A Contemporary Review of Childhood Antisocial Behaviour in School Settings

Emma Sanders O’Connor1 *Annemaree Carroll1 Stephen Houghton2 Caroline Donovan3

The University of Queensland1

The University of Western Australia2 Griffith University3

*Corresponding Author: Associate Professor Annemaree Carroll School of Education The University of Queensland St Lucia, Brisbane Qld 4072 Tel: (07) 3365 6476 Email: a.carroll@uq.edu.au Biographical Information

Emma Sanders O’Connor (MClinPsych) is a registered psychologist and a research officer in the School of Education, The University of Queensland. She is experienced in working with and assisting young people, adults and families in a variety of research and clinical settings. Emma’s research interests focus on the mental health and well-being of children, school-based interventions, and mindfulness interventions.

Associate Professor Annemaree Carroll (PhD) is a registered psychologist in the School of Education at The University of Queensland. Her research activities focus on the self-regulatory processes of adolescent behaviour and child and adolescent emotional and behavioural difficulties. She has developed innovative multimedia methods and strategies for enhancing the engagement and motivation of at-risk children and youth to bring about positive change in their lives. Professor Stephen Houghton (PhD) is Director of the Centre for Child and Adolescent Related Disorders at the University of Western Australia, a registered psychologist and Visiting Professor at the University of Strathclyde, School of Psychological and Health Sciences, Glasgow, Scotland. His research focuses on child and adolescent developmental psychopathology, particularly conduct disorder, psychopathic traits and mental health. Dr Caroline Donovan, PhD is a Senior Lecturer in the School of Applied Psychology, Griffith University. Her research focuses on child and health psychopathology and male and female body image issues. Of particular research interest is the development and evaluation of internet-based, cognitive behavioural programs for youth anxiety disorders. Her research focus stems from a strong belief that early intervention and prevention can disrupt problematic trajectories and ultimately improve the lives of youth and adults. This work was supported by the Australian Research Council Discovery Grants Scheme under Grant Number DP0663491.

A CONTEMPORARY REVIEW OF CHILDHOOD ANTISOCIAL BEHAVIOUR IN SCHOOL SETTINGS

Emma Sanders O’Connor1

*Annemaree Carroll1 Stephen Houghton2 Caroline Donovan3

The University of Queensland1

The University of Western Australia2 Griffith University3

ABSTRACT

The immediate and long-term prognosis for children who display early-onset antisocial

behaviour and who are at-risk of disengagement from school is often extremely poor across

multiple indices of adjustment, including a significantly increased risk of violence and

criminality as adults. Implementing effective programs to redirect the trajectory of antisocial

behaviour toward better outcomes for these children is therefore an important priority. The

school setting is one of the most important socialisation contexts of childhood. It is a place

where antisocial behaviour often plays out and where prevention and intervention efforts are

often focused. Given the important role of the school in understanding childhood antisocial

behaviour, this chapter presents an overview of the contemporary literature on the nature,

scope, impact and etiology of childhood antisocial behaviour, with an emphasis on the school

context. Efforts undertaken in school to prevent and or redirect the trajectory of these children

are reviewed.

Running Head: Childhood Antisocial Behaviour Total Words: 8,063 words Keywords: Antisocial behaviour, Childhood, Aggression, Antisocial Traits, Risk and Protective Factors, Social, Peer, Emotional, School, Interventions

INTRODUCTION

The increasing prevalence of childhood antisocial behaviour is a serious social problem

presenting major costs and challenges for individuals, families, schools and communities

across Australia and worldwide. A body of research shows that children with early-onset

antisocial behaviour are at risk of suspension and exclusion from school and are much more

likely than other children to follow a path leading to adverse social, health, and economic

consequences including criminal behaviour and violence, educational failure, chronic illness,

and unemployment in adulthood (Parsonage, Khan, & Saunders, 2014). Such evidence

highlights the need for effective early intervention and prevention to redirect the trajectory of

antisocial behaviour toward more resilient developmental pathways for these children.

Contemporary developmental models show that the etiology of antisocial behaviour is

complex and multi-determined, arising from an intricate interplay and accumulation of

individual, family, social, peer, school and community risk factors. Such models emphasise

the importance of intervening, not only at the level of the individual child, but also addressing

the larger social ecologies within which the child must live, develop and interact. One of the

most important social ecologies of childhood, and one where antisocial behaviour frequently

occurs, is school. As such, school represents an important setting in which to provide

preventive intervention programs for children at-risk of developing antisocial behaviour. The

aim of this chapter is to provide a review of the contemporary literature on the nature and

scope of the problem of childhood antisocial behaviour, its short- and long-term impacts, the

risk and protective factors contributing to its development (particularly those that play out in

the school setting), and the school-based interventions available to address the problem.

