenile male offenders in which Eysenck's Personality
Questionnaire was used.
Besides scoring higher in psychoticism,
aggressive conduct-disordered adolescents also scored higher than
nonaggressive conduct-disordered youth on sensation seeking.
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7
Stewart and de Blols (1985) analyzed their original data to
find what combinations of traits or specifio symptoms distinguish
children with aggressive conduct disorders from those with other
diagnoses.
The eight symptoms identified include fighting, quarrel­
someness, attacks on adults, extreme competitiveness, stealing out­
side of home, lies, undue need for attention, and difficulty sharing.
It should be noted that these eight symptoms differ from the DSM-III
definition of undersoclallzed conduct disorder, aggressive type, or
the DSM-III-R Solitary Aggressive Type, which is based on criminal
violence and lack of feeling for others.
Stewart and de Blois state
that aggressive conduct disorder is a valid psychiatric syndrome,
but nonaggressive, socialized conduct disorder would not qualify as
a psychiatric syndrome under their criteria.
According to this
study aggressive and nonaggressive conduct disorder should be in
separate categories.
Clearly, there Is a need for more investiga­
tion regarding personality profile differences between aggressive
and nonaggressive conduct-disordered adolescents.
In summary, the American Psychiatric Association released its
first Diagnostic and Statistical Manual of Mental Disorders which
contained a glossary of descriptions of the different diagnostic
categories in 1952.
The DSM-II based its classifications on the
mental disorders of the ICD-8.
The American Psychiatric Association
had provided consultation for the ICD.
went Into effect l6 1968.
The DSM-II and the ICD-8
The American Psychiatric Association
began work on the development of the DSM-III in 1974.
Although this
association worked closely with the World Health Organization on the
development of the ICD-9, there was dissatisfaction with its
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8
glossary.
It was not speolfio enough In criteria and did not make
use of the multiaxial approach to evaluation. The main objective
for the DSM-III was that it be clinically useful.
Because many subspecialties in medicine were dissatisfied
with the ICD-9f it was modified to the ICD-9-CM which in 1979 beoaae
the system used in this country for recording diseases, injuries,
impairments, symptoms, and the cause of death.
The DSM-III was
approved in June, 1979; the DSM-III-R came out in 1987.
It is used
as a reference for clinical diagnosis of mental disorders.
Although
the DSM-IV has not been approved in its final form at present, it is
scheduled to be published in the 1990s.
Statement of the Problem
Dissatisfaction with the DSM-III classification of conduct
disorder has focused attention on the need for further study of the
criteria for diagnosis.
Aggressive and nonaggressive conduct-
disordered adolescents are so dissimilar in behavior, there is
concern with placing them in the same category.
Because their
symptoms are so diverse, they may be better served by placement in
totally separate categories.
If adolescents are labeled conduct-disordered, they may not
be eligible for other services such as special education.
The
label a youth receives can also prevent the investigation of other
areas such as neuropsychological processing weakness.
Some youth today may meet the criteria of conduct disorder
because of violations of the law, but they may not be seriously
disturbed.
They simply may be modeling the behavior of adult
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9
■eabers of the family.
If such an adolescent is removed from his
environment, he may change his behavior.
Other youth who are
seriously disturbed and very aggressive cannot change their behavior
without comprehensive, long-term therapy.
Some aggressive conduct-
disordered youth continue to become progressively worse.
Although there is a limitation in studies and a lack of data
in the area of conduct disorder, there is enough research to
demonstrate a need for modification of the criteria for diagnosis.
Whether the new criteria in the DSM-III-R satisfies this need is yet
to be demonstrated.
Stewart and de Blois (1985) and Kelso and Stewart (1986)
suggest that aggressive conduct disorder is a psychiatric condition.
This suggestion has many implications for management and treatment.
Interest has been shown in the implications of such a diagnosis
because of issues relating to prediction and possible intervention
in attempts to control aggressive conduct disorder.
Another aspect of the problem relates to the definition of
aggressive behavior, about which considerable difference of opinion
exists. Because conduct disorder has a multiplicity of signs and
symptoms characteristic of other psychiatric disorders, misdiagnosis
is a valid concern.
Misdiagnosis can lead to neglect of treatable
neuropsychiatrie conditions and has implications for other areas of
management such as therapy (Lewis, Lewis, Onger, & Goldman, 1984).
Purpose of the Study
The purpose of this study was to (1) explore the characteris­
tics of conduct disorder and their relationship to psychoticism.
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10
depression, snziety, and hostility, (2) determine the degree of
difference between aggressive and nonaggressive conduct-disordered
adolescents in relation to psychiatric syndrome, including hostil­
ity, anxiety, depression, and schizophrenia, and (3) explore the
need for a more specific criteria for aggressive and nonaggressive
conduct disorder in order to facilitate diagnosis, prediction, and
treatment of youth at risk.
In connection with these purposes, the data for this study
have been collected on the basis of the DSM-III criteria.
If the
results show a significant difference, the new criteria in the
DSM-III-R will be in question.
If there is no significant differ­
ence, then, perhaps, the new criteria are a step in the right
direction.
Issues to Be Addressed
Issues to be addressed in this study relate to six hypoth­
eses: hypothesis one relates to differences in the degree of
psychoticism that exist in aggressive and nonaggressive conductdisordered adolescents; hypotheses two, three, and four relate
to differences in the degree of hostility, depression, and anxiety
that exists in aggressive and nonaggressive conduct-disordered
adolescents; hypothesis five relates to differences in the degree
of severity and frequency of symptoms expressed in the composite
score; and hypothesis six relates to differences between the nine
categories of the SCL-90-R when considering which contributes most to
the conduct disorder.
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11
Degree of Psychoticlsm: A Comparison of
Aggressive and Nonaggressive Youth
Stewart and de Blois (1985) present evidence for a diagnosis
of psychiatric syndrome for conduct-disordered youth.
They would
restrict this diagnosis to only severely aggressive youth.
Their
criteria is specified as to length of time for symptoms, the age at
onset, and persistence; they say a year, at least, of persistent
symptoms is necessary for diagnosis.
Stewart and Behar (1983) state
that aggressive children respond better to psychotherapy than those
that are both aggressive and antisocial.
Aggressiveness appears to be remarkably stable especially in
boys from the age of three to adulthood.
Lying and stealing appear
to stabilize at a later age, perhaps not until age 10.
Lewis et al. (1984) report in their study the number of
times conduct-disordered adolescents are admitted to the hospital
with a diagnosis of conduct disorder, but leave with a diagnosis of
schizophrenia.
This study also suggests that conduct disorder may
be an interim diagnosis, and that some individuals deteriorate and
become schizophrenic.
There is a problem in trying to determine the cause for
aggressive behavior.
Fighting, for instance, may be a symptom of
antisocial and aggressive behavior, or it may result from temporary
crises involving anger, hostility, and depression.
Clearly, fighting
in itself would not be sufficient to classify a child as aggressive.
In this study, not only is the degree of psychoticlsm for aggressive
youth analyzed, but it is compared with youth who have been classi­
fied as nonaggressive. Because conduct-disordered adolescents
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12
olasslfied as aggressive generally appear to demonstrate more aotiag
out, more hostility towards peers and adults, and more destructive
behavior, irtiether towards self, persons, or property, than do those
diagnosed as nonaggressive, it is presumed that aggressive oonduotdisordered youth generally score higher in psyohoticism than those
with less severe symptoms.
Hostility, Depression, and Anxiety: A Comparison
of Agressive and Nonaggressive Youth
Hostility
There is a great deal of discussion about the degree of
hostility present in aggressive children and adolescents, and in
those viewed as conduct-disordered but not aggressive.
Some believe
aggressive youth are more hostile because their overt, assaultive
behavior demonstrates hostility.
Others indicate that aggressive
youth may actually harbor less hostility because they act out
aggressively and vent frustration which may lower hostility levels.
Along the same line, there is the possibility that nonaggressive
youth will demonstrate significant hostility on a test instrument
because they tend to allow tension to build rather than to deal with
it effectively.
In this study it was anticipated that aggressive
conduct-disordered youth would score significantly above the nonag­
gressive in hostility.
This assumption was based on clinical
observation of behavior and not on a review of literature or test
results.
The degree of anxiety and depression of conduct-disordered
youth, when compared with nonaggressive youth, is less clear.
If
the assumption is confirmed that aggressive conduct-disordered youth
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13
are more seriously ill than nonaggressive youth, then the aggressive
youth should score higher than nonaggressive youth in depression and
anxiety.
It was anticipated that this would be the case.
The degree
of difference, however, could be less for depression and anxiety than
for hostility.
Depression
The relationship between depression and anxiety is complex.
Conduct-disordered youth may experience severe depression upon
incarceration, especially if it is the first incarceration and the
youth has strong bonds to the family or a boy/girl friend.
Separation and loss of contact cause a feeling of isolation and
helplessness.
Outpatients at mental health clinics or those in
therapy with psychologists in private practice may experience severe
depression if they are going to trial and fear a sentence.
In this
case, anxiety may precede the trial and depression may follow if
incarceration is mandated.
Anxiety
Anxiety has been described as a mixed feeling of dread and
apprehension about the future.
Fear may be chronic and of a mild
degree, or it may be strong and overwhelming.
A generalized anxiety
may begin as a specific anxiety and spiral on to become general.
For
example, criminal activity on the part of those previously arrested
may stimulate an awareness of the possibility of punishment for
their behavior. Most repeat offenders insist that they got caught
because they made a mistake, and that they are not going to make
another mistake.
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1#
Upon arrest, they may display mild anxiety while still
hoping to "get out of it easy," or they may be overwhelmed with
strong anxiety and depression, fearing the worst possible outcome.
Mental health personnel are aware of the danger of suicide attempts
in delinquents during the first day or two of incarceration.
Although there may be more overlap between anxiety and depression,
it appears that anxiety also contributes to decompensation in
conduct-disordered youth who are incarcerated. Conduct-disordered
youth with poor cognitive skills are often frightened and often
demonstrate violent and aggressive behavior as their anxiety levels
increase.
Psychoticism and Its Relationship to Hostility,
Depression, and Anxiety
There is a question regarding psychoticism and its relation­
ship to other clinical diagnostic categories such as hostility,
depression, and anxiety in both aggressive and nonaggressive conductdisordered youth.
It was anticipated that there would be a positive
relationship between psychoticism and hostility, depression, and
anxiety in the aggressive conduct-disordered population.
This
relationship could be greater for hostility than for depression and
anxiety.
There should be a positive relationship between depression
and psychoticism.
It was anticipated that within the nonaggressive conductdisordered population there may not be a significant relationship
between psychoticism and hostility, depression, and anxiety because
the psychoticism scores would be lower.
Even if depression and
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15
anxiety score well above the norm In the nonaggressive conduotdisordered sample, there still may not be a signifioant relationship
between them and psyohoticism.
Definition cf Terms
There are terms that are used repeatedly throughout this
study; therefore, a brief explanation may be helpful.
1.
Antisocial personality: a personality free from gross
symptoms of a psychosis but which does not accept the mores of the
larger society; such an individual acts as a troublemaker.
2. Attention-defieit disorder: inappropriate attention
and impulsivity for the age of the child.
3.
Borderline personality disorder: deficits in a variety
of areas including interpersonal behavior, mood, and self-image.
4.
adolescents.
Conduct disorder: antisocial behavior in children and
The social term is delinquent behavior.
Delinquent
behavior, however, includes a much broader range of symptoms.
In
this study conduct disorder refers to the group of symptoms outlined
in the DSM-III.
5.
Extroversion: attention and interests directed toward
what is outside the self.
6.
Hyperactivity: gross motor activity such as excessive
running or climbing and having difficulty sitting still; haphazard,
poorly organized, and not goal-directed.
7.
Introversion: tendency toward being concerned with or
interested in one's own mental life.
8.
Narcissistic: love of one's self, egocentrism.
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16
9.
Psyobogenlo: a development from mental rather than
physical origins.
10.
Psyohopathlo personality: an emotional and behavioral
disorder Involving Immediate personal gratification In criminal
acts, and clear perception of reality except for social and moral
obligations.
This disorder often Includes addiction and sexual
perversion.
11. Psychoticlsm: a grave mental disorder characterized by
disorganization of thought processes and emotional disturbance.
There may be disorientation as to time, space, and person, and In
some cases delusions and hallucinations.
12. Schizophrenia: a psychotic disorder involving multiple
psychological processes, deterioration from a previous level of
function.
months.
Onset Is before age 45 and duration Is at least six
It Involves delusions, hallucinations, or certain
disturbances In thought-processing.
Limitations
This study Included subjects that were diagnosed conductdisordered upon admission to an outpatient clinic, a detention
center, and to treatment In private practice.
The three categories
were handled as one when collecting and processing the data.
Delimitations
It was not the purpose of this study to deal with delinquency
and its causes.
Hor does this study attempt to design a treatment
plan for conduct-disordered youth based upon Its results.
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17
^2jM£L
In the United States the most widely used diagnostic manual,
the Diagnostic and Statistical Manual, was first published In 1952.
There have been four revisions since It first appeared, and the
DSM-I7 Is due In the 1990s.
Many clinicians, however, are uncom­
fortable with Its criteria for diagnosis.
Some professionals vbo work as clinicians with conductdisordered adolescents believe It would be helpful to separate
aggressive and nonaggressive conduct-disordered youth Into two
separate categories because their behavior Is so different.
There
Is also a question as to the degree of psychoticlsm present In
conduct-disordered adolescents.
Stetiart and de Blols (1985)
Indicate that In severe conduct disorder there Is a psychiatric
syndrome.
Anxiety, depression, and hostility are also observed In
conduct-disordered youth.
The degree of the relationship between
patients diagnosed with these disorders has been compared with
aggressive conduct disorder.
The general anticipation was that there
would be a positive relationship between aggressive conduct disorder
and the other specific disorders discussed In this chapter.
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CHAPTER II
REVIEW OF RELATED LITERATURE
Introduction
Research regarding aggressive behavior in adolescents is a
relatively new area of investigation.
Over the years a few profes­
sionals have shown some Interest in this area, but during the 1980s
research has Increased not only in comparing nonaggressive youth with
those who are considered aggressive but also in the prediction of
aggressive behavior.
This chapter reviews the literature relating
to the development of the diagnosis of conduct disorder.
Because researchers in the field of psychology and psychia­
try have wrestled over the last two decades to develop an acceptable
criteria for the identification of conduct disorder with its varia­
tions , it is necessary in this review of literature to deal with
those studies which address the various mental and emotional condi­
tions thought to be related to or to impact upon conduct disorder.
Therefore, studies dealing with depression, hostility, schizophrenia,
and other conditions seen by researchers to relate to conduct dis­
order are investigated.
