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ADHD: Attention Deficit Hyperactivity Disorder
Childhood Mental Disorders and Illnesses

by John B. Reid, Gerald R. Patterson and James J. Snyder
American Psychological Association, 2002
Review by Lloyd A. Wells, Ph.D., M.D. on Oct 1st 2002

Antisocial Behavior in Children and Adolescents

This book is the result of an effort of more than forty years, at the University of Oregon, to identify causes and treatments of antisocial behavior in children and adolescents.  It is a rather dry book, and will receive little acknowledgment apart from professionals in the field who read it, but it is, in fact, a fantastic accomplishment.  For one thing, few research projects continue over this sort of time span, and the data are voluminous and very helpful.  For another, the findings in this book, if applied at all rigorously, could significantly decrease antisocial behavior in young people.  It is sad that the data probably will not be systematically applied across the country.

The studies reported in this book began in the 1960’s, with the aim of developing approaches to help antisocial children and adolescents.  Most of the studies reported have been prospective, and some have gone on for many years.  The authors and contributors take the view that antisocial actions are shaped largely by social phenomena – especially within the family – and they have excellent data to back up this approach.  They propose a developmental model of conduct that is very useful and interesting, albeit incomplete.

The book begins with a history of the “Oregon model” of the development of antisocial behavior in children and adolescents, going back to the 1960’s.  In contrast to several modern views that look for the origins of this behavior within the child herself or himself, this model examines the environment of the child – especially the family, and the way that the environment reinforces maladaptive, antisocial behavior.  Although the theory may be old-fashioned, the authors argue successfully that theirs is “a theory of aggression that works.”  There is, indeed, abundant evidence in support of it that is presented in the rest of the multi-authored book.

The next section of the book examines “coercion theory”, the way that antisocial behavior develops in the context of the type of coercive environment that the child grows up in.  I would argue against the use of the term coercive because of its connotations.  The authors would maintain, I believe, that all childhood environments are inherently coercive, and that it is the style of coercion that is problematic.  The authors have good data for dispositions by caregivers and styles of coercive environments during the first year of life as being linked to antisocial behavior.  Different authors next address the concept of “competence” (and mastery) in early development.  This is highly linked, in a robust research study, with the quality of attachment, which is a predictor of future positive peer interactions.  In addition, children with early, positive peer interactions are unlikely to become antisocial later.  The next chapter in this section examines the family’s role in reinforcing the development of antisocial behavior.  Lack of familial problem-solving and inconsistent or mean discipline are associated with an increased risk of antisocial behavior, in long-term, well-designed studies, although much remains to be learned about this phenomenon.  A subsequent chapter examines the role of the peer group – which is very powerful – in reinforcing antisocial behavior.  Contextual factors such as parental unemployemnt, family income, parental depression, and lower academic achievement by parents also play a role, and this situation carries into the next generation and beyond, unfortunately.  In another chapter, Patterson and others present data suggesting that early-onset antisocial behavior is of much more significance than late-onset (adolescent) antisocial behavior and should be prioritized in the social/criminal justice systems.

After an interesting chapter on depression and its role, Reid and Eddy write an overview of interventions, which is very good.  They view microsocial processes as the target of interventiion and have an admirable rationale for doing this.  They argue strongly for a family-based treatment model.  This is followed by an excellent chapter on treatment interventions in foster care situations, with a major research agenda over the next two decades, a chapter on prevention during the elementary school years (the well known LIFT project), shown to at least delay onset of serious antisocial behavior, a chapter on social interventions with families of divorce, also quite promising, and, finally, an excellent chapter on a family-centered prevention strategy based in schools.

Patterson then adds a final chapter speculating about extension of the models depicted in the book, with excellent graphics.

The book concludes with a very lengthy and useful list of references and a fine index.

This book has many positives.  It presents lengthy research by a committed group over many years, with interesting and heuristic results and ideas for further research.  The findings are incomplete but compelling, as far as they go.

There are negatives.  The social view presented is too restrictive.  There are many biological correlates and perhaps precipitants of antisocial behavior, well researched but largely ignored in the book.  The psychological vantage point is also very limited.  The writing style is, for the most part, decent, but no more than that, and some of the chapters require rather careful reading because of intricate research design.

For philosophers and philosophically inclined psychiatrists, psychologists and social workers, there are unstated but fascinating questions:

1)        Why should we take a social phenomenon (coercive parenting) and insist that it is an individual syndrome (conduct disorder, oppositional-defiant disorder)?

2)        Given the data on adolescent antisocial behavior as a multigenerational and largely social phenomenon, what is the individual responsibility of the individual delinquent?

I recommend the book!


© 2002 Lloyd A. Wells

Lloyd A. Wells, Ph.D., M.D., is a child and adolescent psychiatrist at the Mayo Clinic in Minnesota. He has a particular interest in philosophical issues related to psychiatry and in the logic used in psychiatric discourse.