METHOD

This review was conducted as part of a larger project investigating the trajectories of

childhood antisocial behaviour (ARC Discovery Project DP0663491). Ethical approval for the

study was obtained from the administering institution, and participating stakeholders. To

conduct the review a search strategy was formulated that included the following criteria,

keywords and relevant search terms:

Criterion 1: Population – antisocial populations. As this review was interested in school

age children and young people, an age restriction was set from 4 to 17 years.

Keywords and search terms: Antisocial behaviour, aggression, reactive aggression, proactive

aggression, oppositional defiant disorder, conduct disorder, behaviour problems,

externalising behaviour, delinquency, disruptive behaviour, violence, antisocial traits, callous

unemotional, impulsivity.

Criterion 2: Impact of antisocial behaviour.

Keywords and search terms: Short-term impact, long-term impact, academic achievement,

school suspension/exclusion, comorbidity, criminal activity.

Criterion 3: Etiology of antisocial behaviour; risk and protective factors; social, peer

and emotional factors.

Keywords and search terms: Etiology, risk factors, causes, social skills deficits, peer

rejection, child/family/school/social/emotional risk factors, deviant peers, emotional

functioning, empathy, protective factors, resilience.

Criterion 4: Prevention and intervention; cognitive-behavioural and school-based

interventions.

Keywords and search terms: Prevention programs, intervention programs, cognitive-

behavioural therapy, school-based programs/interventions, social-emotional

programs/interventions, meta-analysis, treatment outcomes.

Specific electronic databases were used for the literature search (e.g., PsycINFO,

PubMed, Web of Science, ERIC, Google Scholar). Journal articles, book chapters and books

were included in the search criteria. To keep the review contemporary all references prior to

2000 were omitted from the review unless considered “seminal” works. Consequently, 248

references were considered for this review, with a total of 71 included in the final chapter.

This reduction was initially completed on the basis of the critical judgment of one author,

considering factors such as relevance, publication quality and the strength of empirical

studies. However, all references were subsequently reviewed by the other authors, who were

in total agreement with those selected for inclusion.

RESULTS

The findings of the review of the literature are presented based on the four criteria.

First, an overview of the nature and significance of antisocial behaviour in children is

provided. In particular, aggression and antisocial traits emerged as key characteristics for

these children. Second, contemporary literature on the impact of antisocial behaviour is

reviewed, especially short- and long-term impacts. Literature related to the third criterion on

the etiology of antisocial behavior regarding risk and protective factors is presented. The final

criterion on prevention and intervention efforts for children with antisocial behavior focuses

on the importance of school settings.

Criterion 1: Antisocial Behaviour in Children –Nature and Significance of the Problem

Antisocial behaviour can be defined as behaviour that fails to conform to societal

norms and violates the rights of others (Calkins & Keane, 2009). It is characterised by a range

of behaviours including aggression, defiance, non-compliance, bullying, theft, lying, cheating,

vandalism, fire-setting, animal cruelty, and truancy (Wilson & Lipsey, 2007). Extreme

antisocial behaviour may include serious criminal acts of violence and cruelty (e.g., school

shootings; McWhirter, McWhirter, McWhirter, & Mcwhirter, 2013). Often but not always,

childhood antisocial behaviours occur within the context of a diagnosed psychological

disorder (Esturgo-Deu & Sala-Roca, 2010), such as Intermittent Explosive Disorder,

Oppositional Defiant Disorder (ODD) and/or Conduct Disorder (CD) (American Psychiatric

Association; APA, 2013). These disruptive disorders involve problems with impulsivity and

self-regulation of emotions and behaviours and are highly comorbid with Attention Deficit

Hyperactivity Disorder (ADHD), learning difficulties and internalizing disorders (Parsonage

et al., 2014).

Prevalence estimates suggest that childhood antisocial behaviour has increased over

time and is of a serious magnitude. For example, in one Australian study, the prevalence of

conduct problems in children aged 4 to 15 years was estimated at 9.6% (Abu-Rayya & Yang,

2012) making it one of the most common forms of psychopathology among young

Australians. Extrapolated into a typical classroom, these statistics suggest that on average two

to three children in each classroom will display serious conduct problems. Epidemiological

evidence also indicates that over the past few decades there has been an increase in childhood

antisocial behaviour in Australia and other developed nations (Collishaw, Maughan,

Goodman, & Pickles, 2004). Because of its intensely deleterious effect on other people,

antisocial behaviour ranks as the most frequently cited reason for referral of young people to

mental health services, accounting for 33%-50% of all such referrals (Carr, 2006; Lochman,

Powell, Whidby, & Fitzgerald, 2005). It also accounts for 25% of all special services in

schools (Hubbard, McAuliffe, Morrow, & Romano, 2010). However, the majority of children

with severe conduct problems do not receive any intervention (Greenberg, Domitrovich &

Bumbarger, 2001). Two characteristics of antisocial behaviour emerging in the literature that

have received attention are aggression and antisocial traits.