Since the DSM-III classifications of conduct disorder were
used for the selection of subjects for this study, an explanation of
these classifications is given first.
The review of the literature
is divided into decades and attempts to illustrate a progression
18
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19
In the development of a criteria for conduct disorder.
The 1970s
and 1980s are the two decades of consequence because of the volume
of literature produced and because of the expansion of ideas as to
what is involved in conduct disorder.
Therefore, the review of these
decades is specifically divided into areas of disorder.
DSM-III Classifications
The DSM-III criteria for conduct disorder are outlined
because all of the data for this study were gathered under this
criteria.
Conduct disorder is defined as a repetitive and persistent
pattern of conduct which violates the basic rights of others and is
not age-appropriate.
Four specific subtypes of behavior are
included: Dndersocialized, Aggressive; Ondersoclalized, Nonaggres­
sive; Socialized, Aggressive; and Socialized, Nonaggressive.
The
DSM-III recognizes that the validity of these diagnostic subtypes
within the category of conduct disorder is controversial and that
some investigators believe the frequency and degree of the problem
is the important factor, while others believe undersocialized and
socialized should be in separate categories.
The DSM-III outlines four types of conduct disorder:
1.
Undersocialized, Aggressive : The undersocialized aggres­
sive subject fails to establish a normal degree of affection or bond
with others.
Aggressive conduct is present that involves physical
violence against a person or property and ultimately involves con­
frontation with a victim.
2.
Dndersocialized, Nonaggressive: The undersocialized
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20
nonaggresslTe subject lacks bonding with others and does not demon­
strate violence.
Antisocial behavior involves truanoy, substance
abuse, running away, vandalism, lying, firesetting, and stealing
which does not involve confrontation with a victim.
3.
Socialized, Aggressive: The socialized aggressive subject
Is attached to other people and feels remorse at times, but physical
violence, whether against property or persons, is present.
4.
Socialized, Nonaggressive: The socialized nonaggressive
subject shows some social attachment but violates rules without
demonstrating violence.
Overview
Investigation of the relatively new area of conduct disorder
has been hindered by a lack of agreement on criteria for identifica­
tion.
Only a few researchers have been consistently active in the
field.
Recent literature on conduct disorder and aggressive
adolescent behavior is critical of the DSM-III criteria for classifi­
cation of conduct-disordered youth.
There does not appear to be
unanimous thought on new criteria, however.
The review that follows
attempts to trace the development of the diagnosis of conduct
disorder.
Early Investigations
1936-1959
As early as 1936 Healy and Bronner conducted a study of
families who had both delinquent and nondelinquent youth.
There
appeared to be a difference between these two groups in regard to
health and general development.
However, the research did not
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21
verify «my difference in intellectual development.
It that time
Healy and Bronner attributed delinquency to social learning and
believed adolescents modeled behavior seen in movies.
Ten years later Hewitt and Jenkins (1946) pioneered the idea
that delinquency and aggressive behavior are independent of each
other.
They identified delinquency with and without aggressive
behavior, which allowed that delinquency and aggression did not
necessarily go together.
As early as the 1940s, therefore, an
interest in aggressive behavior in adolescents began to develop.
Glueck and Glueck (1950) noted impulsivity and restlessness
in specific adolescents.
They wrote of the extreme lack of control
in behavior within this population. There was also an unusual
frequency of illness and accidents.
Unlike Healy and Bronner,
Glueck and Glueck found that delinquency is associated with low
intelligence.
Bender (1953) conducted research involving older children
that were aggressive.
She suggested that aggression was an adapta­
tion to the environment. She also suggested that such behavior is a
part of the ego-organization in personality.
Previously
Sullivan
(1948) had discussed the behavior of youth and had suggested that the
young people were experiencing anxiety.
He described this anxiety
as being like fear, but experienced on an unconscious level.
Such
anxiety could produce apprehension, but the individual would deny
both fear and anxiety.
As these researchers were beginning to describe the behavior
of a specific group of youth, Morris, Escoll, and Vexler (1956) were
doing a follow-up study of 66 children who were hospitalized for the
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22
treatment of aggreeelve behavior disorders.
Bight years after admis­
sion to the hospital, 23% of them were considered to be well; 18%
had become schizophrenic; 18% had court records due to violations of
the law; and 41% were considered to be poorly adjusted. It was
believed that aggressive behavior In young children predisposed them
to later problems.
They suggested further that deviance In boys'
families heightened the risk of conduct disorder.
Mannheim and Wilkins (1955) and Morris et al. (1956) were
also Investigating the behavior of conduct-disordered youth.
They
decided that the age of the onset of the behavior was a determining
factor In predicting the outcome.
Bradley (1957) Investigated the behavior of the hyperactive
child.
He was saying that the prognosis for the hyperactive child
was positive.
The progression of the change In attitude In regard
to this prognosis has gone from one extreme to the other.
Shortly
after Bradley's positive predictions, many were saying that children
would outgrow hyperactivity.
Tears later the position was the oppo­
site, I.e., hyperactivity was genetically caused ; little could be
done to modify the behavior ; and much of this behavior carried over
Into adulthood. This progression was followed through the 1970s and
1980s. At this point In time. It suffices to say that Bradley was an
early researcher who said that hyperactivity would In time become
less disruptive.
Summary
Between the 1930s and the 1950s, researchers were saying
that conduct disorder was learned and was the result of modeled
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23
beharior.
Observations noted a correlation between anxiety and
aggressive behavior, and some believed aggressive behavior led to
schizophrenia.
A positive correlation demonstrated that boys with
deviance in their families were likely to develop conduct disorders.
At this time, it was hoped youth would simply outgrow byperaotivity.
Intermediate Phase
the 1960s
Most of the research that led to the classification of
conduct disorder took place during the 1970s and the early 1980s.
However, in the 1960s there was already an interest in aggressive
behavior and its contributing factors which paved the way for the
current research.
In 1962 Tablonsky studied violent gang behavior.
The conclusion was that gang members are devoid of stable social role
positions, including the gang leader.
Tablonsky stated further that
the leaders are usually severely disturbed sociopaths who fulfill
their needs through gang activity.
It is interesting that Wolman
(1987 ) and others said the same thing 20 years later, but in the
interim many theories enjoyed popularity.
Warren (1965) was interested in boys who had been admitted
to a hospital with a diagnosis of conduct disorder.
Six years later
42$ were still demonstrating oonduct-disorder behavior; 53$ were
well; the remainder had developed other disorders.
This means that
over half of the boys diagnosed as conduct-disordered recovered
sufficiently to lead a normal life.
At about the same time, Eissnberg (1966 ), reflecting the
earlier position of Bradley (1957), was predicting a positive
diagnosis for the hyperactive child.
But others were beginning to
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24
be concerned with the preralenoe of byperaotivity and its apparent
relationship with adult psychiatric disorders.
In 1966 Robins published work relating to aggressive
behavior in youth and the development of antisocial personalities in
adolescents who were aggressive.
This development seemed to occur
more often in aggressive adolescents than in nonaggressive youth.
Robins' work was the catalyst for others who investigated the
outcome of aggressive behavior.
Shortly afterward, Jones (1968) published a study in which
he stated that aggressive youth appeared to have a higher incidence
of alcoholism than did nonaggressive youth.
Marshall and Mason
(1968) described types of populations and their incidence of delin­
quent behavior: high congruence people are concerned with personal
success and delinquency is absent; low congruence populations seem
to Include broken homes and demoralized families, both of which
contribute to violence.
Marshall and Mason noted that gangs devel­
oped in low congruent, densely populated communities.
Summary
During the 1960s, aggressive behavior and its causes became
a point of increased interest.
A correlation was observed between
aggressive youth and antisocial adults.
The social environment of
delinquents became a point of increased interest.
Developmental Phase
the 1970s
During the 1970s research relating to conduct disorder
escalated. Because various mental and emotional disorders were
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25
being Identified with oonduot disorder during this decade, the
literature review is now subdivided into these various disorders.
However, literature relating to oonduot disorder itself is examined
first,
i similar format is followed for the 1980s.
Conduct Disorder
During the early 1970s researchers began to draw distinc­
tions between aggressive and nonaggressive conduct-disordered
behavior, which laid the foundation for the classifications of
conduct-disorder for the DSM-III.
Early in the decade Wolff (1971)
suggested that aggressive and delinquent patterns of behavior
observed in youth were not necessarily related, thus reflecting the
position taken by Hewitt and Jenkins (1946) 25 years earlier.
In 1973 Adler presented the theory that adolescents choose a
specific lifestyle early in childhood.
They developd the preference
to compensate for perceived feelings of inferiority.
At the same
time, however, Eysenck (1973) was saying extroversion and aggressive
behavior were, in general, biologically determined.
He identified
extroversion-introversion as a dimension of personality dependent
upon cortical potentials.
Depending upon this biological predisposi­
tion, the environment, then, affects individuals differently.
Graham and Rutter (1973) re-examined children who had been
diagnosed conduct-disordered.
Forty-nine percent of the young
people were still conduct-disordered two to three years after the
first diagnosis.
Thirty-three percent did improve.
Eighteen per­
cent, however, developed psychiatric disorders or became worse.
Some years later Lewis et al. (1984) would say that conduct disorder
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26
was an intermediate time in the life of the young person who was
developing schizophrenia.
In the same year that Graham and Rutter published their
findings, Vest and Farrington (1973) showed that extreme aggression
appears to precede delinquency, and that many of these aggressive
youth go on to engage in criminal activity.
Robins (1966 ) said conduct-disorder in adolescence often
predicts antisocial adult behavior.
He also said that the symptoms
of sociopathy appear before age 15 and that overestimation of his
own potential adds to the adolescent's problem.
He then added that
self-destructive behavior and violence is common in youth during
adolescence.
In 1981, Eysenck too said that a percentage of conduct-
disordered youth become antisocial as adults; he noted a correlation
between feelings of insecurity and antisocial behavior on the one
hand and aggression on the other.
Gersten, Langer, Eisenberg, Simcba-Fagan, and McCarthy (1976)
showed an element of stability is children's aggressive and anti­
social behavior.
Robins (1979b) believed that aggression was the
most persistent characteristic demonstrated over time, and found
Juvenile antisocial behavior to be the single most powerful predictor
of adult psychiatric status.
He believed it is difficult to predict
which conduct-disordered youth will have the poorest prognosis, yet
he felt that half of those in his study would continue their diffi­
culties, lAile the other half would not be delinquent nor become
antisocial personalities as adults.
Frank and Quinlan (1976) believed that aggressive behavior
gives the youth a certain amount of pleasure and a feeling of power.
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27
In the late 1980s, Wolaan (1987) said the same thing about the
soclopathlo adolescent.
The earlier positions of Hewitt and Jenkins (19*6) and Wolff
(1971) were refined by West and Farrington (1977) who believed there
Is a distinction between boys who are aggressive and delinquent and
those who are primarily delinquent or primarily aggressive.
Finally,
Moore, Chamberlain, and Mukal (1976) found evidence that aggres­
sive children are often less delinquent as adolescents than those
who steal, and Hylander (1979) believed aggressive youth tend to
become alcoholic In adult life.
Healy and Bronner (1936) found no difference in health and
general development between delinquent and nondellnquent siblings.
However, they did not verify any difference In Intellectual develop­
ment.
Later Glueck and Glueck (1950) found that delinquency Is
associated with low Intelligence.
Glueck and Glueck's position was
supported by Hayes, Solway, and Schreiner (1978), who pointed out
that violent offenders tend to be less Intelligent than nonviolent
offenders.
Schizophrenia and Conduct Disorder
it the beginning of this section, which reviews the litera­
ture linking conduct disorder to schizophrenia. It might be helpful
to note an aspect of the criteria for schizophrenia used In the
United States which differs from the criteria used In Europe.
Kendell, Cooper, Gourley, and Copeland (1971) pointed out that the
criteria for schizophrenia in the United States Includes severe
character disorder whereas In Europe schizophrenics are seen as
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28
undermotive and soolally withdrawn. la a part of the orlteria for
sohlzophrenla, severe oharaoter disorder opens the door for oonduot
disorder to be viewed by some researchers (Lewis et al., 1984; DSMIII-R) in the 1980s as a step toward schizophrenia.
In the 1970s
schizophrenia was aligned more closely with oharaoter disorders and
conduct disorder whereas, prior to this, schizophrenia was viewed
as social withdrawal.
In the mid 1980s, Stone (1986) outlined a scale with
borderline personality midway between neurosis and psychosis.
Prior to this. Masterson (1972) stated that borderlines fail in
separation individuation, and that, as a result of separation, the
child feels abandoned. This separation should take place at about
18 to 36 months.
When the developmental task does not take place,
the feeling of abandonment, depression, and narcissistic personality
can result.
Many conduct-disordered youth demonstrate these same
sysqstoms.
Idler (1973) investigated the borderline personality.
He
revealed that borderlines demonstrate a readiness to form intense
engulfing relationships which were demanding and dependent.
Only
later would this pattern of behavior be investigated in connection
with conduct disorder.
In 1973 Eysenck noted similar situations identified in
an earlier study involving both aggressive youth and the development
of schizophrenia.
Goldstein (1965) had outlined a theory demonstrat­
ing that schizophrenic patients tended to be overaroused and seemed
to sustain this state of excitation.
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29
Hyperaotlvity and Conduct Disorder
In the 1970s a great deal of interest vas generated around
issues related to hyperactivity.
Cohen, Weiss, and Minde (1372)
described the persistence of impulsivity in hyperaotive adolescents,
especially when they were required to attend to visual detail.
They
also found the boys in this study to be sad, pessimistic, and
depressed. Low self-esteem appeared to accompany hyperactive
adolescents.
These same symptoms were most often found in conduct-
disordered youth (Eysenck, 1977).
Vender (1971) said that investigating hyperactivity in
adolescence is important because, although the form usually changes,
many of the main problems persist throughout adult life.
Weiss and
Hechtman (1979) also believed that hyperactivity symptoms appear to
persist into early adulthood and perhaps later.
Their work contrib­
uted to the controversy in the early 1980s over the multiple
etiology of hyperactivity.
Stewart, Mendelson, and Johnson (1973)
demonstrated in their study that hyperactivity often progresses to
antisocial behavior.
Ross and Ross (1982) later contradicted this
view.
Cantwell (1979) believed that diagnosis of hyperactivity
should be based on history, not on any single observation, because so
many hyperactive youth do well on a one-to-one basis, but many are
deviant in a group setting.
This deviant behavior often results in
the label of conduct disorder.
Thomas and Chess (1977) noted definite signs of hyperactiv­
ity in infancy.
This study would have implications for learning
theory versus a neurological genetic component.
