Hostname: page-component-745bb68f8f-lrblm Total loading time: 0 Render date: 2025-01-09T00:31:28.875Z Has data issue: false hasContentIssue false
  • English
  • Français

Mark Twain meets DSM-III-R: Conduct disorder, development, and the concept of harmful dysfunction

Published online by Cambridge University Press:  31 October 2008

John E. Richers  and
Dante Cicchetti
John E. Richers
Affiliation:
Child and Adolescent Disorders Research Branch, National Institute of Mental Health
Dante Cicchetti
Affiliation:
Mt. Hope Family Center, University of Rochester
Get access Rights & Permissions [Opens in a new window]

Abstract

The Diagnostic and Statistical Manual (3rd ed., rev.) (DSM-III-R) diagnosis of conduct disorder assumes that all children who engage in three or more criterion antisocial behaviors for 6 months or more suffer from a mental disorder. It resists all contextual information about a child's developmental history, capacities, strengths and circumstances, and assumes that the antisocial behavior necessarily stems from an underlying disorder. In this review, we use Mark Twain's narrative of the lives of Tom Sawyer and Huckleberry Finn as a point of departure for questioning the reasonableness of this assumption, and for examining normal as well as pathological pathways to antisocial behavior. We begin by reviewing the status of earlier controversies about the mental disorder concept in the service of documenting the impressive progress of the field in conceptualizing disorder. Next, we examine Wakefield's (1992a, 1992b) recently introduced “harmful dysfunction” concept of mental disorder and employ its criteria to evaluate the hypothesis that chronic antisocial behavior in childhood as defined by DSM-III-R is caused by an underlying mental disorder. We also examine some of the difficulties in discriminating between disorder- and nondisorder-based antisocial behavior, and consider issues that warrant attention in future theoretical and empirical work. Finally, we explore the pragmatic rather than scientific basis for DSM-III-R's mental disorder claim and argue that regardless of its status as a mental disorder, this most troubling and harmful behavior syndrome of childhood deserves the intensive interest, concern, and resources of the scientific and public health communities.

Type
Articles
Information
Development and Psychopathology , Volume 5 , Issue 1-2 , Winter-Spring 1993 , pp. 5 - 29
Copyright
Copyright © Cambridge University Press 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Achenbach, T. M. (1993). Taxonomy and comorbidity of conduct problems: Evidence from empirically based approaches. Development and Psychopathology, 5, 51–64.Google Scholar
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.Google Scholar
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.Google Scholar
Ausubel, D. P. (1971). Personality disorder is disease. American Psychologist, 16, 59–74.Google Scholar
Becker, M. L. (1947). Introduction: How this book came to be written. In Twain, M., The adventures of Huckleberry Finn. Cleveland, OH: World Press.Google Scholar
Blackburn, R. (1988). On moral judgments and personality disorders: The myth of psychopathic personality revisited. British Journal of Psychiatry, 153, 505–512.Google Scholar
Bretherton, I. (1985). Attachment theory: Retrospect and prospect. Bretherton, I. & Waters, E. (Eds.), Growing points of attachment theory and research. Monographs of the Society for Research in Child Development 50(1–2, Serial No. 209), 3–35.Google Scholar
Brown, G. L., Goodwin, F. K., Ballenger, J. C., Goyer, P. F., & Major, L. F. (1979). Aggression in humans correlates with cerebrospinal fluid amine metabolites. Psychiatry Research, 1, 131–139.Google Scholar
Buss, D. M. (1984). Evolutionary biology and personality psychology: Toward a conception of human nature and individual differences. American Psychologist, 39, 1135–1147.Google Scholar
Cairns, R. B., Cairns, B. D., & Neckerman, H. J. (1989). Early school dropout: Configurations and determinants. Child Development, 60, 1437–1452.Google Scholar