Aggression

Aggression is often a hallmark of antisocial behaviour and is commonly displayed in

schools (Walker, Ramsey, & Gresham, 2004). It refers to a range of behaviours that can result

in harm to oneself, others or objects in the environment. Aggression manifests in many forms

including physical aggression (e.g., punching, destroying property), verbal aggression (e.g.,

name-calling, threatening) and relational aggression (e.g., ignoring, spreading rumours)

(Coyne, Nelson, & Underwood, 2011).

An important empirically supported distinction has been made between two functional

types of aggression: reactive and proactive (White, Jarrett, & Ollendick, 2013). Reactive

aggression is unplanned aggression motivated by anger or hostility in response to a perceived

threat or provocation (Connor, 2002). Reactively aggressive children are viewed as having

“hot tempers” and being prone to becoming angry and aggressive at minor provocations

(Nelson & Schultz, 2009). Reactive aggression has been described as “emotional”, “angry”,

“defensive”, or “impulsive” aggression (Vitaro & Brengden, 2005). Conversely, proactive

aggression is planned aggression motivated by a desire to achieve a specific goal, whether

that goal involves material or territorial gain or social dominance (Hubbard et al., 2010). It

has been described as “instrumental”, “offensive”, “cold-blooded”, “predatory” and

“deliberate” aggression used in the absence of provocation. Reactive aggression occurs more

often than proactive aggression and boys are more likely than girls to exhibit either form

(Hubbard et al., 2010).

Although measures of reactive and proactive aggression are correlated, they are

distinguishable and associated with differential risk factors, causal processes, and adjustment

outcomes (Card & Little, 2006). Reactive aggression is more consistent with the frustration-

aggression hypothesis (e.g., Berkowitz, 1993), which posits that aggression is triggered by

frustration (failure to reach a desired goal) and is accompanied by high autonomic arousal

(i.e., anger) (Vitaro & Brengden, 2005). It is characterised physiologically and behaviourally

by heightened central nervous system (CNS) arousal, emotional intensity, fear or anger

responses, unplanned attacks on the object of frustration, and defensive posturing in the face

of threat (Connor, 2002; White et al., 2013). Compared to proactively aggressive peers,

children displaying reactive aggression tend to be less liked by peers, have poorer social

skills, more problems with inattention and impulsivity, and exhibit more deficits in emotion

regulation and executive functioning (Bloomquist & Schnell, 2002).

Proactive aggression is consistent with Bandura’s (1973) Social Learning Theory,

whereby aggression is a learned phenomenon reinforced by role modelling and positive

outcomes for aggressive behaviours (Connor, 2002; White et al., 2013). Physiologically and

behaviourally, proactive aggression appears quite distinct from reactive aggression. It is

marked by a notable absence of physiological CNS arousal, featuring very little observable

emotion such as anger or fear, and the behaviour is organised and directed toward the promise

of reward (Hubbard et al., 2010). Although feared and disliked by their peers, proactively

aggressive children are sometimes seen to have leadership skills and a good sense of humour

(Larson & Lochman, 2011).

Antisocial Traits

A set of personality traits often associated with psychopathy including impulsivity,

callous-unemotionality, manipulativeness and narcissism, have also been shown to be

associated with antisocial behaviour in both adults and children (Barry et al., 2007; Houghton,

Hunter, Khan, & Tan, 2013) and appear to be differentially associated with proactive and

reactive aggression. Impulsivity involves a range of behavioural indicators including poor

planning, high activity level, risk taking, low self-control, and difficulty delaying

gratification, resulting in what is seen as irresponsible behaviour (Farrington et al., 2006).

Research has shown that impulsivity is strongly implicated in reactive aggression but not

proactive aggression (e.g., Frick & Viding, 2009).

Callous-unemotionality (CU), on the other hand, has been linked with proactive

aggression, but not reactive aggression in a number of studies (e.g., Frick, Ray, Thornton, &

Kahn, 2014). CU is characterized by specific deficiencies in interpersonal style (e.g., failure

to show empathy or concern for the feelings of others, callous use of others for personal gain)

and deficiencies in emotional experience (e.g., shallow display of emotions, lack of remorse

for wrong-doing, and lack of personal responsibility for one’s actions) (Frick & White, 2008;

Houghton, Hunter, & Crow, 2013). Children who display CU traits tend to be manipulative

(Houghton et al., 2013) and narcissistic (Barry et al, 2007), manifest low levels of emotional

distress, and display insensitivity to punishment (APA, 2013; Bloomquist & Schnell, 2002).

