Assessing Severity
in
Behavior Disorders
7
to do so at
a
higher rate throughout adolescence and had conviction rates twice as high
as those who started later. In what is perhaps the best-known longitudinal study
of
child
psychopathology, Robins
(1966)
found that about four out of five antisocial children
referred to
a
child guidance clinic by age
10
later became sociopaths. Petersilia
(1980)
reported that
45%
of the variance in number
of
arrests was accounted for by age
of
onset. Authorities now agree that serious antisocial behavior rarely emerges
de novo
in childhood. Early adolescence appears to be the time when aggressiveness has crystal-
lized and become highly predictive of aggression and delinquency (Loeber
&
Stouthamer-
Loeber,
1987).
Attention Deficit Disorder
(ADD). Longitudinal research shows that children with
generalized hyperactivity have a very early onset of problems (Gillberg
&
Gillberg,
1988).
A
follow-up study
of
children who had been hyperactive in at least three different assess-
ment settings at age
7
revealed that
73% (11
of
15
subjects) manifested pervasive hyperac-
tivity at age
11
and
40%
(6
of
15
children) at age
13.
The authors noted that a child
who is pervasively hyperactive at age
13
is almost certain to have been hyperactive in
the early years too. Indeed, all affected children in this study had been noted to be overac-
tive by their parents before
2
years
of
age. Moreover,
73%
of
children with generalized
hyperactivity had shown severe attention deficit in preschool according to teacher ratings.
Only
10
of
24
children
(42%)
with cross-situational but not generalized hyperactivity
showed
a
similar degree of attention deficit in preschool. Although generalized hyperac-
tivity with early onset showed a somewhat better prognosis in the 6-year follow-up than
in the 3-year follow-up period, school achievement was problematic throughout the en-
tire follow-up period. The vast majority of children
(73%)
with early onset
of
generalized
hyperactivity continued to have severe academic problems at age
13.
Multiple Settings
Some children show problems only in the school setting, others show them mostly
at home, while still others exhibit problems in neighborhood community settings. A
fourth group may display maladaptive behavior in more than one of the above settings.
Available research studies indicate that children who manifest problems in more than
one setting are more at risk than are those whose maladaptive acts occur only in one
setting.
Attention Deficit Disorder.
Studies
of
ADD youth suggest that youngsters who show
hyperactivity in more than one setting are more at risk for behavior disturbance than
are those who exhibit such behavior in either the home or school. In the Isle of Wight
(England) study,
32%
of
children who had been identified as hyperactive in the home
and in the school (pervasive hyperactives) showed behavior disturbance four years later,
compared with
6-8%
of
those identified as hyperactive in only the home or only in the
school (situational hyperactive). Using
a
sample
of
62
clinic-referred, conduct-disordered
boys in England, Sandberg, Rutter, and Taylor
(1978)
reported that the
7
boys with
pervasive hyperactivity (those rated high by both parents and teachers on the Conners
Rating Scales) showed
a
clear pattern of cognitive and soft neurological deficits in com-
parison with the rest of the clinic sample.
Conduct Disorders.
Children who show antisocial behavior in more than one set-
ting also appear to be more at risk than those who show antisocial behavior only in
one setting. Kirkpatrick
(1978),
for instance, found that of the youth who exhibited
deviant behavior in both settings,
30.5%
had been in contact with the police by age
14,
compared with none
of
the children whose deviant behavior was restricted to the
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