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12 and HoldingA Guide to Asperger SyndromeA Lethal InheritanceA Mother's Courage: Talking Back to AutismA Parent's Guide to Asperger Syndrome and High-Functioning AutismA Special EducationA Toss Of The DiceA Tribe ApartA User Guide to the GF/CF Diet for Autism, Asperger Syndrome and AD/HDA Walk in the Rain With a BrainABC of Eating DisordersADD-Friendly Ways to Organize Your LifeADHD Grown UpADHD in the Schools: Assessment and Intervention StrategiesADHD NationAdolescence and Body ImageAdolescent DepressionAggression and Antisocial Behavior in Children and AdolescentsAll Alone in the UniverseAlpha GirlsAmericaAnother PlanetAntisocial Behavior in Children and AdolescentsAsperger Syndrome and Your ChildAsperger Syndrome, Adolescence, and IdentityAsperger's and GirlsAssessment of Childhood DisordersAttention Deficit DisorderAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderAutism - The Eighth Colour of the RainbowAutism and MeAutism's False ProphetsAutistic Spectrum DisordersBad GirlBeen There, Done That? DO THIS!Before I DieBetween Two WorldsBeyond AppearanceBig Mouth & Ugly GirlBipolar ChildrenBipolar Disorder in Childhood and Early AdolescenceBipolar DisordersBipolar KidsBlackwell Handbook of Childhood Cognitive DevelopmentBody Image, Eating Disorders, and ObesityBody Image, Eating Disorders, and Obesity in YouthBoy AloneBrain-Based Therapy with Children and AdolescentsBreaking PointBreathing UnderwaterBringing Up ParentsBullying and TeasingBullying PreventionBut I Love HimCan't Eat, Won't EatCaring for a Child with AutismCatalystChild and Adolescent PsychiatryChild and Adolescent Psychological DisordersChild and Adolescent PsychopathologyChild NeuropsychologyChild Well-BeingChildren and SexualityChildren Changed by TraumaChildren with Emerald EyesChildren with Sexual Behavior ProblemsChildren, Sexuality and SexualizationChildren’s Dreaming and the Development of Consciousness City of OneCommunication Issues In Autism And Asperger SyndromeConcepts of NormalityConcise Guide to Child and Adolescent PsychiatryConquering the Beast WithinConsuming KidsContesting ChildhoodCount Us InCrackedCrossesCutCyber-Safe Kids, Cyber-Savvy TeensDamageDemystifying the Autistic ExperienceDescartes' BabyDilemmas of DesireDirtyDisconnected KidsDoing SchoolDon't Bother Me Mom--I'm Learning!Don't Pick On MeDying to Be ThinEarly Intervention Programs and PoliciesEating an ArtichokeEducating Children With AutismEight Stories UpElijah's CupEmerald City BluesEmotional and Behavioral Problems of Young ChildrenEpilepticEthical Dilemmas in PediatricsEvery Girl Tells a StoryExiting NirvanaExploiting ChildhoodEye ContactFacing BipolarFamily HistoryFast GirlsForever YoungFreaks, Geeks and Asperger SyndromeFreewillFrictionGirl CultureGirl in the MirrorGirlfightingGirlhoodGirlWiseHandbook of Evidence-Based Therapies for Children and AdolescentsHandbook of Preschool Mental HealthHealing ADDHelping Children Cope With Disasters and TerrorismHelping Hyperactive KidsHelping Parents, Youth, and Teachers Understand Medications for Behavioral and Emotional ProblemsHelping Students Overcome Depression and AnxietyHelping Teens Who CutHollow KidsHope's BoyHow Infants Know MindsHow to Keep Your Teenager Out of Trouble and What to Do If You Can'tHurry Down SunshineI Am Not Joey PigzaIdentifying Hyperactive ChildrenIf Your Adolescent Has an Eating DisorderIn the Company of CraziesIncorporating Social Goals in the ClassroomIntegrated YogaIntrusive ParentingIssues for Families, Schools and CommunitiesJake RileyJoey Pigza Loses ControlJoey Pigza Swallowed the KeyJuvenile-Onset SchizophreniaKim: Empty InsideLearning and Behavior Problems in Asperger SyndromeLearning Disorders and Disorders of the Self in Children and