Diagnosing Antisocial Personality Disorder in Children
Diagnosing Antisocial Personality Disorder in Children
The Diagnostic and Statistical Manual of Mental Disorders defines the antisocial personality disorder as “a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood” (McCallum, 2). While many psychologists follow the debate that antisocial personality disorder cannot be diagnosed in adolescence due to the nature of the child’s evolving personality, it is well known that an un-diagnosed disorder in adolescence can lead to more severe personality disorders in adulthood, namely sociopathic disorders. With that said, a look will now be taken into the various methods of diagnosis, the emergence of the sociopathic disorder as a result of the antisocial personality disorder left un-diagnosed, and the theory of nature versus nurture.
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To begin with, “for reasons both personal and theoretical, clinicians have been reluctant to make the diagnosis of a personality disorder in children and adolescents” (Kernberg, Weiner, and Bardenstein, 6). Many reason that the child has not yet developed strong enough personality traits to make the diagnosis properly. On the other hand, many doctors are reluctant to make such diagnosis due to the stigma that such would place on the child. Even more, while some doctors have been able and successful in diagnosing adolescent patients with personality disorders, “insurance companies…are not always willing to recognize that children have [personality disorders], and the clinician who makes the diagnosis may be told that it is not ‘listed in our computer for patients of that age’” (7). This factor alone makes a diagnosis not only difficult for clinicians, but nearly impossible for the parents of the child.
Further, if a doctor presses his diagnosis, the parents may find that any treatment that must be given will have to come out of their own pockets, and such treatments can be excessively expensive for a long term, “managed care approach” (Kernberg, et al, 7). Thus, making the diagnosis has not proven to be a healthy, life-long approach for many children simply due to the burden that such a diagnosis would bring.
However, despite the conflicts, while many psychologists believe that the child has not yet developed a strong enough personality to make a diagnosis, there are “enduring personality patterns that are apparent by the end of preschool…these include patterns of aggressivity, inflexible coping strategies, and insecure attachment that develop into persistent childhood behaviors and characteristics related to subsequent disorders, such as depression, drug use, and antisocial and criminal behavior” (Kernberg, et al, 4). Each of these is a strong personality trait not common among children, and which should immediately signal that the child is developing the antisocial personality disorder.
Such traits “when…observed in children who appear severely neurotic, the term ‘borderline’ or ‘borderline psychotic’ has been applied” (Lubbe, 3). Instead of giving a true diagnosis, then, most doctors will relegate the antisocial personality disorder in adolescents to something that is “borderline” in nature, and not make the distinction that the disorder may, in effect, be more than that. Even more, “a child’s inappropriate behavior may be caused by his passive-aggressiveness, attention deficit disorder, or faulty cognitions. Because these conditions that are thought to cause behaviors are also seen as relatively stable, traditional models of assessment have a history of being used for identifying, classifying, or diagnosing problems and predicting future behavior” (Reynolds and Kamphaus, 31). And, while many clinicians might, in an attempt to avoid diagnosing a true personality disorder, an adolescent, could, without treatment, evolve into an adult with severe behavioral issues.
Indeed, there are greater drawbacks to not seeking a true diagnosis in adolescence; among them, severe and violent behavioral issues and sociopathic tendencies that can emerge shortly after a child reaches puberty, which could have been diagnosed and managed if found in childhood. Further, “because psychopathy is investigated almost exclusively in adulthood, little is known about the potential childhood precursors of this constellation of personality traits” (Piatigorsky and Hinshaw, 535). Even more, “antisocial youths’ developmental trajectories differ with regard to factors such as the age of onset of antisocial behavior, influences of parents, patterns of offending, levels of impulsivity, types of aggression, rates of desistance, and the influence of peers, among other variables” (535). These trajectories are in place during adolescence, and, often, a pattern of uncommon behavior can be traced in these instances.
With that said, it is well researched that “the antisocial personalities who are responsible for most crime, including violent crime, in the United States are not psychopaths but rather sociopaths, persons of broadly normal temperament who have failed to acquire the attributes of socialization, not because of innate peculiarities in themselves, but because of a failure of the usual socializing agents, primarily their parents” (Lykken, vii). And, it has been found that the sociopath has “a weak and unelaborated conscience, are not shamed by much of what would shame [a normal person]…they take pride in rule breaking rather than in rule observance and are like feral children grown up, gratifying impulses of the moment, disinterested in long-term goals. They are the natural result of weak parental bonding, weak parental control, and bad parental example” (22). Bad parents, then, are viewed as the root cause for an antisocial or sociopathic personality.
The age-old debate of nature versus nurture is common among psychologists, especially in identifying the causes and triggers of personality disorders within adolescent patients. In the case of sociopaths, the debate can be set to rest as the main element that creates a sociopathic personality is bad parenting. Nurture, then, is more significant a force in the sociopathic personality.
Even more, in looking at the antisocial personality disorder, research points extensively to nurture as being the significant factor in manifesting such a disorder within an adolescent or adult patient. Antisocial personalities are diagnosed based upon a wide range of personality traits, all of which, to some degree, do not fully develop until the child has reached a point beyond adolescence, making a diagnose fundamentally difficult. However, psychologists have determined that the antisocial personality disorder can emerge in adults, especially if not properly treated, as a more severe, even sociopathic, disorder, which gives credence to the ideal that nurture is essentially more important than nature in raising a “normal” human personality.
Overall, the diagnosis of the antisocial personality disorder in adolescents is not impossible. The only true difficulty remains within the ideals of the clinician: to place a stigma on the child, to burden the parents and family with treatment that most insurance agencies won’t cover, and to relegate the child to a role as an adolescent and adult with personality problems. Further, it is well-known that the un-diagnosed adolescent has significant chances of evolving into an adult with severe behavioral issues, among them, violence and sociopathic tendencies. And, while there are treatments available which would prevent such behavioral problems, much of psychology has determined that sociopathy, and even antisocial personality disorder, can be traced to a child’s development with their parents. If a child is reared properly, with a strong family background and social interactions, the chances of an antisocial personality disorder are slim. However, if a child is raised with bad parents and few strong social interactions, the outcome of a sociopathic adult are, almost, guaranteed.
Kernberg, Paulina F., Alan S. Weiner, and Karen K. Bardenstein. Personality Disorders in
Children and Adolescents. New York: Basic Books, 2000.
Lubbe, Trevor. The Borderline Psychotic Child: A Selective Integration. London: Routledge,
Lykken, David T. The Antisocial Personalities. Hillsdale, NJ: Lawrence Erlbaum Associates,
McCallum, David. Personality and Dangerousness: Genealogies of Antisocial Personality
Disorder. Cambridge, England: Cambridge UP, 2001.
Piatigorsky, Auran, and Stephen P. Hinshaw. “Psychopathic Traits in Boys with and without
Attention-Deficit/hyperactivity Disorder: Concurrent and Longitudinal Correlates.”
Journal of Abnormal Child Psychology 32.5 (2004): 535+. Print.
Reynolds, Cecil R. and Randy W. Kamphaus, eds. Handbook of Psychological and Educational
Assessment of Children: Personality, Behavior, and Context. 2nd Ed. New York:
Guilford Press, 2003.