# data[].attributes.body
What is conduct disorder in children?

Conduct disorder is a type of behavior disorder. It’s when a child has antisocial behavior. He or she may disregard basic social standards and rules. He or she may also:

Be irresponsible

Skip school or run away (delinquent behavior)

Steal or do other things to violate the rights of others

Physically harm animals or other people, such as committing assault or rape

These behaviors sometimes happen together. But one or more may occur without the others.

What causes conduct disorder in a child?

Experts believe that many factors play a role in conduct disorder. These are:

Brain damage

A traumatic event

Genes

Child abuse

Past school failure

Social problems

Some children with conduct disorders seem to have a problem in the frontal lobe of the brain. This interferes with a child’s ability to plan, stay away from harm, and learn from negative experiences.

Some experts believe that a series of traumatic experiences occurs for a child to develop a conduct disorder. These experiences then often lead to depressed mood, behavior problems, and involvement in a deviant peer group.

Which children are at risk for conduct disorder?

A conduct disorder is more common in boys than in girls. It is also more likely to develop in children or teens who come from homes that are:

Disadvantaged

Dysfunctional

Disorganized

Children with these mental health problems are also more likely to have conduct disorder:

Mood or anxiety disorders

Posttraumatic stress disorder (PTSD)

Substance use disorder

Attention-deficit/hyperactivity disorder (ADHD)

Learning problems

Children or teens who are considered to have a difficult temperament are more likely to develop behavior problems.

What are the symptoms of conduct disorder in a child?

Most symptoms seen in children with conduct disorder also happen at times in children without this problem. But in children with the disorder, these symptoms occur more often. They also interfere with learning, school adjustment, and sometimes with the child’s relationships.

Each child’s symptoms may vary. But the 4 main groups of behaviors are:

Aggressive conduct

Intimidating behavior

Bullying

Physical fights

Cruelty to others or animals

Using a weapon

Forcing someone into sexual activity, rape, or molestation

Destructive conduct

Intentionally destroying property (vandalism)

Arson

Deceitfulness

Lying

Theft

Shoplifting

Delinquency

Violation of rules or age-appropriate norms

Not going to school (truancy)

Running away

Pranks

Mischief

Very early sexual activity

These symptoms may look like other mental health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

# data[].attributes.attachment_link.provider_name
Centers for Disease Control and Prevention

# data[].attributes.attachment_link.readable_text
Children sometimes argue, are aggressive, or act angry or defiant around adults. A behavior disorder may be diagnosed when these disruptive behaviors are uncommon for the child's age at the time, persist over time, or are severe. Because disruptive behavior disorders involve acting out and showing unwanted behavior towards others they are sometimes called externalizing disorders.

Oppositional Defiant Disorder

When children act out persistently so that it causes serious problems at home, in school, or with peers, they may be diagnosed with Oppositional Defiant Disorder (ODD). ODD usually starts before 8 years of age, but no later than by about 12 years of age. Children with ODD are more likely to act oppositional or defiant around people they know well, such as family members, a regular care provider, or a teacher. Children with ODD show these behaviors more often than other children their age.

Examples of ODD behaviors include

Often being angry or losing one's temper

Often arguing with adults or refusing to comply with adults' rules or requests

Often resentful or spiteful

Deliberately annoying others or becoming annoyed with others

Often blaming other people for one's own mistakes or misbehavior

Learn more about ODD
Conduct Disorder

Conduct Disorder (CD) is diagnosed when children show an ongoing pattern of aggression toward others, and serious violations of rules and social norms at home, in school, and with peers. These rule violations may involve breaking the law and result in arrest. Children with CD are more likely to get injured and may have difficulties getting along with peers.

Examples of CD behaviors include

Breaking serious rules, such as running away, staying out at night when told not to, or skipping school

Being aggressive in a way that causes harm, such as bullying, fighting, or being cruel to animals

Lying, stealing, or damaging other people's property on purpose

Learn more about CD
Treatment for disruptive behavior disorders

Starting treatment early is important. Treatment is most effective if it fits the needs of the specific child and family. The first step to treatment is to talk with a healthcare provider. A comprehensive evaluation by a mental health professional may be needed to get the right diagnosis. Some of the signs of behavior problems, such as not following rules in school, could be related to learning problems which may need additional intervention. For younger children, the treatment with the strongest evidence is behavior therapy training for parents, where a therapist helps the parent learn effective ways to strengthen the parent-child relationship and respond to the child's behavior. For school-age children and teens, an often-used effective treatment is a combination of training and therapy that includes the child, the family, and the school.

Get help finding treatment

Here are tools to find a healthcare provider familiar with treatment options:

Managing Symptoms: Staying Healthy

Being healthy is important for all children and can be especially important for children with behavior or conduct problems. In addition to behavioral therapy and medication, practicing certain healthy lifestyle behaviors may reduce challenging and disruptive behaviors your child might experience. Here are some healthy behaviors that may help:

Engaging in regular physical activity, including aerobic and vigorous exercise

Eating a healthful diet centered on fruits, vegetables, whole grains, legumes (for example, beans, peas, and lentils), lean protein sources, and nuts and seeds

Getting the recommended amount of sleep each night based on age

Strengthening relationships with family members

Prevention of disruptive behavior disorders

It is not known exactly why some children develop disruptive behavior disorders. Many factors may play a role, including biological and social factors. It is known that children are at greater risk when they are exposed to other types of violence and criminal behavior, when they experience maltreatment or harsh or inconsistent parenting, or when their parents have mental health conditions like substance use disorders, depression, or attention-deficit/hyperactivity disorder (ADHD). The quality of early childhood care also can impact whether a child develops behavior problems.

Although these factors appear to increase the risk for disruptive behavior disorders, there are ways to decrease the chance that children experience them. Learn about public health approaches to prevent these risks:

# data[].attributes.attachment_link.title
Behavior or Conduct Problems in Children | CDC

# data[].attributes.attachment_link.description
Children sometimes argue, are aggressive, or act angry or defiant around adults. A behavior disorder may be diagnosed when these disruptive behaviors are uncommon for the child's age at the time, persist over time, or are severe. Learn about behavior or conduct problems in children.

# data[].attributes.body
A speech disorder is a condition in which a person has problems creating or forming the speech sounds needed to communicate with others. This can make the child's speech difficult to understand.

Common speech disorders are:

Articulation disorders

Phonological disorders

Disfluency

Voice disorders or resonance disorders

Speech disorders are different from language disorders in children. Language disorders refer to someone having difficulty with:

Getting their meaning or message across to others (expressive language)

Understanding the message coming from others (receptive language)

# data[].attributes.attachment_link.readable_text
Speech is the process of producing specific sounds that convey meaning to the listener. A speech disorder refers to any condition that affects a person's ability to produce sounds that create words.

Speech is one of the main ways in which people communicate their thoughts, feelings, and ideas with others. The act of speaking requires the precise coordination of multiple body parts, including the head, neck, chest, and abdomen.

In this article, we explore what speech disorders are and the different types. We also cover the symptoms, causes, diagnosis, and treatment of speech disorders.

Speech disorders affect a person's ability to form the sounds that allow them to communicate with other people. They are not the same as language disorders.

Speech disorders prevent people from forming correct speech sounds, while language disorders affect a person's ability to learn words or understand what others say to them.

However, both speech and language disorders can make it more difficult for a person to express their thoughts and feelings to others.

Speech disorders can affect people of all ages.

Some types of speech disorder include stuttering, apraxia, and dysarthria. We discuss each of these types below:

Stuttering

Stuttering refers to a speech disorder that interrupts the flow of speech. People who stutter can experience the following types of disruption:

Repetitions occur when people involuntarily repeat sounds, vowels, or words.

Blocks happen when people know what they want to say but have difficulty making the necessary speech sounds. Blocks may cause someone to feel as though their words are stuck.

Prolongations refer to the stretching or drawing out of particular sounds or words.

The symptoms of stuttering can vary depending on the situation. Stress, excitement, or frustration can cause stuttering to become more severe. Some people may also find that certain words or sounds can make a stutter more pronounced.

Stuttering can cause both behavioral and physical symptoms that occur at the same time. These can include:

tension in the face and shoulders

rapid blinking

lip tremors

clenched fists

sudden head movements

There are two main types of stuttering:

Developmental stuttering affects young children who are still learning speech and language skills. Genetic factors significantly increase a person's likelihood of developing this type of stutter.

Neurogenic stuttering occurs when damage to the brain prevents proper coordination between the different regions of the brain that play a role in speech.

Apraxia

The brain controls every single action that people make, including speaking. Most of the brain's involvement in speech is unconscious and automatic.

When someone decides to speak, the brain sends signals to the different structures of the body that work together to produce speech. The brain instructs these structures how and when to move to form the appropriate sounds.

For example, these speech signals open or close the vocal cords, move the tongue and shape the lips, and control the movement of air through the throat and mouth.

Apraxia is a general term referring to brain damage that impairs a person's motor skills, and it can affect any part of the body. Apraxia of speech, or verbal apraxia, refers specifically to the impairment of motor skills that affect an individual's ability to form the sounds of speech correctly, even when they know which words they want to say.

