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Attachment Characteristics and Behavioural Problems in Rural and Urban Juvenile Delinquents Frank J. Elgar, PhD Cardiff University

John Knight, MSc Graham J. Worrall, MBBS, MSc Gregory Sherman, MD Memorial University of Newfoundland

ABSTRACT: Self-reported attachment characteristics, substance use and behavioural problems were assessed in 68 male juvenile delinquents from rural and urban areas. As was predicted, insecure attachment characteristics were related to behavioural problems, substance use, and poor family functioning. Urban delinquents reported more substance use and more interpersonal problems with peers and family members than their rural counterparts. Contextual influences on adolescent attachment relationships and adjustment problems may have implications for the administration and delivery of psychological treatments in youth correctional settings. KEY WORDS: attachment; juvenile delinquency; conduct problems; rural/urban differences; Adolescent Attachment Questionnaire.

Disruptive behavioural problems in young people are characterised by persistent patterns of behaviour that violate both the rights of others and age-appropriate norms.1 Since these norms are established by criminal law and the diagnostic criteria for Conduct Disorder reflect law violations, studying delinquent youth allows an examination of the social, emotional, and behavioural characteristics of conduct problems in a population with elevated rates of behavioural problems. Yet, This research was supported by a research grant from the Janeway Research Advisory Committee, St. John’s Health Care Corporation awarded to all four authors and by doctoral fellowships from the Hospital for Sick Children Foundation and Nova Scotia Health Research Foundation awarded to Frank Elgar. We thank Theresa Kerrivan for her assistance with the data entry, Trudi Walsh and Dan Waschbusch for comments on earlier drafts of this manuscript, and the staff and residents of the Newfoundland and Labrador Youth Centre for their cooperation. Address correspondence to Frank J. Elgar, School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, Wales CF10 3WT; e-mail: [email protected]. Child Psychiatry and Human Development, Vol. 34(1), Fall 2003  2003 Human Sciences Press, Inc.

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Child Psychiatry and Human Development

few quantitative studies have reported on the attachment characteristics of this special population of disturbed youth. It is undetermined how closely linked the quality of attachment relationships is to substance use, social and academic functioning, and behavioural problems in juvenile delinquents. Disruptive behavioural problems (Conduct Disorder and Oppositional Defiant Disorder) afflict about 8% of male adolescents and are generally stable conditions that, left untreated, can develop to sociopathic behaviour in adulthood.2,3 One study that followed 305 individuals for 15 years found that the risk of criminal arrest of adult men was increased threefold by hyperactivity during childhood and sevenfold by conduct problems during childhood.4 Identifying the most salient predictors of disruptive behavioural problems remains an ongoing research priority. The link between parent-child attachment and juvenile crime was first proposed by Bowlby, who described the attachment relationship as an innate tendency for infants and caregivers to respond to one another in ways that increase the likelihood of survival through proximity in times of stress.5,6 Sensitive and responsive parenting promotes the expectation of care when necessary, which influences the child’s socioemotional development and ability to form secure attachment relationships during adolescence.7 Bowlby emphasised the importance of attachment relationships in behavioural problems involving distrust or chronic anxiety, stating that unmet needs for security can lead the child to view the world as “comfortless and unpredictable, and they respond either by shrinking from it or doing battle with it” (p. 208).8 Difficult parent-child relations and inadequate parent discipline—potential sequelae of insecure attachment—have also been identified as developmental precursors to disruptive and antisocial behaviour in adolescents.9 Research on the predictive significance of attachment insecurity in adolescent conduct problems has been hindered by the challenges associated with conducting cohort studies that are large enough to adequately predict low-prevalence disorders. Cohort studies are particularly difficult with special populations, such as incarcerated youth whose anonymity is often protected by law. However, cohort studies of community adolescents have shown that insecure attachment and negative caregiver-child interactions both increase the risk of inhibited, hypervigilant, or ambivalent responses to adult caregivers, indiscriminate sociability, and externalised psychopathology.10,11,12 Insecurely attached children, compared to securely attached children, are

