Conduct Disorder Part II: The Impact of Peers, Institutions and Media Violence

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television_kids.jpgPart 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.