Lambert, Sandoval,
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30
and Sassone (1978) denonstrated that boys outnumber girls six to one
in the byperaotivity group.
Vender (1975) pointed out that hyperac­
tivity is the most oommon behavior disorder in the preadoleacent
group.
All of these issues were carried further and are tied to
conduct disorder during the 1980s.
Sandberg, Rutter, and Taylor
(1978) and Shaffer and Greenhill (1979) believed conduct disorder and
hyperactivity have the same etiology and prognosis; Barkley (1981)
disagreed.
He believed there are definite behavioral differences in
the disorders of hyperactivity and conduct disorder.
Loney, Langhorne, and Paternité (1978) and Prinz, Connor,
and Wilson (1981) worked to differentiate between purely hyperaotive
and purely aggressive youth and those who were both hyperactive and
aggressive.
Environment and Conduct Disorder
The relationship between conduct disorder and environment,
identified early by Healy and Bronner (1936) and Bender (1953),
received further attention during the 1970s.
In 1972, Offer, Ostrov,
and Harohn investigated levels of delinquency within different socio­
economic classes.
Their study demonstrated that delinquency is not
a class phenomenon, but rather the result of emotional turmoil which
in some cases includes anxiety. Rutter (1972) demonstrated that some
anxiety is caused by environmental stress; other researchers demon­
strated both continuity and progression of anxiety, showing that
anxiety escalates with time.
In 1974 and 1975 Crowe published studies supporting the
hypothesis that genetic factors influenced the level of sociopathy
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31
more than environment.
Eysenck (1977) slmilsrly suggested a predis­
position in certain youth toward rapid development of cortical inhi­
bition.
He said sociopaths learn slowly end forget quickly.
Reid
(1978) stated that clinical features of sociopathy can be produced
in the brain, but that not all antisocial behavior is sociopathic.
Reid's position contradicted the idea that conduct disorder is a
result of the environment.
Lefkowitz, Eron, Walder, and Husesann (1977) did a 10-year
follow-up study of 875 boys and found that antisocial, violent
behavior is the product of environmental Influences— a connection
between TV violence and violent behavior is shown— and learning
process.
In particular, parental rejection appeared to be related
to violent behavior in the boys.
Stewart, Adams, and Meardon (1978)
supported this work when they discovered that separation from anti­
social parents helped the boys in their study to i^rove their
behavior.
Summary
During the 1970s the literature showed an increased emphasis
on the relationship between environmental influences and the
development of aggressive behavior.
Genetic factors were not
denied, but an awareness of the importance of the enviromment
developed.
Hyperactivity, often accompanied by aggression, was more
seriously implicated as a factor contributing to conduct disorder.
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32
Current laaues
the 1980a
By 1980 research patterns were clearly developing In areas
specifically tied to conduct disorder. The areas selected for
study are related to the 1980 DSM-III outline of conduct disorder.
Conduct Disorder
There was dissent against DSM-III's criteria for conduct
disorder.
Lewis et al. (1984) insisted that there are scientific and
therapeutic disadvantages to DSM-III's criteria for conduct disorder,
and that the criteria tend to obscure signs and symptoms of treatable
neuropsychiatrie conditions.
Lewis et al. had questions about labeling adolescents as
conduct-disordered.
They pointed out that the symptoms of conduct
disorder are shared with other psychiatric disorders, such as aggres­
siveness, which is one behavior shared with many other disorders.
In addition, they believed that violence alone is not a valid diag­
nostic characteristic distinguishing conduct disorder, and that con­
duct disorder is often an interim designation on the way to a more
rigorous diagnosis which would do away with the diagnosis of conduct
disorder altogether.
Kelso and Stewart (1986) disagreed with Lewis et al.
They
offer evidence that aggressive conduct disorder is a valid psychiat­
ric syndrome.
They think the outcome of conduct disorder is estab­
lished: one-fourth to one-half of the conduct-disordered youth go on
to become antisocial adults.
Kelso and Stewart also demonstrated
that aggression is stable and likely to persist throughout adoles­
cence and adulthood.
They placed an emphasis on the number of
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33
symptoms and found firesetting to be a powerful predictor of conduct
disorder.
Research began to relate conduct disorder to other behaviors
besides aggressiveness and violent behavior.
Cummings and Finger
(1980 ) outlined juvenile delinquency as covering many disorders;
they used the term conduct disorder to describe minimal brain
dysfunction.
Others saw an overlap between attention-defieit
disorder and conduct disorder.
Barkley (1981) said conduct disorder
and hyperactivity do not have the same prognosis (Barkley used the
terms hyperactivity and attention deficit interchangeably).
Loney,
Kramer, and Melich (1981) said hyperactive youth are apt to become
delinquent.
Schizophrenia and Conduct Disorder
Conduct-disordered adolescents often display many of the
same symptoms as the borderline personality.
Stone (1986 ) outlined
a scale with borderline between the neurotic and the psychotic.
He
described two kinds of borderlines, one with a family history of
schizophrenia and the other with relatives who are hysteric dépres­
sives.
Gunderson and Singer (1986) pointed out that depression is
not always present in borderline individuals, but usually loneliness,
helplessness, and anxiety are present.
He stated further that
borderlines may develop pathogenic features, and that the difference
between borderline and schizophrenic individuals is in reality
testing: both share a poor sense of reality, but the borderline
person can test out his experience and the psychotic cannot.
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3*
Kernberg (1986) outlined a theory he called psychoatruotural.
It related to personality organisation.
The borderline
person is in an intermediate positiion between neurotic and psychotic
organization.
Reality testing separates the two.
Gunderson and
Singer's (1986) criteria for borderline diagnosis was really an
outgrowth of Grlnker's model and resembles Kernberg's description of
the borderline individual.
Spitzer, Bndioott, and Gibbon (1986)
developed a list of symptoms that separates the borderline from
the schizophrenic individual.
The borderline is defined psychostruc-
turally by Kernberg and phenomenologically by Grinker, Gunderson and
Singer, and Spitzer et al.
Lewis et al. (1984) believed that conduct disorder is an
intermediate step toward schizophrenia.
The DSM-III-R stated that
conduct disorder and antisocial personality can evolve into schizo­
phrenia.
Benedetti (1987) believed schizophrenia is caused by an
interplay of hereditary predisposition and dangerous life experi­
ences, and he suggested a link between schizophrenia and psycho­
pathology which involves weak ego development.
He noted that
psychopathologlcal factors alone cannot account for schizophrenia;
he credited one's understanding of the biological factors and psycho­
logical factors but asserts that people are unknowledgeable about
their interaction.
It is hard to separate etiology and pathogenesis
in schizophrenia.
Strauss and Carpenter (1981) showed that poor living con­
ditions play an important role in the etiology of schizophrenia.
the literature of the 1970s, researchers also saw a relationship
between environment and the development of conduct disorder.
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In
35
Strauss and Carpenter suggested that oross interdisciplinary inte­
gration of theories is needed to establish a oause and outline a
treatment for sohlzophrenla.
systems as one theory.
interaction.
They oited changes in physiological
Their adaptation model assumes multiple
Adaptive functions may be biological reactions to
events that are internal or external.
Antipsychotic medication fits
several models but is not a focal point since it is believed to be
less significant for the conduct-disordered youth.
Eaton (1986) and Eringlen (1986) suggested that the risk
factor for schizophrenia is dependent upon the number of relatives
who have the disease and how close the relationships are, because
the gene may be carried but not expressed.
Cancro (1985) discussed
both the environment and biological factors and believed both can
contribute tc schizophrenia.
M. Seeman (1985) described the left
brain of schizophrenics as being different from the normal brain and
suggested there may be poor interhemlspheric transfer.
EEC studies
demonstrate similarities between conduct-disordered youth and
schizophrenic adults (Selin & Gottschalk, 1983).
Hyperactivity and Conduct Disorder
August, Stewart, and Holmes (1983) showed that initial
antisocial behavior does carry prognostic weight.
Their subjects,
having a mean age of 14 were of two types: one group presented a
picture of aggressive conduct disorder during childhood ; they were
overaggressive and antisocial as adolescents.
The other boys were
hyperactive but showed no conduct disturbance.
Instead, they had
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36
oognitlve problems but showed little sign of attentlon-deficlt dis­
order or lapulslTlty.
Loney, Krsaer, end Melloh (198I), however,
found an overlap between youth who are hyperactive and those who had
trouble with the law.
Ross and Ross
hyperactivity as poor
(1982) described the secondary symptoms of
social interactions with peers, oftenbeing
aggressive. They believed there is no common cause for hyperactivity
because it is not a disease,
August et al.
but a behavior disorder.
(1983) followed a group of conduct-
disordered, hyperactive boys with aggressive diagnosis and another
group who were simply hyperactive.
ized.
Both groups had been hospital­
Eleven of 30 conduct-disordered boys who were aggressive
still had the problem after four years. None of the purely hyperac­
tive became conduct-disordered.
Environment and Conduct Disorder
The Henn et al. (1980) study indicated a relationship between
low socioeconomic class and aggression.
Stewart and de Blois (1985)
criticized this study and its results because it failed to control
for the degree of misconduct.
Eellam, Ensminger, and Simon (1980) and Pulkkinen (1983)
found that males who are aggressive tend to drink more and tend more
toward alcoholism than do nonaggressives. They also found that
aggression precedes delinquency.
Bron and Huesman (1983) found that
antisocial personality is greater among aggressive youth.
Sorrels (1980) theorized that violent behavior in children
and adolescents is related to sociocultural environment where little
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37
value Is placed on life.
Paternité and Loney (1980) believed that
aggressive behavior In older children Is the single most significant
predictor of adolescent delinquency. Kelso and Stewart (1986),
however, believed that characteristics of youth play a more Important
role In conduct disorder than do environmental factors.
Osborn (1980) and West (1982) believed disruptive school
behavior and criminal parents predict recidivism.
Moving away from
their associates and locality help most to prevent recidivism.
Behar and Stewart (1982) found that boys who Improved often had
stepfathers, new male role models who were not antisocial or
alcoholic.
Bljur, Stewart, Brown, Golding, Butler, and Rush (1983)
and Langley, McGee, Silva, and Williams (1983) found an association
between accident proneness and aggression In boys.
Stewart and
Behar (1983) found aggressive children to be more responsive to
psychological treatment than those who were both aggressive and
antisocial.
Behar and Stewart (1982) concluded that social class, sex,
and age do not affect the clinical picture very much, although sex
does affect the outcome more than social class.
They believed
aggressive conduct disorder to be a valid psychiatric syndrome.
Skllbeck, Acosta, Yamamoto, and Evans (1984) concluded that not
enough attention went Into the way different ethnic groups report
psychiatric problems.
In this study Blacks reported fewer symptoms
than Whites or Hlspanlcs on the SCL-90-R.
Monahan (1981) thought predictions can be made based on
psychological tests.
He believed, however, a family history must
accompany the test results, and that peers and the environment must
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38
be taken Into account.
This study demonstrated that the person's
interaction with the environment Is the key determinant of violent
behavior.
Syverson and Romney (1985), however, concluded that
projective tests do not predict violence with any degree of accuracy.
They also believed extroversion Is of value In predicting violent
behavior.
However, Eysenck's Personality Questionnaire was used by
Berman and Palsey (1984) and their results differed from Syverson
and Romney's.
Eysenck (1981) pointed out that the severity of conduct among
Juveniles Is correlated with psychotlclsm and extroversion.
She
also referred to the characteristics of Impulslvlty and venturesome­
ness.
Palsey and Palsey (1982) and Ralne et al. (1982) suggested
Juvenile misconduct has a dimensional structure parallel to that of
adults.
Wolman (1987) belleveed there are sociological delinquents
who are not pathological, who simply come from a background that
Ignores the law and moral standards.
of learned behavior.
This belief equates with that
He referred to others whose research confirmed
bis: Erlkson and Empey (1965) who found no difference between middle
and lower class as far as soclopathlc behavior Is concerned, but the
upper class has less delinquency than the middle or the lower
classes.
Within the lower class, behavior often relates to parental
rejection and lack of discipline.
Cohen (1955) found that frustra­
tion In the lower class turns to reaction formation or rebellion
against the middle class.
Stanfield (1966) found delinquency related
to parental rejection and lack of discipline.
Spelgel (1967) found
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39
delinquent subcultures arising in response to everyday problems in
the lower olass.
Anxiety and Conduct Disorder
It has been demonstrated that both depression and anxiety
often accompany conduct disorder (Holman, 1987).
Bamilton (1982)
dealt with the overlap between anxiety and depression.
Scrignar
(1983 ) cited Bender (1953) to support his belief that there is a
predisposition toward pathologic anxiety.
attacks do not occur without warning.
He pointed out that panic
Autonomic hyperactivity is a
prerequisite for the development of a panic attack.
People who are
in a mild state of anxiety continually have been overalerted to
danger as children.
Anxiety is always pathologic if intense or
persistant; it is also pathological if the individual is nonfunc­
tional, even if the anxiety is adaptive behavior.
Pathological
anxiety may be genetic, environmental, or both.
Beeghly (1986) spoke of anxious children who become anxious
adults.
Obsessive compulsive and panic disorders can begin as early
as the time of separation anxiety and persist into adulthood.
Goodwin and Guze (1984) described a genetic component to anxiety
neurosis as a family condition.
Torgersen (1983 ) reported twin
studies in which there is twice the rate of anxiety in monozygotic
twins than in dizygotic twins.
Nesteros (1984) and Marx (1984)
presented a theory of anxiety in which some cases appear to be the
result of the environment and others demonstrate continuity and
progression.
Scrignar's (1983) description of anxiety behavior and its
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40
relation to pathology would certainly apply to the conductdlaordered adolescent who suddenly found himself incarcerated.
Niea,
Howard, and Robinson (1982) suggested the use of Monoamine Oxidase
Inhibitor for the treatment of anxiety.
Pitts and Allen (1982)
recommended treating anxiety with dlazapam because It bolsters
confidence and reduces anxiety while the beta-adrenergic blockage
does not Interfere with critical faculties or Judgment.
The topic of medicating Incarcerated youth Is very controver­
sial, tdiether the problem Is anxiety or violent behavior.
Because
drug abuse Is so common, It Is Impossible to determine what other
drugs may already be present.
Monitoring blood levels is essential
in all conduct-disordered adolescents who are Incarcerated.
Depression and Conduct Disorder
Depression Is the most common symptom among conductdisordered adolescents who become Incarcerated. In their new set­
ting, they lack coping skills to replace their usual manipulative
behavior which Is now Ineffective.
Glazer, Clarkln, and Hunt (1981) Identified depression as the
most common psychological disorder.
Rapaport (1986) described an
ego state that Is the essence of depression.
focal point of this theory.