The minority of antisocial children who demonstrate proactive aggression and CU traits are

more likely to show a particularly severe and stable pattern of aggressive behaviour (Frick &

Viding, 2009). They are also at greater risk for the development of delinquency in

adolescence and psychopathy in adulthood and are at increased risk for poorer response to

treatment (Frick & White, 2008).

Criterion 2: The Impact of Antisocial Behaviour

Longitudinal research on the developmental course of antisocial behaviour shows that

for “early starters” serious conduct problems are highly stable over time (Moffit, 2003) and

not usually something children “grow out of” without substantial intervention. Conversely,

less severe conduct problems become increasingly severe over time (Patterson, 2002) and are

associated with serious costs for the children themselves, their families and schools, and

society as a whole.

Short-Term Impact

In the short-term, children exhibiting antisocial behaviour frequently struggle with

social interaction, empathy and social problem solving skills (Coie, 2004), have poor

academic engagement and achievement, lower cognitive abilities (Walker et al., 2004), high

impulsivity (White et al., 2013) and low self-esteem (Ferguson & Horwood, 2002).

Comorbidity with other disorders is also common. For example, in one national survey of

childhood mental health in Britain, Green, McGinnity, Meltzer, Ford, and Goodman (2005)

found that over 33% of children with a conduct disorder had another psychiatric disorder,

particularly ADHD, anxiety and/or depression. They also had poorer physical health than

their non-antisocial counterparts. Children with antisocial behaviour often place great strain

on their families as their behaviour, which requires constant vigilance, impacts on siblings

and renders the tasks of daily living significantly more difficult for parents (Carr, 2006;

Romeo, Knapp & Scott, 2006).

Antisocial behaviour in schools can cause serious harm to students’ wellbeing, disrupt

the classroom, and diminish the academic functioning of others (McWhirter et al., 2013). The

British national survey (Green et al., 2005) found that 52% of children with antisocial

behaviour had special educational needs (compared to 15% of other children), and that well

over 50% were rated as having difficulty with literacy and numeracy.

In response to antisocial behaviour, schools often use exclusionary measures including

removing children from the learning environment, suspension, and exclusion. Australian rates

of suspension and exclusion have increased dramatically in recent years. For example, in

Queensland suspension rates increased by almost 30% in a 3 year period, from 43,929 in

2008-2009 to 61,076 in 2011-2012; among these were children as young as 5 years old

(Department of Education, Training and the Arts, 2012). The most common reasons for these

school suspensions (2011-2012) were physical misconduct (31.5%), verbal or non-verbal

misconduct (21.6%) and persistent disruptive behaviour (14.2%). One study found that

having persistent antisocial behaviour increased the likelihood of being excluded from school

by almost 25 times compared with other children (Meltzer, Gatward, Corbin, Goodman, &

Ford, 2003). Unfortunately however, exclusionary measures often add to the risk load of these

already vulnerable children and contribute to vicious cycles of compounding difficulties. For

example, exclusionary measures lead to fewer learning opportunities and lower academic

achievement, which may contribute to lowered self-esteem and self-efficacy around learning

tasks, which in turn contribute to further disruptive behaviour and lowered achievement, as

well as disrupted social relationships and rejection of prosocial activities and peers (Masten,

Herbers, Cutuli, & Lafavor, 2008; McWhirter et al., 2013).

Long-Term Impact

Children with early-onset antisocial behaviour are four to ten times more likely than

other children to experience adverse outcomes in adolescence and adulthood (Parsonage et al.,

2014). The most convincing evidence on the enduring consequences of childhood antisocial

behaviour from longitudinal data, particularly birth cohort studies (e.g., Farrington et al.,

2006; Fergusson & Lynskey, 1998), show that when these children reach adolescence, they

are at significantly increased risk of educational failure, disengagement from school and

school drop-out. Fergusson and Lynskey (1998) found almost 33% of children who had CD at

age eight left secondary school with no qualifications. Children with antisocial behaviour are

also at increased risk of substance use, poor mental and physical health, and violent behaviour

and crime (Parsonage et al., 2014). The Cambridge longitudinal birth cohort study (Farrington

et al., 2006) demonstrated that the causes of adolescent criminal convictions could be traced

back to childhood, with the best predictors of convictions at 14 to 16 years being troublesome

behaviours at 10 to 13 years, daring behaviours at age 8 to 10, and early school failure from

the age of 6.

