Definitions And Descriptions
Delinquency is a legal term, which is generally defined as antisocial or criminal acts that violate legal laws and cultural norms. Juvenile delinquents are almost always diagnosed with oppositional defiant disorder (ODD) or conduct disorder (CD). According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), the standard manual used by psychologists and psychiatrists, ODD is characterized by a recurrent pattern of defiant, disobedient, and hostile behavior toward authority figures that persists for at least 6 months. These negative behaviors include arguing with adults and authority figures, frequently losing one’s temper, actively disobeying the rules and requests of adults, continually blaming others for one’s own mistakes or misconduct, being overly sensitive or becoming easily irritated by others, behaving in an angry or resentful manner, deliberately doing things that will annoy or anger others, or being actively spiteful or vindictive. Behavior exhibited by children diagnosed with CD involves violations of age appropriate societal norms and the basic rights of others. These behaviors are often present in a variety of settings and can be placed into four main categories (i.e., threatening or aggressive behavior that causes physical harm to humans or animals, nonaggressive conduct that results in property damage or loss, deceitfulness and theft, and serious violations of rules and policies).
Onset, Prevalence, And Course
CD and ODD are the most frequently diagnosed disorders in adolescents and children. Indeed, these disorders account for almost half of all mental health referrals in children. ODD has been reported to occur in up to 16% of all youth, and CD has been estimated to occur in up to 10% of the adolescent population. While onset of ODD is usually gradual, the disorder is usually evident before the child reaches 8 years of age. CD can occur as early as the preschool years. However, a significant proportion of symptoms are usually first evidenced during middle childhood and middle adolescence. Approximately one third of children diagnosed with ODD will subsequently be diagnosed with CD. It should also be noted that if a youth continues to exhibit the social violating behaviors characteristic of CD after the age of 18, then the diagnosis of antisocial personality disorder (ASPD) will be made instead of CD. Without intervention, the severity of criminal acts and related behavioral problems are often exacerbated with the passage of time.
Comorbid Disorders And Causes
There are many disorders that commonly occur in conjunction with delinquency, most often including attention deficit/hyperactivity disorder (ADHD), substance abuse disorders, and mood disorders, such as depression anxiety. Thus, it is not surprising that a child’s risk for juvenile delinquency is often increased when a child’s parent has been diagnosed with either a substance misuse or abuse disorder, a mood disorder, schizophrenia, ADHD, antisocial personality disorder, or conduct disorder. Twin and adoption studies have indicated hereditary influences to delinquency, and parenting and familial risk factors have been shown to play an important role in the development and maintenance of conduct problems. For example, as compared with parents of nondelinquent youth, parents of children with conduct problems experience greater marital and interparental difficulties, stressful events, and chaotic environments. These parents are also more likely to make less positive and more negative statements, to perceive behavioral problems of their children as intentional, to have problem-solving deficits, and to abuse or neglect their children. Extra-familial factors that have been associated with delinquency include low socioeconomic status, social isolation, and low parental social support. Children and youth with conduct problems often lack appropriate social skills, have poor peer relationships, and experience peer rejection more so than youth who do not evidence these problems.
Empirically Supported Interventions
Treatment programs for delinquent youth are usually multidimensional. When the symptoms of delinquency are determined to be primarily biological, psychopharmacological (drug) medications are sometimes prescribed, including psychostimulants and neuroleptic medications. Very few studies have evaluated the effectiveness of psychostimulants for conduct disorders, because these medications are typically combined for use with other interventions. However, studies have been conducted to examine the effectiveness of psychostimulants in the treatment of ADHD (a comorbid disorder that encompasses problems of inattention, hyperactivity, impulsiveness). These studies have reported significant reductions in problems of conduct, aggression, verbal harassment, noncompliance, stealing, and property destruction. Neuroleptic (i.e., antipsychotic) medications have shown reductions in aggression, fighting, explosiveness, and hostility, probably due to their sedative effects. However, these medications have not been widely supported for the treatment of conduct disorders due to adverse side effects associated with these drugs (e.g., sleep disturbance, dry mouth, irritability), and outcome support is mixed.
One treatment approach known as “parent training” assumes that deficits in parenting skills have been partly responsible for the development and/or maintenance of youth conduct problems. This treatment approach emphasizes prosocial goals and teaches parenting techniques, including training in positive reinforcement procedures, problem-solving techniques, role-playing practice, and structured homework exercises. Hanf and Forehand developed one of the first empirically supported parenting programs for younger youth (i.e., 3 to 8 years of age) who evidence ODD. The program focuses on child noncompliance and consists of two phases. In the first phase, the parent is taught to attend to the child’s desired behavior and later praise the child for performance of compliant behaviors. In the second phase, the parent is taught to use time out for noncompliant behaviors through various behavioral methods, including didactic instruction, modeling, and roleplaying. Time out involves the child being excluded from opportunities to be reinforced. Treatment also includes observation of the parent in parenting situations through one-way mirrors, as well as “bug in the ear” devices, which allow the therapist to communicate with the parent during the parent-child interactions. In this treatment program, the parent learns to increase the frequency of social attention, reduce the frequency of competing verbal behavior, and use verbal and physical attention contingent on compliance and other appropriate behaviors. Finally, the parent learns to actively employ the newly acquired skills in the home setting. This program has shown to be effective in improving child behaviors (e.g., aggression, temper tantrums, destructiveness, inappropriate verbal behaviors) and parent behaviors (positive communication, reduction of corporal punishment), as well as parents’ perceptions of their children. Webster Stratton and colleagues have developed an innovative parent training program that involves the use of videotapes. In this program (BASIC), a group of parents is shown videotapes that include examples of appropriate and inappropriate parent-child interactions. After each video clip, a therapist leads a group discussion in which the parents can discuss the video interactions that were modeled. Facilitators are also available to answer questions and provide guidance. The program has demonstrated clear support in controlled outcome studies with younger youth who evidence ODD. For instance, increases have been found in both mothers’ and children’s conduct, as well as in maternal satisfaction and perceptions of their children. Additional videotape components (i.e., ADVANCE, KIDVID) in conjunction with the BASIC program have also resulted in improvements in child problem solving, conflict management skills, communication skills, and consumer satisfaction.