Helplessness Is the
Lewlnsohn (1986) represented the
behavioral approach to depression; be described depression as a
state which fluctuates over time, and as a trait which some people
are more prone to than others.
Kovacs and Beck (1986) believed cognitive changes cause
depression.
They Illustrated the experience of the conduct-
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41
disordered adolescent when they described a person as feeling bad,
thinking he is siok, weak, or inadequate.
unlikable.
He thinks he is bad or
Levinsohn (1986) pointed out that Schachter and Singer
(1962 ) wanted to teaoh the person to relabel.
If the individual can
say he feels bad because he lacks something he needs, then be is in
a better position to help himself.
Beach, Abramson, and Levine (1981) described depression as
being like a fever: it is biological and psychological.
They
combined many theories to account for depression and called this
combination a model theory.
Antisocial Personality and Conduct Disorder
The last area surveyed, because of its relationship to
conduct disorder, is that of the antisocial or the sociopathic
personality.
Building on previous studies, Eysenck (1981), Eysenck
and McGurk (1980), Rusbton and ChrisJohn (1981), and Saklofske and
Eysenck (198O) believed that antisocial juvenile behavior, including
impulsivity and venturesomeness, correlated in a very positive way
with the personality dimensions of psychoticism and extroversion.
Twito and Stewart (1982) found that specific patterns of psychiatric
disorders existed in the relatives of the boys they investigated.
Stewart and de Blois (1981) found evidence that antisocial fathers
are strongly associated with aggressive conduct disorder in boys
in the low socioeconomic class.
Edmunds and Kendrick (1980) demonstrated that psychoticism is
a central component in criminality, but it is not an indicator of a
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disposition to violent behavior.
Berman and Palsey (1984) Investi­
gated the relationship between antisocial behavior and the personal­
ity of juvenile subjects convicted of confrontational or assaultive
crimes. Juveniles convicted of assaultive crimes demonstrated higher
psychoticism, extroversion, and neurotic scores, and lower lie scores
than the youth that were convicted of destruction of property.
In 1980 , Mednlck and Christiansen (1980) found a higher
correlation between sociopaths and their biological parents than
there Is with adoptive parents.
Mednlck, Schulslnger, Hlggens, and
Bell (1986 ) Indicated that all psychopathology. Including minimal
brain dysfunction, Is the result of Interaction between genetic,
parental, and environmental factors.
Allison and Harmala (1981) observed that not all adolescent
murderers are soclopathlc, but that only sociopaths commit deliber­
ate, planned murder.
The soclopathlc adolescent develops resentment
against whomever does not satisfy bis narcissistic needs.
According
to Allison and Harmala, 42$ of adolescent murderers are paranoid
schizophrenics, and 39$ are soclopathlc.
Wolman (1987) pointed out
that as early as 1935 Alchhorn, and later Glover (1960), proposed a
theory that attempted to account for adolescent murder as an
unresolved Oedlpal wish to kill the parent.
Wolman (1987) stated firmly that not all antisocial and
self-righteous youth are sociopaths, but that all sociopaths are
antisocial and self-righteous.
According to Wolman, sociopaths are
parasitic; expect the entire world to act as a milk-giving mother;
are Incapable of self-crltlcism; are occupied with pleasure-seeking
and Immediate gratification; and may combine sex with violence.
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43
They lie intentionally for self-gain.
everyone is a liar.
power.
They are convinced that
Rape gives them the double pleasure of sex and
They take advantage of the helpless.
Investigation indicated
that EEC data and cardiovascular activity of sociopaths appear sig­
nificantly different when compared with normal individuals.
Summary
The effect of the environment upon the development of
pathology became controversial during the 1980s.
Studies to support
the idea that the environment contributes heavily to the development
of pathology and those studies which show that it makes little dif­
ference have been cited. Conduct disorder began to be taken more
seriously.
The view on hyperactivity has changed: it is now seen as
a serious problem as well as a factor contributing to other more
serious conditions.
disorder.
Anxiety and depression are now linked to conduct
The progression of conduct disorder to antisocial person­
ality and schizophrenia is still controversial.
Conclusion
This review of relevant literature on conduct disorder over
a 50-year period presents the following facts: The general attitude
prior to the 1960s was that conduct disorder was learned as a result
of modeled behavior.
During the 1980s conduct disorder is viewed
more seriously by some as a progression that could lead to antisocial
personality as an adult, and that could even progress to schizo­
phrenia.
Anxiety and depression have become linked to conduct dis­
order in this decade.
Hewitt and Jenkins (1946) were ahead of their time in
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44
thinking that aggressive behavior and delinquency were independent
of each other.
It was during the 1960s that interest increased in
aggressive behavior and that a correlation between aggressive
behavior and antisocial behavior was noted.
By 1986, Kelso and
Stewart were saying that aggressive conduct disorder is a valid
psychiatric syndrome.
Attitudes toward hyperactivity have changed greatly since
1957 when Bradley suggested that the prognosis for a hyperactive
child was good and since professionals were saying children would
outgrow this problem.
Although Eisenberg (1966) was suggesting a
positive prognosis, others were beginning to doubt this.
During the
1970s hyperactivity was viewed as a more serious condition contrib­
uting to the development of conduct disorder, often accompanied by
aggression.
During the 1980s this progression developed into the
now more firmly established attitude that hyperactivity contributes
to serious problems.
Interest in the environment and its effect upon the develop­
ment of delinquency— strongest during the 1970s and more controver­
sial in the 1980s— has continued into present studies.
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CHAPTER III
METHOD
Introduction
This chapter discusses the methods selected to test the
six hypotheses proposed by this study.
First, the rationale for
the selection of the Instrument used to test this study's hypotheses
Is detailed and Is followed by a description and critique of the
Instrument.
The pilot study, which led both to the choice of this
study's topic and to the selection of the testing Instrument, Is then
explained.
The selection of the subjects as well as the procedures
for data collecting and data handling are Introduced; and finally, a
discussion of the data analysis, which Includes an explanation of how
each hypothesis was tested, concludes the chapter.
Instrument
Several Instruments were considered before choosing one that
would best assess aggressive and nonaggresslve behavior In conductdisordered adolescents.
Hostility scales were considered but did
not provide enough Information on the range of categories that help
to Identify aggressive conduct disorder. The Brief Psychiatric
History was rejected because many areas of this Instrument are not
of major concern to this study.
Eysenck's Personality Questionnaire
45
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46
was rejected due to conflicting results in studies already oo^>leted
(Edmunds & Kendrick, 1980).
The SCL-90-R, developed under the direction of Leonard R.
Derogatis, was selected because of (1) its wide use in psychiatric
settings, (2) its acceptance by clinicians, (3) its standard scores
in nine specific areas, (4) its global indices, (5) its reliability
and validity, (6) its convenience to administer and score, (7) its
ready availability and reasonable price, and (8) the availability of
information from the test designer regarding procedures used for
tables in the manual.
Description of the SCL-90-R
The SCL-90-R is a multidimensional self-report symptom
inventory designed to measure levels of symptomatic psychological
distress.
This instrument indicates psychopathology by nine primary
dimensions and three global indices of distress.
The nine primary
symptom constructs are Somatization (SOM), Obsessive-Compulsive
(GO), Interpersonal Sensitivity (I.?), Depression (DEP), inxiety
(ANZ), Hostility (HOS), Phobic Anxiety (PHOB), Paranoid Ideation
(PAR), and Psychoticism (PST).
The three global indices are summary measures of psychologi­
cal disorders.
Although correlated, they have displayed distinct
aspects of psychopathology.
The Positive Symptom Total (PST) is a
simple count of the number of symptoms reported as positive.
The
Global Severity Index (GSI) provides information concerning the
combined numbers of symptoms as well as the intensity of distress.
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and a pure intensity measure is found in the Positive Symptom
Distress Index (PSDI).
k discrete 5-point scale ranging from "not-at-all" (0) to
"extremely" (4) represents distress for each item on the SCL-90-R.
Only 83 of the 90 items comprise the nine symptom dimensions.
Seven
additional items were introduced because they contributed significant
discriminatory power in the clinical situation.
Not conceived as
integral to the dimensional structure of the test, these items do not
have univocal loadings on the primary symptom dimensions but are used
instead in a configurai manner with the dimension and global scores
(Derogatis, 1977/1983).
The published norms for the SCL-90-R are for (1) psychiatric
outpatients, (2) psychiatric inpatients, (3) adult non-patient
normals, and (4) adolescent non-patient normals.
Separate norms are
available for men and women; they represent the raw score distribu­
tions of the nine symptom dimensions and three global indices in
terms of area T-scores (Derogatis, 1977/1983).
The SCL-90-R has demonstrated high levels of both internal
consistency and test-retest reliability.
In 1977 Derogatis reported
coefficient alphas between .77 and .90 for the primary symptom
dimensions.
The test-retest coefficients were between .78 and .90.
Validation of this Instrument has been approached in a
"programmatic" fashion using many populations and methods.
Deroga­
tis, Riclcels, and Rock (1976) showed a very high convergent and
discriminant validity between the MMPI and the SCL-90-R.
The SCL-90-R has been used extensively in measuring psycho­
therapeutic outcome regarding change, in assessment to help in
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48
diagnosis In psychiatrie settings, and In medical situations In
which a clinical assessment was needed.
Critique of the SCL-90-R
Payne (1985) and Pauker (1985) have written critiques of the
SCL-90-R.
Payne pointed out that an analogue on the SCL-90-R Is
available and In It Is a definition of psychoticism, one category of
the Instrument that Is Important for this study, which represents a
continuum ranging from a mildly alien lifestyle at one extreme to a
floridly psychotic status at the other.
He noted that the SCL-90-R
Is a brief scale In comparison to the Minnesota Multlphaslc Person­
ality Test (MMPI).
Although some factors, such as hostility and
paranoid Ideation, are measured by as few as six Items, Payne
pointed out that Its reliability Is remarkably high.
Measures of
factor Internal consistency (alpha coefficients) range from .77
(Psychoticism) to .90 (Depression), and test-retest scores range
from .78 (Hostility) to .90 (Phobic Anxiety) In a psychiatric
population.
Besides Its use with psychiatric populations, the test has
been used to evaluate the effects of psychological stress associated
with death, disaster, rape, pain, chronic tension headaches, cancer,
and anorexia nervosa.
Payne believed the most Impressive research done with the
SCL-90-R Involved depression.
The factor score was found to be
correlated with other measures of depression such as Beck's Depres­
sion, the Dempey D-30 Depression Scale, Velssman and Beck Dysfunc­
tional Attitudes Scale, the Zuckerman and Lubln Multiple Affect
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49
Adjective Check List, the Raskin Depression Screen, the Hamilton
Depression Rating Scale, and the CES-D Depression Scale.
According to Payne, these results have led Derogatis to
conclude that the SCL-90-R depression scale has shown a degree of
convergent validity.
The convergent validity of the SCL-90-R was
generally supported by findings that somatic symptoms, obsessivecompulsive, depression, free-floating anxiety, phobic anxiety, para­
noia, and the global scores of the Middlesex Hospital Questionnaire
were each significantly correlated with the respective Somatization,
Obsessive-Compulsive, Depression, Anxiety, Phobic Anxiety, Paranoid
Ideation, and Global Severity Index of the SCL-90-R.
Packer's evaluation of the SCL-90-R was similar to that of
Payne.
Although he did not recommend the SCL-90-R for clinical
diagnostic purposes, he believed It could be very effective In
research studies and In evaluating changes In symptoms produced by
treatment.
Pauker further stated that there were few validity studies
with the SCL-90-R, but that the few demonstrated levels of con­
current , convergent, discriminant, and construct validity were at
levels comparable to other self-report Inventories.
He criticized
the Instrument's ability to distinguish between the anxiety and
depression scales and was concerned that the test measures nothing
beyond psychiatric disturbance.
Pilot Study
The literature review revealed a growing belief (Behar &
Stewart, 1984; Kelso & Stewart, 1986; Stewart & de Blois, 1985) that
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50
aggressive conduct disorder is a valid psychiatric syndrome.
A
small pilot study was conducted using the SCL-90-R to test the
validity of this theory by observing whether a difference between
aggressive and nonaggresslve conduct-disordered youth existed in the
area of psychoticism.
Fifteen male subjects between the ages of 15
to 17 years were involved, 8 aggressive and 7 nonaggresslve.
All
subjects were being detained awaiting trial.
When the 15 subjects were checked for the degree of psychot­
icism, the 8 aggressive conduct-disordered youth scored consistently
above the 70th percentile (a T-score of 55).
The 7 nonaggresslve
youth scored below the 70th percentile.
Derogotis has established a GSI T-score of 63 and above, or
any two primary dimension T-scores of 63 or above, as consideration
for positive diagnosis for adult males.
No T-score has been estab­
lished previously for male adolescents.
Therefore, on the basis of
the pilot study, a T-score of 55 (70th percentile) was set for
evaluating aggressive and nonaggresslve conduct-disordered youth
in the area of psychoticism.
Future studies may show that this
T-score may need adjustment; however, at this point a T-score of
55 serves to show whether aggressive conduct-disordered youth score
significantly higher in psychoticism than do nonaggresslve conductdisordered youth.
Subjects
Male subjects with a mean age of 16 years, who had been
diagnosed as conduct-disordered on the basis of the DSM-III criteria,
were administered the SCL-90-R consecutively upon intake until 130
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51
test results were obtained.
Sixty-two were diagnosed as mggresslve
and 68 as nonaggresslve. As pointed out in Chapter 1, the revised
edition of the DSM-III was not available when the SCL-90-R was
administered.
The subjects oame from a detention center for adoles­
cents, from an outpatient aental-healtb clinic, and from private
practice.
This population represents a broad base, but may not
represent all youth with conduct disorder.
Those from the detention center were boys from urban areas
waiting to go to trial or committed to the state and waiting either
for residential placement, placement in a specific vocational
program, or placement in a residential drug-treatment facility.
The
outpatient clinic offers a full range of services to an urban and
suburban population.
In evaluating the data, no attempt was made to separate
the outpatient subjects from those in the detention center.
Subjects were screened for the study by professionals within the
institutions, and the researcher met with committees in both
facilities to insure standardization in the administration of the
SOL—90—F I
Boys in the study represented intact and single-parent
homes.
One third of the youth were first time offenders; the
remainder had prior and multiple charges ranging from attempting to
steal a car to murder I.
Data Collection Procedures
The 130 male subjects, who had been interviewed by mentalhealth personnel and already diagnosed conduct-disordered,
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52
aggressive or nonaggresslve, socialized or undersooialized, were
administered the SCL-90-R.
Many, but not all, subjects were sub­
sequently administered a full psychological battery.
Subjects were omitted from the study if their reading level,
which was determined on an Individual basis by the subject's
demonstration of ability to a psychologist, was not sufficient to
understand the statements on the SCL-90-R.