Campbell, S. B. (1991). Longitudinal studies of active and aggressive preschoolers: Individual differences in early behavior and in outcome. In Cicchetti, D. & Toth, S. L. (Eds.), Rochester Symposium on Developmental Psychopathology: Vol. 2. Internalizing and externalizing expressions of dysfunction (pp. 57–89). Hillsdale, NJ: Erlbaum.Google Scholar
Campbell, S. B., Breaux, A. M., Ewing, L. J., & Szumowski, E. K. (1986). Correlates and prediction of hyperactivity and aggression: A longitudinal study of parent-referred problem preschoolers. Journal of Abnormal Child Psychology, 14, 217–234.Google Scholar
Carson, R. C. (1991). Dilemmas in the pathway of the DSM-IV. Journal of Abnormal Psychology, 100, 302–307.Google Scholar
Cartwright, S. A. (1981/1851). Report on the diseases and physical peculiarities of the human race. In Caplan, A. L., Egelhart, H. T. Jr., & McCartney, J. J. (Eds.), Concepts of health and disease: International perspectives (pp. 305–326). Reading, MA: Addison-Wesley.Google Scholar
Chamberlain, B., Ervin, F. R., Pihl, R. O., & Young, S. N. (1987). The effects of raising or lowering tryptophan levels on aggression in vervet monkeys. Pharmacology, Biochemistry, and Behavior, 28, 503–510.Google Scholar
Cicchetti, D. (1984). The emergence of developmental psychopathology. Child Development, 55, 1–7.Google Scholar
Cicchetti, D. (1989). Developmental psychopathology: Some thoughts on its evolution. Development and Psychopathology, 1, 1–4.Google Scholar
Cicchetti, D. (1990). Perspectives on the interface between normal and atypical development. Development and Psychopathology, 2(4), 329–333.CrossRefGoogle Scholar
Cicchetti, D. (1991). Fractures in the crystal: Developmental psychopathology and the emergence of self. Developmental Review, 11, 271–287.CrossRefGoogle Scholar
Cicchetti, D., Ganiban, J., & Barnett, D. (1991). Contributions from the Study of High Risk Populations to Understanding the Development of Emotion Regulation. In Garber, J. & Dodge, K. (Eds.), The development of emotion regulation and dysregulation (pp. 15–48). New York: Cambridge University Press.Google Scholar
Cicchetti, D., & Lynch, M. (1993). Toward an ecological/transactional model of community violence and child maltreatment: Consequences for children's development. Psychiatry, 56, 96–118.Google Scholar
Cicchetti, D., & Richters, J. E. (1993). Developmental considerations in the investigation of conduct disorder. Development and Psychopathology, 5, 331–344.Google Scholar
Cicchetti, D., & Schneider-Rosen, K. (1986). An organizational approach to childhood depression. In Rutter, M., Izard, C. E., & Read, P. B. (Eds.), Depression in young people: Developmental and clinical perspectives (pp. 71–134). New York: Guilford Press.Google Scholar
Cicchetti, D., & Toth, S. L. (1991). The making of a developmental psychopathologist. In Cantor, J., Spiker, C., & Lipsitt, L. (Eds.), Child behavior and development: training for diversity (pp. 34–72). Norwood, NJ: Ablex.Google Scholar
Cicchetti, D., Toth, S. L., & Bush, M. (1988). Developmental psychopathology and incompetence in childhood: Suggestions for intervention. In Lahey, B. & Kazdin, A. (Eds.) Advances in clinical child psychology (Vol. 11, pp. 1–71). New York: Plenum Press.Google Scholar
Cocarro, E. F., Siever, L. J., Klar, H. M., Maurer, G., Cochrane, K., Cooper, T. B., Mohs, R. C., & Davis, K. L. (1989). Serotonergic studies in patients with affective and personality disorders: Correlates with suicidal and impulsive aggressive behavior. Archives of General Psychiatry, 46, 587–599.Google Scholar
Cohen, H. (1981). The evolution of the concept of disease. In Caplan, A. L., Engelhardt, H. T. Jr., & McCartney, J. J. (Eds.), Concepts of health and disease: Interdisciplinary perspectives (pp. 209–220). Reading, MA: Addison-Wesley.Google Scholar
Crittenden, P. (1990). Internal representational models of attachment relationships. Infant Mental Health Journal, 11, 259–277.3.0.CO;2-J>CrossRefGoogle Scholar