F. J. Elgar, J. Knight, G. J. Worrall, and G. Sherman

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more likely to feel mistrust and anger towards the caregiver, to fail to internalise the caregiver’s values, and to have less opportunity to develop the skills needed to regulate affect.13,14 The Minnesota MotherChild Project found that children who were insecurely attached as infants were more likely to have poor peer relations and more symptoms of aggression and depression in childhood.15 Lewis and colleagues also found that insecure attachment classification in boys at one year of age was significantly related to psychopathology at six years of age.16 Lyons-Ruth and colleagues reported similar results and suggested that disorganized/disoriented attachment classifications during infancy are more strongly related to child aggression than other insecure attachment classifications.11,17 As well, through qualitative interview data collected from inner city adolescents, the Denver Youth Study found that the quality of attachment relationships were linked to both delinquency and victimisation from violent and property crimes five years later.18 Cross-sectional studies of attachment and psychopathology have also found associations between insecure attachment relationships and conduct problems.19,20 Studies by DeKlyen and colleagues found that a disproportionately large number of children who were referred for oppositional defiant disorder or who were rated high on the aggression scale of the Child Behaviour Checklist showed insecure attachment characteristics.21,22 There are also data to suggest that insecure attachment plays a particularly prominent role in violent and sex offences.23,24 Marcus and Gray found that violent young offenders, compared to non-violent young offenders, were more likely to perceive their mothers as showing more rejection/undifferentiated behaviour and that their attachments (mainly to heterosexual partners) were more anxious.25 While there have been several good community studies showing a link between attachment security and conduct problems, most of the research done on attachment characteristics of juvenile delinquents has been qualitative and, thus, has not produced comparable data for this population. Moreover, this research literature is nearly entirely urban-based. Studies of community adolescents have shown rural/urban differences in point prevalence rates of behavioural problems, with urban males showing higher rates of externalising behaviours than their rural counterparts.26,27 We are aware of no studies that directly investigated rural/urban differences in the psychological functioning of delinquent youth. This need for further study may contribute to a paucity of guidance for mental health professionals who administer

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and deliver treatments to delinquent youth from rural and urban areas. The goals of the present study were (1) to examine levels of, and relations between, self-reported attachment characteristics and behavioural problems in a sample of confined young offenders, and (2) to study rural/urban differences in the degree of disturbances in these domains. Based on previous studies of attachment characteristics of community and clinical adolescents, it was hypothesised that insecure attachment characteristics would correlate with internalising and externalising behavioural problems in juvenile delinquents. Also, based on rural/urban differences in levels of externalising behaviours in community male adolescents, it was hypothesised that urban male delinquents would report higher rates of externalising behaviours than rural male delinquents.

Method Participants Participants were recruited from the Newfoundland and Labrador Youth Centre (Whitbourne, NF), the only secure custodial facility for young offenders in the Canadian province of Newfoundland and Labrador. The Centre normally has a population between 30 and 50 residents who are sentenced for a variety of crimes, most commonly related to disruptive conduct. Over a period of 18 months, 76 consecutive newly admitted delinquents were asked to participate in the study, of which 70 (92.11%) agreed. Two participants (2.86%) were female and were later dropped from the analysis to simplify data interpretation. Of the 68 remaining male participants, 24 (35.29%) were from urban centres, 41 (60.29%) were from rural communities and 3 (4.41%) had lived in both rural and urban settings (“rural” was defined as communities with populations under 2,500).27 Participants ranged from 15 to 18 years of age (M = 16.76, SD = 0.74). Nineteen (27.94%) indicated that their families received some form of income support (e.g., social assistance, employment benefits), and 46 (67.65%) indicated that at least one parent or guardian was employed. The study was granted ethical approval by the Human Investigations Committee of the Faculty of Medicine, Memorial University of Newfoundland.