Subjects were also
omitted from the study if they were on medication for an emotional
disorder, or if they demonstrated evidence of neurological problems
such as a history of seizures.
The completion of the SCL-90-R self-report took place under
the direction of the investigator and other psychologists.
An
intake worker, who met with the investigator to insure standardiza­
tion, screened subjects at the outpatient mental-health clinic.
Outpatient subjects completed forms giving permission to test, and
detention residents, who bad not been committed to the Department of
Human Services, completed permission-granted forms.
Subjects were
instructed to consider their feelings over the past week before they
registered their responses.
All subjects, whether they completed
the SCL-90-R individually or in small groups of three or four,
received individual supervision in completing the questionnaire.
Data Handling
The responses of each subject were tallied by hand. The raw
scores for each of the nine primary symptom constructs and the three
global indices were converted into T-scores and plotted on a profile
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53
graph.
The raw scores for the 130 subjeota were entered Into the
ooaputer and checked twice for accuracy.
Data Analysis
An outline of the analytic procedures, a statement of the
hypotheses, and a description of test methods used in this study are
outlined in this section.
First, the t-test and the Chi-square test are used to compare
aggressive and nonaggresslve subjects in specific categories thought
to relate more specifically to conduct disorder.
For example, since
aggressive youth vent their hostility in aggressive acts, do they
score significantly lower in hostility than nonaggresslve youth, who
may suppress their feelings of hostility?
Second, stepwise regression and best subsets regression are
used to predict a model of conduct disorder.
If the best subsets
model confirms the model predicted by stepwise regression, a
reliable model of the conduct-disordered subjects in this study will
be available.
Third, correlation testing is used to investigate the
relationship between each of the 10 items in the Psychoticism and
Obsessive-Compulsive categories and their respective raw scores, and
to determine which items contribute most to identifying psychoticism
and obsessive-compulsive behavior on the SCL-90-R.
Hypotheses Testing
Hypothesis 1: There will be no difference between aggressive
and nonaggresslve conduct-disordered adolescents as to scoring above
the 70th percentile in the category of Psychoticism.
Chi square is
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54
used to test the difference In the proportion of subjects vbo score
above the 70tb percentile (raw score of .58) in the category of
Psychoticism.
Hypotheses 2 to 5: There will be no differences between
aggressive emd nonaggresslve conduct-disordered adolescents in
hostility, depression, anxiety, and on the Global Severity Index.
The t-test is used for these comparisons.
Rot only will the
differences between aggressive and nonaggresslve conduct-disordered
subjects in the categories of Hostility, Depression, and Anxiety be
Identified as significant or not significant, but differences in the
number of symptoms and the severity of distress will be Identified.
Hypothesis 6: There will be no relationship between the nine
categories when considering which contribute most to explaining
conduct disorder.
Stepwise regression is used to identify a model of
conduct disorder from the nine categories on the SCL-90-R.
The best
subsets regression is used to check the model demonstrated by the
stepwise procedure.
Summary
This chapter described the data-gathering instrument, the
pilot study, the subjects, the data collection, and the data handling
used for this study.
The chapter also specified the analysis of the
data as well as the methods employed to test the study's hypotheses.
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CHAPTER IV
PRESENTATION AND ANALYSIS
OF DATA
Introduction
This chapter presents the statistical findings from testing
the six hypotheses proposed In this study.
Each hypothesis Is
presented with the statistical results upon which the hypothesis Is
either accepted or rejected.
Statistical Analysis of
the Hypotheses
Hypothesis One
Hypothesis
There will be no difference between aggressive and nonaggres­
slve conduct-disordered adolescents scoring above the 70tb
percentile In the category of Psychoticism.
Findings
Research studies suggest that aggressive conduct disorder
may be a valid psychiatric syndrome (Behar & Stewart, 1981; Kelso &
Stewart, 1986; Stewart & de Blois, 1985).
Therefore, It was
anticipated on the basis of this research that the majority of the
aggressive conduct-disordered adolescents would score at the 70th
55
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56
percentile (see Chapter 3) or higher in the category of Psychoticism
on the SCL—90—R.
Hypothesis one was tested by using the Chi-square test to
determine the percentage of subjects having a raw score of .58
(70th percentile) or above, and the percentage scoring below .58.
Among the aggressive conduct-disordered youth, 16.1% scored below
.58, and 83.9% scored .58 or above.
Among the nonaggresslve
conduct-disordered youth, 82.4% scored below .58, and 17.6% scored
.58 or above (see Table 1).
Probability is 0.00.
TABLE 1
CHI-SQUARE TEST FOR PSYCHOTICISM
Less Than .58
.58 or Above
Aggressives
16.1%
83.9%
Nonaggressives
82.4%
17.6%
Because of the large difference between the percentages of
aggressive and nonaggresslve conduct-disordered adolescents who
scored .58 or above, hypothesis one is rejected.
Hypothesis Two
Hypothesis
There will be no difference between aggressive and nonaggres­
slve conduct-disordered adolescents in the category of Hostility.
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57
Flndlpga
Hypothesis two was tested by using the t-test.
With 128
degrees of freedom, the table t-ralue at the .001 level is 3.29.
Hostility has a t-value of 5.45; therefore, there is a significant
difference between aggressive and nonaggresslve conduct-disordered
adolescents in the category of Hostility.
The aggressives have a
mean of 1.31, and the nonaggressives .62 with a mean difference of
.69 (see Table 2).
The standard deviation for Hostility is .79,
giving an effect size (d) of .87.
Cohen (1969/1971, pp. 22-25) suggests three levels of effect
in evaluating the mean difference.
The d is calculated by obtaining
the difference of the means and dividing it by the standard devia­
tion.
A small d is placed at .20, medium at .50, and large at
.80.
The d for Hostility is .87, thus indicating a large mean
difference between aggressive and nonaggresslve conduct-disordered
adolescents.
On the basis of a t-value of 5.45, a d of .87, and a p-value
of 0.00, hypothesis two is rejected.
Hypothesis Three
Hypothesis
There will be no difference between aggressive and nonaggres­
slve conduct-disordered adolescents in the category of Depression.
Findings
Hypothesis three was also tested by using the t-test.
With
128 degrees of freedom the table t-value at the .001 level is 3.29.
Depression has a t-value of 5.61; therefore, there is a significant
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58
difference between mggreaalve and nonaggreaelve conduct-dlaordered
adoleacenta in Depresalon.
The aggreaslve youth have a mean of 1.35,
and the nonaggresslve .72 with a mean difference of .63.
The
standard deviation for depression Is .70, giving a d of .90 (see
Table 2); therefore, there Is a large mean difference between
aggressive and nonaggresslve conduct-disordered adolescents.
On the basis of a t-value of 5.61, a d of .90, and a p-value
of 0.00, hypothesis three la rejected.
Hypothesis Four
Hypothesis
There will be no difference between aggressive and nonaggres­
slve conduct-disordered adolescents In the category of Anxiety.
Findings
Hypothesis four was tested by using the t-test.
With 128
degrees of freedom the table t-value at the .001 level Is 3.29.
Anxiety has a t-value of 7.53; therefore, there Is a significant
difference between aggressive and nonaggresslve conduct-disordered
adolescents.
The aggressive conduct-disordered youth have a mean of
1.12, and the nonaggresslve .43 with a mean difference of .69.
The
standard deviation for anxiety Is .63 giving a d of 1.10 (see Table
2).
There Is a large mean difference between aggressive and
nonaggresslve conduct-disordered adolescents.
On the basis of a t-value of 7.53, a d of 1.10, and a
p-value of 0.00, hypothesis four Is rejected.
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59
Hypothesis Five
Hypothesis
There will be no difference between aggressive and nonaggres­
slve conduct-disordered adolescents on the Global Severity Index
(GSI).
Findings
The GSI is
the current degree
measure.
a composite score that is thebest indicator of
of disorder and should be
used as a summary
It combines information about the number of symptoms and
the intensity of distress.
t-test.
Hypothesis five was tested by using the
With 128 degrees of freedom the table t-value at the .001
level is 3.29.
The GSI has a t-value of 9.31; therefore, there is a
significant difference between aggressive and nonaggresslve oonductdisordered adolescents on the GSI.
The aggressive conduct-disordered youth have a mean of 1.24,
and the nonaggresslve .53 with
standard deviation
Table 2).
a mean difference of .71.
for the GSI is .57 giving
a d
The
of 1.25 (see
There is a large mean difference between aggressive and
nonaggresslve conduct-disordered adolescents.
On the basis of a t-value of 9.31, a d of 1.25, and a
p-value of 0.00, hypothesis five is rejected.
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60
TABLE 2
RESULTS OF THE T-TEST
Mean
Agg.
Nonagg.
t
Mean
Dlf.
SD
d
HOS
1.31
.62
5.45*
.69
.79
.87
DEP
1.35
.72
5.61*
.63
.70
.90
ANX
1.12
.43
7.53*
.69
.63
1.10
GSI
1 .24
.53
9.31*
.71
.57
1.25
•df=128
p<.001
Hypothesis Six
Hypothesis
There will be no relationship between the nine categories
assessed when considering which contribute most to conduct disorder.
Findings
Stepwise regression using BHDP2R was used to choose the best
model for conduct disorder and was verified by best subsets regres­
sion using BMDP9R.
In stepwise regression the F to enter was set at
2.00, and the F to remove at 1.99.
In step one, Psychoticism was chosen with an F to enter of
95.70, having an R square of .4278 with 128 degrees of freedom.
In step two, Obsessive-Compulsive was chosen with an F to enter of
6.16, having an R square of .4543; the F to remove Psychoticism Is
19.56.
In step two, the standardlzed-regresslon coefficient for
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61
Obsessive-Compulsive is .26, end Psyohotieism is .46 (see Table 3).
In step three, Depression was obosen with an F to enter of
2.08 and an R square of .4631.
The change in the R square in the
three steps for Psyohotieism is .4278, Obsessive-Compulsive .0265,
and Depression .0088.
Because the effect of Depression is so small,
it is omitted from the model; therefore, Psyohotieism and ObsessiveCompulsive comprise the best model for predicting conduct disorder.
TABLE 3
MODEL FOR CONDUCT DISORDER
Step
Var
R Sq
Std Reg
Cof
Change
in R Sq
F to
Enter
1
PST
.4278
.46
.4278
95.70
2
OC
.4543
.26
.0265
6.16
The best model given by best subsets regression is the twovariable model of Psyohotieism and Obsessive-Compulsive.
An R
square of .4543 was obtained for this model; and the t-statistic for
Psyohotieism is 4.42 and 2.48 for Obsessive-Compulsive, both of
which are significant at the .05 level with 128 degrees of freedom.
In the subset with the three variables of Psyohotieism,
Obsessive-Compulsive, and Depression, a model that is identical to
step three in stepwise regression, the t-statistic for Depression is
1.44, %Aich is below the table t-value of 1.96 for 128 degrees of
freedom at the .05 level.
Therefore, the subset with three vari­
ables is rejected, and the two-variable subset of Psyohotieism and
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62
Obsessive-Compulsive validates the model obosen In stepwise
regression.
Psyohotieism appears In all subsets constructed by best
subsets regression.
Obsessive-Compulsive appears In all subsets
containing five variables or less.
In tbu subset containing six
variables there are eight possible combinations of the nine catego­
ries contained In the SCL-90-R.
Obsessive-Compulsive falls to
appear for the first time In the last of the eight combinations.
On the basis of stepwise regression and best subsets regres­
sion which agree In forming a model for conduct disorder containing
the variables of Psyohotieism and Obsessive-Compulsive, hypothesis
six Is rejected.
The 10 Items In the Psyohotieism and Obsessive-Compulsive
categories are ranked according to their correlation «rlth the total
scores In each category and are presented here In Tables 4 and 5.
The number of the Item as It appears on the questionnaire Is shown In
parentheses following the rank number.
A brief discussion of the
data In each table Is found in Chapter 5.
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63
TABLE 4
RANKING OF TEN ITEMS IN PSTCHOTICISM CATEGORY
Rank
Item
No.
1
(90)
The Idea that something is wrong with
your mind
.6614
2
(62)
Raving thoughts that are not your own
.6436
3
(77)
Feeling lonely even when you are with
people
.6353
4
(87)
The idea that something serious is
wrong with your body
.6159
5
(84)
Having thoughts about sex that bother
you a lot
.6110
6
(16)
Hearing voices that other people do not
hear
.6041
7
(88)
Never feeling close to other people
.5950
8
(35)
Other people being aware of your
private thoughts
.5476
9
(7)
The idea that someone else can control
your thoughts
.5320
10
(85)
The idea that you should be punished
for your sins
.4581
Item
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r
64
TABLE 5
RANKING OF TEN ITEMS IN OBSESSIVE-COMPULSIVE CATEGORY
Rank
Item
No.
1
(46)
Difficulty making decisions
.7197
2
(38)
Having to do things very slowly to
insure correctness
.6383
3
(55)
Trcuble concentrating
.6243
4
(45)
Having to check and double-check what
you do
.5799
5
(51)
Tour mind going blank
.5596
6
(28)
Feeling blocked In getting things done
.5515
7
(9)
Trouble remembering things
.5150
8
(1)
Repeated unpleasant thoughts that won't
leave your mind
.4939
9
(65)
Having to repeat the same actions, e.g.,
touching, counting, washing
.4438
10
(10)
Worried about sloppiness or carelessness
.3563
Item
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r
65
Conclusion
On the basis of the findings, all six hypotheses are
rejected. The data indicate that aggressive conduct-disordered
youth are more psychotic than nonaggressive youth; they score much
higher on the Global Severity Index; and they manifest greater
depression, anxiety, and hostility.
Both stepwise regression and
best subsets regression indicate psychoticism and obsessivecompulsive behavior as being the best model to identify conduct
disorder.
A discussion of these findings follows in Chapter 5.
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CHAPTER V
SUMMARY, DISCUSSION, AND
IMPLICATIONS
Introduction
This final chapter reviews the problems that are addressed
in this study, the hypotheses, the methods used to test the
hypotheses, and the tests results. Then a detailed discussion of
the six hypotheses is given, followed by an analysis of the profiles
of the aggressive and nonaggressive groups which is based upon the
SCL-90-R test results, a discussion of the need for more specific
criteria, a description of the characteristics of aggressive and
nonaggressive conduct-disordered adolescents, the implications of
this study, and finally, suggestions for future studies.
Problems Addressed in This Study
Dissatisfaction with the DSM-III classification of conduct
disorder has led the editors of the DSM-III-R to group the social­
ized and undersocialized aggressive youth in the same category
(Solitary Aggressive Type).
