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 Part II Interview with Psychologist P. Alex Mabe, Ph.D.
1. Dr. Mabe, thank you for agreeing to provide a follow-up interview regarding your publication on the treatment of childhood conduct disorder. In the first interview, you described the essential features of Conduct Disorder as repetitive and persistent patterns of behavior in which the basic rights of others and major age-appropriate societal norms or rules are violated. Further you noted that a variety of factors represent risk factors, discussing the impact of biological, socio-cultural, and early life experiences. I would be interested in hearing what the research shows about the other factors you presented: peer experiences, social experiences in various institutions; and early exposure to violence on television or videogames?
First, with regard to peer experiences, the amount of exposure that
a child has to aggressive peers in day care or preschool is predictive
of later child aggressive behavior, perhaps because of modeling
effects. Children rejected over a 2-year period were found to be more
aggressive and less socially skillful, as rated by teachers, than were
children rejected in only one grade. Children's social rejection by
peers in the elementary school grades is a potent risk factor for
adolescent conduct problems. Second, regarding social experiences with
major institutions, exposure to high rates of out-of-home day care in
the first 5 years of life was a risk factor for teacher-rated,
peer-rated, and directly observed aggressive behavior in kindergarten.
Children who spent fairly large amounts of time in unsupervised
after-school self-care in the early elementary grades were at elevated
risk for behavior problems in early adolescence, likely related to the
amount and intensity of early exposure to violence on
television/videogames. School failure represents another social
institution risk factor for antisocial outcomes- early school failure
itself seems to be more strongly predictive of adolescent outcomes than
is low intelligence. Retained children are viewed negatively by peers,
which may propel antisocial development.
2. Your research seems to indicate that things get increasingly
difficult as a child with behavioral problems enters adolescence in
that parental influence declines and peer influence gains strength.
Can you offer suggestions on how parents can limit their adolescent’s
exposure to negative peer influences?
Of great importance
to diminishing the negative influences of peers is to continue to work
on establishing or maintaining a good relationship with the teenager.
Teenagers that are struggling in their relationship with their parents
are much more likely to find a “secondary family” in negative peer
relationships. Therefore, parents must work hard to spend quality time
with their teenagers on a weekly basis, learn how to find the good in
them, demonstrate genuine interest in their lives, and develop a more
collaborative and coaching style of parenting rather than an
authoritarian – coercive style of parenting.
Second, “know the
playing field.” Identify the people in the teenager’s life that are
influencing them for good or for bad. Mobilize helpers within the
church leaders/ members, friends, extended family, child protective
services, police officers, mental health professionals, school
teachers/administrators, etc. These individuals can be recruited to
help supervise, encourage, coach, and discipline. With the negative
peer influences you can: (a) use the direct approach – parents have the
right to restrict their teenagers away from contacts with negative peer
influences. But to be successful, the parents must have effective
consequences and must stick to their guns. Parents and teenagers can
comprise an “A list” and a “B list” of peer friendships in which “A
list” friend contacts are allowed and even encouraged, while “B list”
friend contacts are not allowed. To discourage contacts with “B list”
there can be consequences but also direct contacts with “B list” peers
and their parents basically advising them to stay away. (b) use the
indirect approach - make contacts with “A list” friends and with family
more positive and enticing. Generally the more positive engagement
parents have with their teenagers the less the risk for conduct
disturbance – assuming that parents are not modeling antisocial
behavior.
Research on group interventions to address conduct
disorder in teenagers suggests that a great deal of caution should be
exercised because bringing together conduct disordered teenagers can
result in a contagion of more behavioral disturbance. In contrast,
interventions designed to help teenagers better related to non-deviant
peers have shown promise – including school and church peers.
Finally,
though untested I believe that teenagers that have a vision for their
lives that entails a positive sense of what they can do and contribute
to society protects them from negative peer influence. This vision can
include spiritual faith and their religious perspectives on purpose and
meaning.
Research has consistently demonstrated the benefits
of interventions that increase the bond between the conduct disorder
teenager and his/her school. So any intervention that directs
attention toward improving school performance and improving the
teenagers participation in academic or nonacademic activities related
to the school tend to reduce the negative peer influence. It should be
noted, however, that schools that have a high proportion of negative
influence can severely limit the benefits of this school intervention
strategy.
Many of these recommendations come from the work of
Dr. Scott Sells - Sells, S.P. (2001). Parenting your out-of-control
teenager. New York: St. Martin’s Press. See also Dodge KA. Pettit GS. A
biopsychosocial model of the development of chronic conduct problems in
adolescence. Developmental Psychology. 39(2):349-71, 2003 Mar
3.
Part of the Culture of Life mission is to understand the truth about
the human person at all stages of life; I am wondering if you have any
comments on how early difficulties with Conduct Disorder impacts people
into adulthood, married life, etc. from a psychological perspective?
For example, what are the consequences for these young people as they
grow into adulthood and establish their own families?
The
adult outcomes for children/teenagers with untreated conduct disorder
are consistently and extensively poor. They include the following:
(1) More likely to be diagnoses with anxiety and depressive disorders.
(2) Increased risk for the development of antisocial personality symptoms.
(3) Lower marriage rates, higher rates of multiple sexual partners and cohabitation.
(4) Earlier sexual experience and pregnancy.
(5) Increased risk for marital dissatisfaction/discord and divorce.
(6) Higher rates of being perpetrators and victims of intimate partner violence.
(7) Increased risk for their children to develop problems with conduct.
(8) Higher rates of incarceration.
(9) Higher rates of automobile accidents/violations.
(10) Higher rates of alcohol/tobacco/substance abuse.
(11) Less job stability with associated less income and home stability – and greater dependence upon welfare resources.
(12) Higher rates of physical illness morbidity – including sexually transmitted diseases.
P. Alex Mabe received his doctoral degree in clinical psychology from Florida
State University in Tallahassee, Florida. Currently, he is professor and Chief
of Psychology in the Department of Psychiatry and Health Behavior at the Medical
College of Georgia. His publications include over 40 articles in the areas of
clinical child and pediatric psychology. Additionally, he has made numerous
presentations at national and international professional meetings on topics
related to children’s mental health, family and parent management training. Dr.
Mabe is licensed as a psychologist in Georgia and South Carolina and has been
providing clinical psychology services to children and their families in the
Central Savannah River Area for over 25 years.
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