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Articles   |    
Early Prevention of Antisocial Personality: Long-Term Follow-Up of Two Randomized Controlled Trials Comparing Indicated and Selective Approaches
Stephen Scott, F.R.C.Psych.; Jackie Briskman, B.Sc.; Thomas G. O’Connor, Ph.D.
Am J Psychiatry 2014;171:649-657. doi:10.1176/appi.ajp.2014.13050697
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The authors report no financial relationships with commercial interests.

Supported by grant 1206/2491 from the Healthcare Foundation.

The original trials were registered with the ISRCTN register (www.isrctn.org), identification numbers 94713762 and 77566446.

From the Institute of Psychiatry and the National Academy for Parenting Research, King’s College London; the Department of Psychiatry and the Wynne Center for Family Research, University of Rochester Medical Center, Rochester, N.Y.

Address correspondence to Dr. Scott (stephen.scott@kcl.ac.uk).

Copyright © 2014 by the American Psychiatric Association

Received May 29, 2013; Revised December 12, 2013; January 23, 2014; Accepted January 30, 2014.

Abstract

Objective  Antisocial personality is a common adult problem that imposes a major public health burden, but for which there is no effective treatment. Affected individuals exhibit persistent antisocial behavior and pervasive antisocial character traits, such as irritability, manipulativeness, and lack of remorse. Prevention of antisocial personality in childhood has been advocated, but evidence for effective interventions is lacking.

Method  The authors conducted two follow-up studies of randomized trials of group parent training. One involved 120 clinic-referred 3- to 7-year-olds with severe antisocial behavior for whom treatment was indicated, 93 of whom were reassessed between ages 10 and 17. The other involved 109 high-risk 4- to 6-year-olds with elevated antisocial behavior who were selectively screened from the community, 90 of whom were reassessed between ages 9 and 13. The primary psychiatric outcome measures were the two elements of antisocial personality, namely, antisocial behavior (assessed by a diagnostic interview) and antisocial character traits (assessed by a questionnaire). Also assessed were reading achievement (an important domain of youth functioning at work) and parent-adolescent relationship quality.

Results  In the indicated sample, both elements of antisocial personality were improved in the early intervention group at long-term follow-up compared with the control group (antisocial behavior: odds ratio of oppositional defiant disorder=0.20, 95% CI=0.06, 0.69; antisocial character traits: B=–4.41, 95% CI=–1.12, –8.64). Additionally, reading ability improved (B=9.18, 95% CI=0.58, 18.0). Parental expressed emotion was warmer (B=0.86, 95% CI=0.20, 1.41) and supervision was closer (B=–0.43, 95% CI=–0.11, –0.75), but direct observation of parenting showed no differences. Teacher-rated and self-rated antisocial behavior were unchanged. In contrast, in the selective high-risk sample, early intervention was not associated with improved long-term outcomes.

Conclusions  Early intervention with severely antisocial children for whom treatment is indicated may prevent the development of antisocial personality in adolescence and may improve academic performance. In contrast, early intervention with selective high-risk samples may be ineffective.

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FIGURE 1. Antisocial Behavior and Antisocial Personality Traits as a Function of Treatment Exposure and Sample
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TABLE 1.Demographic and Clinical Characteristics of Participants at Study Entry and at Long-Term Follow-Up
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a Within each sample, those allocated at study entry to parent training did not differ significantly from controls on any characteristic, based on chi-square test for sex and analysis of variance for other variables.

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TABLE 2.Long-Term Effects of Early Intervention on Adolescent Antisocial Outcomes and Reading Level in the Indicated and Selective High-Risk Samplesa
Table Footer Note

a Ns range from 88 to 91 in the indicated sample and 76 to 86 in the selective high-risk sample.

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b The treatment effect on Wechsler Objective Reading Dimensions remained significant after accounting for full-scale IQ (Weschler Abbreviated Scale of Intelligence).

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TABLE 3.Long-Term Effects of Early Intervention on Parenting Outcomes in Adolescence in the Indicated and Selective High-Risk Samplesa
Table Footer Note

a Ns range from 74 to 90 in the indicated sample and 68 to 85 in the selective high-risk sample.

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Parent training in the indicated case group treated early in childhood was associated with which enduring improvement effects into adolescence?
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Parent training in the selective case group screened from the community early in childhood was associated with which enduring improvement effects into adolescence?
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What reason or reasons for the difference in effectiveness of indicated and selective strategies in improving adolescent outcomes among children offered parent training early in childhood were found?
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