Dysarthria

Dysarthria occurs when damage to the brain causes muscle weakness in a person's face, lips, tongue, throat, or chest. Muscle weakness in these parts of the body can make speaking very difficult.

People who have dysarthria may experience the following symptoms:

slurred speech

mumbling

speaking too slowly or too quickly

soft or quiet speech

difficulty moving the mouth or tongue

Symptoms of a speech disorder can include repeating or prolonging sounds, rearranging syllables, and speaking very softly.

The symptoms of speech disorders vary widely depending on the cause and severity of the disorder. People can develop multiple speech disorders with different symptoms.

People with one or more speech disorders may experience the following symptoms:

repeating or prolonging sounds

distorting sounds

adding sounds or syllables to words

rearranging syllables

having difficulty pronouncing words correctly

struggling to say the correct word or sound

speaking with a hoarse or raspy voice

speaking very softly

Causes of speech disorders can include:

Risk factors that can increase the likelihood of a person developing a speech disorder include:

being male

being born prematurely

having a low weight at birth

having a family history of speech disorders

experiencing problems that affect the ears, nose, or throat

A speech-language pathologist (SLP) is a healthcare professional who specializes in speech and language disorders.

An SLP will evaluate a person for groups of symptoms that indicate one type of speech disorder. To make an accurate diagnosis, SLPs need to rule out other speech and language disorders and medical conditions.

An SLP will review a person's medical and family history. They will also examine how a person moves their lips, jaw, and tongue and may inspect the muscles of the mouth and throat.

Other methods of evaluating speech disorders include:

Denver articulation screening examination. This test evaluates the clarity of a person's pronunciation.

Prosody-voice screening profile. SLPs use this test to examine multiple aspects of a person's speech, including pitch, phrasing, speech patterns, and speaking volume.

Dynamic evaluation of motor speech skills (DEMSS) manual. The DEMSS is a comprehensive guide for helping SLPs diagnose speech disorders.

The type of treatment will typically depend on the severity of the speech disorder and its underlying cause.

Treatment options can include:

speech therapy exercises that focus on building familiarity with certain words or sounds

physical exercises that focus on strengthening the muscles that produce speech sounds

We discuss some of the treatment options for speech disorders below:

Target selection

Target selection involves a person practicing specific sounds or words to familiarize themselves with particular speech patterns. Examples of therapy targets may include difficult words or sounds that trigger speech disruptions.

Contextual utilization

For this approach, SLPs teach people to recognize speech sounds in different syllable-based contexts.

Contrast therapy

Contrast therapy involves saying word pairs that contain one or more different speech sounds. An example word pair might be "beat" and "feet" or "dough" and "show."

Oral-motor therapy

The oral-motor therapy approach focuses on improving muscle strength, motor control, and breath control. These exercises can help people develop fluency, which produces smoother speech that sounds more natural.

Ear device

Ear devices are small electronic aids that fit inside the ear canal. These devices can help improve fluency in people who have a stutter.

Some ear devices replay altered versions of the wearer's voice to make it seem as though someone else is speaking with them. Other ear devices produce a noise that helps control stuttering.

Medication

Some speech disorders can cause people to develop anxiety disorders. Stressful situations can trigger anxiety, resulting in more pronounced speech disorder symptoms. Anxiety medications may help reduce symptoms of speech disorders in some people.

Speech disorders affect a person's ability to produce sounds that create words. They are not the same as language disorders, which make it more difficult for people to learn words or understand what others are saying to them.

Types of speech disorder include stuttering, apraxia, and dysarthria. There are many possible causes of speech disorders, including muscles weakness, brain injuries, degenerative diseases, autism, and hearing loss.

Speech disorders can affect a person's self-esteem and their overall quality of life. However, speech therapy, breathing exercises, and, sometimes, anti-anxiety medications can help improve speech and reduce symptoms.

# data[].attributes.attachment_link.title
Speech disorders: Types, symptoms, causes, and treatment

# data[].attributes.attachment_link.description
Speech is the process of producing specific sounds that convey meaning to the listener. A speech disorder refers to any condition that affects a person's ability to produce sounds that create words. Speech is one of the main ways in which people communicate their thoughts, feelings, and ideas with others.

# data[].attributes.body
ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.

A child with ADHD might:

•daydream a lot

•forget or lose things a lot

•squirm or fidget

•talk too much

•make careless mistakes or take unnecessary risks

•have a hard time resisting temptation

•have trouble taking turns

•have difficulty getting along with others

There are three different ways ADHD presents:

•Predominantly Inattentive Presentation

-Fails to give close attention to details or makes careless mistakes

-Has difficulty sustaining attention

-Does not appear to listen

-Struggles to follow through with instructions

-Has difficulty with organization

-Avoids or dislikes tasks requiring sustained mental effort

-Loses things

-Is easily distracted

-Is forgetful in daily activities

•Predominantly Hyperactive-Impulsive Presentation

-Fidgets with hands or feet or squirms in a chair

-Has difficulty remaining seated

-Runs about or climbs excessively in children;

-Difficulty engaging in activities quietly

-Acts as if driven by a motor; adults will often feel inside as if they are driven by a motor

-Talks excessively

-Blurts out answers before questions have been completed

-Difficulty waiting or taking turns

-Interrupts or intrudes upon others

•Combined Presentation

People with combined-type ADHD demonstrate six or more symptoms of inattention and six or more symptoms of hyperactivity and impulsivity.

# data[].attributes.attachment_link.provider_name
Centers for Disease Control and Prevention

# data[].attributes.attachment_link.readable_text
ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.

Signs and Symptoms

It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue, can be severe, and can cause difficulty at school, at home, or with friends.

A child with ADHD might:

daydream a lot

forget or lose things a lot

squirm or fidget

talk too much

make careless mistakes or take unnecessary risks

have a hard time resisting temptation

have trouble taking turns

have difficulty getting along with others

Learn more about signs and symptoms
Types

There are three different ways ADHD presents itself, depending on which types of symptoms are strongest in the individual:

Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.

Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.

Combined Presentation: Symptoms of the above two types are equally present in the person.

Because symptoms can change over time, the presentation may change over time as well.

Causes of ADHD

Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. Recent studies link genetic factors with ADHD.

In addition to genetics, scientists are studying other possible causes and risk factors including:

Brain injury

Exposure to environmental risks (e.g., lead) during pregnancy or at a young age

Alcohol and tobacco use during pregnancy

Premature delivery

Low birth weight

Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. Of course, many things, including these, might make symptoms worse, especially in certain people. But the evidence is not strong enough to conclude that they are the main causes of ADHD.

Diagnosis

Deciding if a child has ADHD is a process with several steps. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, sleep problems, and certain types of learning disabilities, can have similar symptoms. One step of the process involves having a medical exam, including hearing and vision tests, to rule out other problems with symptoms like ADHD. Diagnosing ADHD usually includes a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child.
Learn more about the criteria for diagnosing ADHD
Treatments

In most cases, ADHD is best treated with a combination of behavior therapy and medication. For preschool-aged children (4-5 years of age) with ADHD, behavior therapy, particularly training for parents, is recommended as the first line of treatment before medication is tried. What works best can depend on the child and family. Good treatment plans will include close monitoring, follow-ups, and making changes, if needed, along the way.
Learn more about treatments
Managing Symptoms: Staying Healthy

Being healthy is important for all children and can be especially important for children with ADHD. In addition to behavioral therapy and medication, having a healthy lifestyle can make it easier for your child to deal with ADHD symptoms. Here are some healthy behaviors that may help:

Get Help!

If you or your doctor has concerns about ADHD, you can take your child to a specialist such as a child psychologist, child psychiatrist, or developmental pediatrician, or you can contact your local early intervention agency (for children under 3) or public school (for children 3 and older).

The Centers for Disease Control and Prevention (CDC) funds the National Resource Center on ADHD, a program of CHADD - Children and Adults with Attention-Deficit/Hyperactivity Disorder. Their website has links to information for people with ADHD and their families. The National Resource Center operates a call center (1-866-200-8098) with trained staff to answer questions about ADHD.

For more information on services for children with special needs, visit the Center for Parent Information and Resources. To find the Parent Center near you, you can visit this website.

ADHD in Adults

ADHD can last into adulthood. Some adults have ADHD but have never been diagnosed. The symptoms can cause difficulty at work, at home, or with relationships. Symptoms may look different at older ages, for example, hyperactivity may appear as extreme restlessness. Symptoms can become more severe when the demands of adulthood increase. For more information about diagnosis and treatment throughout the lifespan, please visit the websites of the National Resource Center on ADHD and the National Institutes of Mental Health.

More Information

Reference

Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., . . . Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews. doi:10.1016/j.neubiorev.2021.01.022

# data[].attributes.attachment_link.description
ADHD is one of the most common neurobehavioral disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), and in some cases, are overly active.

# data[].attributes.body
Speech is one of the main ways in which we communicate with those around us. It develops naturally, along with other signs of normal growth and development. Disorders of speech and language are common in preschool age children.

Disfluencies are disorders in which a person repeats a sound, word, or phrase. Stuttering may be the most serious disfluency. It may be caused by:

Genetic abnormalities

Emotional stress

Any trauma to brain or infection

Articulation and phonological disorders may occur in other family members. Other causes include:

Problems or changes in the structure or shape of the muscles and bones used to make speech sounds. These changes may include cleft palate and tooth problems.

