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Journal of Personality Disorders, 24(2), 258-271.

2010 © 2010 The Guilford Press

ANTISOCIAL PERSONALITY DISORDER WITH AND WITHOUT ANTECEDENT CHILDHOOD CONDUCT DISORDER: DOES IT MAKE A DIFFERENCE?
Glenn D. Walters, PhD, and Raymond A. Knight, PhD
The purpose of this study was to test whether prior conduct disorder increased deviance in persons diagnosed with antisocial personality disorder. One hundred and three male inmates satisfying adult antisocial and conduct disorder criteria for antisocial personality disorder achieved significantly higher scores on self-report measures of criminal thinking and antisocial attitudes than 137 male inmates satisfying only the adult criteria for antisocial personality disorder and 87 male nonantisocial inmates. Inmates satisfying adult antisocial and conduct disorder criteria for antisocial personality disorder were also more likely to receive disciplinary infractions for misconduct than inmates in the other two conditions. The theoretical, diagnostic, and practical implications of these results are discussed.

The Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition (DSM-IV; American Psychiatric Association, 2000) requires something of antisocial personality disorder that it does not demand of any other personality disorder. Taking a page from Robins' (1966) classic book on childhood conduct problems and adult antisocial behavior, DSM-IV stipulates that an Axis I disorder—childhood conduct disorder—must be present before an Axis II disorder—antisocial personality disorder—can be diagnosed. The DSM-IV approach to antisocial personality raises at least three questions. First, given the well-documented continuity in behavioral problems from childhood to adulthood (Glueck & Glueck, 1950), is childhood conduct disorder redundant with adult antisociality in diagnosing antisocial personality disorder? Second, if assessing conduct disorder before the age of 15 in someone eligible for a diagnosis of antisocial personality disorder (>18 years old) requires retrospective accounts that may not coincide with contemporaneous reports of conduct disorder from childhood (Rueter,

From Federal Correctional Institution, Schuylkill. Pennsylvania (G, D. W.); and Brandeis University (R, A. K,). The assertions and opinions contained herein are the private views of the authors and should not be construed as official or as reflecting the views of the Federal Bureau of Prisons or the United States Department of Justice, Address all correspondence to Glenn D. Walters. Psychology Services. FCI-SchuylklU. P, O, Box 700. Minersville. Pennsylvania 17954-0700; E-mail: gwalters@bop.gov 258

CONDUCT DISORDER 259 Choo. & MacMillan. & Conger. 1994)? Constructing diagnoses from a file review. criminal history. and more diverse groups of correlates. 2001) but when comparisons are made between adult antisocial patients with and without a history of conduct disorder there are few if any clinically significant between-group differences (Langbehn & Cadoret. and Duggan (2007) found no evidence of sociodemographic. criminal history. including behavioral outcome measures.. Using a structured interview instead of a file review and community volunteers instead of psychiatric patients. or adult antisocial differences between 30 individuals who satisfied both the adult antisocial and conduct disorder criteria for antisocial personality disorder and 39 individuals who satisfied only the adult antisocial criteria. studies with more participants. conceptual. and clinical advantages to knowing whether antecedent conduct disorder contributes to a diagnosis of adult antisocial personality disorder. conduct disorder is unnecessary in making a diagnosis of antisocial personality disorder. One of the few significant differences between the groups was greater trait and expressed anger on the part of individuals satisfying both the adult antisocial and conduct disorder criteria for antisocial personality disorder. Marmorstein (2006) also failed to uncover a significant group difference between individuals from a large population-based sample satisfying the adult Jintisocial and conduct disorder criteria for antisocial personality disorder £ind those satisfying only the adult antisocial criteria on a number of sociodemographic. Axis I. Before we can assume that this group of late bloomers is comparable to DiLalla and Gottesman's (1989) continuous antisocials (i. Blazer. and diagnostic variables. historical. however.e. Rathbone. There are practical. are required. & Kendler. 2001). Research indicates that genetic factors play a role in early onset antisocial beha'vior (Jacobson. substance abuse. Prescott. on the one hand. or current antisocial behavior differences between the two groups. adult antisocial individuals with a clear background of childhood conduct disorder). . time can be saved by skipping a retrospective and potentially unreliable review of prior conduct disorder sjmiptomatology. Such individuals purportedly either experienced relatively few environmental pressures during childhood or had fewer opportunities to engage in conduct disorder because of strong parental controls. if. Huband. more reliable diagnoses. how should we diagnose and treat the not insignificant number of people who fall under this classification (Tweed. Black and Braun (1998) compared 32 psychiatric patients who met the adult antisocial and childhood conduct disorder criteria for antisocial personality and 23 patients who met only the adult antisocial criteria and discovered few if any sociodemographic. Perdikouri. Neale. DiLalla and Gottesman (1989) classify as late bloomers individuals who satisfy the adult criteria for antisocial personality disorder but not the conduct disorder criteria. George. From a practical standpoint. If. in the event antisocial personality disorder without antecedent conduct disorder is a meaningful clinical entity. Swartz. how useful is a retrospective diagnosis of conduct disorder? Third. 2000).