A large literature on long-term outcomes shows that when children exhibiting antisocial

behaviour reach adulthood, they have: significantly more criminal behaviour, arrests,

convictions, imprisonments and driving offenses; higher rates of psychiatric hospitalisations

and all psychological symptoms, antisocial personality disorder and substance abuse; lower

educational attainment, higher unemployment, and lower occupational status if employed, as

well as more frequent job changes; higher rates of relationship breakdown and violent

relationships with partners; less contact with relatives, friends and community; and more

children with conduct problems (Carr, 2006; Parsonage et al., 2014; Farrington et al., 2006;

Fergusson & Lynskey, 1998). Children, whose antisocial behaviour persists, affect society

directly through the impact of their behaviour on others and indirectly through financial costs

involved in their treatment and rehabilitation in mental health, educational, correctional,

medical, and other social services (Romeo et al., 2006). Scott and colleagues estimated that

individuals with persistent antisocial behaviour at age ten years cost society ten times more

than controls by the time they reach 28 years old (Scott, Knapp, Henderson, & Maughan,

2001). In short, childhood antisocial behaviour is a serious social problem with detrimental

short- and long-term impacts on individuals, families, schools and the wider community. The

implementation of effective interventions to divert the trajectory of antisocial behaviour

towards more adaptive outcomes for these children is crucial (Larson & Lochman, 2011).

Criterion 3: Etiology of Antisocial Behaviour – Risk and Protective Factors

Antisocial behaviour in children is complex and multi-determined, with a host of

constitutional and environmental factors cumulating to influence its development (Parsonage

et al., 2014). Contemporary developmental models such as the contextual social-cognitive

model (Lochman & Wells, 2002) are informed by ecological theories of child development

(Bronfenbrenner, 1995), which emphasise the dynamic mutual interplay between children’s

individual characteristics and the social contexts in which they live, develop and interact.

Although a thorough review of the entire literature on the etiology and risk and protective

factors of childhood antisocial behaviour is beyond this chapter, comprehensive summaries

have been conducted by Bezdjian, Raine, Baker, and Lynam (2011), Bloomquist and Schnell

(2002), Masten et al. (2008) and Glenn and Raine (2014).

Risk factors are defined as factors that increase the likelihood of the development of

antisocial behaviour. As children develop they can experience an accumulation or “stacking”

of risk factors from multiple life domains. The likelihood of negative outcomes rises

progressively as a child is subject to an increasing number of adverse influences in early life

(Murray, Irving, Farrington, Colman, & Bloxsom, 2010). Protective factors are those

competencies, skills and life circumstances that function to protect against or buffer the risk

of the development of antisocial behaviour. Protective factors can also accumulate and stack

in children’s lives, sometimes leading to a “positive cascade” that averts the spreading

influence of early problems and fosters resilience in high-risk children (Masten et al., 2008, p.

78). In line with the contextual social-cognitive model (Lochman & Wells, 2002), risk and

protective factors are summarised here within the domains of child, family and parenting,

social and peer, school and neighbourhood. The social, peer and emotional risk factors are

explored in greater depth in the discussion, with particular emphasis on those that are

modifiable through school-based interventions.

Influence of Social, Peer and Emotional Factors in the School Setting

As children enter school, the social realm exerts a strong influence on their

development. For children with antisocial behaviour, the social, peer and emotional factors

associated with this context can function to escalate or worsen problems, and therefore

represent important targets for intervention programs.

Peer Rejection. Children who display antisocial behaviour at school and who lack skills

to get along with other children are at high risk of non-acceptance and rejection by low-risk

peers (Coie, 2004). Green et al. (2005) found that children with antisocial behaviour were

three times more likely than average to have trouble making friends and eight times more

likely to have difficulty keeping them. These children are also more likely than others to be

involved in school bullying, as perpetrators, victims, and bully/victims (Wolke, Woods,

Bloomfield, & Karstadt, 2000). Evidence shows that childhood aggression and peer rejection

independently predict conduct problems and delinquency in adolescence. However,

aggressive children who are also socially rejected tend to show more severe antisocial

behaviour than those who are either aggressive only or rejected only (Coie, 2004).

Consequently, peer rejection can significantly exacerbate existing problems for children with

antisocial behaviour (Poulin & Boivin, 2000). Rejection from prosocial peers can lead

aggressive children to seek out and connect with deviant peers with the same status, attitudes

and behavioural characteristics as themselves. This, in turn, is highly likely to escalate the

seriousness of conduct problems (e.g., Coie, 2004). Dealing with peer rejection should

therefore be an integral part of any comprehensive plan for preventing chronic antisocial

behaviour (Coie, 2004).

