LETTERS TO THE EDITOR was totally omitted from DSM-JIl-R and can only be entered as conduct disorder-undifferentiated type, which it does not fit. This unsocialized runaway category of conduct disorder has been described (Jenkins. 1971, Jenkins and Stahle. 1972) and offers a prognosis for continued delinquency and adult crime significantly worse than conduct disorder, group tvpe (Jenkins, 1980). It seems a little ironic that the delinquent whose story has been most widely used in courses in colleges and universities, should be "Stanley." His story was published in The Jack-Roller by Clifford Shaw in 1930 and reprinted in 1960. Stanley was a classical picture of the runaway reaction as described in DSM-Il. "Individuals with this disorder characteristically escape from threatening situations by running away from home for a day or more without permission. Typically they are immature and timid. and feel rejected at home, inadequate, and friendless. They often steal furtively." Stanley had a father who drank too much and was brutal. Stanley hated his stepmother and ran away from home countless times beginning at age 6. He was "immature and timid." As a small and goodlooking runaway boy, he was victimized by homosexual men. He learned to lure such men (usually when they were drunk) into a vacant building or other location, presumably for sex. There the man was "rolled" (robbed) by a confederate of Stanleys-s-with Stanley's help. Stanley wrote that "One day my partner didn't show up, and right then and there I lost all my nerve. I needed someone with me to steal. I was too cowardly to steal alone. A companion made me brave and gave me a sense of security. I couldn't to save my soul steal a dime alone. " Rather miraculously. Stanley was habilitated by Clifford Shaw and his coworkers. A 50-year follow-up of Stanley has been published (Snodgrass et al., 1(82). Richard L. Jenkins, M.D. The University of Iowa

Variations on the Theme of Conduct To the Editor: Among the various innovations in DSM-Ill and DSM-IIl-R, none seems to have been so widely misunderstood as the diagnosis conduct disorder. This is a purely behavioral diagnosis among the "disorders usually first evident in infancy, childhood, or adolescence." DSMIIl-R introduces it as follows: "The essential feature of this disorder is a persistent pattern of conduct in which the basic rights of others and major age-appropriate societal norms or rules are violated. The behavior pattern typically is present in the home, at school. with peers. and in the community. The conduct problems are more serious than those seen in Oppositional Defiant Disorder. " The point should be made that the diagnosis of conduct disorders should be based solely on conduct-disordered behavior. The diagnosis requires no psychotic or organic pathology. although it may (and often does) overlap with psychotic or organic diagnoses. Lewis et al. (1984) protested that "With its focus on manifest behaviors and its lack of clear exclusionary criteria. the conduct disorder diagnosis obfuscates other potentially treatable neuropsychiatric disorders" (p. 5(4). However. DSM-Ill simply states. "On both Axes I and II multiple diagnoses should be made when necessary to describe the current condition" (p. 24). One does not choose between a psychotic or organic diagnosis and a diagnosis of conduct disorder. I f both diagnoses are warranted, both diagnoses should be made. The differentiation of the socialized or group type of conduct disorder and the unsocialized aggressive type, and the typical background of each type were established in a statistical study of 500 case records from the Michigan Child Guidance Institute (Hewitt and Jenkins. 1946). These two clusters of behavior were clearly confirmed by Quay (Wells. 1988). The socialized or group type of conduct disorder tends to develop in a large family with an alcoholic or absent father, living in an impoverished deteriorated neighborhood where' 'bad companions" are likely to be the only companions available. The solitary aggressive or unsocialized aggressive type of conduct disorder. by contrast often developing in only children, is associated with (and is presumably at least in part caused by) parental rejection which often relates to an unwanted pregnancy in an immature ummarried female not ready to accept the responsibilities of motherhood. The socialized and unsocialized types of unsocialized conduct disorder differ significantly in prognosis. with the socialized conduct disorder offering the better prognosis (Herin et al.. 1(80). The differentiation of the unsocialized runawav type of delinquent as a third separable group of conduct disorder was published in 1967 (Jenkins and Boyer) from a statistical study of the case records of 300 delinquent boys committed to the New York State Training School for Boys at Warwick. The family background of the unsocialized runaway type of conduct disorder is similar to that of the unsocialized aggressive type but tends to be more extreme in the lack of parental love and nurturing than of even the unsocialized aggressive type. The diagnosis conduct disorder that first appeared in DSM-IlJ combined three diagnoses from DSM-Il. Group delinquent reaction of childhood (or adolescence) of DSM-Il became conduct disorder, socialized of DSM-IlJ and conduct disorder, group type of DSM-JIl-R. Unsocialized aggressive reaction of childhood (or adolescence) of DSM-Il became conduct disorder, unsocialized agressivc in DSM-JIl and conduct disorder, solitary aggressive in DSM-IlJ-R. The runawav reaction of childhood (or adolescence) of DSM-Il became conduct disorder. unsocialized, non aggressive in DSM-IlJ. Unfortunately, it

REFERENCES

Henri. F.. Bardwell. R. & Jenkins. R. L. (1980), Juvenile delinquents revisited: adult criminal activity. Arch. Gen. Psychiatry, 37: 1160-1163. Hewitt, H. E. & Jenkins. R. L. (I (46). Fundamental Patterns o] Maladjustment: The Dynamics of Their Origin, State of Illinois. 1946. Jenkins, R. L. (1971). The runaway reaction. Am. J. Psvchiatrv. 128:60--65. ~- (1980), Status offenders. J. Am. Acad. Child Psychiatry, 19:320-325. comment 334--336. ~- Boyer. A. (1967), Types of delinquent behavior and background factors. lnt. J. Soc. Psychiatry, 14:65-76. ~- Stahle, G. (1972). The runaway reaction: a case study. J. Am. Acad. Child Psychiatry, II :294--313. Lewis, D. 0., Le~is, M.'. Unger, L. & Goldman. C. (1984), Conduct disorder and its synonyms: diagnoses of dubious validity and usefulness. Alii. J. Psvchiatrv. 141:514--519. Shaw, C. R. (1930), "rhe Ja;'k-Roller: A Delinquent Boy's Own Story. Chicago, IL: University of Chicago Press. Snodgrass. J. with Geis , G .. Short, J. F. Jr. & Kobrin, S. (1987), The Lack-Roller at Seventv. Lexington, MA: Lexington Books. Wells, K. C. (1988). Diagnosis and treatments outlined for adolescent conduct disorder. Psychiatric Times. Oct. 1988:8-10.

What Motivates Infants? To the Editor: Infants are certainly attracted to novelty, as described in structured

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Variations on the theme of conduct.

LETTERS TO THE EDITOR was totally omitted from DSM-JIl-R and can only be entered as conduct disorder-undifferentiated type, which it does not fit. Thi...
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