However, the symptoms and behavior of
aggressive and nonaggressive youth are so diverse, they may be
better served by placement in totally separate categories.
Although there is a limitation in studies and a lack of data
in the area of conduct disorder, there is enough research to
66
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67
denonstrate a need for modification of the criteria for diagnosis.
Whether the new criteria in the DSM-III-R satisfies this need is
yet to be demonstrated.
Because conduct disorder has a multiplicity of signs and
symptoms characteristic of other psychiatric disorders, misdiagnosis
is a valid concern, and can lead to neglect of treatable neuropsychi­
atrie conditions, as well as having implications for other areas of
management, such as therapy.
Methods and Findings
The SCL-90-R was given to 130 male adolescents with a mean
age of 16 years who were diagnosed as aggressive and nonaggressive
conduct-disordered.
The Chi-square test determined if there was a
significant difference in the percentage of subjects in each group
who scored at the 70th percentile or above in the category of Psy­
choticism.
The t-test determined if there was a significant differ­
ence between the two groups in the categories of Hostility, Depres­
sion, Anxiety, and on the Global Severity Index.
Stepwise and best
subsets regression determined a model for predicting conduct dis­
order, and the correlation between each of the 10 items and the raw
scores in the categories of Psychoticism and Obsessive-Convulsive was
obtained.
Psychoticism and Obsessive-Compulsive make up the model for
predicting conduct disorder.
While 83.9$ of the aggressive group
scored at the 70th percentile or above in the category of Psychoti­
cism, only 17.6$ of the nonaggressive group scored that high.
The
t-test showed a significant difference between the two groups in
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68
Hostility, Depression, Anxiety, and on the Global Severity Index.
Also, high correlations exist between the 10 items and the raw
score in the Psyohotieism category (which also has an alpha of .79),
while the correlation in the Obsessive-Compulsive category is not as
high.
Hypotheses and Results
The first null hypothesis stated that there will be no
difference between aggressive and nonaggressive conduct-disordered
adolescents as to scoring at or above the 70th percentile in the
category of Psychoticism.
This hypothesis was rejected because the
Chi-square test showed 83.9% of the aggressive group did score at
the 70th percentile or above while 17.6% of the nonaggressive group
scored that high.
Hypotheses two to five stated that there will be no differ­
ence between the aggressive and nonaggressive conduct-disordered
adolescents' scoring in the categories of Hostility, Depression,
and Anxiety, and on the Global Severity Index.
These hypotheses
were rejected because the t-tests showed a significant difference
between the two groups in all four categories.
Hypothesis six stated that there will be no relationship
between the nine categories when considering which contribute most
to predicting conduct disorder.
This hypothesis was rejected
because stepwise and best subsets regression chose Psychoticism and
Obsessive-Compulsive as a model for predicting conduct disorder.
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69
Dlsousslon of the Hypotheses
The following section of this chapter presents each
hypothesis Individually and discusses the results of Its testing.
Hypothesis One
Hypothesis:
There will be no difference between aggressive
and nonaggressive conduct-disordered adolescents as to scoring above
the 70th percentile In the category of Psychoticism.
Berman and
Palsey (1984), using Eysenck's Personality Questionnaire, show that
aggressive conduct-disordered youth score higher In psychoticism and
sensation seeking than do nonaggressive conduct-dlsoredered youth.
The present study appears to correlate with Berman and Palsey*s
study In this regard.
On the basis of the pilot study. It was believed that a
significant number of subjects In the aggressive group would score
above the 70th percentile In the category of Psychoticism.
There­
fore , the results of the Chi-square test that measured hypothesis
one were anticipated.
In the aggressive group, 8 3 .9$ had a raw
score of .58 (70th percentile) or above.
In the nonaggressive
group 1 7 .6 % scored above the 70th percentile.
The large difference
In the scores of the aggressive and nonaggressive groups Indicates
that the aggressive conduct-disordered group has many more psychotic
symptoms than the nonaggressive group. The surprising number of
aggressive conduct-disordered youth who scored high on the type of
Items that went Into the development of the Psychoticism score
Indicates a problem which can lead to schizophrenia.
As cited In Chapter 1, Stewart and de Blols (1985) gave a
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70
clinical picture of the subjects in their study and believed their
picture gave evidence to support the likelihood that aggressive
conduct disorder is a valid psychiatric syndrome. They also believed
social class and age made little difference in their findings.
Schizophrenia
The DSM-III-R describes conduct disorder as childhood signs
of antisocial personality disorder.
Clinicians are cautioned not
to label a young person as antisocial because such behavior may
actually terminate, or it may evolve into other disorders such as
schizophrenia.
Lewis et al. (1984) described adolescents diagnosed as
conduct-disordered upon entering the hospital but who left with a
label of schizophrenia.
The data from the Psychoticism category
indicate that the aggressive conduct-disordered youth in this
study are at risk for schizophrenia if the environment brings
specific stressors.
Selin and Gottschalk (1983) discussed the similarities in
neurological symptoms using the Halstead-Reitan Battery between the
conduct-disordered group and the schizophrenic group.
within the impaired range.
Both scored
Selin and Gottschalk said that the
schizophrenic adults and conduct-disordered adolescents have some
overlap in clinical, neuropsychological processing and speech
deficits.
EEC test results also indicated that the schizophrenic
and conduct-disordered groups showed greater brain impairment than a
group of depressives, which indicates that the similarities between
conduct disorder and schizophrenia are due to genetic predisposition.
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71
Some aggressive conduct-disordered youth continue to become
progressively worse.
Lewis et al. described conduct disorder as an
intermediate time for those developing schizophrenia.
Clearly not
all youth diagnosed conduct-disordered are schizophrenic, but some
are.
It is the aggressive conduct-disordered youth that is at risk
for schizophrenia.
Few, if any, of the nonaggressive adolescents
become schizophrenic; their symptoms are less severe and fewer in
number.
Benedetti (1987) described schizophrenia as an interplay of
heredity predisposition and dangerous life experiences.
Benedetti
also discussed weak ego development and schizophrenia.
Others have
described the relationship between these same conditions and conduct
disorder.
Bender (1953) said psychotic symptoms in delinquents are
overlooked because they are seen as merely sociopathic.
This is a
serious problem for professionals.
Psychiatric hospitals do not want to bother with conductdisordered youth.
The youth
avoid incarceration.
are seen as manipulative in order to
Often this is the case.
But there are times
when the youth are dangerously out of control and desperate.
It is
under these conditions that they attack caretakers or try to harm
themselves. They demonstrate many borderline personality symptoms in
that they decompensate under stress but are able to pull themselves
together again with enough support and encouragement.
The psychiat­
ric hospital usually provides a nurturing environment, and they are
able to behave normally within a short time after admission.
This
does not always mean that they are going to be able to keep them­
selves together when they return to a stressful environment.
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72
Eysenck (1981) has discussed the severity of antisocial
behavior as correlated with psyohotieism.
The DSM-III-R sees
conduct disorder as consisting of childhood signs of antisocial
personality disorder.
Many more aggressive conduct-disordered youth
demonstrate antisocial behavior than do nonaggressive youth.
The
nonaggressive youth that are undersocialized are not as severe as
the aggressive youth.
Berman and Paisey (1984) demonstrated a positive relationship
between psychoticism scores and crimes of violence.
Delinquents who
experience psychotic symptoms, become involved in criminal acts, and
become schizophrenic often have a parent with a diagnosis of
schizophrenia.
The Review of the Literature (Chapter 2) cites many
who point out a correlation between psychoticism, aggression, and
violence.
Hypothesis Two
Although the model chosen to predict conduct disorder does
not include any of the three categories that were expected to be
included, the t-tests that were run on Depression, Anxiety, and
Hostility indicate a significant difference in these categories
between the aggressive and nonaggressive groups. In this section,
these three categories, plus the GSI category, are discussed
Hypothesis:
There will be no difference between aggressive
and nonaggressive conduct-disordered adolescents' scoring in the
category of Hostility.
There are those who have insisted that aggressive youth are
more hostile than less aggressive youth, but some have indicated
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73
they believe the nonaggresaive group la more hoatllc than thoae who
act out their impulaea and hoatility, which oausea reaentment to
build within the individual.
With a t-value of 5.*5 and a d of .87,
there ia a aignifioant difference between the two groupa in the
category of Hoatility, and a large difference in the meana.
Although the category of Hoatility la one of the two categoriea that haa the leaat number of itema (six, the other category
being Paranoid Ideation), they are apecific and relate to irritation,
uncontrollable temper outburats, ahouting and throwing objecta, urgea
to beat, injure, break, and amaah thinga.
Deatruction of property ia
a common complaint of caretakera of conduct-diaordered youth.
Moat
detention centera have valla that have had holes punched in them.
Many of theae youth are expelled from achool or a vocational program
due to deatruction of property or to fighting that reaulta in an
aaaault charge.
The amount of anger preaent in many of the conduct-diaordered
youth ia extreme.
Such youth have been physically and emotionally
abused, neglected, and have no support system. The less aggressive
group appear to be leas resistant and usually learn more easily.
The more aggressive and hostile the individual, the more time ia
needed to improve behavior.
Hypothesis Three
Hypothesis:
There will be no difference between aggressive
and nonaggressive conduct-diaordered adolescents' scoring in the
category of Depression.
Depression is often denied by aggressive conduct-diaordered
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74
youth, while nonaggreaaive oonduct-diaordered youth are Inclined to
admit ita preaence.
With a t-value of 5.61 and a d of .90, there
ia a aignifioant difference between the aggreaaive and the nonaggreaaive groupa in the category of Depreaaion, and there ia a large
difference in the means.
Manipulative adoleacents throw a tantrum to get attention.
They may deliberately exaggerate acting-out behavior in order to
achieve a specific end, but seldom do they fake withdrawal or
depression.
The hostile acting out of conduct-diaordered youth
is often a defense mechanism against depression and accompanying
possible decompensation.
Even when there are no classic symptoms of
depression, such as slowed psychomotor activity and behavior illus­
trating helplessness, depression may be present.
Depression and conduct disorder are often found in the same
individual, but the relationship between them is unclear.
Depres­
sion may be the result of poor social skills, social maladaptlon, or
it may result from rejection by parents or peers.
The adolescent
"burns out" the parent and then proceeds through the family one at a
time until no one will take him in or assume responsibility for him
because be is egocentric, narcissistic, and destructive.
This is not as likely to take place if there is an
appropriate surrogate such as a grandmother or aunt.
In some cases
where drugs are concerned, a parent who cannot resist the temptation
to obtain large sums of money may covertly encourage the youth to
sell drugs.
This can place the youth in a double bind and can
result in severe depression and a sense of helplessness.
He is
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75
punished if oaugbt, and he falls to please at home If he does not
bring In large amounts of money.
Although adolescents are often unstable and often resort to
suicidal Ideation more readily than adults when they become depres­
sed , they can be worked with and can respond more quickly than
adults.
The danger Is always that a youth will accidently succeed at
suicide.
Many conduct-disordered adolescents may be Inclined toward
depression due to biological factors (Beach et al., 1981), social
and environmental factors, or both.
The formation of peer support
groups designed for positive reinforcement, and enough attention to
cause the youth to feel less helpless Is often enough to prevent a
downward spiral.
Hypothesis Four
Hypothesis:
There will be no difference between aggressive
and nonaggressive conduct-disordered adolescents' scoring In the
category of Anxiety.
Anxiety seems to be present In conduct-disordered youth
whether depression Is or not.
A t-value of 7.53 and a d of 1.10
shows there Is a significant difference between these two groups
and a large difference In means.
Conduct-disordered adolescents seem to experience a great
deal of anxiety, but It Is more severe In the aggressive group.
The
difference Is that the nonaggressive group can handle their anxiety
better.
The aggressive group becomes nonfunctional In specific
stressful situations.
If this high level of anxiety persists, It
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76
becomes pathological.
Often rejection by relatives, impending
disposition in court, and new demands for adaptation while in
detention produce stress that results in high levels of anxiety.
Bender (1953) spoke of a predisposition toward pathological
anxiety.
It does appear that some youth are much more anxious than
others.
Social histories often indicate that previous experiences
can account for high levels of anxiety.
The most anxious youth are
often limited physically and cognitively, and they are often
deprived.
Hypothesis Five
Hypothesis:
There will be no difference between aggressive
and nonaggressive conduct-disordered adolescents' scoring on the
Global Severity Index.
The Global Severity Index is the best single indicator of a
disorder.
The GSI combines the number of symptoms indicated with
the intensity of distress.
Separate scores,
symptoms recorded and another for
available on the SCL-90-R.
one forthe number of
the degree of intensity only, are
The GSI, which combines these two scores,
can be used to indicate total adjustment.
It should be noted that a
category demonstrates the largest
t-value of 9.31 inthe GSI
difference betweenthe two groups
when it is compared with the other t-tests in this study.
The
t-value of 9.31 indicates that there is a significant difference
between the aggressive and nonaggressive groups, and a d of 1.25
indicates a large difference in means.
The data in the GSI category more than anything else
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77
indicate bow different these two groups are when it cones to
symptoms of pathology.
The nonaggressive group demonstrates fewer
symptoms, and the symptoms that are recorded are not rated as severe
as the aggressive group.
In summary, the computer correlation matrix shows a corre­
lation between Psychoticism and Anxiety of .79, a correlation between
Psychoticism and Hostility of .70, and a correlation between Psy­
choticism and Depression of .69.
There is a high correlation between
Psychoticism and Anxiety, while the correlation between Psychoticism
Hostility, and Depression is not as high.
Depression was chosen for
the model by stepwise regression in step three; however, its contri­
bution is so small (see discussion of hypothesis six) it is rejected
in the final model for this study.
There is a greater overlap
between Psychoticism, Anxiety, and Hostility than there is between
Psychoticism and Depression.
Hypothesis Six
Hypothesis:
There will be no relationship between the nine
categories of the SCL-90-R when considering which contribute most to
conduct disorder.
The most significant finding of this study is the model
developed by the stepwise regression and confirmed by the best sub­
sets regression used to test hypothesis six.
Of the nine SCL-90-R
categories: (1) Somatization, (2) Obsessive-Compulsive, (3) Inter­
personal Sensitivity, (h) Depression, (5) Anxiety, (6) Hostility,
(7) Phobic Anxiety, (8) Paranoid Ideation, and (9) Psychoticism—
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78
ObsessiTe-Cofflpulslve and Pysoboticlsm contributed moat to predict
conduct disorder.
From the results of previous studies conducted by Stewart
and bis colleagues (Bebar & Stewart, 1984; Stewart & de Blols, 1985;
Kelso & Stewart, 1986), It was anticipated tbat tbe aggressive
conduct-disordered youtb would score blgber in psycboticlsm tban tbe
nonaggressive group.
