Antisocial Personality Disorder:
The most important goals of treating antisocial behavior are to measure and describe the individual child's or adolescent's actual problem behaviors and to effectively teach him or her the positive behaviors that should be adopted instead. In severe cases, medication will be administered to control behavior, but it should not be used as a substitute for therapy. A child who experiences explosive rage may respond well to medication. Ideally, an interdisciplinary team of teachers, social workers, and guidance counselors will work with parents or caregivers to provide services to help the child in all aspects of his or her life: home, school, work, and social contexts. In many cases, parents themselves need intensive training on modeling and reinforcing appropriate behaviors in their child, as well as in providing appropriate discipline to prevent inappropriate behavior.
A variety of methods may be employed to deliver social skills training, but especially with diagnosed anti-social disorders, the most effective methods are systemic therapies which address communication skills among the whole family or within a peer group of other antisocial children or adolescents. These probably work best because they entail actually developing (or redeveloping) positive relationships between the child or adolescent and other people. Methods used in social skills training include modeling, role-playing, corrective feedback, and token reinforcement systems. Regardless of the method used, the child's level of cognitive and emotional development often determines the success of treatment. Adolescents capable of learning communication and problem-solving skills are more likely to improve their relations with others.
Unfortunately, conduct disorders, which are the primary form of diagnosed antisocial behavior, are highly resistant to treatment. Few institutions can afford the comprehensiveness and intensity of services required to support and change a child's whole system of behavior. In most cases, for various reasons, treatment is terminated (usually by the client) long before it is completed. Often, the child may be fortunate to be diagnosed at all. Schools are frequently the first to address behavior problems, and regular classroom teachers only spend a limited amount of time with individual students. Special education teachers and counselors have a better chance at instituting long-term treatment programs—if the student stays in the same school for a period of years. One study showed teenage boys with conduct disorder had had an average of nine years of treatment by 15 different institutions. Treatments averaged seven months each.
Studies show that children who are given social skills instruction decrease their antisocial behavior, especially when the instruction is combined with some form of supportive peer group or family therapy. But the long-term effectiveness of any form of therapy for anti-social behavior has not been demonstrated. The fact that peer groups have such a strong influence on behavior suggests that schools that employ collaborative learning and the mainstreaming of antisocial students with regular students may prove most beneficial to the antisocial child. Because the classroom is a natural environment, learned skills do not need to be transferred. By dividing the classroom into groups and explicitly stating procedures for group interactions, teachers can create opportunities for positive interaction between antisocial and other students.
