Neurodevelopmental Disorders/Childhood Disorders

A. Two broad domains of childhood disorders

a. Externalizing disorders are characterized by more outward-directed
behaviors, such as aggressiveness, noncompliance, overactivity, and
impulsiveness
i. The category includes attention-deficit/hyperactivity disorder,
conduct disorder, and oppositional defiant disorder
b. Internalizing Disorders are characterized by more inward-focused
experiences and behaviors, such as depression, social withdrawal, and
anxiety
i. The category includes childhood anxiety and mood disorders
B. Attention-Deficit/Hyperactivity Disorder
a. Description
i. The primary characteristics of such people include a pattern of
inattention or of hyperactivity and impulsivity
ii. DSM-5 differentiates two categories of symptoms
1. Inattention people may appear not to listen to others; them
may lose necessary school assignments; and they may not
pay enough attention to details
2. Hyperactivity includes fidgeting, having trouble sitting for
any length of time, always being on the go
iii. Impulsivity includes blurting out answers before questions have
been completed and having trouble waiting turns
iv. Children with ADHD are likely to be unpopular and rejected by their
peers
v. Some research shows that having a specific gene mutation (a COMT
gene polymorphism) and a low birth weight predicts later behavior
problems in children with ADHD
b. Statistics
i. 5.2% of the child populations across all regions of the world
ii. Debates continue to rage about the validity of ADHD as a real
disorder
1. Some people believe that children who are just normally
active are being misdiagnosed with ADHD
iii. Some have argued that ADHD in children is simply a cultural
construct (due to the different rates of diagnosis across cultures)
meaning that the behavior of these children is typical from a
developmental perspective and it is Western cultures intolerance
that causes labeling ADHD as a disorder
1. However, 3% to 9% of the worldwide population currently
meet the criteria for ADHD that significantly interferes with
their quality of life
iv. Boys are 3 times more likely to be diagnosed with ADHD than girls,
and this discrepancy increases for children being seen in clinics
1. The reason for this gender difference is still unknown
2. It may be that adults are more tolerant of hyperactivity
among girls, who tend to be less active than boys with ADHD.

Boys tend to be more aggressive, which will more likely to

result in attention by mental health professionals
a. Girls with ADHD tend to display more behaviors
referred to as internalizing, specifically anxiety and
depression
3. Most research over the last decades used young boys as
participants because of their active and disruptive behaviors
(questioning the validity of ADHD diagnosis)
v. Children with ADHD are first identified as different from their peers
around age 3 or 4
vi. It is estimated that about 50% of the children with ADHD have
ongoing difficulties through adulthood
vii. Teens with ADHD are at greater risk for pregnancy and contracting
STIs. They are also more likely to have driving difficulties, such as
crashes; to be cited for speeding; and to have their licenses
suspended
viii. Based on a research, adults with ADHD were employed but in jobs
with significantly lower positions that the comparison group. They
also had 2.5 fewer years of education. These men were also more
likely to be divorced and to have substance use problems and
antisocial personality disorder
ix. Oppositional defiant disorder, conduct disorder, and bipolar
disorders seem to overlap significantly with this disorder because
they have some characteristics seen in children with ADHD
1. ODD includes behaviors such as often loses temper,
argues with adults, often deliberately annoys people,
touchy and easily annoyed by others, and often spiteful
and vindictive
c. Causes
i. Researchers have known for some time that ADHD is more common
in families in which one person has the disorder
1. These families display an increase in psychopathology in
general, including conduct disorder, mood disorders, anxiety
disorders, and substance abuse. Thus, some shared genetic
deficits may contribute to the problems experience by people
with these disorders
ii. ADHD is considered to be highly influenced by genetics
1. Environmental influences play a relatively small role in the
cause of the disorder when compared with many other
disorders
iii. Most attention to date focuses on genes associated with the
neurochemical dopamine, although norepinephrine, serotonin, and
gamma-aminobutyric acid are also implicated in the cause of ADHD
1. There is a strong evidence that ADHD is associated with the
Dopamine D4 receptor gene, the dopamine transporter gene
D1, and the dopamine D5 receptor gene
iv. Some research indicates that poor inhibitory control (the ability
to stop responding to a task when signaled) may be common