Family functional therapy (FFT) is a family-based intervention program that was designed to work with adolescent delinquents with both minor and major juvenile offenses. FFT concentrates on family members’ expectations during treatment and serves to modify any inappropriate attributions or expectations. Various behavioral techniques are used, including role playing, communication skills training, and contingency management. Finally, the program serves to maintain therapeutic goals while also stressing the importance of the family’s independence from the therapy context. FFT has shown improvements in communication variables and lower recidivism rates.
Multi-systemic therapy (MST) focuses on multiple systems within an adolescent’s world, including the role of family, school, and peer groups. Thus, the program incorporates school consultation, peer interventions, marital therapy, and individual therapy. The theoretical underpinnings of this program are family systems therapy and cognitive-behavioral therapy (e.g., joining family together, functional analysis, drug refusal skills training, stimulus control, and harm reduction). Recently, MST has incorporated a sophisticated contingency contracting procedure. The MST treatment approach has resulted in decreases in conduct problems, incarceration and arrest rates, peer aggression rates, substance-related arrests, and improved family relations. Unique to most programs, counselors usually visit youth in their home or school environment.
Problem-solving skills training (PSST) teaches youth with conduct problems how to solve problems in various situations and settings. Most PSST-based programs focus on teaching youth to learn four basic steps when confronted by a dilemma (i.e., state the problem clearly and succinctly, brainstorm options available and think of the advantages and disadvantages of each option, choose one or more options, implement one or more of the options). PSST has been shown to have positive effects in extremely aggressive children as well as in children with moderate to mild behavioral problems. Additionally, PSST has proven to be extremely effective when combined with parent training treatment programs.
Only one treatment outcome study has been conducted with youth formally diagnosed with both a conduct disorder and a substance abuse disorder (i.e.,the two most prevalent mental health disorders among delinquent youth). In this study, Nathan Azrin and his colleagues found individualized cognitive problem-solving skills training programs and family behavior therapy to significantly improve problems associated with delinquency and drug abuse (e.g., decrease in depression, decrease in frequency of alcohol and illicit drug use, decrease in days institutionalized, increase in school and employment attendance, and decrease in misconduct). Additionally, youth and their parents reported greater satisfaction with one another.
When conduct is extreme, youth are often placed in institutional or group home settings where their conduct can be better monitored and controlled. In this regard, the Teaching-Family Model (TFM), developed by professors at the University of Kansas, is a model program. The more than 250 TFM group homes are managed by young married couples, known as “teaching parents,” who have undergone extensive behavioral skills training and are certified by the Teaching-Family Association. These programs emphasize a strong positive relationship between youths and teaching parents. Treatment components include youth self-government procedures, social skills training, behavioral skills training, academic tutoring, and reinforcement systems designed to monitor school behavior (home-based token economy) and home conduct (level system). The TFM approach has proven more effective than comparison programs in school performance, offense and delinquency rates, and youth and school personnel satisfaction. However, similar to other programs, these differences dissipate when the adolescent leaves the group home.
Later Consequences Of Delinquency As A Child
Delinquent youth will often “outgrow” their problems of conduct without intervention. However, they are at greater risk for continuing to engage in more serious behaviors throughout adolescence and into adulthood, particularly when the onset of conduct problems occurs at an early age (i.e., before adolescence). These individuals are also at high risk to be later diagnosed with ASPD and other psychiatric diagnoses. Indeed, as compared with their nondelinquent counterparts, delinquent youth experience severe negative life outcomes, including lower occupational adjustment and educational attainment, poorer physical health and relationships with others, and higher rates of divorce.
There have been many encouraging findings and evaluations regarding the application of a variety of treatment approaches with conduct disordered children and adolescents. Empirically supported treatments have predominately been family oriented and cognitive-behavioral or behaviorally based, and have also incorporated multiple interventions to address commonly encountered comorbid disorders (e.g., substance abuse and substance dependence.
It is important for all programs to take into account the progressive nature of conduct problems. For example, once conduct problems have been established and maintained, it becomes more difficult for changes and improvements to occur. Therefore, it is essential that treatment programs be implemented as soon as conduct problems first emerge or, ideally, prior to their onset through the implementation of prevention programming.
- American Psychological Association. (2000). Diagnostic and statistical manual of mental disorders (4th , text revision). Washington, DC: Author.
- Azrin, H., Donohue, B., Teichner, G., Crum, T., Howell, J.,& DeCato, L. (2002). A controlled evaluation and description of individual cognitive problem-solving and family behavioral therapies in conduct-disordered and substance dependent youth. Journal of Child and Adolescent Substance Abuse, 11(1), 1–43.
- McMahon, R. , & Wells, K. C. (1998). Conduct problems. In E. R. Mash & R. A. Barkley (Eds.), Treatment of childhood disorders (2nd ed., pp. 111–207). New York: Guilford.
- Yoshikawa, H. (1995). Long-term effects of early childhood programs on social outcomes and delinquency [Electronic version]. The Future of the Children, 5(3). Retrieved from http://www.futureofchildren.org/information2826/information_show.htm?doc_id=77676