Disorder attribution and clinical judgment in the assessment of adolescent antisocial behavior

When social workers judge that an antisocially behaving adolescent has a mental disorder, what are the implications of that attribution for other clinical judgments about the youth? Clinical case vignettes that satisfied DSM-IV diagnostic criteria for conduct disorder were presented to 250 MSW students. Based on DSM-IV guidelines and on the "harmful dysfunction" analysis of the concept of mental disorder, the context of the symptoms presented in the vignettes was manipulated experimentally to suggest either internal dysfunction or a normal response to a difficult environment as the cause of the youth's antisocial behavior. Students were asked to judge whether the youth had a psychiatric disorder and to assess prognosis, need for professional help, and appropriateness of medication.