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Parent-child interaction patterns

Fine-grained analysis by Patterson(22) has shown that the moment-to-moment responses of parents towards children have a powerful effect on their behaviour. In families with a conduct-disordered child, the children are likely to be ignored when they are behaving reasonably, but criticized and shouted at when they are misbehaving. The consequence is that to gain attention, they have to behave badly. What is perhaps surprising is that for these children who receive very little positive attention, they are prepared to elicit often unpleasant and frankly hostile reactions from their parents rather than be ignored. By contrast, children who receive a reasonable amount of positive attention within the family tend to avoid behaving in a way that elicits negative attention. All this can be summarized as the 'attention rule', which states that children will behave in whatever way necessary to gain a reasonable amount of attention.

Other behaviours by parents can unwittingly raise the probability of disruptive behaviour in the child. Giving up insisting that something the child finds unpleasant is carried out (for instance, tidying up the toys) unintentionally rewards the child for whining and refusing to do it, thus making the behaviour more likely next time a request is made (negative reinforcement). Giving in to demands and tantrums for what the child wants has similar effects (positive reinforcement for negative behaviour).

Most emphasis in social learning theory has been on the harmful effect of negative behaviour. However, other research (23> has made it clear that the presence of positive parental behaviour is equally important. Children with antisocial behaviour are ignored for a lot of the time by their parents, who do not respond to their overtures to join in activities, nor praise them when they are behaving well. Not only does this make quiet prosocial activity less likely, but also no models are provided for the child to learn social skills such as turn-taking, negotiating skills, etc.

The implications of the impact of the immediate interaction patterns on child antisocial behaviour are far-reaching. Rather than the child being seen as innately aggressive or with an antisocial type of personality which is unchangeable, he can be viewed as responding to the immediate context he is in. Therefore changing the context offers the possibility of changing the behaviour of the child. This allows some therapeutic optimism if the response contingencies around the child can be altered, and has led to the development of effective treatments.

Parenting practices

Conduct disorder is strongly associated with harsh erratic discipline, hostility directed at the child, lack of warmth, and poor supervision. (24> Follow-up and intervention studies show that these factors have a causal role in initiating and maintaining the child's disorder, and are not just a reaction to the child's behaviour. However, there is also good evidence that children with conduct problems elicit harsh negative parenting; both processes operate. In adolescence, supervision becomes a major factor, with parents of antisocial youths typically not knowing where they are for several hours in the day and at night. Discord between parents is also associated with persistent antisocial behaviour.(11' The association of conduct disorder with large family size, and with broken homes (divorce, single parenthood, adoption), seem chiefly to be mediated by parenting practices and the previous characteristics of the individuals, rather than by the impact of a large family or broken home in themselves.

Psychiatric disorder in parents

Depression features commonly in mothers; alcoholism, drug abuse, and psychoses are not infrequent in parents of children with severe conduct disorder. These disorders exert their effects in childhood through the quality of interaction and parenting practices, and by affecting the inherited characteristics of the child. There is no specific child psychiatric disorder which is more common, but conduct problems are more frequent as are emotional disorders. (25) Children of depressed mothers may have impaired cognitive and social development.

Criminality of the father

As an environmental influence, this is important and may be mediated through parent-child interactions and parenting practices as described above, plus an antisocial set of values and living in a deprived neighbourhood. It also represents an increased genetic risk.

Physical and sexual abuse

Physical and sexual abuse can lead to the emergence of conduct problems in girls or boys who were previously free of such problems. Kessler et al. (26> found that physical aggression from the father was associated with a more than doubling of the rates of conduct disorder and quadrupling of the rates of antisocial personality disorder. Trickett and McBride-Chang(27> found sexual and physical abuse associated with a wide range of poor outcomes. The difficulty in ascertaining their effect arises, as they are usually associated with multiple other risk factors such as poor parenting and rejection, in addition to a genetic predisposition. Widom, (28> however, found that early childhood victimization only raised later criminality by 50 per cent.

Obstetric complications

Obstetric complications have no or only an extremely weak influence on antisocial behaviour; Raine (29> has suggested they contribute to violent behaviour, but the evidence is unconvincing. There is more evidence that prenatal in utero exposure to alcohol and cocaine can impair brain development and lead to impulsivity and lower IQ, and hence antisocial behaviour.(3031)

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