Damage to parts of the brain or the nerves (such as from cerebral palsy) that control how the muscles work together to create speech.

Hearing loss.

Voice disorders are caused by problems when air passes from the lungs, through the vocal cords, and then through the throat, nose, mouth, and lips. A voice disorder may be due to:

Acid from the stomach moving upward (GERD)

Cancer of the throat

Cleft palate or other problems with the palate

Conditions that damage the nerves that supply the muscles of the vocal cords

Laryngeal webs or clefts (a birth defect in which a thin layer of tissue is between the vocal cords)

Noncancerous growths (polyps, nodules, cysts, granulomas, papillomas, or ulcers) on the vocal cords

Overuse of the vocal cords from screaming, constantly clearing the throat, or singing

Hearing loss

# data[].attributes.attachment_link.readable_text
What is a speech impediment?

Speech impediment, or speech disorder, happens when your child can't speak or can't speak so people understand what they're saying. In some cases, a speech impediment is a sign of physical or developmental differences.

Left untreated, a speech impediment can make it difficult for children to learn to read and write. Children with speech impediments might also have trouble socializing. There are some speech impediments like tongue tie or cleft palate that may be treated with surgery. In most cases, however, speech therapy helps treat speech impediments.

What are some speech impediment types?

Some common speech impediments are:

Stuttering. This condition might indicate developmental delay, an inherited condition or a sign your child's brain isn't coordinating the functions that drive speech.

Articulation errors. This happens when children can't form speech sounds because they have trouble placing their tongue in the right position. Lisping is an example of an articulation error.

Tongue-tie (ankyloglossia). This is a physical condition that makes it hard for children to move their tongues.

Apraxia.This condition happens when a child's brain can't coordinate the muscles that enable speech.

Dysarthria.This condition happens when children slur their words because of brain damage.

Selective mutism. This condition happens when children become so anxious about being in certain places and situations that they can't speak.

Are speech impediments common?

Studies show approximately 5% of children entering first grade have noticeable speech impediments.

What's the difference between a speech impediment and a language disorder?

A speech impediment happens when your child's mouth, jaw, tongue and vocal tract can't work together to produce recognizable words. A language disorder happens when your child has trouble understanding what's being said or people have trouble understanding what your child is saying. For example, your child might use one word when they mean to use another word. They might also say words out of order.

What's the difference between a speech impediment and speech as a child's developmental milestone?

Speech is an important developmental milestone. Healthcare providers track children's development against timelines. A speech impediment might be a reason why your child's speech isn't developing as it should, but it might not be the only reason.

# data[].attributes.attachment_link.title
Speech Impediment: Definition, Causes, Types & Treatment

# data[].attributes.attachment_link.description
Speech impediment, or speech disorder, happens when your child can't speak or can't speak so people understand what they're saying.

# data[].attributes.body
According to National Institute of Mental Health (2022) Autism spectrum disorder (ASD) is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. Although autism can be diagnosed at any age, it is described as a “developmental disorder” because symptoms generally appear in the first 2 years of life.

Generally ASD is noted by:
a lack of or difficulty communicating and socializing with others.
Limited interests
Repetitive behavior
Difficulty absorbing information due to focus and interest issues.

Long term treatment can ameliorate symptoms.  At time of writing there is no known cure.

Most critically for diagnosis is the understanding that ASD is a spectrum disorder which means that there is a large variance in degree of severity with minor autistic cases being nearly to fully functional without any support or assistance, to major cases being rendered nearly unsocial and non-communicative without intense therapy and assistance to reach out and form proper lines of communication. As with many developmental disorders ASD is better managed when diagnosed early and can generally be diagnosed as early as age 2.

National Institute of Mental Health. (2022). Autism spectrum disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd

‌

# data[].attributes.attachment_link.provider_name
National Institute of Mental Health (NIMH)

# data[].attributes.attachment_link.readable_text
Overview

Autism spectrum disorder (ASD) is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. Although autism can be diagnosed at any age, it is described as a "developmental disorder" because symptoms generally appear in the first two years of life.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by the American Psychiatric Association that health care providers use to diagnose mental disorders, people with ASD often have:

Difficulty with communication and interaction with other people

Restricted interests and repetitive behaviors

Symptoms that affect their ability to function in school, work, and other areas of life

Autism is known as a "spectrum" disorder because there is wide variation in the type and severity of symptoms people experience.

People of all genders, races, ethnicities, and economic backgrounds can be diagnosed with ASD. Although ASD can be a lifelong disorder, treatments and services can improve a person's symptoms and daily functioning. The American Academy of Pediatrics recommends that all children receive screening for autism. Caregivers should talk to their child's health care provider about ASD screening or evaluation.

Signs and Symptoms of ASD

People with ASD have difficulty with social communication and interaction, restricted interests, and repetitive behaviors. The list below gives some examples of common types of behaviors in people diagnosed with ASD. Not all people with ASD will have all behaviors, but most will have several of the behaviors listed below.

Social communication / interaction behaviors may include:

Making little or inconsistent eye contact

Appearing not to look at or listen to people who are talking

Infrequently sharing interest, emotion, or enjoyment of objects or activities (including by infrequently pointing at or showing things to others)

Not responding or being slow to respond to one's name or to other verbal bids for attention

Having difficulties with the back and forth of conversation

Often talking at length about a favorite subject without noticing that others are not interested or without giving others a chance to respond

Displaying facial expressions, movements, and gestures that do not match what is being said

Having an unusual tone of voice that may sound sing-song or flat and robot-like

Having trouble understanding another person's point of view or being unable to predict or understand other people's actions

Difficulties adjusting behaviors to social situations

Difficulties sharing in imaginative play or in making friends

Restrictive / repetitive behaviors may include:

Repeating certain behaviors or having unusual behaviors, such as repeating words or phrases (a behavior called echolalia)

Having a lasting intense interest in specific topics, such as numbers, details, or facts

Showing overly focused interests, such as with moving objects or parts of objects

Becoming upset by slight changes in a routine and having difficulty with transitions

Being more sensitive or less sensitive than other people to sensory input, such as light, sound, clothing, or temperature

People with ASD may also experience sleep problems and irritability.

People on the autism spectrum also may have many strengths, including:

Being able to learn things in detail and remember information for long periods of time

Being strong visual and auditory learners

Excelling in math, science, music, or art

Causes and Risk Factors

Researchers don't know the primary causes of ASD, but studies suggest that a person's genes can act together with aspects of their environment to affect development in ways that lead to ASD. Some factors that are associated with an increased likelihood of developing ASD include:

Having a sibling with ASD

Having older parents

Having certain genetic conditions (such as Down syndrome or Fragile X syndrome)

Having a very low birth weight

Diagnosing ASD

Health care providers diagnose ASD by evaluating a person's behavior and development. ASD can usually be reliably diagnosed by the age of two. It is important to seek an evaluation as soon as possible. The earlier ASD is diagnosed, the sooner treatments and services can begin.

Diagnosis in Young Children

Diagnosis in young children is often a two-stage process.

Stage 1: General Developmental Screening During Well-Child Checkups

Every child should receive well-child check-ups with a pediatrician or an early childhood health care provider. The American Academy of Pediatrics recommends that all children receive screening for developmental delays at their 9-, 18-, and 24- or 30-month well-child visits, with specific autism screenings at their 18- and 24-month well-child visits. A child may receive additional screening if they are at high risk for ASD or developmental problems. Children at high risk include those who have a family member with ASD, show some behaviors that are typical of ASD, have older parents, have certain genetic conditions, or who had a very low birth weight.

Considering caregivers' experiences and concerns is an important part of the screening process for young children. The health care provider may ask questions about the child's behaviors and evaluate those answers in combination with information from ASD screening tools and clinical observations of the child. Read more about screening instruments on the Centers for Disease Control and Prevention (CDC) website.

If a child shows developmental differences in behavior or functioning during this screening process, the health care provider may refer the child for additional evaluation.

Stage 2: Additional Diagnostic Evaluation

It is important to accurately detect and diagnose children with ASD as early as possible, as this will shed light on their unique strengths and challenges. Early detection also can help caregivers determine which services, educational programs, and behavioral therapies are most likely to be helpful for their child.

A team of health care providers who have experience diagnosing ASD will conduct the diagnostic evaluation. This team may include child neurologists, developmental pediatricians, speech-language pathologists, child psychologists and psychiatrists, educational specialists, and occupational therapists.

The diagnostic evaluation is likely to include:

Medical and neurological examinations

Assessment of the child's cognitive abilities

Assessment of the child's language abilities

Observation of the child's behavior

An in-depth conversation with the child's caregivers about the child's behavior and development

Assessment of age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting

Because ASD is a complex disorder that sometimes occurs with other illnesses or learning disorders, the comprehensive evaluation may include:

The outcome of the evaluation may result in a formal diagnosis and recommendations for treatment.

Diagnosis in older children and adolescents

Caregivers and teachers are often the first to recognize ASD symptoms in older children and adolescents who attend school. The school's special education team may perform an initial evaluation and then recommend that a child undergo additional evaluation with their primary health care provider or a health care provider who specialize in ASD.