& Stoolmiller. 2000). theoretical. Brame. 1998.54 years (SD= 1. range = 20-71) and the mean educational level was 11. 2007). this information would be helpful in assigning individuals to interventions because program intensity often correlates positively with treatment gains in high risk individuals but has been found to have a detrimental effect on low risk individuals (Bonta. Nowhere is the answer to this question more important than in civil commitment proceedings for sex offenders where a diagnosis of antisocial personality disorder often serves as an indicator of current mental disorder or abnormality (Jackson & Hess. Moffitt and several colleagues (2008) concluded that the age at which a conduct disorder first appears is a strong indicator of the severity of adult antisocial behavior. and institutional misconduct. prior conduct disorder is associated with more severe forms of adult antisocial behavior. Hence. Yoerger. African-Americans comprised . Paternoster. participants satisfying adult antisocial and childhood conduct disorder criteria for antisocial personality disorder would score significantly higher than participants fulfilling only the adult antisocial criteria. including retrospective accounts of prior conduct disorder symptomatology may be justified. MazeroUe. if prior conduct disorder symptomatology portends more serious subsequent adult antisocial behavior.13. Moffitfs (1993) Life Course Persistence (LCP) model proposes that early conduct disorder constitutes a vital link in the series of developmental events that can lead to severe adult antisocial behavior. 2007. 2008). Clinically.260 WALTERS AND KNIGHT on the other hand. METHOD PARTICIPANTS Participants were 327 male inmates housed in a medium security federal prison located in the northeastern United States. determining whether childhood conduct disorder predicts more serious behavioral outcomes in adults is central to testing and validating Moffitfs LCP model. Consistent with these data. It was hypothesized that on measures of criminal history. Marshall. who in turn would score significantly higher than nonantisocial participants.55). Hence. Forgatch. criminal/ antisocial attitudes. Patterson. & Pratt. and clinical reasons why it is important to ascertain whether prior conduct disorder sjmiptomatology adds anything to an adult diagnosis of antisocial personality disorder. & Rooney.26 years (SD= 10. Wallace-Capretta. An early age of onset of criminality has consistently been found to be a reliable predictor of chronic or persistent offending as well as criminal versatility (McGloin. Piquero. Piquero. there are practical. In this study a series of anedyses were conducted on recent admissions to a federal prison to determine the contribution of childhood conduct disorder symptomatology to diagnoses of adult antisocial personality disorder. 1999. Sullivan. The mean age of participants was 36. & Dean. &Wortley. In a recent paper. Smallbone.

