To what degree do serious conduct problems in childhood and adolescence predict later antisocial

160 Pages·2014·1.31 MB·English

Competing with the gang; an exploration of
MST therapists’ experiences working with
gang-involved young people and their
families.

Rebecca Packer
D.Clin.Psy. thesis (Volume 1), 2014
University College London
Thesis declaration form
I confirm that the work presented in this thesis is my own. Where information has
been derived from other sources, I confirm that this has been indicated in the thesis.

Signature:
Name: Rebecca Packer
Date: Tuesday 14th October 2014
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Overview
Volume 1 of this D.Clin.Psy. thesis is the research component of the thesis and is
divided into three parts.

Part one is a systematic literature review evaluating twenty two studies that examine
the relationship between conduct disorder in childhood and adolescence and later
antisocial personality disorder in adulthood. A narrative synthesis of their results is
offered, with consideration of how these fit with the wider literature examining the
persistence of childhood and adolescent antisocial behaviour.

Part two is an empirical paper using a qualitative design to explore the experiences
of multisystemic therapy (MST) therapists working with gang-involved young people.

Part three is a critical appraisal of the research process. I initially offer a more
informal discursive account of my own interest in youth antisocial behaviour. This is
followed by discussion of the definitional issues associated with gang research, a
wider consideration of whether youth antisocial behaviour is best thought of as
encompassing a broad spectrum of behaviours, and, how gang-involvement might fit
as a more nuanced part of this. Finally, I talk about the choice of therapists as
participants in my study, examining the challenges and benefits that I felt
accompanied this.
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Table of Contents
Overview.................................................................................................................................3 
List of Tables..........................................................................................................................6 
List of Figures........................................................................................................................6 
Acknowledgements...............................................................................................................7 
Part One: Literature Review................................................................................................8 
Introduction.......................................................................................................................10 
Method..............................................................................................................................13 
Results..............................................................................................................................18 
Discussion........................................................................................................................50 
References.......................................................................................................................57 
Part Two: Empirical Paper.................................................................................................68 
Introduction.......................................................................................................................70 
Methods............................................................................................................................75 
Setting...........................................................................................................................75 
Participants...................................................................................................................76 
MST Quality Assurance and Therapeutic Practice................................................77 
Procedure.....................................................................................................................77 
Background of the researcher...................................................................................79 
Interviews......................................................................................................................79 
Method of Analysis......................................................................................................80 
Results..............................................................................................................................81 
Discussion........................................................................................................................95 
References.....................................................................................................................107 
Part Three: Critical Appraisal...........................................................................................114 
Introduction.....................................................................................................................115 
The ongoing value in understanding youth antisocial behaviour...........................115 
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Problems in definition...................................................................................................118 
Distinguishing gang-involvement as a separate part of youth antisocial behaviour
.........................................................................................................................................120 
Welcoming therapists to the other side of the table.................................................122 
Bridging the gap between evidence-based practice and practice-based evidence
.........................................................................................................................................124 
Replicating this study....................................................................................................126 
Final Considerations.....................................................................................................127 
References.....................................................................................................................128 
Appendices.........................................................................................................................133 
Appendix I: Quality criteria for critical appraisal of observational studies...........134
Appendix II: Ethical Approval Letter....................................................................136
Appendix III: Participant information form...........................................................139
Appendix IV: Participant consent form................................................................142
Appendix V: Interview schedule..........................................................................145
Appendix VI: Phases of thematic analysis..........................................................149
Appendix VII: Checklist of criteria for good thematic analysis............................151
Appendix VIII: Thematic map of results..............................................................153
Appendix IX: An example of the qualitative coding process...............................155 

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List of Tables

Part One: Literature Review
Table 1: Characteristics of the longitudinal studies included........................................19 
Table 2: Characteristics of the cross-sectional studies included.................................23

List of Figures

Part One: Literature Review
Figure 1: Flowchart of search results ..............................................................................17 
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Acknowledgements