Measures Adolescent Attachment Questionnaire (AAQ). The AAQ is a 9-item selfreport questionnaire that assesses attachment characteristics in adolescents.7 The AAQ has three subscales that reflect the degree of adolescents’ (1) confidence in the availability of the attachment figure (Availability), (2) empathy


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towards the needs of the attachment figure (Goal-Directed Partnership), and (3) anger towards the attachment figure (Angry/Distress). Responses to each item (e.g., “My parent only seems to notice me when I am angry”) are made on a 5-point scale that ranges from “strongly disagree” to “strongly agree.” Scores in the Availability and Goal-Directed Subscales are reversed so that higher scores on all three subscales reflect less secure attachment characteristics. In clinic-referred adolescents, West et al.7 demonstrated adequate convergent validity of the AAQ subscales (Availability, Goal-Directed Partnership and Angry/Distress) to the attachment classifications of the more widely used Adult Attachment Interview (AAI) (Autonomous, Preoccupied and Dismissing, respectively).28 The subscales of the AAQ have been shown to be reliable over time (3-month test-retest reliability coefficients range from .69 to .73) and internally consistent.7 Alpha coefficients in the present study were .80 (Availability), .85 (Goal-Directed Partnership) and .59 (Angry/Distress). Drug Use Screening Inventory-Revised (DUSI-R). The DUSI-R is a 159-item computerised self-report questionnaire that assesses adolescents’ involvement with drugs and alcohol in addition to social competence, family functioning, academic performance, and peer relations.29 The DUSI-R contains ten factoranalytically-derived subscales and an overall problem density index. The domains are Substance Use (e.g., degree of involvement), Behaviour Patterns (e.g., acting out, social isolation), Health Status (e.g., accidents, injuries and illnesses), Psychiatric Disorder (e.g., antisocial and psychotic symptoms, depression, anxiety), Social Competence (e.g., quality of interactions, social skills), Family System (e.g., dysfunction, conflict, parental supervision, marital quality), School Performance (academic performance, adjustment at school), Work Adjustment (e.g., competence at work, motivation to work), Peer Relations (e.g., gang involvement, quality of friendships), and Leisure/Recreation (e.g., quality of leisure activities). Higher scores reflect greater severity of problems in each domain. In addition, a “lie scale” that ranges between 0 and 10 is scored by counting the number of no responses to the last item in each domain. The authors of the DUSI-R recommend that a score of 5 or higher on the lie scale indicates possible invalidity of the data due to deliberate deception by the respondent. These 10 items are not used in computing total problem density. The DUSI-R has been shown to be reliable over time (one-week test-reliability coefficients range from .95 to .88) and internally consistent.30,31 In the present study, alpha coefficients in DUSI-R subscales ranged from .72 to .83. Youth Self-Report (YSR). The YSR is a 112-item self-report questionnaire that assesses in a standardised format the social competencies and behavioural problems of children and adolescents age 11 to 18 years.32 It is a widelyused self-report assessment tool in clinical and community settings. The YSR measures two main classes of problems—internalising and externalising behaviour—which include eight subscales (withdrawn, somatic complaints, anxiety and depression, social problems, thought problems, attention problems, aggressive behaviour, and delinquent behaviours). Male respondents are scored on an additional subscale measuring self-destructive/identity problems. Higher scores reflect greater severity of behavioural problems. YSR scores have been

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found to be stable over time (one-week test-retest reliability coefficients range from .65 to .83).32 Good internal consistency was found in the present study; alpha coefficients were .90 (internalising problems), .89 (externalising problems), and .73 (self-destructive/identity problems).

Procedure A research assistant met individually with each participant in an interview room and administered the survey questionnaires in random order. The research assistant offered help to participants in reading and interpreting assessment items that they had difficulty with. The AAQ and YSR were completed in paper format and the DUSI-R was completed using the computerised Version II (www.dusi.com). The three instruments were completed together in one occasion. All data were stored anonymously in a computer database with unique code numbers assigned to participants.