To qualify for a diagnosis of iintisocial personality disorder (APD) the person must be at least 18 years of age. The ASPD is a semi-structured interview modeled after the DSM-IV (American Psychiatric Association.91 for the conduct disorder symptom count. First. assault. Interrater reliability was adequate to good as evidenced by a weighted kappa coefficient of .1%). where the point assignments are reversed. AAB. Three PICTS scores were included in the present investigation: the General Criminal Thinking (GCT) score.1%). 1995) is an 80-item self-report measure designed to assess criminal thinking. and satisfy three or more of the seven adult antisocial items at the threshold level. MEASURES The Antisocial Personality Disorder (ASPD) module of the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II.1%). 2 = subthreshold. 1997) was administered to all participants.5% of the sample being Caucasian.66 for diagnosis (antisocial personality with conduct disorder.2%). and .91 for the total ASPD symptom count. The most common instant offense was a drug crime (42. NA) and intraclass correlation coefficients (ICC: single measures. and disagree responses 1 point on all scales except for Defensiveness-revised (Df-r). rape. absolute agreement) of .g. robbery (13. miscellaneous offenses (10. the Proactive Criminal Thinking (P) composite score. .3%) had at least one prior conviction for a violent crime (e.. divorced. Gibbon. 2000) criteria for antisocial personality disorder and consists of 15 conduct disorder items and 7 adult antisocial items. and 1. with 18. and 0. uncertain responses 2 points.77 for the adult antisocial symptom count. Williams. 3 = threshold or true). antisocial personality without conduct disorder. The Psychological Inventory of Criminal Thinking Styles (PICTS.8%.CONDUCT DISORDER 261 71. The first author conducted all of the ASPD interviews for this study. Walters.6% of the sample.5% Asian.9% describing themselves as married.5%). 10. violent crimes (9. A random sample of 33 participants (10% of the total sample) was independently interviewed by a second mental health professional within a week of the original interview.4% Hispanic. The 64-item GCT score is the summed raw score of the eight thinking style scales on which the PICTS is based. with 16. agree responses 3 points. & Benjamin. Approximately three-quarters of the sample (74. Ninety-six percent of these participants had one or more prior convictions and nearly two-thirds of participants (63. robbery). satisfy two or more of the 15 conduct disorder items at the threshold level (before age 15). Each PICTS item is rated on a four-point Likert-type scale with strongly agree responses earning respondents 4 points. the 18-item P score is designed to assess the proactive or instrumental aspects of criminal thinking. Each item is rated on a three-point scale (1 = absent or false.0%). and the 18-item R score is designed to assess the reactive or . followed by weapons violations (19. and property offenses (6. and the Reactive Criminal Thinking (R) composite score. nonantisocial. and widowed. Spitzer.6%) listed their marital status as single. 5. respectively. ASP.7%.

Each item on the 344-item PAI is rated on a four-point scale (1 . 2 0 . Furthermore.29.23-. P = .93. Of those excluded.84-. 2 = mainly true. P = . whereas the PICTS and ANT were administered by a psychology technician responsible for the psychological testing portion of the psychology intake process.18-.88). who was aware of the study hj^otheses) as part of the intake screening interview. The ANT is composed of three 8-item nonoverlapping subscales. 24 inmates had been transferred or released prior to taking part in the intake. The Antisocial Features (ANT) scale of the Personality Assessment Inventory (PAI. Morey. In the current study the standalone ANT correlated . correlations with recidivism: GCT = .62. The psychologist who administered the ASPD had no knowledge of the PICTS/ANT assessment until elfter the ASPD had been administered and the psychology technician who administered the PICTS/ANT had no knowledge of the ASPD until after the PICTS and ANT had been scored. 3 = slightly true. ANT-S = .73. 2007) also served as a dependent measure in this study. P = . 2 inmates achieved a T-score of 100 or more on the PICTS Cf-r scale. which compares favorably with the correlation Walters and Geyer (2005) obtained (r= .96.79.86. and Stimulus Seeking (ANT-S).78. and 3 inmates left more than two items blank on the ANT.51) when the embedded ANT and PICTS GCT were correlated. 18-.70-. and Edens (2008) found when they correlated the embedded ANT with the SCID-II ASPD symptom count (r= . Test-retest reliability (r) after 2 4 .53 with the PICTS GCT scale.very true. ANT-A = . Test-retest reliability (2-12 weeks: GCT= . was good in the current sample of participants (GCT = . PROCEDURE The ASPD. the correlation obtained in the present study between the standalone ANT and SCID-II ASPD symptom count (r = . ANT-A = .35.78-.78-.49) is comparable to what Guy. Skeem. Egocentricity (ANT-E). Poythress.49. Although the psychology . ANT-E = . Douglas. 2006) and internal consistency. R = .59). P = .86.92. Antisocial Behaviors (ANT-A).88) and predictive validity (correlations with disciplinary adjustment: GCT= .262 WALTERS AND KNIGHT hostile aspects of criminal thinking. 2007) and internal consistency (a) was fair in the current sample (ANT= . R = .80-.2 8 days was adequate (ANT = .84) in the normative sample (Morey. 2002. ANT-S = .70-. 3 inmates left more than 10 items blank on the PICTS. The ASPD was administered by a staff psychologist (first author.26. and ANT were administered within two weeks of an inmate's arrival at the federal prison where this study took place. these 24 items were administered as a standalone inventory rather than as part of the full 344-item PAI.38. PICTS. ANT-E = . 4 = false). R = . as measured by Cronbach's alpha (a). P.81-. and R are adequate (Walters. All admissions from J a n u a r y 2008 through May 2008 were inciuded in this study except for 32 inmates excluded for multiple reasons.20.26) data on the GCT. R = .13-.51). Because of time constraints imposed by the intake screening process.