Cronbach, L. J., & Meehl, P. E. (1955). Construct validity in psychological tests. Psychological Bulletin, 52, 281–302.Google Scholar
Cummings, J., & Volkman, E. (1992). Goombata: The improbable rise and fall of John Gotti and his gang. New York: Avon Books.Google Scholar
Daughterly, T. K., & Quay, H. C. (1991). Response perseveration and delayed responding in childhood behavior disorders. Journal of Child Psychiatry and Psychology, 32, 453–461.Google Scholar
Dawkins, R. (1976). The selfish gene. Oxford: Oxford University Press.Google Scholar
Dishion, T. J., & Loeber, R. (1985). Adolescent marijuana and alcohol use: The role of parents and peers revisited. American Journal of Drug and Alcohol Abuse, 11, 11–15.Google Scholar
Dishion, T. J., Patterson, G. R., & Skinner, M. S. (1989, 04). A process model for the role of peers in adolescent social adjustment. Paper presented at the biennial meeting of the Society for Research in Child Development,Kansas City, MO.Google Scholar
Dodge, K. A., Bates, J., & Pettit, G. S. (1990). Mechanisms in the cycle of violence. Science, 250, 1678–1683.Google Scholar
Dodge, K. A., Coie, J. D., Pettit, G. S., & Price, J. M. (1990). Peer status and aggression in boys' groups: Developmental and contextual analyses. Child Development, 61, 1289–1309.Google Scholar
Dodge, K. A., Murphy, R. R., & Buchsbaum, K. (1984). The assessment of intention-cue detection skills in children: Implications for developmental psychopathology. Child Development, 55, 163–173.CrossRefGoogle ScholarPubMed
Dodge, K. A., Pettit, G. S., McClaskey, C. L., & Brown, M. (1986). Social competence in children. Monographs of the Society for Research in Child Development, 51, (2, Serial No. 213).Google Scholar
Faraone, S. V., Biederman, J., Keenan, K., & Tsuang, M. T. (1991). Separation of DSM-III attention deficit disorder and conduct disorder: Evidence from a family genetic study of American child psychiatry patients. Psychological Medicine, 21, 109–121.Google Scholar
Farrington, D. P. (1993). Motivations for conduct disorder and delinquency. Development and Psychopathology, 5, 225–241.Google Scholar
Fingerhut, L. A., & Kleinman, J. C. (1990). International and interstate comparisons of homicide among young males. Journal of the American Medical Association, 263, 3292–3295.Google Scholar
Foucault, M. (1978). History of sexuality: Vol. I. An introduction. New York: Pantheon.Google Scholar
Garmezy, N. (1978). Never mind the psychologists: Is it good for the children? The Clinical Psychologist, 31 (3–4), 1–6.Google Scholar
Greenberg, M. T., Speltz, M. L., & Deklyen, M. (1993). The role of attachment in the early development of disruptive behavior problems. Development and Psychopathology, 5, 191–213.Google Scholar
Higley, J. D., Mehlman, P. T., Taub, D. M., Higley, S. B., Suomi, S. J., Linnoila, M., & Vickers, J. H. (1992). Cerebrospinal fluid monoamine and adrenal correlates of aggression in free-ranging rhesus monkeys. Archives of General Psychiatry, 49, 436–441.Google Scholar
Hinshaw, S. (1987). On the distinction between attentional deficits/hyperactivity and conduct problems/aggression in child psychopathology. Psychological Bulletin, 101, 443–463.Google Scholar
Hinshaw, S. P., Lahey, B. B., & Hart, E. L. (1993). Issues of taxonomy and comorbidity in the development of conduct disorder. Development and Psychopathology, 5, 31–49.Google Scholar
Hutschnecker, A. (1969). A plan for prevention of crime. Memo to the President of the United States on the Eisenhower Commission on Crime.Google Scholar
Institute of Medicine. (1989). Research on children and adolescents with mental, behavioral, and developmental disorders. Washington, DC: National Academy Press.Google Scholar
Jampala, V., Sierles, F., & Taylor, M. (1988). The use of DSM-III-R in the United States: A case of not going by the book. Comprehensive Psychiatry, 29, 39–47.Google Scholar
Kagan, J. (1984). The nature of the child. New York: Basic Books.Google Scholar