AdolescentsLearning Outside the Lines Let Kids Be KidsLiberation's ChildrenLife As We Know ItLisa, Bright and DarkLook Me in the EyeLoserLove and SexLove That DogMad at SchoolMaking ADD WorkMaking American BoysManicMastering Anger and AggressionMaverick MindMedicating ChildrenMind FieldsMind to MindMommy I'm Still in HereMore Than a LabelMy Flesh and BloodMyths of ChildhoodNew Hope for Children and Teens with Bipolar DisorderNew Look at ADHD: Inhibition, Time, and Self-ControlNo Child Left DifferentNo Two AlikeNon-Drug Treatments for ADHDNot Much Just Chillin'NurtureShockOdd Girl OutOdd Girl Speaks OutOne Hot SecondOne in ThirteenOphelia SpeaksOphelia's MomOur Journey Through High Functioning Autism and Asperger SyndromeOut of the WoodsOvercoming ADHDOvercoming School AnxietyParenting a Child Who Has Intense EmotionsParenting Children With ADHDParenting Your Out-Of-Control TeenagerPediatric PsychopharmacologyPediatric PsychopharmacologyPediatric PsychopharmacologyPeople with HyperactivityPhobic and Anxiety Disorders in Children and AdolescentsPINSPlease Don't Label My ChildPraising Boys WellPraising Girls WellProblem Child or Quirky Kid?Problem GirlsPsychotherapy for Children and AdolescentsPsychotherapy with Children and AdolescentsPurgeRaising a Moody 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Revised EditionTaming the Troublesome ChildTemple GrandinThe American Psychiatric Publishing Textbook Of Child And Adolescent PsychiatryThe Anti-Romantic ChildThe Bipolar ChildThe Boy Who Loved Too MuchThe Boy Who Loved WindowsThe Boy Who Was Raised as a DogThe Buffalo TreeThe Bully Action GuideThe Bully, the Bullied, and the BystanderThe Burn JournalsThe Color of AbsenceThe Curious Incident of the Dog in the Night-TimeThe Depressed ChildThe Developing MindThe Dragons of AutismThe Einstein SyndromeThe EpidemicThe Evolution of ChildhoodThe Explosive ChildThe Eyes of van GoghThe Fasting GirlThe Field of the DogsThe Flight of a DoveThe Hidden Gifts of the Introverted ChildThe Horse BoyThe Identity TrapThe Inner World of a Suicidal YouthThe Inside Story on Teen GirlsThe Kindness of StrangersThe Last Normal ChildThe Little MonsterThe Medicated ChildThe Myth of LazinessThe New Gay TeenagerThe Nurture AssumptionThe OASIS Guide to Asperger SyndromeThe Other ParentThe Perversion of YouthThe Philosophy of AutismThe Psychoanalytic Study of the ChildThe Real Truth About Teens and SexThe Ride TogetherThe Rise and Fall of the American TeenagerThe Science of ADHDThe Sex Lives of TeenagersThe Survival Guide for Kids With LD*The Unhappy ChildThen Again, Maybe I Won'tTherapy with ChildrenThings I Have to Tell YouThings Tom LikesThrough the Glass WallThumbsuckerTotally WiredTouching Spirit BearTrauma in the Lives of ChildrenTreating ADHD and Comorbid DisordersTreatment of Childhood DisordersTwistedUnder the Wolf, Under the DogUnhappy TeenagersUnstrange MindsWastedWe've Got IssuesWeather Reports from the Autism FrontWhat about the KidsWhat in the World Are Your Kids Doing Online?What Works for Whom?What Would Joey Do?What's Happening to My Body? Book for BoysWhat's Happening to My Body? Book for GirlsWhat's Happening to Tom?When Nothing Matters AnymoreWhen Your Child Has an Eating DisorderWhose America?Why Don't Students Like SchoolWill's ChoiceWinnicott On the ChildWorried All the TimeYou Hear MeYoung Minds in Social WorldsYoung People and Mental HealthYour Child, Bully or Victim?
In the 480 pages of this book, Connor has assembled, organized and discussed an
immense treasure-trove of information about a problem that poses an
ever-increasing threat to the very foundations of civilization—the problem of
violence, aggression and antisocial behavior. Connor addresses this problem at
its inception during the developmental periods of childhood and adolescence.