Informed consent was not obtained because the ASPD. and behavioral data. AAB > NA). 1. race. and ANT may have been inflated by shared method variance in that all three measures are based on offender self-report. and ANT-S scales. and R scores and the PAI ANT.5 months in participants who did not receive an incident report during the follow-up and from 0. Omnibus tests for all three groups (APD. F (2. and instant offense. and ANT were administered for routine clinical purposes. 324) = 2. Participants were assigned to one of three conditions based on the results of the ASPD. P. or behavioral measures included in this study. The beha\'ioral outcome measure for this study was receipt of an incident report for a disciplinary infraction during the follow-up period that ended twenty weeks after the last intake and ranged from 1. AAB. x^ (6) = 6. There were two members of the nonantisocial (NA) condition who satisfied the conduct disorder criteria (>2 reported sjmiptoms) but not the adult antisocial criteria (>3 reported symptoms) for an ASPD diagnosis of antisocial personality disorder. education. After completing the ASPD the staff psychologist reviewed an electronic file compiled by the U.05. Permission to use these data for research purposes was granted by the Bureau of Prisons' national institutional review board.05. RESULTS There were no significant omnibus group differences in age.CONDUCT DISORDER 263 technician was unaware of the study hypotheses. correlations between the ASPD. education. x^ (6) = 5. AAB.1 to 8.S. ANT-A. or instant offense. psychometric. p > . ANT-E. When these participants were removed from the NA group there were no significant changes in outcome on any of the criminal history.73. psychometric. AAB vs. p > .13. criminal background. p > . marital status.0 to 9.05. The nonantisocial (NA) condition contained inmates who failed to meet the ASPD adult antisocial criteria.05.8 months in participants who received an incident report during the follow-up.13. The antisocial personality disorder (APD) condition comprised inmates who satisfied both the adult antisocial and conduct disorder criteria for antisocial personality disorder as deñned by the ASPD. NA) were conducted first. Criminal background variables included the number of prior delinquency adjudications and adult convictions and age at first adjudication/conviction. 324) = 0. The adult antisocial behavior (AAB) condition included inmates who met the ASPD adult antisocial criteria but not the conduct disorder criteria. x^ (10) = 3.48. race. . Probation Department and computed the number of prior delinquency adjudications and adult convictions and age at flrst adjudication/ conviction. NA) to determine whether the results supported the study hypotheses (APD > AAB. F (2. Demographic variables included age. PICTS. p > .' The dependent variables for this study w^ere derived from demographic. PICTS. Psychometric variables examined in this study included the PICTS GCT.59. marital status. followed by individual planned comparisons (APD vs.