Kendell, R. E. (1975). The concept of disease and its implications for psychiatry. British Journal of Psychiatry, 127, 305–315.Google Scholar
Klein, D. F. (1978). A proposed definition of mental illness. In Spitzer, R. L. & Klein, D. F., (Eds.), Critical issues in psychiatric diagnosis (pp. 41–71). New York: Raven Press.Google Scholar
Kruesi, M. J. P., Hibbs, E. D., Zahn, T. P., Keysor, C. S., Hamburger, S. D., Bartko, J. J., & Rapoport, J. L. (1992). A two-year prospective follow-up study of children and adolescents with disruptive behavior disorders: Prediction by cerebrospinal fluid 5-hydroxyindoleacetic acid, homovanillic acid, and autonomic measures. Archives of General Psychiatry, 49, 429–435.CrossRefGoogle Scholar
Kruesi, M. J. P., Rapoport, J. L., Hamburger, S. D., Hibbs, E. D., Potter, W. Z., Lenare, M., & Brown, G. L. (1990). Cerebrospinal fluid monoamine metabolites, aggression, and impulsivity in disruptive behavior disorders of children and adolescents. Archives of General Psychiatry, 47, 419–426.Google Scholar
Ladd, G. S., Price, J. M., & Hart, C. H. (1990). Preschooler's behavioral orientations and patterns of peer control: Predictive of peer status? In Asher, S. R. & Coie, J. D. (Eds.), Peer rejection in childhood (pp. 90–115). Cambridge: Cambridge University Press.Google Scholar
Lahey, B. B., McBurnett, K., Loeber, R., & Hart, E. L. (in press). Psychobiology of conduct disorder. In Sholeuar, G. P. (Ed.), Conduct disorders in children and adolescents: Assessments and interventions. American Psychiatric Press.Google Scholar
Laing, R. D. (1967). The politics of experience. London: Penguin Books.Google Scholar
Lochman, J. E. (1987). Self and peer perceptions and attributional biases of aggressive and non-aggressive boys in dyadic interactions. Journal of Consulting and Clinical Psychology, 55, 404–410.Google Scholar
Loeber, R. (1988). Natural histories of conduct problems, delinquency, and associated substance use: Evidence for developmental progressions. In Lahey, B. B. & Kazdin, A. E. (Eds.), Advances in clinical child psychology (Vol. II, pp. 73–124). New York: Plenum Press.Google Scholar
Loeber, R., & Dishion, T. J. (1983). Early predictors of male delinquency: A review. Psychological Bulletin, 74, 68–99.Google Scholar
Loeber, R., & Stouthamer-Loeber, M. (1987). Prediction. In Quay, H. C. (Ed.), Handbook of juvenile delinquency (pp. 325–382). New York: Wiley.Google Scholar
Loney, J. (1987). Hyperactivity and aggression in the diagnosis of attention deficit disorder. In Lahey, B. B. & Kazdin, A. (Eds.), Advances in clinical child psychology (Vol. 10, pp. 99–135).New York: Plenum Press.Google Scholar
Lynch, M., & Cicchetti, D. (1991). Patterns of relatedness in maltreated and nonmaltreated children: Connections among multiple representational models. Development and Psychopathology, 3, 19–30.Google Scholar
McCord, J. (1993). Conduct disorder and antisocial behavior: Some thoughts about processes. Development and Psychopathology, 5, 321–329.Google Scholar
Meehl, P. E. (1973/1959). Some ruminations of the validation of clinical procedures. In Meehl, P. E. (Ed.), Psychodiagnosis: Selected papers (pp. 90–116). Minneapolis: University of Minnesota Press.Google Scholar
Meltzer, L. J., Levine, M. D., Karniski, W., Palfreg, J. S., & Clarke, S. (1984). An analysis of the learning style of adolescent delinquents. Journal of Learning Disabilities, 17, 600–608.Google Scholar
Moffitt, T. E. (1990a). Juvenile delinquency and attention-deficit disorder: Developmental trajectories from age 3 to 15. Child Development, 61, 893–910.Google Scholar
Moffitt, T. E. (1990b). The neuropsychology of delinquency: A critical review of theory and research. In Morris, N. & Tonry, M. (Eds.), Crime and justice (Vol. 12, pp. 99–169). Chicago: University of Chicago Press.Google Scholar
Moffitt, T. E. (1992). “Life-course-persistent” and “adolescent-limited” antisocial behavior: A developmental taxonomy. Psychological Review.Google Scholar
Moffitt, T. E. (1993). The neuropsychology of conduct disorder. Development and Psychopathology, 5, 135–151.Google Scholar
