Antisocial behaviour in clinically referred boys: Early identification and assessment procedures in child psychiatry

.......................................................................................................................................................... 5 LIST OF PUBLICATIONS.................................................................................................................................. 6 TABLE OF CONTENTS...................................................................................................................................... 7 ABBREVIATIONS ............................................................................................................................................... 8 INTRODUCTION................................................................................................................................................. 9 DEFINITIONS AND CLINICAL NOMENCLATURE ................................................................................................... 10 FOCUS OF THE THESIS........................................................................................................................................ 14 THE SIGNIFICANCE OF AN EARLY AGE FOR FUTURE ANTISOCIAL BEHAVIOUR .................................................... 15 PREVALENCE AND EPIDEMIOLOGY .................................................................................................................... 16 RISK FACTORS AND CORRELATES ...................................................................................................................... 17 ADULT PSYCHIATRIC ASSESSMENTS: IMPROVED PREDICTIONS OF ANTISOCIAL BEHAVIOUR.............................. 19 CHILD RISK ASSESSMENT: A NEW APPROACH FOR EARLY IDENTIFICATION OF ANTISOCIAL BEHAVIOUR ........... 20 ALTERNATIVE APPROACHES TO RISK ASSESSMENT: THE ROLE OF EARLY ONSET, HYPERACTIVITY, CONDUCT DISORDER AND PERSONALITY TRAITS IN SUBTYPING ANTISOCIAL BEHAVIOURS ................................................ 21 ETHICAL AND PROFESSIONAL CONSIDERATIONS OF AN EARLY IDENTIFICATION................................................ 25 LIMITATIONS OF PRIOR RESEARCH .................................................................................................................... 25 AIMS AND RESEARCH QUESTIONS ........................................................................................................... 27 METHOD ............................................................................................................................................................ 28 SETTING ............................................................................................................................................................ 28 DESIGN AND GENERAL CONSIDERATIONS .......................................................................................................... 28 PARTICIPANTS AND PROCEDURE ....................................................................................................................... 29 MEASURES ........................................................................................................................................................ 31 ANALYSES......................................................................................................................................................... 36 ETHICAL CONSIDERATIONS ............................................................................................................................... 39 RESULTS ............................................................................................................................................................ 40 DESCRIPTIVE INFORMATION ABOUT THE REFERRED BOYS AND THEIR FAMILIES................................................ 40 SWEDISH VALIDATION OF THE EARLY ASSESSMENT RISK LIST FOR BOYS (EARL-20B), A DECISION-AID FOR USE WITH CHILDREN PRESENTING WITH CONDUCT-DISORDERED BEHAVIOUR (PAPER I).................................... 41 PREDICTING AGGRESSIVE AND DISRUPTIVE BEHAVIOUR IN REFERRED 6-12 YEAR-OLD BOYS: PROSPECTIVE VALIDATION OF THE EARL-20B RISK/NEEDS CHECKLIST. (PAPER II)............................................................... 43 CALLOUS-UNEMOTIONAL TRAITS ARE ASSOCIATED WITH CLINICAL SEVERITY IN REFERRED BOYS WITH CONDUCT PROBLEMS (PAPER III) ...................................................................................................................... 47 CLINICAL WORK WITH ANTISOCIAL BEHAVIOUR IN BOYS: NARRATIVE INTERVIEWS WITH CLINICAL TEAMS IN SWEDISH CHILD AND ADOLESCENT PSYCHIATRY (PAPER IV)............................................................................ 49 GENERAL DISCUSSION.................................................................................................................................. 53 SUMMARY AND REFLECTIONS ON THE USEFULNESS OF RISK ASSESSMENT AND CU-TRAITS APPROACHES......... 53 EMPLOYING STRUCTURED APPROACHES IN MENTAL HEALTH SETTINGS ............................................................ 55 IMPLICATIONS FOR TREATMENT ........................................................................................................................ 55 CLINICAL SERVICES FOR CHILDREN WITH ANTISOCIAL BEHAVIOUR .................................................................. 57 LIMITATIONS AND STRENGTHS .......................................................................................................................... 58 FUTURE DIRECTIONS ......................................................................................................................................... 59 ACKNOWLEDGEMENTS................................................................................................................................ 62 REFERENCES.................................................................................................................................................... 63