I would like to thank a number of people for their contributions and assistance in
helping me to complete this thesis. First and foremost, I would like to thank Dr
Stephen Butler for his guidance and support throughout the research process. He
has shown limitless patience and encouragement, providing me with confidence in
my own abilities as a researcher, even in the face of tasks which at times felt
overwhelming.
I am grateful to all of the therapists and supervisors who gave up their time to
participate in my study. They offered thoughtful and interesting accounts of their
experiences, providing me with a wealth of data to work with!
I owe the most heartfelt thanks and gratitude to my incredible friends and family.
They have shown unending support and encouragement from the very first day that
I showed an interest in psychology… and in all those years since! I would like to
thank my parents for their continuing support and the hours that they spent
meticulously proof-reading my work, a topic which up until now has been completely
alien to them, but in which they are now both experts! You have always had
confidence in me and put me back on my feet when my own has wavered. Especial
thanks to my boyfriend who took over all domestic duties in a relentless bid to rid me
of any opportunity for procrastination and whose encouragement has kept me
motivated through the long nights spent working. I hope that I have been able to
make you all proud.
Finally, I would like to thank all of the clients whom I have worked with throughout
my training. It has been a privilege to share some of their journey, and something
that has kept me focused, reminding me of what I am working towards and why this
is so important to me.
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Part One: Literature Review

To what degree do serious conduct problems
in childhood and adolescence predict later
antisocial personality disorder?
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Abstract
Aims: This review explores the degree to which conduct disorder (CD) in childhood
and adolescence might predict later antisocial personality disorder (ASPD) in
adulthood, with consideration of other potential influencing factors.
Method: A systematic search using the database, Ovid PsychINFO resulted in 122
citations. After initial inclusion and exclusion criteria were applied and studies were
quality assessed twenty two studies remained.
Results: The studies reviewed widely recognise CD as a significant predictor of
more enduring and persistent antisocial behaviour, whether diagnosed as ASPD or
evidenced in later social maladaptation as a result of persistent antisocial behaviour
in adulthood. It is less clear what distinguishes those young people with CD who
progress to later adult ASPD from those who do not. Associated risk factors are
identified and reviewed in relation to their impact on the development of ASPD.
These include biological background, social- environmental factors, psychiatric
disorder, temperament, personality, comorbid pathology, severity of CD (in terms of
early onset and increased number of symptoms endorsed), number of covert CD
symptoms and endorsement of callous and unemotional traits.
Conclusions: There was evidence to suggest that early onset CD symptomatology
may not be an unequivocal or consistent predictor of later ASPD. Personality traits
such as callous unemotional traits linked to child psychopathy are considered as
potential means to refine prediction of those at greatest risk of persistent antisocial
behaviour. Implications for future research and clinical practice are considered and
limitations of the review discussed.

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Introduction
  This review examines the persistence of antisocial behaviour from childhood
into later adulthood based upon the Diagnostic and Statistical Manual (DSM)
diagnoses of conduct disorder (CD) and antisocial personality disorder (ASPD). CD
is characterised by a persistent pattern of behaviour in which the rights of others, or
major age-appropriate societal norms and rules are violated. Behaviours are broadly
divided into four categories: aggression to people and animals, destruction of
property, deceitfulness or theft and serious violation of rules. ASPD is characterised
by a lack of empathy or remorse and a pervasive pattern of disregard for, or
violation of, the rights of others. To receive a diagnosis of ASPD, an individual must
be over eighteen years old and the impairments in their personal and social
functioning should be relatively stable across time (i.e. there is evidence of earlier
CD, with an onset before fifteen years old). Whilst other diagnostic systems
operationalise similar diagnostic categories (i.e. dissocial personality disorder
describes the equivalent disorder to ASPD in the International Statistical
Classification of Diseases and Related Problems, ICD-10), this review focuses on
those as defined by DSM criteria as these are widely adopted in research studies of
the development of antisocial behaviour.
Youth antisocial behaviour has been a topic of widespread concern and
investigation for many years, with Werry (1997) positing conduct disorder as
potentially the most important social and public health problem faced in childhood
and adolescence. Longitudinal research has demonstrated that persistent antisocial
behaviour in youth significantly increases the risk of criminality, unstable
relationships and mental health problems in proceeding adulthood (Hill & Maughan,
2001). In addition to these individual costs, the cost to society is considerable.
Individuals showing persistent antisocial behaviour at 10 years of age are estimated
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