Aggression and antisocial behavior in underserved populations : towards a comprehensive treatment approach

Antisocial behaviors are highly prevalent among children and adolescents as well as adults. When these behaviors reach clinical significance they place a high burden on the individual, his or her immediate surrounding and society in general. Better insight into the correlates of antisocial behavior is needed in order to develop adequate prevention and intervention strategies matched to an individual’s personal risk to engage in antisocial behavior and experience associated risk factors. To date, studies have indicated a strong relationship between community violence exposure and antisocial behavior. However, most studies have investigated samples with a mixed composition of healthy children and adolescents as well as those with a clinical diagnosis. Little is known about the specific associations between community violence exposure and antisocial behaviors in healthy controls compared to children and adolescents with existing, clinically significant behavioral problems (i.e., a diagnosis of conduct disorder). Furthermore, little is known about the effectiveness of intervention programs targeting antisocial behaviors in underserved settings with a high prevalence of aggressive behavior disorders, such as correctional institutions or residential youth settings.
This dissertation aims to further the understanding of the correlates of antisocial behaviors as well as the treatment of youths and adults exhibiting these behaviors in restrictive settings. First, the specific association between community violence exposure and antisocial behaviors in a healthy child and adolescent sample as well as a clinical sample with a diagnosis of conduct disorder was examined. Second, the effectiveness of an evidence-informed skills training designed to target antisocial behaviors of offenders within correctional settings was evaluated. Third, a comprehensive, randomized-controlled treatment evaluation plan for a skills training adapted to the needs of female adolescents with conduct disorder residing in residential youth settings is introduced.
The research presented in this dissertation expands current knowledge on the relationship between community violence exposure and antisocial behaviors. It is shown that there are no clear differences between the association of witnessing community violence and antisocial behavior between healthy controls and those with a diagnosis of conduct disorder. Thus, any potential confound with regard to studies that have used mixed samples can be ruled out. Furthermore, this work provides evidence for the effectiveness of a skills training targeting behavioral problems in inmates. The more sessions are completed the fewer disciplinary infractions are received. Finally, a treatment evaluation protocol adhering to the rigorous standards of the CONSORT guidelines is introduced. The protocol introduces a comprehensive implementation and evaluation guide to evaluate the effectiveness of a skills training designed for antisocial, aggressive female adolescents within residential youth settings. The results of this work encourage future studies to further investigate the association between community violence exposure and antisocial behaviors in healthy youths compared to those with a diagnosis of CD in a longitudinal approach. Design and evaluation of interventions for antisocial youths who are exposed to violence are called for, especially in settings with high prevalence rates of aggressive behavior disorders. In addition, treatment evaluation studies should use rigorous standards for scientific evaluation as exemplified in the final study to provide instructive implications and increase the clinical gain.