among both children with ADHD and their unaffected family

members
v. Research found that children with a specific mutation involving the
dopamine system were more likely to exhibit the symptoms of
ADHD if their mothers smoked during pregnancy
vi. Researchers now know that overall volume of the brain in those
children with this disorder is slightly smaller (3% to 4%) than in
children without this disorder
vii. A number of areas in the brains of those with ADHD appear
affected, especially those involved in self-organizational abilities
viii. Allergens and food additives have been considered as possible
causes of ADHD over the years, although little evidence supports
the association (Feingold, 1975)
ix. Some large-scale research now suggests that there may be a small
but measurable impact of artificial food colors and additives on the
behavior of young children
x. Other researches now points to the possible role of the pesticides
found in foods as contributing to an increased risk of ADHD
xi. Negative responses by parents, teachers, and peers may contribute
to feelings of low self-esteem
d. Treatments
i. Psychosocial Interventions generally focus on broader issues such
as improving academic performance, decreasing disruptive
behaviors, and improving social skills
1. In general, the programs set such goals as increasing the
amount of time the child remains seated, the number of
math papers completed, or appropriate play with peers
2. Reinforcement programs reward the children for
improvement, and, at times, punish misbehavior with loss of
rewards
3. Parent education programs teach families how to respond
constructively to their childs behaviors
4. For adults with ADHD, cognitive-behavioral interventions are
used to reduce distractibility and improve organizational
skills
ii. Biological Interventions typically, its goal is to reduce the
childrens impulsivity and hyperactivity and to improve their
attention skills
1. The first types of medication used were stimulants
2. Drugs such as methylphenidate, and several non-stimulant
medications such as atomoxetine, guanfacine, and clonidine
have proved helpful in reducing the core symptoms of ADHD
3. An issue in using stimulant is its addictive nature
4. Medications often result in unpleasant side effects, such as
insomnia. Drowsiness, or irritability
iii. Combined approach to Treatment
1. Initial reports from the study of NCIM (2001) suggested that
the combination of behavioral treatment and medication, and

medication alone, were superior to behavioral treatment

alone and community interventions for ADHD symptoms
C. Specific Learning Disorder characterized by performance that is substantially
below what would be expected given the persons age, intelligence quotient (IQ)
score, and education
a. Clinical Description
i. Defined as a significant discrepancy between a persons academic
achievement and what would be expected for someone of the same
age-referred to by some as unexpected achievement
ii. The criteria require that the person perform academically at a level
of significantly below that of a typical person of the same age,
cognitive ability, and educational level
iii. A diagnosis of specific learning disorder requires that the persons
disability not be caused by a sensory difficulty, such as trouble with
sight or hearing, and should not be the result of poor or absent
instruction
iv. DSM-IV-TR listed specific disorders in reading, mathematics, and
written expression, but because of the significant overlap in these
disabilities they are now combined to assist clinicians in taking a
broader view of the individuals learning styles
v. Clinicians can use the specifiers for disorders of reading, writing
expressions, or mathematics to highlight specific problems for
remediation
vi. Historically, a specific learning disorder would be defined as a
discrepancy of more than 2 SD between achievement and IQ
1. An approach called response to intervention is now being
used as an alternative
a. It involves identifying a child as having a specific
learning disorder when the response to a known
effective intervention is significantly inferior to the
performance by peers