44)c 14.09 (2.05).01) but not prior adjudications/convictions (fp.86). 9. 324) = 392. .001. p < .03*' ANT Total 23.82 (6.55). F (2.46 (15.69 (21.001. Age Adj/Convict = age at first delinquency adjudication or adult conviction.69 (2.3% of the sample) received a disciplinary report for assault or fighting during the follow-up: APD (7.8%). 324) Prior Adj/Convict 3.17 (27.0%.3%).25 (6.25). is the standard deviation.98).18). 61. NA= 19.98 (22. Planned comparisons (simple contrasts) revealed a significant APD-AAB effect (p< .55 (2.20). 2.03). . it TABLE 1.23).37). **p< . P = Proactive composite score. PICTS = Psychological Inventory of Criminal Thinking Styles.51. A Cox semi-parametric duration (survival) regression analysis of the disciplinary report measure disclosed a significant effect for diagnosis (APD. means with different subscript letters are significantly different from one another (p < . 24.36 (3. Seventy-eight participants (23.00)a 5. X^ (2) = 7. NA = nonantisocial condition. and ANT achieved a significant multivariate analysis of variance (MANOVA) effect.97)e 20.05) but no AAB-NA effect (p> .91. 636) = 5.78)c 20.69 (2.16 (25.79)a 107. 4. 16.22. MANOVA Between-Subject Effects and Post Hoc Results Variable APD(n = 103) AAB (n = 137) NA(n = 87) F (2. 14.264 WALTERS AND KNIGHT p > . although criminal history.7%.60 (3. *p< . R = Reactive composite score.86*' ANT-S 6.34).65). NA (2.70)e 21. p< . ANT-A = ANT Antisocial Behaviors subscale.42"' PICTS P 78. but AAB was not greater than NA.39)a 2.04. first number in each column is the group mean and second number. 4.05. ANT-E = ANT Egocentricity subscale.43 (3.43).26 (24.001.51*' ANT-E 3. and APD had an earlier age of onset than AAB and NA (see Table 1).05) predicted the presence of a subsequent disciplinary infraction in this sample.^ Significant omnibus group differences were also noted for all seven PICTS and ANT scales and six of the seven scales displayed the predicted pattern of planned comparison results (APD > AAB > NA).41 (2. Prior Adj/Convict = number of prior delinquency adjudications and/or adult convictions. F (16.40 (3. GCT = General Criminal Thinking score. p< .50). p > .64 (6.98** Note.24L 21.33). AAB (2.9%). the PICTS. AAB. Because APD participants achieved significantly higher ASPD adult antisocial scores than AAB or NA participants. 4.22 (24. 10. in parentheses.91 19.97)a 71. 324) = omnibus F test with 2 and 324 degrees of freedom. 18.65)a 4. 1.30)a 68. AAB = 19. The lone exception was ANT-S.87 (4. 21.9%) received a disciplinary report during the follow-up period (APD = 33. F (2. p < . 98. 60. 11. NA). There were significant omnibus group differences on criminal history variables and planned comparisons revealed that APD and AAB had more prior adjudications and convictions than NA. An earlier age of onset (rp5 = -.03*' PICTS R 84.52*' ANT-A 13. AAB = adult antisocial behavior condition.74).05). APD = antisocial personality disorder condition.48 (8.56 (2. ANT-S = ANT Stimulus Seeking subscale.5%).00 (3.32 (6. where APD > AAB.19" PICTS GCT 121. A meaningful Cox regression einalysis could not be conducted on violent disciplinary infractions because only 14 participants (4. ANT Total = total score for the Personality Assessment Inventory Antisocial Features scale.32 (19. 11.01. 14.75* Age Adj/Convict 18.05.09).58 (4.

050 19. Variance Infiation Factor = 1.73** .22** .96* .93* PICTS GCT .349). df= degrees of freedom.178 7.45' .087 37. Two-Step Multiple Regression and Cox Regression Results Multiple Regression Cox Regression Step 1 Step 2 Block 1 Block 2 Ait' F (1.28** ANT-A .024 PICTS R .024 ANT-E . With the exception of the prior conviction variable. 325) = F test of change with 1 and 325 degrees of freedom.70 1 .026 8. F [I. 324) = F test of change with 1 and 324 degrees of freedom.18** ANT-S .100 36.69* Note. AR^ = change in R square from previous model (R^ of current model—R^ of previous model).04' . ANT-E = ANT Egocentricity subscale.006 Prior Adj/Convict . Prior Adj/Convict = number of prior delinquency adjudications and/or adult convictions. **p< . *p< . P = Proactive composite score.052 17. ANT Total = total score for the Personality Assessment Inventory Antisocial Features scale. ANT-S = ANT Stimulus Seeking subscale. When variable order was reversed and conduct disorder symptoms were entered at Block 1 and adult antisocial symptoms were entered at Block 2.324) df p df P Any Disciplinary Report 1.00 Age Adj/Convict . The results showed consistent support for Part 1 and TABLE 2.05). x^ = Chi-square change from previous step. ANT-A = ANT Antisocial Behaviors subscale. F [I. R = Reactive composite score. DISCUSSION A two-part hypothesis was evaluated in this study. and behavioral variables examined in this study exhibited a significant effect for conduct disorder at Step/Block 2 of the regression equation after adult antisocial S3rmptoms had already been entered at Step/Block 1 (see Table 2).06** ANT Total .119 44. Age Adj/Convict = age at first delinquency adjudication or adult conviction.55*' .17* .65** PICTS P . psychometric. all of the criminal history. Step/Block 1 = step or block in which ASPD adult antisocial items entered. GCT = General Criminal Thinking score. The number of conduct disorder symptoms displayed incremental validity relative to the number of adult antisocial symptoms in Cox regression analyses of institutional infractions. p = signiflcance of chi square change.90*' 9.96' .82 1 .104 37. . adult antisocial symptoms failed to demonstrate incremental validity relative to conduct disorder symptoms in a Co. This possibility was evaluated by computing a series of two-step multiple regression and Cox regression analyses with adult antisocial symptoms entered at Step/Block 1 and conduct disorder symptoms entered at Step/Block 2.07* 9. Step/ Block 2 = step or block in which ASPD conduct disorder items entered.035 13.043 14.098 37.741.CONDUCT DISORDER 265 could be argued that many of the significant effects observed in this study were the result of group differences in adult antisocial symptoms rather than group differences in conduct disorder symptomatology.01.000 0.001. 3.151 57.36* .030 9.325) AR' F (1.108 39.x regression analysis of the institutional infraction measure (p > . Part 1 (APD > AAB) and Part 2 (AAB > NA).078 30. PICTS = Psychological Inventory of Criminal Thinking Styles.^ CoUinearity between predictor variables was not a problem in this study (Tolerance = .128 47.