Moffitt, T. E., & Silva, P. A. (1988). IQ and delinquency: A direct test of the differential detection hypothesis. Journal of Abnormal Psychology, 97, 330–333.Google Scholar
Morey, L., & Ochoa, E. (1989). An investigation of adherence to diagnostic criteria: Clinical diagnosis of the DSM-III-R personality diagnosis. Journal of Personality Disorders, 3, 180–192.Google Scholar
National Institute of Mental Health. (1993). Request for applications: Cooperative agreement for epidemiological research into child and adolescent mental disorders. Washington, DC: Author.Google Scholar
Newman, J. P. (1987). Reaction to punishment in extroverts and psychopaths: Implications for the impulsive behavior of disinhibited individuals. Journal of Research in Personality, 21, 464–480.Google Scholar
Newman, J. P., & Howland, E. (1989). The effect of incentives on Wisconsin card sorting task performance in psychopaths. Unpublished manuscript, University of Wisconsin at Madison.Google Scholar
Newman, J. P., & Kosson, D. S. (1986). Passive avoidance learning in psychopathic and nonpsychopathic offenders. Journal of Abnormal Psychology, 95, 257–263.Google Scholar
Oldham, P. D., Pickering, G., Fraser Roberts, J. A., & Sowry, G. S. C. (1960). The nature of essential hypertension. Lancet, ii, 877–882.Google Scholar
Patterson, G. R., Capaldi, D., & Bank, L. (1991). An early starter model for predicting delinquency. In Pepler, D. & Rubin, K. H. (Eds.), The development and treatment of childhood aggression (pp. 139–168). Hillsdale, NJ: Erlbaum.Google Scholar
Pennington, B. F., & Bennetto, L. (1993). Main effects or transactions in the neuropsychology of conduct disorder? Commentary on “the neuropsychology of conduct disorder.” Development and Psychology, 5, 153–164.Google Scholar
Pileggi, N. (1985). Wiseguy: Life in a mafia family. New York: Pocket Books.Google Scholar
Quay, H. C. (1993). The psychobiology of undersocialized aggressive conduct disorder: A theoretical perspective. Development and Psychopathology, 5, 165–180.Google Scholar
Radke-Yarrow, M., & Zahn-Waxler, C. (1990). Research on children of affectively ill parents: Some considerations for theory and research on normal development. Development and Psychopathology, 2, 349–366.Google Scholar
Raine, A., & Venables, P. H. (1984). Electrodermal non-responding, antisocial behavior and schizoid tendencies in adolescents. Psychophysiology, 21, 424–433.Google Scholar
Raine, A., Venables, P. H., & Williams, M. A. (1990). Autonomic orienting responses in 15-year-old male subjects and criminal behavior at age 24. American Journal of Psychiatry, 147, 933–937.Google Scholar
Raliegh, M. J., Brammer, G. L., Ritvo, E. R., Geller, E., McGuire, M. T., & Yuwiler, A. (1986). Effects of chronic fenfluramine on blood serotonin, cerebrospinal fluid metabolites, and behavior in monkeys. Psychopharmacology, 90, 503–508.Google Scholar
Reid, J. B. (1993). Prevention of conduct disorder before and after school entry: Relating interventions to developmental findings. Development and Psychopathology, 5, 243–262.Google Scholar
Richters, J. E. (1993). Community violence and children's development: Toward a research agenda for the 1990's. Psychiatry, 56, 3–6.Google Scholar
Richters, J. E., & Cicchetti, D. (1993). Editorial. Toward a developmental perspective on conduct disorder. Development and Psychopathology, 5, 1–4.Google Scholar
Richters, J. E., & Martinez, P. (1993). The NIMH Community Violence Project: Children as victims and witnesses to violence. Psychiatry, 56, 7–21.Google Scholar
Richters, J. E., & Waters, E. (1991). Attachment and socialization: The positive side of social influence. In Lewis, M. & Feinman, S. (Eds.), Social influences and socialization in infancy (pp. 185–213). New York: Plenum Press.Google Scholar
Robins, L. N. (1966). Deviant children grown up. Baltimore, MD: Williams & Wilkins.Google Scholar
Robins, L. N., & Regier, D. A. (1991). Psychiatric disorders in America: The Epidemiological Catchment Area Study. New York: The Free Press.Google Scholar