Therefore, tbe model of Psycboticlsm and
Obsessive-Compulsive was unexpected.
If psycboticlsm bad formed a model In any combination wltb
hostility, depression, or anxiety, this would not have been a
surprise.
Wolman (1987) outlines a clear picture of depression and
anxiety accompanying conduct disorder.
The aggressive group scored
high In both of these categories (a profile T-score of 62 for
Depression and 61 In Anxiety), but neither was chosen for tbe model
by stepwise regression.
Overlap accounts for tbe model selected in
this study.
Psycboticlsm contributed more toward tbe model wltb an R
square of .4278.
Obsessive-Compulsive made tbe second highest
contribution with an addition to the R square of .0265.
Depression
was chosen by stepwise regression as tbe third factor, but It did
not contribute enough to warrant its inclusion (F to enter is 2.08
and tbe contribution to tbe R square is .0088).
All other catego­
ries contributed very little in comparison to Psycboticlsm and
Obsessive-Compulsive. Tbe selection of a model for conduct disorder
made by stepwise regression is verified by best subsets regression.
In tbe final analysis, Psychoticism and Obsessive-Compulsive form
tbe best model for predicting conduct disorder.
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79
Previously tbe relationship between psychoticism and conduct
disorder was noted.
For example, Hewitt and Jenkins (1946) found
that unsocialized aggressive youth came to the psychiatric clinic at
an earlier age than those with better social skills and less deswnstrated aggression.
Stewart and de Blois (1985) believed aggressive
conduct disorder is a valid psychiatric syndrome.
Kelso and Stewart
(1986) suggested that aggressive conduct disorder is a psychiatric
condition.
A correlation between psychoticism, impulsivity, and
extroversion has also been observed. But none of the studies cited
in this work demonstrate a relationship between psychoticism and
obsessive-compulsive behavior.
Psychoticism
A brief discussion of the two categories that make up the
model in this study for predicting conduct disorder follows, begin­
ning with Psychoticism.
Psychotic symptoms are generally thought of as delusions,
hallucinations that last for several days, incoherence, catatonic
behavior, and an inappropriately flat affect.
deterioration in the functions of daily living.
There is always a
Ruling out psycho-
active substance abuse before a diagnosis of psychosis is made in
conduct-disordered adolescents is difficult because the use of
phenocyclidine and cocaine is so common.
Among schizophrenics there is withdrawal and social isola­
tion.
Personal hygiene becomes impaired, and there may be poverty
of speech or overelaborate speech.
Superstition and magic may have
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80
a strong Influence, and illusions and a lack of initiative are
COBUBOn.
Derogatis (1977/1983) has ranked the 10 items in the
Psychoticism category (see Table 4, p. 63) according to "first-rank
symptoms" of schizophrenia (items 7, 16, 35, and 62) and schizoid
lifestyle.
Table 4 shows that one first-rank symptom ("Having
thoughts that are not your own") is ranked second by the responses
of tbe subjects in this study; a second first-rank symptom ("Hearing
voices that other people do not bear") is ranked sixth; and the
remaining two ("Other people being aware of your private thoughts"
and "The idea tbat someone else can control your thoughts") are
ranked eighth and ninth, respectively.
The subjects' rating of the 10 items in Psychoticism indi­
cates that these young people are not schizophrenic but are demon­
strating some serious symptoms of schizophrenia.
They could be
classified as conduct-disordered with psychotic features or prepsychotic.
This means that under circumstances that are very stress­
ful for them, they could become psychotic.
Obsessive-Compulsive
The obsessive-compulsive individual demonstrates a pattern
of perfectionism and inflexibility.
Although these people strive
for perfection, they are thwarted in their efforts by their overly
strict adherence to unattainable standards that interfere with
satisfaction.
They never feel they have done well enough, while
being extremely critical of others.
Mismanagement of time becomes a
problem because tasks are put off until the last moment. They are
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81
overly sensitive to doalnanoe/submlsslon status, and feel a need to
dominate others.
While resisting authority, they want others to
oonforn to their extreme way of doing things, and deolslon-making Is
difficult due to fear of making a mlsteke (DSM-III, 1980).
This disorder Includes recurrent obsessions that are severe
enough to cause distress, that are time comsumlng, and that Interfere
with efficient functioning at work, at home, and In relationships
with others.
The obsessions consist of Ideas, thoughts, and
Impulses that are senseless.
Unlike delusional thinking, the
obsessive-compulsive Individual recognizes that the obsessions are
within their own minds and are not caused by outside forces.
Compulsions are repetitive, purposeful, and Intentional behavior.
Such Individuals adhere to certain rules that help to prevent
discomfort. Adolescents realize their behavior Is unreasonable and
state they do not know irtiy they act as they do.
Depression and anxiety usually accompany obsessivecompulsive disorder.
In the conduct-disordered youth, bizarre
behavior Is common under stress, but compulsive behavior Is less
obvious.
The problem of drug and alcohol abuse Is a complication of
obsessive-compulsive disorder.
Many conduct-disordered youth abuse
both drugs and alcohol.
The Items In the Obsessive-Compulsive category contain
symptoms that are highly Identified with a standard clinical syn­
drome. The dimension focuses on thoughts. Impulses, and behavior
that Is unremitting and Irresistible but unwanted. They are of an
ego-allen nature.
Some congnltlve performance attenuation Is
Included in this category.
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82
High levels of anxiety contributed to tbe high rating of
Obsessive-Compulsive items on this test (see Table 5, p. 64).
It
appears that anxiety levels are high enough to dominate daily living
habits and contribute to inefficiency of both time and energy.
In summary, aggressive conduct-disordered youth demonstrate
symptoms similar to those diagnosed as psychotic and obsessivecompulsive.
The model for predicting conduct disorder which consists
of psychoticism and obsessive-compulsive is obtained by stepwise
regression and confirmed by best subsets regression.
It was no
surprise that psychoticism was in tbe model, but the combination
with obsessive-compulsive was unexpected. Psychoticism contributes
most to the model.
Depression was chosen in step three but it did
not contribute enough to warrant its inclusion.
Profile of SCL-90-R for
Conduct Disorder
This section examines the profile of the aggressive and nonaggressive subjects.
The profiles describe the aggressive and non-
nonaggressive groups and, therefore, should not be used for predic­
tion.
The model of Psychoticism and Obsessive-Compulsive is best
used for prediction because intercorrelation has been accounted for.
The following category descriptions are based on the SCL-90-R manual
(Derogatis, 1977/1983).
A mean raw score was obtained for each of the nine categories
in the SCL-90-R and converted to a T-score.
On the basis of this
T-score, a profile for the aggressive and nonaggressive groups was
obtained.
A profile chart for each group is found in Appendix A.
For the purpose of the present discussion, however, the T-scores,
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83
wltb the raw scores below them, are given In two tables for the
oonvenlence of tbe reader.
Table 6 contains the scores for the
aggressive group, and Table 7 those for the nonaggressive group.
TABLE 6
Aggressive Profile Scores
SOM
OC
IS
DEP
ANX
HOS
PHOB
PAR
PST
GSI
63
61
59
62
61
57
62
59
62
61
1.09
1.41
1.26
1.35
1.12
1.31
.81
1.47
1.18
1.24
TABLE 7
Nonaggressive Profile Scores
SOM
OC
IS
DEP
ANX
HOS
PHOB
PAR
PST
GSI
52
50
48
55
52
50
53
53
50
52
.42
.63
.48
.72
.43
.62
.23
.81
.34
.53
Nine Categories of the SCL-90-R
Somatization
This dimension reflects distress that results from a per­
ception of bodily dysfunction.
The complaints are focused on cardio­
vascular, gastrointestinal, and respiratory symptoms, as well as
symptoms of autonomic mediation. The symptoms are prevalent In
disorders that have functional etiology although they may result from
true physical diseases.
Somatic equivalents of anxiety are Included
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84
here.
It appears that tbe nonaggressive subjects demonstrate fever
symptoms In Somatization, and they are less severe then the aggres­
sive group.
A T-score of 52 on the SCL-90-R profile sheet was obtained
for the nonaggressive group, giving a percentile of 58.
A T-score
of 50 is middle average, therefore, this score is considered within
the average range.
The aggressive group, however, has a T-score of 63 in
Somatization.
This is well above the average and is equivalent to
a percentile rank of 87.
Clearly, the aggressive group is manifes­
ting more physical symptoms of stress.
This may be because the
symptoms of psychological stress are much more severe than those of
the nonaggressive group.
Obsessive-Compulsive
This dimension reflects symptoms identified with the stan­
dard clinical syndrome of obsessive-compulsive.
It measures thought,
impulses, and actions that are experienced as unremitting and irre­
sistible by the person, but those that are ego-alien or unwanted
action.
Some behavior and experiences that are of general cognitive
performance attenuation are included. The profile T-score for nonaggresslves in the category of Obsessive-Compulsive is 50.
This is
middle average and is much lower than the T-score of the aggressive
group.
The aggressive group has a profile T-score of 61 in this
category.
Obsessive-compulsive is one of two areas tbat was chosen
for the model of conduct disorder.
The T-score of 61 is well beyond
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85
tbe avermge range and equals a percentile of 86.
Interpersonal Sensitivity
Interpersonal Sensitivity focuses on feelings of inadequacy
and inferiority.
Self-depreciation, uneasiness, and feeling shy or
uncomfortable when talking with people are measured in this cate­
gory,
A T-score of 48 was obtained by the nonaggressive group.
This is Just below the middle average.
not feel inferior to others socially.
Evidently this group does
The aggressive group,
however, has a T-score of 59 and is in the 83rd percentile.
Depression
Depression has been discussed in terms of the t-test that
was run to test hypothesis three; however, the profile T-scores have
not been discussed. The depression dimension of the SCL-90-R
reflects a wide range of clinical symptoms.
Dysphoria and affect
are viewed as signs of withdrawal of life interest, slow psychomotor
activity, and a lack of motivation.
More severe symptoms such as
feelings of hopelessness and thoughts of suicide are also measured.
Tbe nonaggressive conduct-disordered group has a T-score of
55, giving a percentile rank of 70.
This is above the average range
and the highest peak for the nonaggressive profile.
Therefore,
depression must be viewed as a major symptom of nonaggressive
conduct disorder.
The profile for the aggressive group has three categories
scoring equally high.
The aggressive group has a T-score of 62 in
depression, giving a percentile rank of 86.
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86
Anxiety
The anxiety dimension includes symptoms and signs that are
associated clinically with high levels of manifest anxiety.
These
include feelings of nervousness, tension, trembling, panic attacks
and a sense of terror. Some of the cognitive components that make
up this score include feelings of apprehension and dread.
The nonaggressive group has a profile T-score of 52, giving
a percentile rank of 58.
Although this is slightly above average,
it is far below the T-score of 61 for the aggressive group, which is
a percentile rank of 86.
There is evidence of high levels of
anxiety within the aggressive group.
Feelings of impending doom and
frightening thoughts are common among this group.
There appears to
be a big difference in the amount of anxiety in the two groups.
Hostility
The hostility dimension indicates thoughts, feelings, and
actions that are characteristic of a negative attitude and an affect
state of anger. The items reflect aggression, irritability, rage,
and resentment. Although the number of items is small in this
category, the statements are severe.
The nonaggressive group has an average profile T-score of
50.
The aggressive group, however, has a T-score of 57, giving a
percentile rank of 73.
There is evidence of much more hostility
within the aggressive group.
It should be noted, however, that in
terms of the profile, hostility was the lowest score for the
aggressive subjects.
This may be due, in part, to denial and the
overt admission required in responding to such extreme statements.
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87
Phobic Anxiety
The category of phobic anxiety la viewed as a persistent
fear response to a specific person, place, object, or situation that
Is seen as being Irrational In proportion to the stimulus and which
leads to avoidance or escape behavior.
The category focuses on
disruptive behavior.
The nonaggressive subjects have a profile T-score of 53,
giving a percentile rank of 60.
The aggressive subjects have a
T-score of 62, with a percentile rank of 86.
The large difference
between the two groups Indicates that specific anxieties as well as
generalized anxiety Is much greater In the aggressive group.
Paranoid Ideation
This dimension represents paranoid behavior as a disordered
mode of thinking.
Characteristics of projective thought, hostility,
suspiciousness, grandiosity, centrality, fear of loss of autonomy,
and delusions are the main aspects of this disorder.
The nonaggressive group has a profile T-score of 53, placing
them In the 60th percentile.
Once again this Is above average, but
there Is considerable difference between the two groups.
The
aggressive group has a T-score of 59, placing It at the 83rd percen­
tile.
Conduct-disordered youth are apt to blame others for their
troubles, but this Is especially true of the aggressive group.
PsychoticIsm
The psychotlclsm scale Is designed to represent a continuous
dimension of human experience.
lifestyle are represented.
Withdrawal, Isolation, and schizoid
First-rank symptoms of schizophrenia.
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88
including hallucinations and thought-broadcasting, are represented.
They are arranged in a graduated continuum from mild interpersonal
alienation to clear psychosis.
The nonaggressive group has a profile T-score of 50, which
is average.
The aggressive group, however, has a T-score of 62,
which gives a percentile rank of 86.
The implications of psychosis
are clear when there is a high Anxiety score and an elevated
Psychotlclsm score combined with one or more first-rank symptoms,
such as the idea that someone is controlling thoughts, hearing
voices others do not hear, people being a%#are of one's private
thoughts, and having thoughts that are not one's own.
Phobic
anxiety is almost always elevated in the psychotlclsm profile
according to Derogatls (1977/1983).
Since the profile of the
aggressive group meets the criteria as outlined in the manual for
the SCL-90-R (1977/1983), the aggressive group is congruent with
others who have met the criteria for psychosis.
Global Severity Index
The GSI score is a global, composite score.
The operational
rule is that a GSI score greater than or equal to a profile T-score
of 63, or any two primary dimension scores that are greater than or
equal to a T-score of 63 shall then give the individual considera­
tion for positive diagnosis (Derogatls, 1977/1983).
is outlined for adult males.
This definition
The aggressive adolescents come very
close to this definition for adult males.
Although the adolescents
scored 61 in the GSI category, giving a percentile rank of 86, they
have a 63 in Somatization and three T-scores of 62 (Depression,
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89
Phobie Anxiety, and Psychoticism). The generalizability of the
criteria needs to be explored further.
point, hoirever.
It may be a useful reference
The nonaggressive group has a profile T-score of
52, giving a percentile rank of 58.
In summary, on the basis of the profile T-scores the prog­
nosis of a psychotic condition in the aggressive conduct-disordered
adolescents is a real probability.
This is not true for the non-
aggressive group since they do not come close to meeting the defini­
tion outlined by Derogatis.