the relationship between age of onset and ASPD. Black & Braun. 2007). (2006) note that conduct disorder is the most frequent psychiatric diagnosis in detained juvenile delinquents. 1998. First. It should be noted..266 WALTERS AND KNiGHT mixed support for Part 2. however. an approach that has produced reliable and valid results in research conducted in the criminology and criminal justice fields (Thomberry & Krohn. Perdikouri et al. cannot be attributed to shared method variance. these results indicate that self-report may be vital in gaining a fuller understanding of an individual's offending history. antisocial attitudes. Consequently. 2003) and highlight this variable's ability to predict future problem behavior (Lahey et al. That adult antisocial behavior was associated with greater levels of criminal thinking. the results of this study furnish only mixed support for the possibility of a meaningful distinction between offenders with and without a history of adult antisocial behavior in the absence of prior conduct disorder. Teplin et al.. Age at time of first delinquency adjudication or adult conviction but not total number of delinquency adjudications and/or adult convictions successfully predicted future disciplinary infractions in this study. age of onset was one of the few variables included in this study that was not based on offender self-report. with prevalence rates exceeding . 2006. ANT. whereas one of the few significant differences separating emtisocial adults with and without antecedent childhood conduct disorder in the Perdikouri et al. unlike the relationships between the PICTS. 2000). offender age at first documented delinquent adjudication or criminal conviction successfully discriminated between participants in the APD and AAB conditions but failed to distinguish between participants in the AAB and NA conditions. Second. This is important for several reasons. Marmorstein. the two groups failed to differ in their subsequent disciplinary reports. According to the results of the current investigation. Third. The average age of first adjudication/conviction in the APD group was 18 years (range = 11-34 years). hence. (2007) study was self-reported trait and expressed anger. Although the AAB group scored significantly higher than the NA group on most of the self-report measures of criminal thinking and antisocial attitudes. Langbehn & Cadoret. that the focus of much of the prior research had been on criminal history and psychiatric symptomatology. Juvenile delinquency and conduct disorder may derive from different theoretical and clinical traditions but they overlap extensively. and behavioral adjustment difficulties when accompanied by two or more sjrmptoms of conduct disorder before age 15 is inconsistent with much of the previous research conducted on this subject (cf. these results confirm the role of age of onset in ASPD (Farrington. Hence. 2001. 1999). In the present study the one variable that failed to distinguish between the APD and AAB groups was the number of prior delinquency adjudications/adult convictions. and ASPD. there were a number of serious conduct disorder acts that preceded the first adjudication/conviction that could only be identified through offender self-report.