A child's caregivers may talk with these health care providers about their child's social difficulties, including problems with subtle communication. These subtle communication differences may include problems understanding tone of voice, facial expressions, or body language. Older children and adolescents may have trouble understanding figures of speech, humor, or sarcasm. They also may have trouble forming friendships with peers.

Diagnosis in adults

Diagnosing ASD in adults is often more difficult than diagnosing ASD in children. In adults, some ASD symptoms can overlap with symptoms of other mental health disorders, such as anxiety disorder or attention-deficit/hyperactivity disorder (ADHD).

Adults who notice the signs and symptoms of ASD should talk with a health care provider and ask for a referral for an ASD evaluation. Although evaluation for ASD in adults is still being refined, adults can be referred to a neuropsychologist, psychologist, or psychiatrist who has experience with ASD. The expert will ask about:

Social interaction and communication challenges

Sensory issues

Repetitive behaviors

Restricted interests

The evaluation also may include a conversation with caregivers or other family members to learn about the person's early developmental history, which can help ensure an accurate diagnosis.

Obtaining a correct diagnosis of ASD as an adult can help a person understand past challenges, identify personal strengths, and find the right kind of help. Studies are underway to determine the types of services and supports that are most helpful for improving the functioning and community integration of autistic transition-age youth and adults.

Treatments and Therapies

Treatment for ASD should begin as soon as possible after diagnosis. Early treatment for ASD is important as proper care and services can reduce individuals' difficulties while helping them learn new skills and build on their strengths.

People with ASD may face a wide range of issues, which means that there is no single best treatment for ASD. Working closely with a health care provider is an important part of finding the right combination of treatment and services.

Medication

A health care provider may prescribe medication to treat specific symptoms. With medication, a person with ASD may have fewer problems with:

Irritability

Aggression

Repetitive behavior

Hyperactivity

Attention problems

Anxiety and depression

Read more about the latest medication warnings, patient medication guides, and information on newly approved medications at the Food and Drug Administration (FDA) website.
Behavioral, psychological, and educational interventions

People with ASD may be referred to a health care provider who specializes in providing behavioral, psychological, educational, or skill-building interventions. These programs are typically highly structured and intensive, and they may involve caregivers, siblings, and other family members. These programs may help people with ASD:

Learn social, communication, and language skills

Reduce behaviors that interfere with daily functioning

Increase or build upon strengths

Learn life skills necessary for living independently

Other resources

Many services, programs, and other resources are available to help people with ASD. Here are some tips for finding these additional services:

Contact your health care provider, local health department, school, or autism advocacy group to learn about special programs or local resources.

Find an autism support group. Sharing information and experiences can help people with ASD and their caregivers learn about treatment options and ASD-related programs.

Record conversations and meetings with health care providers and teachers. This information helps when it's time to decide which programs and services are appropriate.

Keep copies of health care reports and evaluations. This information may help people with ASD qualify for special programs.

Join a Study

Learn More

Free Brochures and Shareable Resources

Federal Resources

Research and Statistics

Last Reviewed: March 2022
Unless otherwise specified, NIMH information and publications are in the public domain and available for use free of charge. Citation of NIMH is appreciated. Please see our Citing NIMH Information and Publications page for more information.

# data[].attributes.attachment_link.description
Autism spectrum disorder (ASD) is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. Although autism can be diagnosed at any age, it is described as a "developmental disorder" because symptoms generally appear in the first two years of life.

# data[].attributes.body
This is not an exhaustive list.  Further not all will present with all symptoms, however most will present with many if not most of them.
(List cited from the National Institute of Mental Health.)

Social communication / interaction behaviors may include:

Making little or inconsistent eye contact

Appearing not to look at or listen to people who are talking

Infrequently sharing interest, emotion, or enjoyment of objects or activities (including infrequent pointing at or showing things to others)

Not responding or being slow to respond to one’s name or to other verbal bids for attention

Having difficulties with the back and forth of conversation

Often talking at length about a favorite subject without noticing that others are not interested or without giving others a chance to respond

Displaying facial expressions, movements, and gestures that do not match what is being said

Having an unusual tone of voice that may sound sing-song or flat and robot-like

Having trouble understanding another person’s point of view or being unable to predict or understand other people’s actions

Difficulties adjusting behaviors to social situations

Difficulties sharing in imaginative play or in making friends

Restrictive / repetitive behaviors may include:

Repeating certain behaviors or having unusual behaviors, such as repeating words or phrases (a behavior called echolalia)

Having a lasting intense interest in specific topics, such as numbers, details, or facts

Showing overly focused interests, such as with moving objects or parts of objects

Becoming upset by slight changes in a routine and having difficulty with transitions

Being more sensitive or less sensitive than other people to sensory input, such as light, sound, clothing, or temperature

People with ASD may also experience sleep problems and irritability.

In addition to weaknesses people on the autism spectrum also may have many strengths, including:

Being able to learn things in detail and remember information for long periods of time

Being strong visual and auditory learners

Excelling in math, science, music, or art

# data[].attributes.body
Contemporary Trends

Medical science first documented children exhibiting inattentiveness, impulsivity and hyperactivity in 1902. Since that time, the disorder has been given numerous names, including minimal brain dysfunction, hyperkinetic reaction of childhood, and attention-deficit disorder with or without hyperactivity. With the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) classification system, the disorder has been renamed attention-deficit/hyperactivity disorder or ADHD. The current name reflects the importance of the inattention aspect of the disorder as well as the other characteristics of the disorder such as hyperactivity and impulsivity.

Research has demonstrated that ADHD has a very strong neurobiological basis.

Although precise causes have not yet been identified, there is little question that heredity makes the largest contribution to the expression of the disorder in the population.

In instances where heredity does not seem to be a factor, difficulties during pregnancy, prenatal exposure to alcohol and tobacco, premature delivery, significantly low birth weight, excessively high body lead levels, and postnatal injury to the prefrontal regions of the brain have all been found to contribute to the risk for ADHD to varying degrees.

Issues Related to The Topic

In 1994, the name of the disorder was changed in a way that is confusing for many people. Since that time all forms of attention deficit disorder are officially called “Attention-Deficit/Hyperactivity Disorder,” regardless of whether the individual has symptoms of hyperactivity or not. Even though these are the official labels, a lot of professionals and lay people still use both terms: ADD and ADHD. Some use those terms to designate the old subtypes; others use ADD just as a shorter way to refer to any presentation.

Treatment Research

The bulk of treatment research on ADHD has focused on the condition in children, and the options for them have a strong evidence base for symptom reduction. For many, the need for intervention persists over the long term. Research from the landmark National Institute of Mental Health Multimodal Treatment Study of ADHD showed significant improvement in behavior at home and school in children with ADHD who received carefully monitored medication in combination with behavioral treatment. These children also showed better relationships with their classmates and family than did not children receiving this combination of treatment. Further research confirms that combining behavioral and stimulant treatments are more effective than either treatment alone.

# data[].attributes.attachment_link.readable_text
Everybody can have difficulty sitting still, paying attention or controlling impulsive behavior once in a while. For some people, however, the problems are so pervasive and persistent that they interfere with every aspect of their life: home, academic, social and work.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting 11 percent of school-age children. Symptoms continue into adulthood in more than three-quarters of cases. ADHD is characterized by developmentally inappropriate levels of inattention, impulsivity and hyperactivity.

Individuals with ADHD can be very successful in life. However, without identification and proper treatment, ADHD may have serious consequences, including school failure, family stress and disruption, depression, problems with relationships, substance abuse, delinquency, accidental injuries and job failure. Early identification and treatment are extremely important.

Medical science first documented children exhibiting inattentiveness, impulsivity and hyperactivity in 1902. Since that time, the disorder has been given numerous names, including minimal brain dysfunction, hyperkinetic reaction of childhood, and attention-deficit disorder with or without hyperactivity. With the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) classification system, the disorder has been renamed attention-deficit/hyperactivity disorder or ADHD. The current name reflects the importance of the inattention aspect of the disorder as well as the other characteristics of the disorder such as hyperactivity and impulsivity.
Symptoms
Typically, ADHD symptoms arise in early childhood. According to the DSM-5, several symptoms are required to be present before the age of 12. Many parents report excessive motor activity during the toddler years, but ADHD symptoms can be hard to distinguish from the impulsivity, inattentiveness and active behavior that is typical for kids under the age of four. In making the diagnosis, children should have six or more symptoms of the disorder present; adolescents 17 and older and adults should have at least five of the symptoms present. The DSM-5 lists three presentations of ADHD-Predominantly Inattentive, Hyperactive-Impulsive and Combined. The symptoms for each are adapted and summarized below.
ADHD predominantly inattentive presentation

Fails to give close attention to details or makes careless mistakes

Has difficulty sustaining attention

Does not appear to listen

Struggles to follow through with instructions

Has difficulty with organization

Avoids or dislikes tasks requiring sustained mental effort

Loses things

Is easily distracted

Is forgetful in daily activities

ADHD predominantly hyperactive-impulsive presentation

Fidgets with hands or feet or squirms in chair

Has difficulty remaining seated

Runs about or climbs excessively in children; extreme restlessness in adults

Difficulty engaging in activities quietly

Acts as if driven by a motor; adults will often feel inside as if they are driven by a motor

Talks excessively

Blurts out answers before questions have been completed

Difficulty waiting or taking turns

Interrupts or intrudes upon others

ADHD combined presentation

The individual meets the criteria for both inattention and hyperactive-impulsive ADHD presentations.