Need for a More Specific Criterion
The DSM-III criteria for conduct disorder designate areas
as Aggressive, Socialized and Undersocialized, and Nonaggressive,
Socialized and Undersocialized.
The DSM-III-R combines the Aggres­
sive, Socialized and Undersocialized, with the Nonaggressive,
Undersocialized, into a single group labeled Solitary Aggressive
Type.
The Group Type in the DSM-III-R (the Nonaggressive, Social­
ized of the DSM-III) may now include some degree of aggressive
behavior.
There is also a group called Undifferentiated Type.
It
may be that aggressive and nonaggressive groups in the new category
of Solitary Aggressive Type have not been separated simply because
of disagreement over what constitutes aggressive behavior.
Frequent
fighting and arguments may indicate many problems, but crimes of
violence and those involving direct confrontation with the victim
indicate aggressive conduct disorder.
The DSM-III-R has solved some problems involving the social­
ized and undersocialized designation, and the Undifferentiated
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90
category Is helpful, but this Is not enough.
The issue of placing
aggressive and nonaggressive youth together in the same category
ignores their extreme difference in behavior.
This issue must be
addressed.
Characteristics of Conduct Disorder
General Characteristics
There are characteristics of the conduct-disordered adoles­
cents that are constant whether the young persons are aggressive
or nonaggressive.
They consistently violate the rights of others,
and they violate societal norms for their age.
They frequently
behave like a much younger child in that they are very impulsive.
Stealing is common, and they often lie for their own advantage and
cheat in games (DSM-III, 1980).
Self-esteem is usually low even though behavior may project
a macho or tough image.
They are apt to have temper tantrums, tend
to be irritable, restless, and frustrated.
The behavior is consis­
tent over a period of a year or more and is persistent. Truancy and
school failure are usually present.
Hyperactivity, attention
deficit, and borderline personality disorder are diagnoses fre­
quently associated with conduct disorder.
Nonaggressive
The nonaggressive conduct-disordered youth score on the
SCL-90-R within one T-score above average in all areas evaluated
except Interpersonal Sensitivity, where they score below average.
The nonaggressive profile has three peaks, the highest being that of
Depression, thus indicating they are a depressed group.
Phobic
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91
Anxiety and Paranoid Ideation are the other two peaks and are above
average.
Hostility and Psyohotlclsn score middle average, while
Anxiety scores just above middle average.
This group demonstrates fewer symptoms than the aggressive
group, and their behavior Is less severe.
Many nonaggressive
conduct-disordered youth are not soclopathlc; they simply demonstrate
learned behavior.
These youth may make friends, and they are rea­
sonable and pleasant to work with.
They are simply doing what
adults In the family do, but the adolescents get caught.
They become
bitter and angry If they are abandoned by the family.
At times they have a genuine desire to leave their environ­
ment because they feel helpless and depressed.
Upon admission to a
detention center, they may cry, feel sorry for what they have done,
wonder how they ever got Into such a situation, look for a positive
way out, and respond to supportive direction.
These youth are often used and taken advantage of by adults.
Realizing this and feeling resentment, they need positive role
models, academic remediation, and vocational training.
With
positive experiences and careful monitoring, most of these youth can
be successful In the community, but without proper support systems,
they return to crime, pick up new charges, and recidivism results.
Aggressive
The aggressive conduct-disordered youth are overtly aggres­
sive . They make no real attempt to conform to societal codes
unless It Is necessary, or they think It will accomplish their
purpose.
The aggressive youth Is less accepting of Incarceration.
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92
Their profile is extremely different from the nonaggressive
group.
The peak on the aggressive group is Somatization.
This
score is high enough to Indicate pathology when combined with high
Anxiety and Psychoticism.
Just below Somatization there are four
peaks; Depression, Anxiety, Phobic Anxiety, and Psychoticism.
Scores range between the 80th and 90th percentile.
This group of subjects is considered prepsychotic and are
demonstrating many psychotic symptoms.
Those who can learn to
develop and utilize a support system stabilize and improve.
Those
who cannot continue to have the same problems, only these problems
become more serious as they reach adulthood because they are not
able to conform well enough to hold a Job.
Criminal activity then
becomes a necessity for survival.
They are more apt to enjoy crime and have developed a more
rigid system of meeting their needs.
They feel no sorrow for %Aat
they have done and brag and take pride in their manipulative skills.
Their one desire is to beat the charges against them, get away with
their crime, and not get caught the next time.
Often they are
plotting new adventures before the results of their present
situation are known.
Lack of academic success due to poor self-discipline and a
lack of perseverance contribute to low self-esteem and frustration.
Many aggressive youth then take pride in their negative accomplish­
ments.
Although all conduct-disordered adolescents tend to deny
reality and to assume little responsibility for their behavior, this
denial system is more rigid in the aggressive group.
They are
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93
usually barder to work with because of this, and therapeutic progress
is slower.
More time and intervention is necessary in order to make
progress in changing the behavior of aggressive conduct-disordered
adolescents.
They need more structure for a longer period before
they are ready to consider alternatives.
The extreme restraints and
structure that are negative for the nonaggressive youth, because
these restraints lead them to give up in despair, are necessary for
aggressive youth and have a positive effect in the long run.
Only
when they know changes must be made in order to gain freedom dothey
seriously consider modifying their behavior.
Structure, reward,
and modification are necessary in every aspect of living.
Another major difference between the two groups is that the
nonaggressive individuals are more apt to remain under control once
they learn a few coping techniques, whereas the aggressive youth
have more difficulty keeping themselves under control.
They may
regain composure for a time, but under stressful circumstances they
resort to violent outbursts again and again.
The aggressive group appears to suffer a greater degree of
hyperactivity.
Hyperactive youth are not necessarily conduct-
disordered , but the combination of antisocial tendencies with hyper­
activity and impulsiveness is especially problematic.
The most
severe acting out is often a result of parental rejection.
There is
a question, as to whether parents reject their children because they
are uncontrollable, violent, and destructive, or whether the rejec­
tion stimulates the deviant behavior.
Conduct disorder will exist
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94
as long as children have Inadequate discipline, a poor role model,
and lack supervision and nurturance.
Implications for Diagnosis. Trreatment.
and Research
Diagnosis
It is inappropriate to place aggressive and nonaggressive
conduct-disordered youth in the same diagnostic category.
Their
behavior and requirements are so diverse rehabilitation needs dif­
ferent structure.
It is necessary to determine which youth have
sociopathic characteristics and which are emotionally disturbed.
To treat these two groups the same is not in their best interest.
Emotionally impaired youth respond better to support and therapy.
They may be damaged further by harsh treatment.
This does not mean,
however, that the youth should be permitted to use manipulation to
reinforce negative behavior.
According to the findings of this study, aggressive and
nonaggressive conduct-disordered youth are significantly different
in all areas tested; therefore, separate diagnostic categories for
these young people are necessary to better meet their needs.
Treatment
It is easy to lock up conduct-disordered youth in over­
crowded detention centers where services are strained to the limit,
but this does nothing to prevent recidivism, and the number of youth
involved in crimes continues to rise.
Conduct-disordered youth
generally do not respond to incarceration alone.
They hate being
locked up, although there is status among many youth groups in the
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95
community in having done tine.
It is not possible to punish most
aggressive conduct-disordered youth enough to modify behavior,
because they are hardened and resistant.
They have endured depriva­
tion and neglect, and most of them consider themselves survivors.
However, lightening sentences would be positive reinforcement fcr
negative behavior.
Detention centers are often incarceration units Uhere youth
are treated strictly as criminals, and where there is a lack of
emphasis on mental health and rehabilitation programs.
The emphasis
is on serving time, rather than doing something constructive, such
as vocational training and developing skills.
Aggressive youth with conduct disorder need a behavioral
point system that rewards desired behavior.
token system.
This is more than a
In the token system the youth may purchase toilet­
ries , desserts, and personal items with tokens that have been earned,
This system may be helpful for outpatients as well.
In a detention
center, the point system should involve all aspects of everyday
living from personal hygiene, housekeeping chores within the boys'
rooms, and unit detail to the earning of such privilages as moving
from a secure unit to an open cottage, involvement in work study
programs, and other school and vocational activities.
Weekend home visits have always been used as rewards for
good behavior in detention centers.
consistently.
Such visits need to be managed
The balance between security and treatment causes
tension, but they can be combined in order to promote the assuming
of responsibility for behavior and, at the same time, motivation in
the youth.
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96
A treatment unit within m detention center would solve many
problems for emotionally impaired youth.
Such a unit would maintain
a controlled environment where supportive services are primary.
A
point system could then be combined with therapy.
Some nonaggressive conduct-disordered youth can be rehabili­
tated by remediating academic deficiencies, providing vocational
training, and creating positive experiences.
The creation of
positive learning and social experiences enhances self-esteem.
Time and money are wasted on youth who could become law-abiding
citizens if deficits were remediated.
Aggressive youth need similar attention but, in addition,
they need individual therapeutic work in order to deal with intense
anger and to develop coping techniques in place of self-destructive
behavior.
Without therapy the truly aggressive youth will not be
able to take advantage of efforts to remediate their deficits.
Self-destructive behavior will continue, and they will sabotage
efforts to help them.
This is why correct diagnosis is necessary.
The aggressive youth is more emotionally disturbed and needs to
work through serious problems before he is able to attend to
constructive learning tasks.
Many parents of aggressive adolescents with conduct disorder
are willing to try to help their children but are afraid of them
because they become violent when confronted.
There is a lack of
discipline and little supervision in the home. A court-ordered
curfew is often necessary and helpful to parents.
This must be
combined with experiences that motivate responsibility.
Because
conduct-disordered adolescents lack a sense of positive
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97
accompllshnent, they need something positive with which they can
Identify and In which they can take pride.
Caretakers of these youth need training in behavior manage­
ment that Includes more understanding of the affective domain,
as well as the cognitive.
Firm discipline Is necessary, but
emotional support and positive reinforcement are equally Important.
Behavloral-management programs based upon positive reinforcement,
such as the token system, can work If the staff are well-trained. A
major problem exists in that an adolescent with a conduct-disordered
label Is viewed as delinquent, not mentally 111.
Some are purely
delinquent, but emotional disturbance and personality disorders are
prevalent among conduct-disordered youth.
There Is little recogni­
tion of this, however. Too often these youth are written off
because caretakers assume value systems and behavior cannot change.
In summary, It Is not efficient to treat aggressive and
nonaggressive conduct-disordered youth alike.
Aggressive youth need
more structure in their environment and require more time for
rehabilitation.
Many nonaggressive youth can make it in society if
their environment is modified slightly and they can learn to develop
a support system.
A percentage of aggressive conduct-disordered
youth are on their way to becoming soclopathlc and will not be able
to take advantage of opportunities.
To assume this Is true of
nonaggressive youth Is a serious mistake and pushes them in the
wrong direction.
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98
Research
The new Interest in conduct-disordered youth is a positive
sign.
The large number of youth involved in drug abuse and its
implications for society have captured the attention of profession­
als, and it is anticipated that interest will increase.
More
research is needed, however, to determine causes for aggressive
conduct disorder, and the extreme differences between nonaggressive
youth who have committed crimes against society, and truly aggres­
sive conduct-disordered adolescents.
Treatment of the two groups
should be different in order to prevent recidivism.
There is a need for replication of this study to determine
whether the model of Psychoticism and Obsessive-Compulsive would
be chosen for another group.
Another need is to gather more infor­
mation .
A larger number of conduct-disordered subjects would help to
establish an operational rule for diagnosing psychoticism in
adolescents as Derogatls has for adult males.
Further comparisons
of aggressive and nonaggressive conduct-disordered groups are
necessary to establish the necessity for separating aggressive and
nonaggressive conduct-disordered adolescents.
It was not the primary purpose of this study to deal with
treatment and management of conduct-disordered youth.
However, if
the Psychoticism and Obsessive-Compulsive model is verified and
similar profiles are obtained in further studies, management and
treatment can address these issues.
A comparison of the SCL-90-R results with that of other
instruments would also be helpful.
A study with female
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99
oonduct-dlsordered adolescents should be completed in order to
determine if the model and the profile would be the same as it is
for the adolescent males in this study.
Due to the necessity of protecting the rights of the accused
who have not yet been tried, research may fall upon those working
directly with conduct-disordered adolescents.
Sensitivity and
caution are required, but the need for research is extreme, both
for the preservation of society and to help individual youth become
independent, fully functioning adults.
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APPENDIX A
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101
SYMPTOM PROFILE: AGGRESSIVE
s
s
m
M 00
m
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102
SYMPTOM PROFILE: NONAGGRESSIVE
m
CM
m
IL
a.
o>
m
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APPENDIX B
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104
May 27, 1988
Leonard R, Derogatis, Ph.D.
Clinical Psychometric Research
1228 Wine Spring Lane
Towson, MD 21204
Dear Dr. Derogatis:
The SCL-90-R has been used for a study of 130 male adoles­
cents to determine the difference between aggressive and nonaggres­
sive conduct-disordered youth. The data collected is used in my
doctoral dissertation. Communication with your office indicated it
would be acceptable to include a profile of each group if my data
is superimposed on the profile. I left my address with your
secretary but have not beard from you.
Would you be kind enough to communicate with me concerning
this matter? Thank you for your consideration.
Sincerely yours,
y;
Janet M. Rice
8214 Dragonfly Court
Laurel, MD 20707
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105
n
*
C l i n i c a l P s v c h o m e t r i c ' R e s e a r c h . In c .
Leonard R Derogatit, Ph.D. Presidem
M a ureen F. D ero gatis. M .A .S .. V ice P resideni
June 9. 1966
Ms Janet M Rice
6214 Dragonfly Court
Laurel. MI'
20707
Dear Ms
Rice
Thank you for your interest in the SCL-90-R
Please be advised
that this letter gives forma; permission for the inclusion of the
SCL-90-R profile form with your date super imposed on it within
your dissertation
Sincerely.
-I
/ Vk /.
y
Maureen T
Derogatis
mfd/peb
P.O. Bos 614 R jd rrw oo d , M D 21139 T d (301) 3214163
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VITA
Name:
Janet M. Rloe
Date of birth:
Place of birth:
December 16, 1935
Natick, MA
Education:
B.S.
M.Ed.
Western Michigan University
University of Tennessee
C.A.G.S.
Assumption College
Ph.D. Andrews University
Work experience:
Cleveland Beights-University Heights High School, Teacher
Bradley County High School, Guidance Counselor
Tahanto Regional High School, Guidance Counselor
Nashoba Regional High School, Guidance Counselor/School Psychologist
Berrien County Intermediate School District, School Psychologist
Crownsville Hospital Center, APA Clinical Internship
PSI Associates, Clinical Psychologist
EOBA Associates, Clinical Psychologist
130
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