Offord D R, Reitsma-Street M
Psychiatr Dev. 1983 Summer;1(2):207-24.
The importance of antisocial behaviour is underlined by the magnitude of the problem (largest category of emotional disturbance in youth) and by the poor psychosocial prognosis for the chronically affected child. The medical/psychological approach has pointed to the role of marital discord and parental psychopathology as significant features in the individual's environment predicting antisocial development. Conversely, sociology and criminology, which have begun with social theories, appear to have had less statistical success in accounting for aetiology. Definition of conduct disorder in terms of type, duration, frequency, and severity of anti-social behaviour is indispensible for the characterization of subgroups of affected children, and hence variables which protect against or accentuate risk factors. Prognosis depends among other things on age of onset (worse younger) and setting (home or community), implying that treatment programmes cannot be evaluated adequately without the differential characterisation of subgroups, their natural histories, and responsiveness to intervention. Although such data come from the study of individuals, case-by-case treatment runs the risk in certain groups of escalating anti-social behaviour. Thus community/youth oriented interventions, focusing on the remedial treatment of learning handicaps, improvement of non-school skills, may provide more promising points of attack. Incomplete knowledge of aetiology should not prevent action, provided the methodological issues raised serve as the basis for vigorous evaluation.
反社会行为问题的严重性(青少年情绪障碍的最大类别)以及长期受影响儿童不良的社会心理预后凸显了该行为的重要性。医学/心理学方法指出,婚姻不和和父母精神病理学在预测个体反社会行为发展的环境中起着重要作用。相反,从社会理论出发的社会学和犯罪学在病因学解释方面似乎在统计学上的成效较小。根据反社会行为的类型、持续时间、频率和严重程度来定义品行障碍,对于确定受影响儿童的亚组特征至关重要,从而确定预防或加剧风险因素的变量。预后尤其取决于发病年龄(年龄越小预后越差)和环境(家庭或社区),这意味着如果不对亚组进行差异化特征描述、了解其自然病史以及对干预的反应,就无法充分评估治疗方案。尽管这些数据来自对个体的研究,但个案治疗在某些群体中存在反社会行为升级的风险。因此,以社区/青少年为导向的干预措施,专注于学习障碍的补救治疗、非学校技能的提升,可能会提供更有希望的切入点。只要所提出的方法学问题作为有力评估的基础,病因学知识的不完整不应妨碍采取行动。