These symptoms can change over time, so children may fit different presentations as they get older.
Confusing labels for ADHD
In 1994, the name of the disorder was changed in a way that is confusing for many people. Since that time all forms of attention deficit disorder are officially called "Attention-Deficit/Hyperactivity Disorder," regardless of whether the individual has symptoms of hyperactivity or not. Even though these are the official labels, a lot of professionals and lay people still use both terms: ADD and ADHD. Some use those terms to designate the old subtypes; others use ADD just as a shorter way to refer to any presentation.
Severity of symptoms
As ADHD symptoms affect each person to varying degrees, the DSM-5 now requires professionals diagnosing ADHD to include the severity of the disorder. How severe the disorder is can change with the presentation during a person's lifetime. Clinicians can designate the severity of ADHD as "mild," "moderate" or "severe" under the criteria in the DSM-5.

Mild: Few symptoms beyond the required number for diagnosis are present, and symptoms result in minor impairment in social, school or work settings.
Moderate: Symptoms or functional impairment between "mild" and "severe" are present.
Severe: Many symptoms are present beyond the number needed to make a diagnosis; several symptoms are particularly severe; or symptoms result in marked impairment in social, school or work settings.

As individuals age, their symptoms may lessen, change or take different forms. Adults who retain some of the symptoms of childhood ADHD, but not all, can be diagnosed as having ADHD in partial remission.
ADHD throughout the lifespan
Children with ADHD often experience delays in independent functioning and may behave younger than their peers. Many children affected by ADHD can also have mild delays in language, motor skills or social development that are not part of ADHD but often co-occur. They tend to have low frustration tolerance, difficulty controlling their emotions and often experience mood swings.

Children with ADHD are at risk for potentially serious problems in adolescence and adulthood: academic failure or delays, driving problems, difficulties with peers and social situations, risky sexual behavior, and substance abuse. There may be more severe negative behaviors with co-existing conditions such as oppositional defiant disorder or conduct disorder. Adolescent girls with ADHD are also more prone to eating disorders than boys. As noted above, ADHD persists from childhood to adolescence in the vast majority of cases (50-80 percent), although the hyperactivity may lessen over time.

Teens with ADHD present a special challenge. During these years, academic and life demands increase. At the same time, these kids face typical adolescent issues such as emerging sexuality, establishing independence, dealing with peer pressure and the challenges of driving.

More than 75 percent of children with ADHD continue to experience significant symptoms in adulthood. In early adulthood, ADHD may be associated with depression, mood or conduct disorders and substance abuse. Adults with ADHD often cope with difficulties at work and in their personal and family lives related to ADHD symptoms. Many have inconsistent performance at work or in their careers; have difficulties with day-to-day responsibilities; experience relationship problems; and may have chronic feelings of frustration, guilt or blame.

Individuals with ADHD may also have difficulties with maintaining attention, executive function and working memory. Recently, deficits in executive function have emerged as key factors affecting academic and career success. Executive function is the brain's ability to prioritize and manage thoughts and actions. This ability permits individuals to consider the long-term consequences of their actions and guide their behavior across time more effectively. Individuals who have issues with executive functioning may have difficulties completing tasks or may forget important things.
Co-occurring Disorders
More than two-thirds of children with ADHD have at least one other co-existing condition. Any disorder can co-exist with ADHD, but certain disorders seem to occur more often. These disorders include oppositional defiant and conduct disorders, anxiety, depression, tic disorders or Tourette syndrome, substance abuse, sleep disorders and learning disabilities. When co-existing conditions are present, academic and behavioral problems, as well as emotional issues, may be more complex.

These co-occurring disorders can continue throughout a person's life. A thorough diagnosis and treatment plan that takes into account all of the symptoms present is essential.
Causes
Despite multiple studies, researchers have yet to determine the exact causes of ADHD. However, scientists have discovered a strong genetic link since ADHD can run in families. More than 20 genetic studies have shown evidence that ADHD is strongly inherited. Yet ADHD is a complex disorder, which is the result of multiple interacting genes.

Other factors in the environment may increase the likelihood of having ADHD:

exposure to lead or pesticides in early childhood

premature birth or low birth weight

brain injury

Scientists continue to study the exact relationship of ADHD to environmental factors, but point out that there is no single cause that explains all cases of ADHD and that many factors may play a part.

Previously, scientists believed that maternal stress and smoking during pregnancy could increase the risk for ADHD, but emerging evidence is starting to question this belief. However, further research is needed to determine if there is a link or not.

The following factors are NOT known causes, but can make ADHD symptoms worse for some children:

watching too much television

eating sugar

family stress (poverty, family conflict)

traumatic experiences

ADHD symptoms, themselves, may contribute to family conflict. Even though family stress does not cause ADHD, it can change the way the ADHD presents itself and result in additional problems such as antisocial behavior.

Problems in parenting or parenting styles may make ADHD better or worse, but these do not cause the disorder. ADHD is clearly a brain-based disorder. Currently research is underway to better define the areas and pathways that are involved.

For more information on the following topics:

# data[].attributes.attachment_link.title
About ADHD - Symptoms, Causes and Treatment - CHADD

# data[].attributes.attachment_link.description
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting up to 11 percent of school-age children and many adults.

# data[].attributes.body
A non comprehensive timeline of ASD.  (Items have been removed for brevity.  A full list can be found here: https://www.verywellhealth.com/autism-timeline-2633213)

1910s

1911: Psychiatrist Paul Eugen Bleuler coined the term, using it to describe what he believed to be the childhood version of schizophrenia.

1920s

1926: Grunya Sukhareva, a child psychiatrist in Kiev, Russia, writes about six children with autistic traits in a scientific German psychiatry and neurology journal.

1930s

1938: Louise Despert, a psychologist in New York, details 29 cases of childhood schizophrenia, some who have symptoms that resemble today's classification of autism.

1940s

1943: Leo Kanner publishes a paper describing 11 patients who were focused on or obsessed with objects and had a “resistance to (unexpected) change.” He later named this condition “infantile autism.”

1944: Austrian pediatrician Hans Asperger publishes an important scientific study of children with autism, a case study describing four children ages 6 to 11. He notices parents of some of the children have similar personalities or eccentricities, and regards this as evidence of a genetic link. He is also credited with describing a higher-functioning form of autism, later called Asperger’s syndrome.

1949: Kanner proclaims his theory that autism is caused by "refrigerator mothers," a term used to describe parents who are cold and detached.

1950s

1952: In the first edition of the American Psychiatric Associations's Diagnostic and Statistical Manual of Mental Disorders (DSM), children with symptoms of autism are labeled as having childhood schizophrenia.

1956: Leon Eisenberg publishes his paper "The Autistic Child in Adolescence," which follows 63 autistic children for nine years and again at 15 years old.

1960s

1964: Bernard Rimland publishes Infantile Autism: The Syndrome and Its Implications for a Neural Theory of Behavior, challenging the “refrigerator mother” theory and discussing the neurological factors in autism.

1964: Ole Ivar Lovaas begins working on his theory of Applied Behavioral Analysis (ABA) therapy for autistic children.

1965: The Sybil Elgar School begins teaching and caring for children with autism.

1967: Bruno Bettelheim writes Empty Fortress, which reinforces the “refrigerator mother” theory as the cause of autism.

1970s

1970s: Lorna Wing proposes the concept of autism spectrum disorders. She identifies the “triad of impairment,” which includes three areas: social interaction, communication, and imagination.

1975: The Education for All Handicapped Children Act is enacted to help protect the rights and meet the needs of children with disabilities, most of whom were previously excluded from school.

1977: Susan Folstein and Michael Rutter publish the first study of twins and autism. The study finds that genetics are an important risk factor for autism.

1980s

1980: The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) includes criteria for a diagnosis of infantile autism for the first time.

1990s

1990: Autism is included as a disability category in the Individuals with Disabilities Education Act (IDEA), making it easier for autistic children to get special education services.

1998: Andrew Wakefield publishes his paper in the Lancet suggesting that the measles-mumps-rubella (MMR) vaccine triggers autism. The theory is debunked by comprehensive epidemiological studies and eventually retracted.

2000s

2003: The Global and Regional Asperger Syndrome Partnership (GRASP), an organization run by people with Asperger’s syndrome and autism spectrum disorders, is formed.

2006: The president signs the Combating Autism Act to provide support for autism research and treatment.

2010s

2010: Andrew Wakefield loses his medical license and is barred from practicing medicine, following the retraction of his autism paper.

2013: The DSM-5 combines autism, Asperger’s, and childhood disintegrative disorder into autism spectrum disorder.

2014: The president signs the Autism Collaboration, Accountability, Research, Education and Support (CARES) Act of 2014, reauthorizing and expanding the Combating Autism Act.

2020: The Centers for Disease Control and Prevention determines one in 54 children have been identified with an autism spectrum disorder (ASD).