Results Descriptive statistics on scores from the AAQ, DUSI-R and YSR are shown in Table 1. Skewness statistics above 1.00, reflecting a significant number of extreme cases above the mean, were found in the GoalDirected Partnership subscale of the AAQ and the Behaviour Patterns and Problem Density subscales of the DUSI-R. None of the 68 cases scored 5 or higher on the DUSI-R lie scale. Using Spearman correlations and ANOVAs, it was found that attachment characteristics and substance use and behavioural problems were unrelated to family size, rs = .02 to .13, ps > .10, birth order, rs = .04 to .11, ps > .10, and whether or not participants’ families received income support, Fs = .01 to .08, ps > .10. Also, rural and urban samples were equivalent on each of these demographic indicators, Fs = .21 to .33, ps > .10. Correlations between measures are shown in Table 2. Attachment characteristics correlated most highly with Family Status, a DUSI-R subscale that measures substance use and criminal behaviour by parents and general family functioning. Two of three AAQ subscales correlated positively with behavioural problems. Angry/Distress correlated with Family Status, Peer Relations, Psychiatric Disorder and Problem Density subscales of the DUSI-R and with all YSR problem scores, including Self-Destructive/Identity problems. Availability correlated with DUSI-R Family Status, Social Competence, and Problem Density subscales and all YSR problem scores. However, Goal-Directed Partnership correlated only with Substance Use. Overall, AAQ sub-

Measure AAQ Angry/Distress Availability Goal-Directed Partnership DUSI-R Substance Use Behaviour Patterns Health Status Psychiatric Disorder Social Competence Family System School Performance Work Adjustment Peer Relations Leisure/Recreation Problem Density YSR Internalising Problems Externalising Problems Self-Destuctive Problems Total Problems

Range (min, max) 10 (3, 13) 12 (3, 15) 12 (3, 15) 167 (7, 173) 105 (15, 120) 110.00 (0, 110) 95 (15, 110) 71 (0, 71) 107 (7, 114) 110 (20, 130) 80 (0, 80) 136 (0, 136) 108 (17, 125) 56 (10, 66) 45 49 29 43

(32, (41, (50, (37,

77) 90) 79) 80)

M (SE)

SD

Kurtosis (SE)

Skewness (SE)

5.87 (.32) 7.06 (.41) 6.25 (.38)

2.61 3.33 3.12

−.42 ( .58) −.47 ( .58) 1.09 ( .58)

.68 (.29) .75 (.29) 1.20 (.29) .58 1.46 .67 .67 .06 .58 .62 .31 .12 .44 1.40

67.70 51.85 42.56 53.15 34.40 47.95 64.13 33.51 71.53 59.58 49.98

(4.53) (3.14) (3.00) (2.83) (2.14) (3.40) (3.36) (2.34) (3.29) (3.26) (1.73)

30.70 21.30 20.37 19.22 14.50 23.07 22.78 15.87 22.29 22.09 11.75

2.05 3.30 1.79 .69 .69 .59 1.41 .78 3.97 .58 2.50

( ( ( ( ( ( ( ( ( ( (

.69) .69) .69) .67) .69) .69) .69) .69) .69) .69) .69)

56.62 65.22 61.00 62.28

(1.34) (1.27) (.97) (1.20)

11.15 10.55 8.03 9.93

−.48 .57 −.84 .06

( .57) (−.21) ( .57) ( .57)

(.35) (.35) (.35) (.35) (.35) (.35) (.35) (.35) (.35) (.35) (.35)


Table 1 Descriptive Statistics for the AAQ, DUSI-R and YSR

−.42 (.29) −.21 (.29) .12 (.29) −.59 (.29) 41

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Table 2 Spearman Correlations Between Attachment Characteristics and Substance Use and Behavioural Problems