Social Skills Deficits. Children with antisocial behaviour exhibit deficits in social skills

that contribute to their friendship difficulties. Not only are these children aggressive, but

compared to other children, they: show poorer communication in cooperative tasks, are less

able to ask questions, show less interest in others; are more likely to interrupt, be inattentive,

make critical and disapproving comments to peers; and have difficulty solving social

problems, sharing, and have a higher activity levels. These deficits make it difficult for

antisocial children to connect appropriately with peers, thereby highlighting the importance of

helping them develop good social skills.

Deficits in Emotional Functioning. Linked with their peer problems are deficits in

emotional functioning displayed by children with antisocial behaviour. These include

difficulties with emotional understanding, emotion regulation and empathy. In terms of

emotional understanding, children with antisocial behaviour have difficulty: identifying and

labeling emotions in themselves; reading emotional cues in others (e.g., facial expressions and

voice tone); talking about their emotional experiences; and masking verbal and facial displays

of anger in social situations (e.g., Dodge et al., 2002). Such problems may impact children’s

ability to self-regulate their own emotions and make it difficult for the child to understand and

connect with other people in a sensitive way (Baumeister & Lobbestael, 2011). Indeed,

mounting evidence suggests that emotion dysregulation constitutes an important risk factor in

the development of antisocial behaviour and its associated peer problems (Roll, Koglin, &

Petermann, 2012).

Children with antisocial behaviour are prone to strong emotional intensity of both

positive and negative emotions. However, they lack the skills to regulate these strong

emotions. In a longitudinal study of five year olds, Rydell, Berlin, and Bohlin (2003) found

that low regulation of both positive and negative emotions correlated with externalizing

behaviour problems and low prosocial behaviour. Other research has shown that aggressive

children use adaptive emotion regulation strategies (e.g., problem-solving, cognitive

reappraisal, self-calming) significantly less often than non-aggressive children (Calvete &

Orue, 2012). Given their difficulty tuning into emotional cues, these children are unlikely to

be cognizant of their emotional state before it escalates, making it difficult to implement other

steps in adaptive regulation (Zeman, Cassano, Perry-Parrish, & Stegall, 2006). Such problems

in emotional regulation can result in the child committing unplanned antisocial acts for which

they may be remorseful afterwards but may still have difficulty controlling in the future

(Pardini, Lochman, & Frick, 2003).

Another important emotional risk factor associated with antisocial behaviour is low

empathy. Empathy is the ability to experience and understand the emotions of another person

(Jolliffe & Farrington, 2004) and functions to facilitate prosocial behaviour and concern for

others and to prevent harmful behaviours (Feshbach & Feshbach, 2009). It is an important

ingredient in social connectedness (Baumeister & Lobbenstael, 2011). Individuals with CU

traits show impaired empathic functioning and lower levels of guilt and remorse for

wrongdoing. In a study by Blair (2007), those with CU traits were emotionally under-reactive

to distress cues in others. That is, they failed to respond to other people’s emotional displays,

presumably because they were not aware of it in themselves and therefore could not respond

to it in others - a deficit attributed to amygdala dysfunction. As argued by Frick and Viding

(2009), temperamental deficits in emotional responsiveness could interrupt normal conscience

development, making it more difficult for children to develop appropriate empathy for others

or guilt over wrongdoing, which in the extreme could result in antisocial behaviour.

Understanding the risk factors involved in the development of antisocial behaviour

allows researchers to more accurately tailor interventions to the needs of these children. Such

programs aim to reduce the impact of known risk factors and promote the protective factors

that buffer against risk across the different contexts of the child’s social ecology. The next

section of the chapter reviews the most relevant literature pertaining to preventative and

intervention programs for children with antisocial behaviour, with a particular focus on school

settings.

Criterion 4: Prevention and Intervention Efforts for Children with Antisocial Behaviour

The seriousness of childhood antisocial behaviour and the growing knowledge about its

etiology is reflected in the plethora of prevention and intervention efforts designed to

ameliorate it. Because of the stability of early-onset antisocial behaviour and the difficulties

treating adolescents who already manifest conduct disorders, many prevention initiatives have

focused on the preschool and primary school years (Greenberg et al., 2001). It is anticipated

that preventive interventions can interrupt the early onset trajectory before behaviour patterns

become too deeply ingrained and before the rejection by peers, adults and schools function to

perpetuate the antisociality (Petermann & Natzke, 2008). Given the small number of children

and families who receive help for antisocial behaviour, a challenge for program developers is

to increase the accessibility and uptake of effective programs (Greenberg et al., 2001).