Iannelli, V. (2015, November). Timeline and the History of Autism. Verywell Health; Verywell Health. https://www.verywellhealth.com/autism-timeline-2633213

‌

# data[].attributes.attachment_link.readable_text
The history of autism as a formal diagnosis began in 1911. Swiss psychiatrist Paul Eugen Bleuler coined the term, using it to describe what he claimed to be the childhood version of schizophrenia.

Since then, our understanding of autism has evolved, culminating in the current diagnosis of autism spectrum disorder (ASD).

Most of the public history of autism has been dominated by allistic (non-autistic) professionals and caregivers. Some of the language in this article includes stigmatizing terminology and ideas that aim to accurately reflect the language used by the cited experts.

1926: Grunya Sukhareva, a child psychiatrist in Kyiv, Russia, writes about six children with autistic traits in a scientific German psychiatry and neurology journal.

1938: Louise Despert, a psychologist in New York, details 29 cases of childhood schizophrenia, some of whom have traits that resemble today's classification of autism.

1943: Leo Kanner publishes a paper describing 11 patients who were focused on or obsessed with objects and had a "resistance to (unexpected) change." He later named this condition "infantile autism."

1944: Nazi-funded, Austrian pediatrician Hans Asperger publishes a popularized scientific study on autistic children, a case study describing four children ages 6 to 11. Much of his science was rooted in eugenics and the "race hygiene" politics of the Nazi regime. He notices parents of some of the children have similar personalities or eccentricities, and regards this as evidence of a genetic link. He was foundational to the development of the phased-out functioning labels (high vs. low functioning), and the former DSM diagnosis, Asperger's syndrome, was named after him.

1949: Kanner proclaims his theory that autism is caused by " refrigerator mothers," a term used to describe parents who are cold and detached. This theory has long been disproved.

1952: In the first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), children with autistic traits are labeled as having childhood schizophrenia.

1956: Leon Eisenberg publishes his paper "The Autistic Child in Adolescence," which follows 63 autistic children for nine years and again at 15 years old.

1959: Austrian-born scientist Bruno Bettelheim publishes an article in Scientific American about Joey, a 9-year-old autistic child.

1964: Bernard Rimland publishes Infantile Autism: The Syndrome and Its Implications for a Neural Theory of Behavior, challenging the "refrigerator mother" theory and discussing the neurological factors in autism.

1964: Dr. Ole Ivar Lovaas, creator of LGBTQ conversion therapy, begins working on his theory of Applied Behavioral Analysis (ABA) therapy for autistic children. While ABA is the current standard therapy for autistic people, autistic self-advocates draw parallels to the therapy as a form of conversion therapy for autistic people and have begun pushing against its use due to the post-traumatic symptoms individuals experience after ABA.

1965: The Sybil Elgar School begins teaching and caring for autistic children.

1965: A group of allistic parents (people who are not on the autistic spectrum) of autistic children have the first meeting of the National Society of Autistic Children (now called the Autism Society of America).

1967: Bruno Bettelheim writes Empty Fortress, which reinforces the "refrigerator mother" theory as the cause of autism.

1970s: PsychiatristLorna Wing proposes the concept of autism spectrum disorders. She identifies the "triad of impairment," which includes three areas: social interaction, communication, and imagination.

1975: The Education for All Handicapped Children Act is enacted to help protect the rights and meet the needs of children with disabilities, most of whom were previously excluded from school.

1977: Susan Folstein, M.D., and professor Michael Rutter publish the first study of twins and autism. The study finds that genetics are an important factor for being autistic.

1980: The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) includes criteria for a diagnosis of infantile autism for the first time.﻿﻿

1990: Autism is included as a disability category in the Individuals with Disabilities Education Act (IDEA), making it easier for autistic children to get special education services.

1996: Temple Grandin writes Emergence-Labeled Autistic, a firsthand account of her life with autism and how she became successful in her field.

1998: Andrew Wakefield, M.D. publishes his paper in the Lancet suggesting that the measles-mumps-rubella (MMR) vaccine triggers autism. The theory is debunked by comprehensive epidemiological studies and eventually retracted.

1999: The Autism Society adopts the Autism Awareness Puzzle Ribbon as "the universal sign of autism awareness." Due to the symbol's implications of autistic people as incomplete and its association with autism hate groups, the autistic community now uses an infinity symbol (black or rainbow-colored) instead.

2003: The Global and Regional Asperger Syndrome Partnership (GRASP), an organization run by people with Asperger's syndrome and autism spectrum disorders, is formed.

2003: Bernard Rimland, M.D. and Stephen Edelson, Ph.D. write the book Recovering Autistic Children.

2006: Ari Ne'eman establishes the Autistic Self Advocacy Network (ASAN).

2006: Dora Raymaker and Christina Nicolaidis, M.D. start the Academic Autistic Spectrum Partnership in Research and Education (AASPIRE) to provide resources for autistic adults and healthcare providers.

2006: The president signs the Combating Autism Act to provide support for autism research and treatment.

2010: Andrew Wakefield loses his medical license and is barred from practicing medicine, following the retraction of his autism paper.

2013: The DSM-5 combines autism, Asperger's, and childhood disintegrative disorder into autism spectrum disorder.

2014: The president signs the Autism Collaboration, Accountability, Research, Education and Support (CARES) Act of 2014, reauthorizing and expanding the Combating Autism Act.

2020: The Centers for Disease Control and Prevention estimates one in 54 children has been identified as having an autism spectrum disorder (ASD) diagnosis.

2020: A large-scale genetic sequencing study identifies 102 autism-related genes involved in early brain development.

2023: The Centers for Disease Control and Prevention estimates 1 in 36 children has been identified with autism spectrum disorder (ASD).

Autism research and advocacy continue to build on these past events. As autistic self-advocates are growing in both political power and public presence, they aim to move towards a future of total acceptance and understanding of autistic people.

Advocates also work to provide access to resources to address the current gaps in support that autistic children and adults currently experience.

# data[].attributes.attachment_link.description
The term "autism" was first coined in 1911. Since then, research has led to steady developments in understanding autism.

# data[].attributes.body
Types of treatment for ADHD include

---Behavior therapy, including training for parents;

---Medications.

The goals of behavior therapy are to learn or strengthen positive behaviors and eliminate unwanted or problematic behaviors. Behavior therapy for ADHD can include

•Parent training in behavior management;

•Behavior therapy with children

Psychological therapy is meant to treat a mental health condition or help a child manage their symptoms so that they can function well at home, in school, and in their community.

•Behavioral interventions in the classroom

1 ADHD treatments, such as behavioral classroom management or organizational training. The behavioral classroom management approach encourages a student’s positive behaviors in the classroom, through a reward system or a daily report card, and discourages their negative behaviors.

2 Special education services;

The support a child with ADHD receives at school will depend on if they meet the eligibility requirements for one of two federal plans funded by IDEA and Section 504:  an individualized education program (IEP) or a 504 Plan.

3 Accommodations to lessen the effect of ADHD on their learning.

-Extra time on tests;

-Instruction and assignments tailored to the child;

-Positive reinforcement and feedback;

-Using technology to assist with tasks;

-Allowing breaks or time to move around;

-Changes to the environment to limit distraction

-Extra help with staying organized.

# data[].attributes.body
The first period establishes the historical context of conduct disorders. This period is marked by the growing realisation that childhood and adolescence were a distinct phase of
development. Consequently interventions began to be implemented when the youth exhibited social and emotional problems.

The second period spans the stage from 1910 to 1968 when
behaviour disorders were first included in the medical classification system. In this period there was an increasing recognition of the role of both psychological and environmental factors in shaping behaviour and hence a change in the perception and treatment of antisocial
youth.

The third period is from 1968 until today and is marked by a rapid growth of knowledge and a change to a holistic perspective on conduct disorders and the individual.

# data[].attributes.body
Individuals with Disabilities Act (IDEA)

IDEA is a federal law that supports children ages 3 – 21, so they can have a free and appropriate education. It ensures that those found eligible will receive special education or related services. IDEA supports students with ADHD, but only when the ADHD is so severe that a student needs an Individualized Educational Program (IEP). This can make it more difficult for children with ADHD to qualify. To be eligible for special education services, ADHD is under IDEA’s disability category of "Other Health Impairment" (OHI).

Section 504 of the Rehabilitation Act

If student is having trouble in school and does not qualify for services under IDEA, he or she may be eligible under Section 504. Unlike IDEA, Section 504 is a civil rights law which covers all people with disabilities regardless of age, who experience limitations in their major life activities, one of which is learning. Its purpose is to stop discrimination against all people regardless of disability.

A Section 504 Plan addresses specific accommodations and modifications to a student’s educational program (as can an IEP). It helps a student in the regular classroom setting receive a similar experience to his peers.

Americans with Disabilities Act Amendments Act (ADAAA)

Like Section 504, the Americans with Disabilities Amendments Act (ADAAA) is a civil rights law, written into law in 1990, and amended in 2008. It prohibits discrimination for all persons with disabilities that impacts major life activities in employment, accommodations and public services. Related to education, this means any educational facility that receives federal funding.

# data[].attributes.attachment_link.readable_text
Three Laws to Support ADHD Students

School can be tough for learners with ADHD. It can be challenging to keep track of assignments and follow through on projects. On top of that, it's tough to keep track of the various services available for students with ADHD.