The possibility is raised that early identification of at-risk children and
adolescents, followed by appropriate and persistent intervention, might reverse
the current trends of increasing adult violence, overwhelmed police forces and
over-crowded correctional facilities. Unfortunately, the author notes, a study
of health insurance coverage found that more than four million youngsters, aged
10-18 years, had no coverage at all in the United
States for the year 1995. "In
short, the caveat is that the very youth who need comprehensive, readily
available and long-duration mental health care for CD may not have enough (or
any) mental health insurance coverage—and that mental health treatment without
adequate funding is never satisfactory or effective."
Chapter 1, "Definitions and Subtyping of Aggressive Behavior,"
differentiates between aggressive behaviors that are adaptive—e.g. for self-preservation
or defense of the family or community, and those that are
maladaptive—antisocial and criminal behaviors.
Terms currently used to describe maladaptive aggression vary according to their
social contexts. For example, the same terms may have different meanings in
medical settings than they do in criminal justice studies. It is recommended
that common terminology be adopted for all settings so that research can allow
for more explicit distinction of various types and sub-types. Such distinction
is necessary because of differences in risk factors, etiologies, prognoses and
Chapter 2, "Prevalence of Aggression, Antisocial Behaviors and Suicide,"
gives evidence that the current rates of maladaptive aggression in children and
adolescents, with resultant injuries and deaths, present a serious public
health problem for the United States. Identification and treatment of affected individuals
are among the greatest challenges for professionals in juvenile justice,
educational, psychiatric and mental health treatment settings.
Chapter 3, "Stability, Impairment and Desistance," discusses the
importance of early differentiation of sub-types so that those who will have
lifelong antisocial behavior patterns are identified and treated early.
Chapter 4, "Categorical Psychiatric Diagnoses and Aggression," points
out that aggression in the context of these diagnoses has "multidimensional,
diverse and complex etiologies." There is no simple way to explain or
understand such aggression.
These first four chapters taken together may be considered as a section
intended to acquaint us with the nature and scope of the aggression problem.
The next four chapters, chapters 5 through 8, consider the various social and
biological factors that are found to be associated with increased maladaptive
"Chapter 5, "Risk and Protective Factors in Aggression and Related
Behaviors," defines risk factors as "conditions and influences that
predispose children and adolescents to the maladaptive expression of aggressive
behavior," and protective factors as "contingencies that shield
youngsters from the influence of risk factors."
Individual risk factors discussed are: heritable factors; temperament;
infant-caregiver attachment; exposure to neurotoxins (prenatal alcohol, fetal
cocaine, prenatal and childhood lead); academic underachievement and academic
failure; and body size and build.
Family risk factors include: ineffective
parenting practices; family functioning; family structure; parental
psychopathology; and child abuse and neglect.
Extrafamilial risk factors considered are: peer
factors; social deprivation, community factors (collective efficacy,
neighborhood violence, availability of firearms and media violence).
Protective factors are presented in tabular form. They include: easy
temperament; higher IQ; internal locus of control; high self-esteem; academic
competence; social competence; competence in activities; good parent-child
relations; external supports; friendships and availability of opportunities.
Chapter 6 discusses psychobiological factors, and chapter 7
neurobiological factors associated with aggressive behaviors. Chapter 8
presents the results of research that attempts to identify and test "multivariable
models of the development of early-onset aggression and related behaviors in
children and adolescents."
Throughout this four-chapter section the author expresses
disclaimers of any sort of deterministic orientation toward aggressive
behaviors. Risk factors are frequently described as "correlative, not
causal. In chapter 5 summary, Connor writes: "Most of the associations
between these factors and behavioral outcomes are correlational and not causal;"
and in chapter 8 summary we find this sentence: "It is important to
highlight the idea that this research does not find biological processes to be
deterministic for antisocial outcomes (McCord, 1996); rather, the degree to
which biological factors determine outcomes varies in relation to environmental
conditions, as well as the variability in biological risk factors."
Despite the author's denials, this reviewer finds the orientation
of the book to be generally deterministic. There is little said about the child's
or adolescent's ability to choose pro-social rather than antisocial behaviors,
despite the accumulation of risk factors and lack of protective factors in his
Chapter 8, "Issues in Female Aggression and Related
Behaviors," discusses gender differences in the quality and quantity of
aggression and related behaviors. Research is quoted to confirm that "the
individual, family and environmental correlates of aggression and antisocial
behaviors are generally similar in males and females." The findings of
some laboratory studies suggest that testosterone is related to aggression,
anger, and violence in adult females, as it is in adult males. However, in
adolescent females, studies found no such relationship. In the chapter summary,
the author concludes: "Although males tend to be more aggressive than
females at all developmental ages throughout the lifespan, female aggression is
neither uncommon, trivial, nor unimportant."