AAQ 1. Angry/Distress 2. Availability 3. Goal-Directed Partnership DUSI-R 4. Behaviour Patterns 5. Family Status 6. Health Problems 7. Leisure/Recreation 8. Peer Relations 9. Psychiatric Disorder 10. School Performance 11. Social Competence 12. Substance Use 13. Work Adjustment 14. Problem Density YSR 15. Internalising Problems 16. Externalising Problems 17. Self-Destructive Problems 18. Total Problems

1

2

3

— .49* .21

— .52*

—

.19 .50* .20 .13 .30* .34* .17 .25 .23 −.02 .32*

.16 .44* .23 .11 .23 .22 .19 .31* .26 .07 .40*

.23 .16 .06 .26 .26 .14 .19 .22 .30* .25 .25

.36* .34* .39* .41*

.28* .30* .34* .35*

.05 .20 .07 .12

*p < .05.

scales Angry/Distress and Availability were correlated significantly with the problem indices on the DUSI-R and YSR. As seen in Table 3, ANOVA comparisons of levels of substance use and behavioural problems revealed significant differences between rural and urban samples. Urban delinquents reported more problems than rural delinquents on several DUSI-R subscales (Substance Use, Behaviour Patterns, Health Status, Psychiatric Disorder, and School Performance). On the YSR, urban delinquents also reported more externalising problems and more overall problems than rural delinquents.

Discussion The goal of this study was to examine relations between selfreported attachment characteristics and substance use and behav-


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Table 3 Mean Attachment Characteristics and Behavioural Problems in Rural and Urban Male Juvenile Delinquents (SD) Measure AAQ Angry/Distress Availability Goal-Directed Partnership DUSI-R Substance Use Behaviour Patterns Health Status Psychiatric Disorder Social Competence Family System School Performance Work Adjustment Peer Relations Leisure/Recreation Problem Density YSR Internalising Problems Externalising Problems Self-Destructive Problems Total Problems

Rural

Urban

5.51 (2.55) 6.64 (3.12) 6.03 (2.61)

6.38 (2.67) 7.33 (3.44) 6.54 (3.72)

55.60 45.59 35.40 48.21 32.90 43.62 57.70 30.86 65.01 55.06 48.10

(24.81) (14.59) (52.16) (14.93) (15.34) (22.36) (16.92) (13.37) (20.16) (19.33) (12.88)

87.10 64.34 52.16 62.35 37.67 56.14 78.62 39.94 82.43 68.38 53.38

(31.80) (26.94) (21.96) (23.50) (14.19) (24.34) (25.65) (18.37) (23.80) (25.01) (10.37)

55.27 62.59 60.29 60.20

(12.17) (10.45) (8.72) (10.52)

58.50 69.58 61.92 65.71

(9.82) (7.49) (6.41) (7.38)

*p < .05; **p < .01.

ioural problems in a sample of juvenile delinquents and to compare rural and urban delinquents in rates of such problems. With regard to the first hypothesis, these data indicate that insecure attachment characteristics were related to internalising and externalising behaviours as well as problems in family functioning and peer relationships. This relation was particularly strong between attachment characteristics and family functioning—two distinct, but closely associated constructs.5,6 Behavioural problems related to just two of the three subscales of the AAQ—Angry/Distress and Availability. Similar results were found in an early validation study of the AAQ in which these same two subscales correlated with depressive and suicidal behaviours in clinic-referred adolescents,33 and in unpublished dissertation studies that found relations between the AAQ subscales Angry/Distress and Availability and solvent abuse and antisocial behaviour in native adolescents,34 and poor social information processing and ag-