Rotenberg, M. (1978). Psychopathy and differential insensitivity. In Hare, R. D. & Schalling, D. (Eds.), Psychopathic Behavior. New York: Wiley.Google Scholar
Rourke, B. P. (1985). Statistical analysis of large neuropsychological data bases: Methodological and clinical considerations. Journal of Clinical and Experimental Neuropsychology, 7, 631.Google Scholar
Rutter, M. (1986). Child psychiatry: The interface between clinical and developmental research. Psychological Medicine, 16, 151–160.Google Scholar
Sarbin, T. (1967). On the futility of the proposition that some people be labeled ‘mentally ill.’ Journal of Consulting Psychology, 31, 447–453.Google Scholar
Shapiro, S. K., Quay, H. C., Hogan, A. E., & Schwartz, K. P. (1988). Response perseveration and delayed responding in undersocialized aggressive conduct disorder. Journal of Abnormal Psychology, 97, 371–373.Google Scholar
Spitzer, R. L., Sheehy, M., & Endicott, J. (1977). Guiding principles. In Rakoff, V. M., Staneer, H. C., & Keeward, H. B. (Eds.), Psychiatric diagnosis (pp. 1–24). New York: Bruner/Mazel.Google Scholar
Sroufe, L. A., & Rutter, M. (1984). The domain of developmental psychopathology. Child Development, 55, 17–29.Google Scholar
Susman, E. J. (1993). Psychological, contextual, and psychobiological interactions: A developmental perspective on conduct disorder. Development and Psychopathology, 5, 181–189.Google Scholar
Szasz, T. S. (1960). The myth of mental illness: Foundations of a theory of personal conduct. New York: Harper & Row.Google Scholar
Szasz, T. S. (1971). The sane slave. American Journal of Psychotherapy, 25, 228–239.Google Scholar
Taylor, V. A. (1989). The vote on DSM-IV. Archives of General Psychiatry, 46, 959.Google Scholar
Twain, M. (1876/1950). The adventures of Tom Sawyer. Middlesex, England: Penguin Books, Ltd.Google Scholar
Twain, M. (1947). The adventures of Huckleberry Finn. Cleveland, OH: World Publishing.Google Scholar
Wakefield, J. C. (1992a). The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist, 47, 373–388.Google Scholar
Wakefield, J. C. (1992b). Disorder as harmful dysfunction: A conceptual critique of DSM-III-R's definition of mental disorder. Psychological Review, 99, 232–247.Google Scholar
Walker, J. L., Lahey, B. B., Russo, M. F., Christ, M. A. G., McBurnett, K., Loeber, R., Stouthamer-Loeber, M., & Green, S. M. (1991). Anxiety, inhibition, and conduct disorder in children: Relations to social impairment. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 187–191.Google Scholar
Washington Post (1970, 04 10). Dr. Hutschnecker's modest proposal. Washington Post, p. A18.Google Scholar
Waters, E., Vaughn, B., & Egeland, B. (1980). Individual differences in infant-mother attachment. Antecedents in neonatal behavior in an urban economically disadvantaged sample. Child Development, 51, 208–216.Google Scholar
White, J., Moffitt, T. E., Caspi, A., Needles, D. J., & Stouthamer-Loeber, M. (in press). Measuring impulsivity and examining its relationship to delinquency. In Sholeva, G. P. (Ed.), Conduct disorders in children and adolescents: Assessments and interventions. Washington, DC: American Psychiatric Press.Google Scholar
Wilson, M. (1993). DSM-III and the Transformation of American Psychiatry. American Journal of Psychiatry, 150, 399–410.Google Scholar
Zoccohillo, M. (1992). Co-occurrence of conduct disorder and its adult outcomes with depressive and anxiety disorders: A review. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 547–556.Google Scholar
Zoccohillo, M., Pickles, A., Quinton, D., & Rutter, M. (1992). The outcome of childhood conduct disorder: Implications for defining adult personality disorder. Psychological Medicine, 22, 971–986.Google Scholar
Zubin, J. (1978). But is it good for science? Clinical Psychologist, 31(2), 1–7.Google Scholar
Zubin, J., & Spring, B. (1977). Vulnerability - A new view of schizophrenia. Journal of Abnormal Psychology, 86, 103–126.Google Scholar