Three Laws for Educational Support

There are many ways our schools can support students with ADHD, as defined by US law. These laws can be confusing, especially when we're teaching our kids and ourselves to stand up for what they need. Here are three U.S. laws and how they can best support students of all ages with ADHD.

Individuals with Disabilities Act (IDEA)

IDEA is a federal law that supports children ages 3 - 21, so they can have a free and appropriate education. It ensures that those found eligible will receive special education or related services. IDEA supports students with ADHD, but only when the ADHD is so severe that a student needs an Individualized Educational Program (IEP). This can make it more difficult for children with ADHD to qualify.

To be eligible for special education services, ADHD is under IDEA's disability category of "Other Health Impairment" (OHI).
Quick Tips:
* Each state differs for deciding how children with ADHD are eligible for OHI services. Here in Illinois, a medical diagnosis is not required but can be helpful. ADHD can exist with other disabilities or conditions. Thus, a team needs to decide if a child is eligible under "other health impaired" or another category.
* the services* annual* special education * how the child will take standarized tests * how the child will take part in general education classes * accommodations* modifications to support what the student is taught or needs to learn to support how the student learns and supplementary services Quick Tips: education goals* Classroom instruction:* Standardized Testing: * Other Supports: extra transition time between classes, study summaries or highlighted reading materials * * * Other Supports: tested on less material or less complex material Quick Tips: Standardized Testing: alternative methods or type of assessment Classroom instruction: shorter or less elaborate in-class assignments extra time to complete a test or take a test in a quiet setting audiotapes, calculators or computers and how the school will track the student's progress a student receives, according to how he or she is performing PS. Need more support to for an ADHD Strategy Assessment and we can talk about a plan you can put into place now! reduce overwhelm and stress and in your family?
Section 504 of the Rehabilitation Act

If your student is having trouble in school and does not qualify for services under IDEA, he or she may be eligible under Section 504. Unlike IDEA, Section 504 is a civil rights law which covers all people with disabilities regardless of age, who experience limitations in their major life activities, one of which is learning. Its purpose is to stop discrimination against all people regardless of disability.

A Section 504 Plan addresses specific accommodations and modifications to a student's educational program (as can an IEP). It helps a student in the regular classroom setting receive a similar experience to his peers.

Accommodations (for both a 504 and IEP) can support a student's learning. Examples are:

Students can also receive modifications (for both a 504 and IEP). Examples are:

Americans with Disabilities Act Amendments Act (ADAAA)

Like Section 504, the Americans with Disabilities Amendments Act (ADAAA) is a civil rights law, written into law in 1990, and amended in 2008. It prohibits discrimination for all persons with disabilities that impacts major life activities in employment, accommodations and public services. Related to education, this means any educational facility that receives federal funding.

* Adult students (18+) can request supports like those listed under Section 504. These supports must not be a threat to the health or safety of others, change the curriculum, or cause undue hardship to the facility.

* Adult students are their own advocates. It's neither the parents' nor the school's responsibility to ask for supports on behalf of the student. Students can request support from the school disabilities support center.

To sum up, three U.S. laws apllying to educational support for students with ADHD can be confusing. They are:

* The Individuals with Disabilities Act (IDEA), which qualifies your child for an Individualized Educational Plan (IEP), with annual goals, timely tracking of performance and special education and related services, accommodations and modifications

* Section 504 of the Rehabilitation Act, which qualifies your child for specified modifications and accommodations

* Americans with Disabilities Act, Amended, for adults to request accommodations and services in a qualified educational facility

It's useful to be aware of the differences in these laws, so you can assist your student and yourself to advocate for what you need.

If you need further assistance to see the possiblities available to you or your child, feel free to reach out to me.

Warmly,

Why ADHD and Mindfulness are a Promising Twosome Four Tips to Reduce Clutter and Stress with ADHD

# data[].attributes.attachment_link.description
ADHD Coaching, adults with ADHD, parents living with ADHD, productivity and ADHD, young adults with ADHD, parents launching adult child with ADHD, entrepreneurs with ADHD, clutter and ADHD, talk to child about ADHD, homework and ADHD, what is ADHD, executive functioning and ADHD, ADHD Assessment Quiz

# data[].attributes.body
IEP: An individualized educational plan (IEP) includes personalized goals, objectives, services, and benchmarks for your child. This document guides teachers and staff as they work with your child and provide the best possible education that meets his or her individual needs.

Customized learning strategies and study skills

One-on-one instruction, if necessary

Shortened assignments and tests

Extended assignment and test completion time

Customized curriculum and/or grading system

Assistive technology devices and/or aids

Break passes

Fidget tools

Progress monitoring

Health services

Transportation accommodations

Field trips and community outings

Collaboration:  Proper work with ASD will require hand and glove interaction and communication between the school teachers, special ed teachers, the parents, and any occupational, speech and language, and physical therapists that may be engaged in the child's care.

Classroom Accommodations:

1. Personal classroom aide

2. School psychiatrist

3. School based speech and language services, usually through a pathologist.

Specialized classrooms for ASD:
Every child with autism has unique needs. Specialized classrooms in an autism school are designed to provide the autism support, emotional support, or life skills your child needs to succeed academically and in life.

A specialized classroom features a high adult to child ratio. Additional support may consist of:

Positive behavior plan

ABA behavior therapy

Visual teaching tools

Assistive technology devices

Sensory tools and toys

Calming corners

Social skills training and practice opportunities

Several of these strategies can be incorporated into a general classroom but will usually require a level of understanding and engagement from the general students depending on their ages.

Transition services:
For children who are 14-21 and are on the path to exiting schooling.  The goal of these services is to prepare the student for life after schooling

Prepare for further schooling or vocational training

Function in the workplace

Develop daily living, social, and other life skills

Learn to live independently

Participate in community activities

These services are written into the IEP, feature clear and measurable goals, and will change as your child progresses through high school and as his or her needs change.

SDCAadmin. (2019, December 19). 5 Essential Autism School Services Every Parent Should Look For. Sarah Dooley Center for Autism. https://www.sarahdooleycenter.org/news/autism-school-services-everyone-should-look-for/#:~:text=Behavioral%20Services%201%20Classroom%20Accommodations%20To%20address%20your

‌

# data[].attributes.attachment_link.title
5 Essential Autism School Services Every Parent Should Look For

# data[].attributes.attachment_link.description
A good school for autism will meet your child's academic, emotional, and social needs. However, you also want to ensure that the school offers five essential services. These services offer a wide range of assistance for children from preschool to age 21 or older.

# data[].attributes.headline
Expectations For Educational Institutions 

# data[].attributes.subject
Expectations For Educational Institutions 

# data[].attributes.body
•Identify and evaluate students who may have ADHD or other disabilities.

•Develop and implement individualized plans (such as IEPs or 504 Plans) that outline accommodations, modifications, and support services for students with ADHD.

•Provide reasonable accommodations to ensure equal access to educational programs and activities.

•Train teachers and staff to understand and support students with ADHD.

•Foster a supportive and inclusive learning environment that promotes the success and well-being of students with ADHD.

# data[].attributes.headline
Specific Support Services Available in Educational Institutions

# data[].attributes.subject
Specific Support Services Available in Educational Institutions

# data[].attributes.body
Commonly provided school-based interventions include:

Observation and assessment of behavioral issues in the school setting

Consultation with school staff regarding implementation of interventions related to behavior, social skills, or anger management

Workshops with school staff on evidence-based strategies for behavior management and promoting improved academic functioning

Help with implementation of IEP behavior plans, daily report cards, and other classroom accommodations

Tailoring of individualized student behavior plans to maximize effectiveness

Live in-class coaching of school staff on implementation of strategies to reduce problematic behaviors and promote school success

# data[].attributes.attachment_link.title
School-Based Services - Child Mind Institute

# data[].attributes.attachment_link.description
Problems in school are common for children and adolescents with ADHD and behavior disorders. School can be a challenging environment for some students, and progress made in office-based treatments does not always carry over to the school setting. We know that educators can provide invaluable support…

# data[].attributes.headline
Laws associated with Conduct Disorders in Children

# data[].attributes.subject
Laws associated with Conduct Disorders in Children

# data[].attributes.body
Sec. 300.8 (c) (4) - Individuals with Disabilities Education Act

(A) An inability to learn that cannot be explained by intellectual, sensory, or health factors. (B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers. (C) Inappropriate types of behavior or feelings under normal circumstances.

Public Law 94-142 94th Congress An Act

be cited as the "Education for All Handicapped Children Act of 1975*'. ... (2) the special educational needs of such children are not being fully met;.Public Law 94-142 94th Congress An Act

# data[].attributes.attachment_link.readable_text
Summary

International classification systems (such as DSM-IV and ICD-10) provide definitions of various diagnostic criteria for conduct disorder, including aggression, violent behaviour, the destruction of property, theft, deceitfulness and serious violation of rules. This broadly covers the various different classes of delinquent behaviour. Although conduct disorder is defined in terms of violation of established social norms in a given socio-cultural context, no antisocial act can be attributed purely to conduct disorder.