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gressive behaviour in juvenile delinquents.35,36 Consistent with Bowlby’s theory, which emphasised the importance of perceived availability, responsiveness and supportiveness of the attachment figure and the detrimental effects of frustration and anger directed towards the attachment figure,8 we found that juvenile delinquents who reported feeling angry or “let down” by their primary caregiver tended also to report more difficulties in social and emotional functioning. These results are also consistent with studies of clinic-referred and community adolescents who were assessed using the AAI. The Angry/ Distress and Availability subscales of the AAQ show good convergent validity with the Preoccupied and Autonomous classifications of the AAI respectively,7 and studies have found that Preoccupied and Autonomous attachment classifications are associated with anxious and depressive symptoms.37 Interestingly, just one dimension of attachment (Goal-Directed Partnership) was associated with substance use but not with behavioural problems, while the two other dimensions of attachment (Angry/Distress and Availability) were associated with behavioural problems but not substance use. While cross-sectional correlations are only suggestive of qualitative differences between attachment classifications and types of adjustment problems, they do suggest that connection between insecure attachment and substance use problems may be mediated by other factors (e.g., peer influences).9 Also, it is not clear from these results whether the Goal-Directed Partnership subscale of the AAQ measures a construct that is unrelated to behavioural problems or is prone to generating positively skewed data in high risk adolescents, thereby precluding significant correlations due to a “ceiling effect.” Additional research is needed to elucidate the psychometric properties of the AAQ in relation to well-established behavioural assessments. Regarding the second hypothesis, it was found that juvenile delinquents from urban environments report more substance use, more behavioural problems, poorer health, poorer academic performance and more difficulty in peer relationships than young delinquents from rural communities. This difference is particularly intriguing given that it is likely that both samples had approximately the same number of previous encounters with the law. This rural/urban difference corresponds to studies of community adolescents and may be attributed to greater opportunities to join deviant peer groups in urban environments.9,27 These results contribute to a small but essential research literature on rural mental health. An implication for administrators


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and clinicians who organise and provide psychological treatments to juvenile delinquents is that the health needs of the population may vary as a function of whether they are from urban or rural home environments. In all, this sample of juvenile delinquents reported considerably elevated levels of internalising, externalising, and self-destructive behavioural problems. YSR scores far exceeded norms for both community and clinical samples of male adolescents.33 DUSI-R Problem Density scores showed significant positive skewness, indicative of a significant number of cases at the high end of the scale. In fact, based on the criterion of 24% or higher Problem Density that Tarter and colleagues used with 84% accuracy in screening community adolescents for Substance Use Disorder,24 it may be inferred that 80% of this sample of juvenile delinquents may be diagnosed with the Disorder. These are crude indicators of the prevalence of psychological problems, but in comparison to normative data, these data reflect high rates of emotional and behavioural disturbances in this population. A significant limitation of the study is the reliance on self-report data. Though none of the participants indicated that his responses were untruthful, additional sources of information (e.g., parental reports, psychiatric assessments) may have provided more complete assessments. Also, a cross-sectional study such as this does not inform about either direction of influence between attachment characteristics and adjustment problems or about the influence of unmeasured explanatory variables (e.g., parental criminality or psychiatric disorders). While the theoretical premise of attachment security suggests that insecure attachment is likely to precede behavioural disturbances, it cannot be ruled out that ambivalent or negative feelings towards caregivers may coincide with or follow behavioural disturbances. In light of these methodological caveats, these findings are unique in that they may be the first published data from the AAQ in a population of juvenile delinquent youth. An association was found between attachment insecurity and the health and behaviour of delinquent youth. Given the potential significance of attachment insecurity in the developmental course of antisocial behaviour, treatment recommendations have emphasised family involvement in behavioural interventions,38 and evaluation studies have demonstrated cost-effective methods to include caregivers in rehabilitation programs for delinquent youth.39 Still, further study is needed on this population to establish the empirical base for such interventions, such as longitudinal re-

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search on the long-term predictive significance of attachment in future criminal behaviour and the influence of caregiver characteristics on attachment security. Moreover, because the length and complexity of the AAI protocol have posed challenges in assessing adolescents with attention problems, the development of the AAQ presents an important opportunity to examine attachment characteristics in adolescents who show hyperactive, inattentive or aggressive behaviours.7 Such research may add to the evidence base for family-oriented rehabilitation of juvenile delinquents.