b. Statistics
i. It is estimated that approximately 6.5 million students between the
ages of 3 and 21 were receiving services for specific learning
disorder between 2009 and 2010
ii. Difficulties with reading are the most common of the learning
disorders and occur in some form in 4% to 10% of the general
population
iii. Mathematics disorder appears approximately 1% of the population,
but there is limited information about the prevalence of disorder of
written expression among children and adults
iv. More recent research indicates that boys and girls may be equally
affected by reading disorder
v. Students with specific learning disorders are more likely to drop out
of school, more likely to be unemployed, and more likely to have
suicidal thoughts and attempt suicide
vi. A group of disorders loosely identified as communication disorders
seem closely related to specific learning disorder
1. Childhood-onset Fluency Disorder
a. A disturbance in speech fluency that includes a
number of problems with speech, such as repeating
syllables or words, prolonging certain sounds, making
obvious pauses, or substituting words to replace one
that are more difficult to articulate
2. Language Disorder
a. Limited speech in all situations. Expressive language
(what is said) is significantly below receptive language
(what is understood)
3. Social (Pragmatic) Communication Disorder
a. Difficulties with the social aspects of verbal and
nonverbal communication, including verbosity,
prosody, excessive switching of topics, and dominating
conversations
c. Causes
i. It is clear that learning disorders run in families, and sophisticated
family and twin studies bear this out
ii. Genes are not specific, meaning that there are not different genes
responsible for reading disorders and mathematical disorders
1. They are genes that affect learning and they may contribute
to problem across domains
iii. Genes located on chromosomes 1, 2, 3, 6, 11, 12, 15, and 18 have
all been repeatedly linked to problems with word recognition
iv. Environmental influences such as the home reading habits of
families can significantly affect outcomes suggesting that reading
to children at risk for reading disorders can lessen the impact of
genetic influences
v. Three areas of the left hemisphere appear to be involved In
problems with dyslexia Brocas area (which affects articulation
and word analysis), an area in the left parietotemporal area (which

affects word analysis), and an area in the left occipitotemporal area

(which affects recognizing and word form)
vi. The intraparietal sulcus seems to be critical for the development of
a sense of numbers and is implicated in mathematics disorder
vii. In contrast, no current evidence for specific deficits responsible for
disorders of written expression
d. Treatments
i. Specific learning disorders primarily require educational
intervention
ii. Biological treatment is typically restricted to those individuals who
may also have comorbid ADHD
iii. Educational efforts can be categorized into two: (1) specific skills
instruction, including instruction on vocabulary, finding the main
idea, and finding facts in reading; (2) strategy instruction, which
includes efforts to improve cognitive skills through decision making
and critical thinking
iv. Direct Instruction
1. This program includes several components; among them are
systematic instruction (using highly scripted lesson plans that
place students together in small groups based on their
progress) and teaching for mastery (teaching students until
they understand all concepts)
2. Direct instruction and several related training programs
appear to significantly improve academic skills in children
with specific learning disorder
v. One study used fMRI to compare how children with and without
reading disorders processed simple tasks. The children with reading
difficulties were then exposed to 8 weeks of intensive training on a
computer program that helped them worked on their auditory and
language-processing skills. Not only did the children improve their
reading skills but also their brains started functioning in a similar
ways as compared to the control group
D. Autism Spectrum Disorder
a. Overview
i. A neurodevelopmental disorder that, at its core, affects how one
perceives and socializes with others
ii. DSM V combined most of the disorders previously included under
the umbrella term pervasive developmental disorders (e.g.
autistic disorder, Aspergers disorder, and childhood disintegrative
disorder) and included them into this one category
iii. Rett disorder, a genetic condition that affects mostly females, is
diagnosed as ASD with the qualifier associated with Rett
syndrome or associated with MeCP2 mutation (not as a separate
disorder anymore)
iv. The designation not otherwise specified which was applied to
other disorders prior to DSM-5, was deleted
b. Clinical Description
i. Two major characteristics:

1. Impairments in social communication and interaction

2. Restricted, repetitive patterns of behavior, interests, or
activities
ii. In addition, DSM-5 recognizes that the impairments are present in
early childhood and that they limit daily functioning
iii. DSM-5 introduced 3 levels of severity:
1. Level 1 requiring support
2. Level 2 requiring substantial support
3. Requiring very substantial support
c. Impairments in Social Communication and Social Interaction
i. One of the defining characteristics of people with ASD is that they
fail to develop age-appropriate social relationships
ii. Difficulties with social communication and interaction are further
defined by the inclusion of three aspects problems with social
reciprocity (a failure to engage in back-and-forth social
interactions), nonverbal communication, and initiating and
maintaining social relationships all three of which must be present
to be diagnosed with ASD
iii. Social reciprocity for individuals with more severe symptoms of ASD
(previously diagnosed with Autistic Disorder) involves the inability
to engage in joint attention
iv. Among people with milder symptoms of ASD (previously diagnosed
with Aspergers disorder), this lack of social reciprocity might
present itself as appearing self-focused and not showing interest in
things other people care about
v. Research suggests that people with ASD for reasons not yet fully
understood may not be interested in social situation
vi. Individuals with the less severe form of ASD may also lack
appropriate facial expressions or tone of voice (prosody) when
speaking or just give the appearance of general nonverbal
awkwardness
vii. Approximately 25% of individuals with ASD do not develop speech
proficiency sufficient to communicate their needs effectively
viii. Some repeat the speech of others, a pattern called echolalia
d. Restricted and Repetitive patterns of behavior, interests, or activities
i. Maintenance of Sameness intense preference for the status quo
1. People with ASD are extremely upset if even a small change
was introduced
ii. Often, people with ASD spend countless hours in stereotyped and
ritualistic behaviors, making such stereotyped movements as
spinning around in circles, waving their hands etc.
iii. For individuals with less severe ASD, these behaviors can take the
form of an almost obsessive interest in certain, very specific
subjects
e. Statistics
i. An average of 1 in 50 school-aged children in the United States had
a diagnosis under the category of ASD (2013)
ii. Male to female ratio is 4.4 to 1

iii. People with ASD have a range of IQ scores.

1. It is estimated that approximately 38% of individuals with
ASD have intellectual disabilities (IQ less than 70)
iv. IQ measures are used to determine prognosis: the higher children
score on IQ tests, the less likely they are to need extensive support
by family members or professionals, conversely young children with
ASD who score lower on IQ tests are more likely to be severely
delayed in acquiring communication skills and to need a great deal
of educational and social support as they grow older
f. Causes: Psychological and Social Dimensions
i. Historically, ASD was seen as the result of failed parenting
1. Mothers and fathers of children with the more severe form of
ASD were characterized as perfectionistic, cold, and aloof,
with relatively high socioeconomic status, and higher IQs
than the general population
ii. Other theories about the origins of ASD were based on the unusual
speech patterns of some individualsnamely, their tendency to
avoid first-person pronouns such as I and me and to use he and she
instead.
1. This led to some theorists to wonder whether ASD involves a
lack of self-awareness
iii. Later research has shown, however, that some people with ASD do
seem to have self-awareness and that it follows a developmental
progression
iv. It is estimated that 1/3 of individuals with ASD have Savant Skills
1. These exceptional skills appear to be the result of possessing
superior working memory and highly focused attention
g. Causes: Genetic Influences
i. Numerous genes on a number of our chromosomes have already
been implicated in some way in the presentation of ASD. Many
genes are involved but each one has only a relatively small effect
ii. Families that have one child with ASD have about a 20% chance of
having another child with this disorder
iii. One area that is receiving attention involves the gene responsible
for oxytocin because oxytocin is shown to have a role in how we
bond with others and in our social memory
iv. Research shows that fathers 40 years old and up were more than
five time more likely to have a child with ASD than fathers under
the age of 30
1. The same correlation does seem to hold up for maternal age
2. These findings suggests that mutations may occur in the
sperm of fathers or the eggs of mothers (called de novo
mutations) that influence the development of ASD