A body of evidence demonstrates that the most efficacious preventive interventions for

childhood antisocial behaviour, especially in the preschool and primary school years, are

parent-mediated behavioural family interventions (Weisz & Kazdin, 2010). These

interventions seek to arrest the trajectory of antisocial behaviour by improving parenting

skills and developing positive parent-child relationships. Although parent-mediated

interventions are the gold-standard for intervening with conduct disordered children, engaging

such families can be difficult, particularly once children have started school. Drop-out rates

for multiple risk factor families are high and change can be hard to achieve when the parents’

own issues dominate (Kazdin & Wassell, 2000).

Other promising preventive interventions for antisocial behaviour are cognitive-

behavioural therapy (CBT) programs targeted at the level of the child him/herself. The

efficacy of CBT for a wide range of psychological disorders is well-established (Kendall,

2006). CBT incorporates behaviour theory, social learning theory and cognitive theory to

inform practice and places an emphasis on the role of cognitions and behaviour in the

maintenance of maladjustment (Mayer & Van Acker, 2009). Many CBT programs for

antisocial behaviour address salient social and emotional risk factors, and teach children more

adaptive social and emotional skills to reduce problem behaviour. Such skills include:

emotion regulation, anger management, impulse control, social skills, assertiveness skills,

social problem solving, and empathy. Methods used in CBT include: goal setting; monitoring

thoughts and emotions; identifying and challenging distortions in thinking; using self-talk and

relaxation techniques to regulate emotions; using structured learning tasks, modeling,

feedback and role play to practice skills (Corey, 2013).

Given the importance of the broader social context in the development of antisocial

behaviour, focusing solely on up-skilling the child individually is unlikely to translate into

lasting change. Consequently, policy-informing agencies such as the National Institute for

Health and Clinical Excellence (NICE, 2013) recommend that interventions also include the

broader social ecology of the child in the intervention, including for example, a peer, parent or

classroom component. According to Frick and White (2008), the most successful

interventions for children with severe antisocial behaviour problems tend to be “…

comprehensive by focusing on a number of different contextual risk factors that could lead to

a child’s behaviour problems and they tend to be individualized in that the focus of the

comprehensive intervention is tailored to the child’s unique needs” (p. 369).

School-based Interventions

Schools are an ideal setting for intervention programs targeting children with antisocial

behaviour problems for a number of reasons. First, schools are “… where the children are

located” (Van Acker & Mayer, 2009, p. 87). They are a setting where children’s emotional

and behavioural problems play out and where interpersonal aggression and other antisocial

behaviour takes place (Wilson & Lipsey, 2007). Given that almost one in ten students exhibit

antisocial behaviour, and that only a fraction receive help for it, school seems a logical place

to provide assistance. School-based interventions have the important benefit of being easily

accessible for families. They also reduce the stigma related to accessing mental health

services, with research showing that families are more comfortable receiving services through

schools than through community mental health centres (Van Acker & Mayer, 2009).

Importantly, school-based programs can target elements in the social ecology that

exacerbate antisocial behaviour (e.g., peer relations, student-teacher interactions, academic

demands, and disciplinary approaches) and they provide improved potential for the

coordination of interventions around the “whole child” and family (Van Acker & Mayer,

2009). Because of the deleterious impact of antisocial behaviour on the child, as well as those

around him/her, educators are often keen to access programs that address these issues.

Learning skills to get along well in school is a major advantage for the child specifically, and

the school in general. Schools provide a social context in which children can practice newly

learned skills in real-life situations and obtain feedback from adults and peers about their

progress (Lochman et al., 2005). Finally, if existing school staff can be trained in program

delivery, effective school-based programs are likely to be more sustainable and cost-effective,

as they can be incorporated as routine practice within the school (Wilson & Lipsey, 2007).

Impact of School-based Interventions

Several recent meta-analyses exploring the impact of school-based cognitive-

behavioural interventions targeting antisocial behaviour and a range of other adjustment

outcomes in children have shown promising results. In a systematic review of randomized

evaluations of child skills training in preventing antisocial behaviour, Losel and Beelman

(2003) showed the majority of reviewed programs had treatment benefits, with significant but

small to medium mean effect sizes of d = .38 (post-intervention) and d = .28 (follow-up).

Wilson and Lipsey (2007) conducted a meta-analysis of 249 experimental or quasi-

experimental studies of school-based interventions for aggressive and disruptive behaviour

using cognitive-behavioural and social skills methods. The overall mean effect sizes for the

universal and targeted interventions were significant at d = 0.21 and d = 0.29, respectively.