The last three chapters, 10 through 12, are concerned with
planning and carrying out treatment plans for children and adolescents with
aggressive and antisocial behaviors.
Chapter 10, "Clinical Assessment, Case Formulation and
Treatment Planning," contains a detailed table of goals and specific
content areas for the assessment of children and adolescents with conduct
disorder. This table considers appropriate goals and content areas for the
child; the family; larger systems in the environment; and treatment resources
and expertise available in the clinical setting. Some specific assessment
techniques discussed are: structured diagnostic interviews, behavior rating
scales, and direct behavioral observation. The last section in the chapter
presents a plan for conducting a forensic assessment—assessing the risk of harm
to others. Although there are risk factors known empirically to be related to
future violence, the author warns that "None of these risk factors are
powerful enough alone or in combination to produce individual predictions with
Chapter 11, "Psychosocial Interventions," discusses
family interventions, cognitive-behavioral skills training, and prevention
programs. In a summary of prevention programs, Connor writes: "The
characteristics of successful programs include (1) multimodal interventions that
target family supports and early childhood education (interventions with only a
single focus are much less effective); (2) interventions of sufficient
intensity delivered on a daily to weekly basis; (3) sufficient duration of
intervention (at least 2 years and often longer); (4) use of interventions
shown to be effective in ameliorating known psychosocial mechanisms that
increase risk for CD; (5) interventions that begin early in a child's life
(between ages 0 and 6 years); and (6) collaboration among community, school,
and mental health professionals. Prevention programs that have these
characteristics appear to reduce CD during a child's development."
Under the heading "Treatments That Appear Not To Work,"
the author includes psychoanalysis and group therapy.
In the final chapter, "Psychopharmacological Treatments,"
the author warns that "there is a very real risk that nonmethodically
conducted medication trials may result in the exposure of aggressive youth to
multiple ineffective medications, each with the potential for adverse side
effects or drug-drug pharmacological interactions that may impair the
youngsters' quality of life." With this caveat, however, he reports
studies that demonstrate the effective use of neuroleptics, antipsychotics,
mood stabilizers and stimulants in selected cases of childhood and adolescent
Connor writes very clearly. The only suggestion this reviewer can
think of to increase the book's readability is to add a glossary of
abbreviations. For example, here are some I came across in a few pages: AACAP,
ADHD, ADHD-PHI, ANS, ASPD, BAS, BD, BIS, CD, CDC, CPS, CSF, CNS, DA, DSH, DSM,
EDA, ECF, ERP, HRL, HRR, MDD, MDI, NE, OCD, ODD, PCL, PCL-R, PFC, PTSD, SC,
SCL, SES, SF's, and SUD. A glossary in the form of a bookmark could save the
readers—who represent so many different disciplines—a lot of time.
Some idea of the amount and the breadth of material Connor has accumulated,
organized and discussed in this book, can be gained by considering the 78-page
list of references. There are 17 or 18 references per page, alphabetized by
authors, making a total of over 1300 if my arithmetic is correct. If and when
the book is re-published, this reviewer would recommend adding a few more. On
page 134, there is a section "Body Size and Build," and the terms "endomorphic",
"mesomorphic" and "ectomorphic" are used. I believe this
section would justify the inclusion of W. Sheldon,'s "Varieties of
Delinquent Youth" New York 1949, as well as his two previous volumes, "Varieties
of Human Physique" and "Varieties of Human Temperament"; E. Kretschmer's
"Physique and Character" Berlin 1948; and P. Schilder's "The
Image and Appearance of the Human Body" London 1935.
Hopefully, Connor's explanations of the root causes for the
constantly increasing violence in our society will come to the attention of
politicians, insurance providers, and the health-care industry, so that funding
will be provided for the remedial treatment Connor recommends.
© 2004 Jack R. Anderson
Jack R. Anderson, M.D. is a retired psychiatrist living in Lincoln, Nebraska.