h. Causes: Neurobiological Influences

i. One theory involves research on amygdala
1. Researchers studying the brains of people with ASD after
they died not that adults with and without the disorder have
amygdalae of about the same size but that those with ASD
have fewer neurons in this structure
2. Earlier research showed that young children with ASD
actually have larger amygdala
a. The theory being proposed is that the amygdala in
children with ASD is enlarged early in life causing
excessive anxiety and fear. With continued stress, the
release of the stress hormone cortisol damage the
amygdala, causing the relative absence of neurons in
adulthood. The damage may account for the different
way people with ASD respond to social situations
ii. Some research on children with ASD found lower levels of oxytocin
in their blood, and giving oxytocin to children with ASD improved
their ability to remember and process information with emotion
content
iii. One highly controversial theory is that mercury is responsible for
the increases seen in ASD
1. Large epidemiological studies conducted in Denmark show
that there is no increased risk for ASD in children who are
vaccinated
2. The correlation between when a child is vaccinated for
measles, mumps, and rubella (12-15 months) and when the
symptoms of ASD first become evident (before 3 years)
continues to fuel the belief by many families that there must
be some connections
i. Treatments
i. Psychosocial Treatments
1. Treatments based solely on ego development have not had a
positive impact on the lives of people with ASD
2. Greater success have been achieved with behavioral
approaches that focus on skill building and behavioral
treatment of problem behaviors
3. Imitation, shaping and behavioral techniques such as
discrimination training seem to be effective
4. Naturalistic Teaching Strategies
a. Include arranging the environment so that the child
initiates an interest and this is used as a teaching
opportunity
b. These techniques seem to increase a variety of social
communication skills among some children with more
severe forms of ASD
5. A number of approaches are now used to teach social skills
including the use of peers who do not have ASD as trainers,

and there is evidence that those with ASD can improve their
socialization skills
ii. Biological Treatments
1. Medical intervention has had little positive impact on the core
symptoms of social and language difficulties
2. Major tranquilizers and serotonin-specific reuptake inhibitors
seem to be helpful
iii. Integrating Treatments
1. For children, most therapy consists of school education with
special psychological supports for problems with
communication and socialization. Behavioral approaches
have been most clearly documented as benefiting children in
this area
2. As children with ASD grow older, intervention focuses on
efforts to integrate them into the community, often with
supported living arrangements and work settings
E. Intellectual Disorder (Intellectual Developmental Disorder)
a. Overview
i. ID is a disorder evident in childhood as significantly below-average
intellectual and adaptive functioning
ii. DSM-5 identifies difficulties in three domains: conceptual, social,
and practical areas
b. Clinical Description
i. ID was previously included on Axis II of DSM IV TR.
1. The rationale for placing these disorders (including PD) on a
separate axis was that they tend to be more chronic and less
amenable to treatment, and second, it was to remind
clinicians to consider whether these disorders, if present,
were affecting Axis I disorder
ii. The DSM 5 criteria no longer include numeric cutoff for IQ scores
iii. To be diagnosed with ID, a person must have significantly
subaverage intellectual functioning, a determination made with one
of several IQ tests with cutoff score set by DSM 5 of approximately
70
iv. The second criterion calls for concurrent deficits or impairments in
adaptive functioning. A person must have also significant difficulty
in areas such as communication, self-care, home living, social and
interpersonal skills etc.
v. The final criterion for ID is the age of onset. The characteristic
below-average intellectual and adaptive abilities must be evident
before the person is 18
vi. Traditionally, classification systems have identified four levels of ID:
1. Mild: 50 55 and 70 IQ score
2. Moderate: 35 40 to 50 55 IQ score
3. Severe: ranging from 20 25 to 35 40 IQ score
4. Profound: below 20 25

vii. AAIDD definition of ID added the description of different levels of

this disorder, which are based on the level of support or assistance
people needed: Intermittent, Limited, Extensive, or Pervasive
c. Statistics
i. Approximately 90% of people with ID fall under the label of mild
intellectual disability
ii. The total population of people with ID represents approximately 2%
of the general population
iii. The course of ID is chronic
iv. Flynn Effect IQ scores are rising every decade
1. As IQ scores rise, those who make up IQ tests adjust the
assessment every decade or two to keep the average score
around 100
d. Causes
i. Genetic Influences
1. Multiple genetic influences appear to contribute to ID:
chromosomal disorders, single-gene disorders, mitochondrial
disorders and multiple genetic mutations
2. Genetic mutations including de novo disorders were present
in those children with ID of unknown origin
3. Phenylketonuria, a recessive gene disorder, which affects 1 of
every 10,000 newborns and is characterized by an inability to
break down phenylalanine
4. Lesch-Nyhan Syndrome an X-linked disorder, is
characterized by ID, signs of cerebral palsy and self-injurious
behaviors
a. Only males are affected because a recessive gene is
responsible; when it is on the X-chromosome in males,
it does not have a normal gene to balance it because
males do not have a second X chromosome
ii. Chromosomal Influences
1. Down Syndrome (discovered by John Langdon Down) the
most common chromosomal form of ID
a. The term mongoloidism was used because people with
Down Syndrome resemble people from Mongolia
b. The disorder is caused by the presence of an extra 21 st
chromosome (trisomy 21)
c. The incidence of children born with Down Syndrome
has been tied to maternal age (positively correlated)
i. At the age of 20: 1 in 2,000 chance
ii. At the age of 35: 1 in 500
iii. At the age of 45: 1 in 18
2. Fragile X Syndrome second common chromosomally related
cause of ID.
a. Only affects males
b. Unlike Lesch-Nyhan carriers, women who carry Fragile
X syndrome commonly display mild to severe learning
disabilities