Although relatively small, the effect sizes for such interventions show a decrease in

aggressive and disruptive behaviour that is of practical significance to schools (Wilson &

Lipsey, 2007). Interestingly, multi-component comprehensive programs (involving multiple

intervention elements such as social skills for students and parenting skills training) did not

show significant effects in this meta-analysis. This may be due to difficulties implementing

such comprehensive programs with integrity. Another finding from the meta-analysis was that

significantly larger reductions in aggressive and disruptive behaviours were produced by

programs with better implementation and those involving students at higher risk for

aggressive behaviour. Wilson and Lipsey (2007) noted that most school-based programs

included in the meta-analysis were research programs with a high degree of researcher

involvement, which is not necessarily routine practice in schools. Thus, a challenge for

program developers is to design programs that can be implemented in schools without high-

level involvement of external parties.

Durlak, Weissberg, Dymnicki, Taylor, and Schellinger (2011) examined 213 school-

based universal programs aimed at promoting students’ social and emotional development

across a range of outcomes. In general, programs yielded significant positive effects on the

various targeted social emotional competencies. Compared to controls, children in the

universal programs showed improvements in: attitudes about self, others and school;

behavioural adjustment; prosocial behaviour; and academic achievement. Although only a

small percentage of studies gathered follow-up data, those that did reported gains were

reduced in magnitude but remained significant for a minimum of six months post-

intervention (Durlak et al., 2011). An important finding from this meta-analysis was that

classroom teachers and other school staff effectively conducted social-emotional learning

programs. This is consistent with studies demonstrating teacher effectiveness in the delivery

of cognitive-behavioural interventions for a range of difficulties, including aggression and

antisocial behaviour (Larson & Lochman, 2011). This suggests that as long as appropriate

training, support and monitoring are provided for facilitating teachers or other school staff,

programs can be incorporated into routine educational practices without requiring outside

personnel for their effective delivery (Franklin, Kim, Ryan, Kelly, & Montgomery, 2012).

Durlak et al. (2011) also found that the positive impact of programs included in their

meta-analysis was moderated by two key variables. The first was the skills-training approach

used in the program. Specifically, programs were more likely to be effective if they used a

combination of: a sequenced step-by-step training approach; active forms of learning; focused

sufficient time on skill development; and had explicit learning goals. This is consistent with

other reviews that concluded that successful youth programs are engaging and interactive in

nature, use coaching and role playing, and employ a set of structured activities to guide young

people towards achieving specific goals (DuBois, Holloway, Valentine, & Cooper, 2002).

Current research in prevention recognises the importance of increasing client engagement by

tailoring programs to the specific needs of the intended target groups (August, Egan,

Realmuto, & Hektner, 2003).

The second factor found to moderate program impact was quality of program

implementation or fidelity. Durlak et al. (2011) reported that problems with implementation

had a negative influence on program outcomes. Although few studies provided specific

details of problems during implementation, the challenges inherent in working in a school

may hinder implementation. Such challenges include: insufficient time due to busy schedules

and competing priorities; student absence; low teacher buy-in or commitment to the program;

discomfort teaching social-emotional content; limited follow-up of content or practice of

skills; insufficient support from administration or families; role conflicts; and communication

and confidentiality issues. As Durlak et al. (2011) noted, “Developing an evidence-based

intervention is an essential but insufficient condition for success; the program must also be

well-executed” (p. 409).

Limitations of the Review

The conducting of this review is not without its limitations. The four criteria did restrict

the search to certain parameters concerning childhood antisocial behaviour and therefore, did

not consider all lifespan or etiological issues of the antisocial population, as it was restricted

to school age children and young people with etiological factors focused on peer and social

factors. Also, this review adopted a broad and general view of the construct of antisocial

behaviour in the school context, which precluded any detailed exploration of some of the

important specificities of the area. For example, some young people engage in acts of extreme

antisociality, such as school shootings or violent extremism. Such instances of antisocial

behaviour in young people warrant a separate chapter. Finally, given the vast literature on

antisocial behaviour in young people, this review is by no means comprehensive.

CONCLUSION

The importance of efforts to improve outcomes for children with early onset antisocial

behaviour cannot be understated. These children are among the most vulnerable and are often

exposed to a multitude of compounding risk factors and stressors early in their lives, which

can set them on a trajectory towards an adulthood characterized by problems across all major

life domains, including, in many cases, criminal behaviour and violence. Schools are in a

unique position to assist these children to learn important social and emotional competencies

they may not have acquired in their early lives. If children learn to: manage their emotions

and behaviour, have a sense of worth in themselves, have empathy for others, interact with

others in positive and fulfilling ways, and engage with their education, the trajectory of

antisocial behaviour may be diverted toward more positive and resilient outcomes. As a

result, the serious and violent criminality awaiting in adolescence and adulthood may be

averted.

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