& Hare.. 2005) will. Knight. 2006.g. psychopathy in adults (Edens. 2007. matter whether an individual who displays adult antisocial sjonptoms also reports a history of childhood conduct disorder. is research showing that socioeconomic status interacts with conduct disorder to increase risk for adult antisocial behavior (Lahey. earlier onset could be associated with increased genetic risk that interacts with abusive and stressful environments. 2007). of course. the total number of conduct disorder symptoms displayed greater reliability and validity than the total number of adult antisocial sjnnptoms in this study. Whereas the results of this study confirm the existence of a clinically meaningful distinction between antisocial adults with and without antecedent childhood conduct disorder. 2007). Concerns about the unreliability of a person's recall of years. Walters. Moffltt. In fact. Lilienfeld. the early onset or life course persistent pattern may carry with it a greater magnitude of developmental deficits than Moffltt's (1993) adolescent- . 2007) suggest that these constructs possess an underlying dimensional structure. & Poythress. our results support the early work of Robins (1966) on childhood precursors of adult antisocial behavior and Moffltt's (1993) more recent work on early onset or life course persistent delinquency.CONDUCT DISORDER 267 90% in several samples. Marcus. Loeber. a taxometric analysis of the ASPD module of the SCID-II using the same sample of participants as the current study also showed evidence of dimensional latent structure (Walters & Ruscio. Walters. Lilienfeld. Edens. and psychopathy in children (Murrie et al. but equally important. Diamond. Magaletta. even though the conduct disorder sjrmptoms preceded the adult antisocial symptoms by three or more years. Moreover. it does not necessarily support the presence of a taxonic boundary between the two groups. 2009). Less well known. 2006. 2000) aside.. 2000). Geyer. The results of this study highlight the role childhood conduct disorder plays in serious adult antisociality. & Poythress. The chief diagnostic implication of this study is that it may. Burke. One conceptual possibility is that lack of empathy and living in an environment where opportunities for conventional success are limited but criminal role models and associations abound sets up a situation in which prosocial avenues of interaction become increasingly remote and antisocial avenues of interaction increasingly accessible. be required to unravel these Gordian knots. taxometric research on antisocial personality disorder (Marcus. & Duncan. What we now need is research on the transition from conduct disorder to antisocial personality in order to clarify the nature of this relationship. Longitudinal panel studies and appropriate paradigms to unravel genetic and environmentai contributions (e.. Despite evidence of dimensional latent structure. in fact. Ruscio. As such. It is well known that many conduct disordered children and adolescents suffer from weak empathy (Eisenberg. Alternatively. The relationship between early conduct disorder and juvenile delinquency and later adult antisocial and criminal behavior is also well documented. & Applegate..or decades-old symptoms (Rueter et al. 2005). Guay. Gray et al.

a clear difference was observed between antisocial adults with and without antecedent childhood conduct disorder. and behavioral variables.. It could even be argued that the second part of the h5q5othesis for this study (AAB > NA) would have received support had the follow-up period been longer and the infractions more severe. whereas the present study demonstrates that the essential content of antisocial personality disorder—antisocial attitudes. whereas lower risk individuals often display diminished or even negative treatment effects with increased intervention intensity (Bonta et al. tend to respond better to more intense interventions. psychometric. Although the vEiriable effect sizes and patterns observed in research on prison misconduct are similar to the variable effect sizes and patterns found in research on community recidivism (French & Gendreau. focused on family. and did not analyze psychiatric or family history variables. By contrast. One notable limitation of this study is that the criterion diagnoses (structured interview) and many of the dependent variables (e. 2006). ANT) were based on self-report.. The current findings are inconsistent with previous research comparing antisocial adults with and without antecedent conduct disorder (Black and Braun. Perdikouri et al. Data show.. however. 2000). psychiatric. with the exception of an earlier onset of delinquency/criminality in the APD condition. when crime-relevant variables like criminal thinking. Taxometric studies denote that antisocial personality disorder may possess a dimensional latent structure. and institutional adjustment were examined. antisocial attitudes. 1998. that life course persistent or early onset delinquency is associated with moderate to high levels of neurocognitive impairment (Raine et al. and criminal history variables. 2006.. the behavioral measure was restricted to relatively minor infractions taking place over a relatively brief period of time. Criminal justice clients who are at elevated risk for reoffense.g. in part because of a history of early and persistent antisociality. Marmorstein. 2001. emotional impulsivity. 2005). Contin- . behavioral deviance—has its roots in childhood conduct disorder. 2007). PICTS. Much of the previous research. Shared method variance and criterion contamination may therefore have artificially inflated the relationship between antisocial personality disorder and several of the self-report inventories included in this study.268 WALTERS AND KNIGHT limited pattern or DiLalla and Gottesman's (1989) late bloomers. The current study also failed to find substantial criminal history differences between the three conditions. in fact. Whereas a meaningful relationship was also observed between these diagnoses and a behavioral outcome measure. The form and intensity of intervention may accordingly need to vary depending on whether an adult antisocial client reports a history of childhood conduct disorder. one could still question the relevance and generalizability of the current results to disruptive behavior outside of a correctional facility. The advantage the present study has over previous research on the antisocial personality-conduct disorder controversy is that it assessed a relatively large sample of criminal justice clients on a range of historical. Langbehn & Cadoret.

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