c. 1 of every 4000 males and 1 of every 8000 females

are born with this disorder
iii. Psychological and social dimensions
1. Includes abuse, neglect, and social deprivation
2. Cultural-familial intellectual disability people with these
characteristics are thought to have cognitive impairments
that result from a combination of psychosocial and biological
influences, although the specific mechanisms that lead to
this type of intellectual disability are not yet understood
e. Treatment
i. Biological treatment for ID is not a viable option
1. Generally, the treatments of people with ID parallels that of
people with severe forms of ASD
2. For individuals with mild ID, intervention is similar to that for
people with learning disability
3. Communication training is important for people with ID
4. For severe ID, Augmentative communication strategies can
be used
a. Augmentative Communication Strategies: may use
picture books, teaching the person to make a request
by pointing to a picture
F. Conduct Disorder
a. Description
i. The DSM-5 criteria for conduct disorder focus on behaviors that
violate the basic rights of others and violate major societal norms
ii. These behaviors include aggression and cruelty toward people or
animals, damaging property, lying, and stealing
1. Often the behavior is marked by callousness, viciousness,
and lack of remorse
2. DSM-5 will likely include a callous and unemotional trait
diagnostic specifier for children who show these types of
characteristics
iii. Conduct disorder is three to four times more common among boys
than among girls
iv. A related but less well understood externalizing disorder in the
DSM-IV-TR is oppositional defiant disorder (ODD)
1. ODD is diagnosed if a child does not meet the criteria for
conduct disordermost especially, extreme physical
aggressivenessbut exhibits such behaviors as losing his or
her temper, arguing with adults, repeatedly refusing to
comply with requests from adults, deliberately doing things
to annoy others, and being angry, spiteful, touchy, or
vindictive
2. ODD is different from ADHD in that the defiant behavior is
not thought to arise from attentional deficits or sheer
impulsiveness

a. One manifestation of difference is that children with

ODD are more deliberate in their unruly behavior than
children with ADHD
b. Prevalence, and Prognosis of Conduct Disorder
i. A longitudinal investigation of conduct disorder in boys, found a
strong association between substance use and delinquent acts
ii. Anxiety and depression are common among children with conduct
disorder, with comorbidity estimates varying from 15 to 45 percent
iii. Recent estimates suggest that conduct disorder is fairly common,
with a prevalence rate of 9.5 percent
iv. The incidence and the prevalence of serious lawbreaking peak
sharply at around age 17 and drop precipitously in young adulthood
v. Two different courses for CD
1. Life-Course-Persistent Pattern
a. Children begin to show conduct problem by age 3 and
continuing to commit serious transgressions into
adulthood
2. Adolescent-Limited Pattern
a. they have typical childhoods, engage in high levels of
antisocial behavior during adolescence, and have
typical, non-problematic adulthoods
3. The life-course-persistent type is more common among boys
(10.5%) than girls (7.5%); the adolescence-limited type is
also more common among boys (19.6%) than girls (17.4%)
vi. The prognosis for children diagnosed as having conduct disorder is
mixed
1. The results just described show that men and women with
the life-course-persistent type of conduct disorder will likely
continue to have all sorts of problems in adulthood, including
violent and antisocial behavior
c. Etiology of Conduct Disorder
i. Genetic Factors
1. A study of over 3,000 twin pairs indicated only a modest
genetic influence on childhood antisocial behavior; family
environment influences were more significant
a. However, a study of over 2,600 twin pairs in Australia
found a substantial genetic influence and almost no
familyenvironment influence for childhood symptoms
of conduct disorder
2. As with most traits, studies indicate that criminal and
antisocial behavior is accounted for by both genetic and
environmental factors
3. A meta-analysis of twin and adoption studies of antisocial
behavior indicated that 40 to 50 percent of antisocial
behavior was heritable
4. Children who were both maltreated and had low MAOA
activity were more likely to develop conduct disorder than
either children who were maltreated but had high MAOA

