Risk Factors Associated with the Co-Occurrence of Hyperactivity-Impulsivity-Inattention and Conduct Problems.

American society recently has been confronted by children and youths who display a behavior pattern marked by highly aggressive, antisocial behaviors that harm others and disrupt school ecologies. These children come to school from backgrounds in which antisocial behavior is prototypical rather than atypical. They are highly agitated and invested in antisocial attitudes and beliefs that legitimize violent solutions to interpersonal problems with peers and adults (Cole, 1985; Walker & Gresham, 1997). Frequently these children misinterpret neutral behaviors as hostile and confrontational, which prompts an aggressive and, in some instances, lethal response (Dodge, 1993). This reactive aggression, coupled with easy access to alcohol, recreational drugs, and weapons, sets the stage for a host of violent exchanges. Antisocial behavior can be defined as recurrent violations of socially acceptable behavior patterns (Simcha-Fagan, Langner, Gersten, & Eisenberg, 1975). Specific characteristics include hostility toward others, aggressive behavior, defiance of authority figures, and persistent violations of social norms. Prevalence rates for antisocial behavior in the general population range from 2% to 6%, reflecting between 1.3 and 3.8 million students (Kazdin 1993; Walker, Colvin, & Ramsey, 1995). Some 55% of all crimes are committed by juvenile delinquents, with 87% of these offenders between ages 11 and 17 years meeting diagnostic criteria for conduct disorder (Eppright, Kashani, Robinson, & Reid, 1993). Kazdin (1987) indicated that there is a small window of opportunity to intervene effectively with this population; namely, antisocial behavior is developmentally salient by age 3 and is relatively stable by age 8. After age 8, antisocial behavior can be viewed as a chronic disorder requiring ongoing management and support. Furthermore, antisocial behavior patterns tend to be stable over time and are typically resistant to intervention (Gresham, 1991; Lane, 1999). Bullis and Walker (1994) indicated that interventions implemented after age 8 are no longer preventative in nature; instead the focus shifts to remediation. This is of particular concern given that referrals for specialized services typically are not made until second or third grade (Forness, 1981). Without early intervention, these children tend to experience numerous long-term negative outcomes-including academic underachievement, impaired social relationships, increased rates and types of aggressive behavior, substance abuse, and delinquent behaviors-that collectively result in significant costs to society as well as the students themselves (Kazdin, 1987; Walker et al., 1995). If that is not disconcerting enough, there appears to be a particularly virulent strain of antisocial behavior that is even more disturbing-the fledgling psychopath (Lynam, 1996). Fledgling Psychopath Current research has recently identified a group of children and youths who are at a heightened risk for developing a lifelong insidious pattern of antisocial and delinquent behavior. These children exhibit behaviors characterized by hyperactivity-impulsivity-- inattention (HIA) and conduct problems (CP). Their behavioral repertoire includes fighting, stealing, truancy, noncompliance, and arguing and simultaneously lacks behaviors such as empathy, compassion, and honesty. Using terminology from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV, American Psychiatric Association, 1994), these children would be diagnosed as being comorbid for attention deficit with hyperactivity disorder (ADHD) and conduct disorder (CD). Hinshaw (1987) stated that aggressive, antisocial conduct problems and hyperactivity-- impulsivity--inattention are the two most common types of behavioral problems resulting in referral to mental health services. Although these two classes of behavior receive different DSM-IV classifications (i.e., CD and ADHD respectively), the research community has questioned whether or not these two classes represent distinctly separate entities (Barkley, 1982; Farrington, Loeber, & Van Kammen, 1990; Loney & Milich, 1982). …