Summary The purpose of the present study was to examine cross-sectional associations between attachment characteristics and substance use and behavioural problems in a sample of male juvenile delinquents and rural/urban differences in these problems. Consistent with previous studies, it was found that insecure attachment characteristics correlated with behavioural problems, substance use, and poor family functioning. It was also found that urban delinquents, compared to their rural counterparts, reported more substance use problems, more interpersonal problems with peers and family members, and more externalising behaviour (e.g., hyperactivity, aggression, inattention). Such rural/urban differences highlight the importance of contextual influences on adolescent psychopathology and criminality and the administration and delivery of psychological treatments in youth correctional settings.

References 1. World Health Organisation: The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva, Author, 1992. 2. Offord DR, Boyle MH, Szatmari P, Rae-Grant NI, Links PS, Cadman DT, Byles JA, Crawford JW, Blum HM, Byrne C, Thomas H, Woodward CA: Six month prevalence of disorder and rates of service utilization. Arch Gen Psychiatry. 1987 Sep;44(9): 832–6. 3. McMahon RJ, Wells KC: Conduct problems. In: Treatment of Childhood Disorders, ed. Mash EJ, Barkley RA. New York: Guilford, 1998. 4. Babinski LM, Hartsough CS, Lambert NM: Childhood conduct problems, hyperactivity-impulsivity, and inattention as predictors of adult criminal activity. J Child Psychol Psychiatry. 1999 Mar;40(3):347–55. 5. Bowlby J: Forty-four Juvenile Thieves: Their Characters and Home-life. In: The


6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24.

25. 26.

47

Mark of Cain: Psychoanalytic Insight and the Psychopath, ed. Meloy JR. Hillsdale, NJ: Analytic Press, 1944. Bowlby J: A Secure Base: Parent-child Attachment and Healthy Human Development. New York: Basic Books, 1988. West M, Rose M, Spreng S, Sheldon-Keller A, Adam K: Adolescent Attachment Questionnaire: a brief assessment of attachment in adolescence. J Youth Adoles. 1998 Oct;27(5):661–73. Bowlby J: Attachment and Loss Vol II. Separation. New York: Basic Books, 1973. Patterson GR, Reid JB, Dishion TJ: Antisocial Boys. Eugene, OR: Castalia, 1992. Lewis M, Feiring C, McGuffog C, Jaskir J: Predicting psychopathology in six-yearolds from early social relations. Child Dev. 1984 Feb;55(1):123–36. Lyons-Ruth K, Alpern L, Repacholi B: Disorganized infant attachment classification and maternal psychosocial problems as predictors of hostile-aggressive behavior in the preschool classroom. Child Dev. 1993 Apr;64(2):572–85. Wasserman GA, Miller LS, Pinner E, Jaramillo B: Parenting predictors of early conduct problems in urban, high-risk boys. J Am Acad Child Adolesc Psychiatry. 1996 Sep;35(9):1227–36. Cummings ME, Davies P: Emotional security as a regulatory process in normal development and the development of psychopathology. Dev Psychopathol. 1996 Jan; 8(1):123–39. DeKlyen M, Speltz ML: Attachment and conduct disorder. In: Conduct Disorders in Childhood and Adolescence., ed. Hill J, Maughan B. New York: Cambridge University Press, 2001. Egeland B, Sroufe LA: Developmental sequelae of maltreatment in infancy. New Directions for Child Development. 1981;11:77–92. Lewis M, Feiring C, McGuffog C, Jaskir J: Predicting psychopathology in six-yearolds from early social relations. Child Dev. 1984 Feb;55(1):123–36. Lyons-Ruth K, Easterbrooks MA, Cibelli CD: Infant attachment strategies, infant mental lag, and maternal depressive symptoms: predictors of internalizing and externalizing problems at age 7. Dev Psychol. 1997 Jul;33(4):681–92. Esbensen FA, Huizinga D, Menard S: Family context and criminal victimization in adolescence. Youth and Society. 1999 Mar;31(2):168–98. Moss E, Rousseau D, Parent S, St-Laurent D, Saintonge J: Correlates of attachment at school age: maternal reported stress, mother-child interaction, and behavior problems. Child Dev. 1998 Oct;69(5):1390–405. Gardner FE: Positive interaction between mothers and conduct-problem children: is there training for harmony as well as fighting? J Abnorm Child Psychol. 1987 Jun;15(2):283–93. DeKlyen M: Disruptive behavior disorder and intergenerational attachment patterns: a comparison of clinic-referred and normally functioning preschoolers and their mothers. J Consult Clin Psychol. 1996 Apr;64(2):357–65. Speltz ML, Greenberg MT, DeKlyen M: Attachment in preschoolers with disruptive behaviour:a comparison of clinic-referred and nonproblem children. Development and Psychopathology. 1990;2:31–46. Marshall WL, Hudson SM, Hodkinson S: The importance of attachment bonds in the development of juvenile sex offending. In: The Juvenile Sex Offender., ed. Barbaree HE, Marshall WL, Hudson SM. New York: Guilford Press, 1993. Smallbone SW, Dadds MR: Childhood attachment and adult attachment in incarcerated adult male sex offenders. Journal of Interpersonal Violence. 1998;13(5): 555–73. Marcus RF, Gray L Jr: Close relationships of violent and nonviolent African American delinquents. Violence Vict. 1998 Spring;13(1):31–46. Atkins FD, Krantz S: Stress and coping among Missouri rural and urban children. J Rural Health. 1993 Spring;9(2):149–56.