activity or children who were not maltreated but had low

MAOA activity
ii. Neuropsychological Factors and the Autonomic Nervous System
1. Neuropsychological deficits have been implicated in the
childhood profiles of children with conduct disorder
a. These deficits include poor verbal skills, difficulty with
executive functioning (the ability to anticipate, plan,
use self-control, and solve problems), and problems
with memory
b. In addition, children who develop conduct disorder at
an earlier age (i.e., life-course-persistent type) have an
IQ score of 1 standard deviation below age-matched
peers without conduct disorder
2. Lower levels of resting skin conductance and heart rate are
found among adolescents with conduct disorder, suggesting
that they have lower arousal levels than adolescents without
conduct disorder
a. These studies suggest that adolescents who exhibit
antisocial behavior may not fear punishment as much
as adolescents who dont exhibit such behavior
iii. Psychological Factors
1. Children with conduct disorder seem to be deficient in this
moral awareness, lacking remorse for their wrongdoing
a. Moral awareness the acquisition of a sense of what is
right and wrong and the ability, even desire, to abide
by rules and norms
2. Children who are physically abused by parents are likely to
be aggressive when they grow up
a. Children may also imitate aggressive acts seen
elsewhere, such as on television
3. In addition, parenting characteristics such as harsh and
inconsistent discipline and lack of monitoring are consistently
associated with conduct problems in children
a. Perhaps children who do not experience negative
consequences for early misbehavior later develop
more serious conduct problems (Coie & Dodge, 1998)
4. Dodge (1982) found that the cognitive processes of
aggressive children had a particular bias; these children
interpreted ambiguous acts, such as being bumped in line, as
evidence of hostile intent
iv. Peer Influences
1. Investigations of how peers influence aggressive and
antisocial behavior in children have focused on two broad
areas:
a. Acceptance or rejection by peers
i. Studies have shown that being rejected by
peers is causally related to aggressive behavior,
particularly in combination with ADHD

ii. Other studies have shown that being rejected by

peers can predict later aggressive behavior,
even after controlling for prior levels of
aggressive behavior
b. Affiliation with deviant peers
i. Associating with other deviant peers also
increases the likelihood of delinquent behavior
v. Sociocultural Factors
1. Poverty and urban living are associated with higher levels of
delinquency
2. Unemployment, poor educational facilities, disrupted family
life, and a subculture that deems delinquency acceptable are
all contributing factors
3. African American youths were more likely than white youths
to have committed serious delinquent acts
d. Treatment of Conduct Disorder
i. Family Interventions
1. Some of the most promising approaches to treating conduct
disorder involve intervening with the parents and families of
the child
2. Parent Management Training (by Gerald Patterson and
colleagues)
a. Parents are taught to modify their responses to their
children so that prosocial rather than antisocial
behavior is consistently rewarded
b. Parents are taught to use techniques such as positive
reinforcement when the child exhibits positive
behaviors and time-out and loss of privileges for
aggressive or antisocial behaviors
ii. Multisystemic Treatment (MST)
1. MST involves delivering intensive and comprehensive
therapy services in the community, targeting the adolescent,
the family, the school, and, in some cases, the peer group
2. The treatment is based on the view that conduct problems
are influenced by multiple factors within the family as well as
between the family and other social systems.