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27. Elgar FJ, Arlett C, Groves R: Rural-urban differences in stress, coping styles and behavioural problems in adolescents. J Adoles. In press, 2003. 28. Main M, Goldwyn R: Adult Attachment Scoring and Classification System,I unpublished manuscript. Berkeley (CA): Univ of California, 1994. 29. Tarter RE: Evaluation and treatment of adolescent substance abuse: a decision tree method. Am J Drug Alcohol Abuse. 1990;16(1–2):1–46. 30. Tarter R, Mezzich A, Kirisci N: Reliability of the Drug Use Screening Inventory among adolescent alcoholics. J Adolesc Subst Abuse 1994;3(1):25–36. 31. Kirisci L, Tarter RE, Hsu TC. Fitting a two-parameter logistic item response model to clarify the psychometric properties of the Drug Use Screening Inventory for adolescent alcohol and drug abusers. Alcohol Clin Exp Res. 1994 Dec;18(6):1335–41. 32. Achenbach TM: Manual for the Youth Self-Report and 1991 Profile. Burlington (VT): University of Vermont, Department of Psychiatry, 1991. 33. West ML, Spreng SW, Rose SM, Adam KS. Relationship between attachment-felt security and history of suicidal behaviours in clinical adolescents. Can J Psychiatry. 1999 Aug;44(6):578–82. 34. Hammond WA: Canadian Native Adolescent Solvent Abuse and Attachment Theory [dissertation]. Calgary, Canada: Univ of Calgary; 2000. 35. Gurevich LA: Insecure attachment and deviant social information processing as mechanisms associated with violent behavior in adolescent offenders [dissertation]. Charlottesville (VA): Univ of Virginia; 1997. 36. Vermeer SM: Quality of attachment and social problem-solving in juvenile delinquents [dissertation]. Charlottesville (VA): Univ of Virginia; 1997. 37. Armsden GC, McCauley E, Greenberg MT, Burke PM, Mitchell JR: Parent and peer attachment in early adolescent depression. J Abnorm Child Psychol. 1990 Dec; 18(6):683–97. 38. Carr A: What Works With Children and Adolescents? A Critical Review of Psychological Interventions with Children, Adolescents and their Families. New York: Routledge, 2000. 39. Greenwood PW, Model KE, Hydell CP, Chiesa JR: Diverting Children from a Life of Crime: Measuring Costs and Benefits. Santa Monica, CA: Rand Corporation, 1996.