In the field of mental health, the word disorder refers to a set of morbid conditions characterised by impairment of an individual's behavioural, interpersonal and psychological functioning according to the norms expected at his or her age. In this context, conduct disorder is primarily defined by the repetition and persistence of behaviour patterns that flout societal rules and other people's fundamental rights. As with the majority of so-called exteriorised behavioural problems, the clinical expression of conduct disorder will depend on the subject's age. During childhood, the manifestations are usually confined to school and the family environment; the disorder will affect the child's general functioning and may be associated with learning disorders. By adolescence, it encompasses the adolescent's whole social setting and can entail high-risk behaviour, unprotected sex, premature pregnancy, substance abuse and even criminal activity.

Depending on the age of onset (whether it is before or after 10 years of age), both the symptoms and the course of development of the problem differ, with the prognosis being poorer and the likelihood of progression to full-blown antisocial personality disorder in adulthood being greater in cases of early onset.

Attention-deficit hyperactivity disorder and oppositional defiant disorder are often associated with some form of conduct disorder. Such co-morbidity exacerbates the conduct disorder and can promote its persistence. The question of links between these three problems nevertheless remains controversial in terms of shared risk factors, predictors, and clinical entities. Conduct disorders can also be associated with other mental problems, such as anxiety and mood disorders, problems due to psychoactive substance abuse, and learning disorders.

Longitudinal studies are particularly important for the study of the evolution of the different symptoms of conduct disorder (e.g., aggression, theft, deceitfulness, and the contravention of established rules). It is now recognised that oppositional behaviour and aggression are quite normal in young children, disappearing with advancing age. Therefore, the key question to be addressed is why aggressive, antisocial behaviour persists in certain cases.

The etiologic factors are unknown and the risk factors appear to be many and various. It is clear that there is no single factor that, on its own, can either predict or explain why some children keep or adopt aggressive or antisocial behaviour patterns. The question of personal predisposition to conduct disorder is quite different from that of the conditions that cause a predisposed individual to manifest antisocial behaviour. Most experts emphasise that multiple risk factors interact to perpetuate antisocial behaviour patterns and conduct disorder. When it comes to devising and implementing preventive programmes, identifying predictors and risk factors remains a priority, especially because such factors might be present from pregnancy. It is ultimately hoped that it may be possible to effectively screen potential problem behaviours and instigate early intervention.

There is much current research into how environmental conditions-familial and psychosocial factors-might interact with personal factors such as genetic susceptibility, temperament, and personality. The persistent, cumulative effects of environmental factors may influence cognitive processes, neuro-endocrine function (especially stress management), and the activities of certain cerebral structures. Research in the field of neuroscience, largely based on animal models, is shedding light on the how a variety of neuro-physiological systems are involved in expression of the disorder.

Conduct disorder manifests as various symptoms defined in the classification systems

Conduct is defined as a way of acting and behaving, a definition that includes a degree of moral judgement. The phrase "conduct disorder" implies a behaviour pattern that contravenes accepted social rules. Such a disorder is therefore at a junction between psychiatric, social, and legal concepts.

Historically, since Lombroso's idea of the "born criminal", paediatric conduct disorders have raised questions regarding the frontier between responsibility and blame as well as between law and medicine. Some experts have proposed constitutional explanations based on ideas such as a "congenital abnormality of instinct", whereas others (influenced by ideas from psychoanalysis) point to the importance of environment. Different terminologies reflect different attitudes, often coloured with some form of moral judgement, e.g., perverse child, guilty child, psychopath, etc.

In 1968, the term conduct disorder was first used in the Diagnostic and Statistical Manual of Mental Disorder (DSM-II) drawn up under the auspices of the American Psychiatric Association (APA). In 1977-1978, the term was taken up by the World Health Organisation (WHO) in its updated International Classification of Diseases (ICD-9).

In DSM-IV and its updated version (DSM-IV-TR), one chapter is entitled "Attention-Deficit Disorder and Disruptive Behaviour", in which a distinction is made between four entities, namely attention-deficit/hyperactivity disorder (ADHD), conduct disorder, oppositional defiant disorder (ODD), and non-specific disruptive behaviour disorder.

Conduct disorder covers three criteria (A, B, and C). Criterion A defines the disorder as "A repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months." Symptoms are broken down into four broad categories:

Diagnostic Criteria (A) of DSM-IV

Aggression to people and animals (Criteria 1-7)

1. Often bullies, threatens, or intimidates others

2. Often initiates physical fights

3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)

4. Has been physically cruel to people

5. Has been physically cruel to animals

6. Has stolen while confronting a victim (e.g., mugging, purse-snatching, extortion, armed robbery)

7. Has forced someone into sexual relations

Destruction of property (Criteria 8-9)

8. Has deliberately engaged in fire setting with the intention of causing serious damage

9. Has deliberately destroyed others' property (other than by fire setting)

Deceitfulness or theft (Criteria 10-12)

10. Has broken into someone else's house, building, or car

11. Often lies to obtain goods or favours or to avoid obligations (i.e., "cons" others)

12. Has stolen items of non-trivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

Serious violations of rules (Criteria 13-15)

13. Often stays out at night despite parental prohibitions, beginning before age of 13

14. Has run away from home overnight at least twice while living in the parental or parental surrogate home (or once without returning for a lengthy period)

15. Is often truant from school, beginning before the age of 13

Criterion B addresses the degree of impairment in social, academic, or occupational functioning. If the individual is 18 years of age or older, a diagnosis of conduct disorder can only be made if the criteria for antisocial personality disorder (criterion C) are not met.

Two parameters have to be taken into account, namely the age of onset and the severity of the disorder. With respect to age, the distinction is made between childhood-onset (prior to the age of 10) and adolescent-onset (after the age of 10). These two types differ in terms of symptoms, development, relative prevalence in boys and girls, and co-morbidity. The severity of the problem is graded as mild, moderate, or severe.

Similarly, ICD-10 defines conduct disorder as a repetitive and persistent pattern of behaviour in which the basic rights of others or societal norms or rules are violated, again with the idea that the behaviour has persisted for at least 6 months. This system gives a list of 23 identifiable symptoms, and the type of conduct disorder depends on which of these symptoms are found together in the patient:

socialised or un-socialised, depending on whether the child has normal relationships with his/her peers

conduct disorder confined to the family environment

oppositional defiant disorder (ODD), which is included in conduct disorder

DSM-IV and ICD-10 agree on the global definition of conduct disorder and on the value of differentiating childhood-onset and adolescent-onset. However, there are differences: ICD-10 emphasises the socialisation aspect and classifies ODD as a subtype of conduct disorder, whereas in DSM-IV, ODD is a distinct, strictly personalised diagnostic category.

In ICD-10, attention-deficit/hyperactivity disorder is called hyperkinetic disorder and there is a special mixed category for those in whom hyperkinetic disorder and conduct disorder co-occur.

Although the first version of the French classification system for mental disorders was quite different from the international systems, the version published in 2000 was more similar, including a "conduct and behaviour disorder" category.

The different classification systems have made no distinction between symptoms in boys and girls. In girls, the data on age of onset are variable, and the prognosis for late-onset is considered as being the same as for early-onset, unlike observations in boys. Some experts propose that, to distinguish between early and late onset in girls, the threshold of puberty is more relevant than the age of 10. Adolescent-onset in girls is characterized by sexual behaviour problems, premature pregnancy, and depression. In general, girls commit fewer aggressive acts and more frequently manifest manipulative behaviours.

The virtue of category-based classification systems such as ICD and DSM is that they specify groups of symptoms and make it possible to constitute uniform groups of patients for studies and trials to evaluate treatment modalities. However, such systems do not characterise relationships between the different types of disorder or the probability of one developing into another. As mentioned above, ODD is classified as a conduct disorder in ICD-10, whereas it is a quite separate entity in DSM-IV. It is considered as a precursor for conduct disorder in some cases and as co-morbidity in others. Should ADHD, which is classified as a separate entity, also be considered a conduct disorder or a co-morbid condition?

Finally, it is important to note the definition of antisocial personality as being one who exhibits "a pervasive pattern of disregard for and violations of the right of others occurring after the age of 15". To meet these diagnosic criteria, the subject must be at least 18 and must have met the diagnostic criteria for conduct disorder since at least the age of 15. Thus, antisocial personality disorder is both a differential diagnosis and a possible sequel to conduct disorder. Some experts have questioned the notion of antisocial personality as a diagnostic entity and its inclusion in classification systems for mental disorder, given the absence of any effective treatment coupled with the possibility that the diagnosis might be used to avoid penal sanctions.

The prevalence of conduct disorder in boys of 15 years old is between 5% and 9% in the general population

Many studies, including some multiple cohort studies with long follow-up times, have yielded high-quality data on the prevalence of conduct disorder in children and adolescents in the general population. Key factors affecting the pertinence of such studies are how representative the sample is, the use of validated instruments for evaluation, and high follow-up rates (for prospective studies). Fewer studies have focused on young offenders or those in special educational establishments.

On the basis of the classification systems used to establish the psychiatric diagnoses (ICD or DSM), a distinction is usually made between ODD and conduct disorder (which itself is divided into two types, namely aggressive and non-aggressive).

In studies focusing on children, the parents are not the ideal source of information, and the diagnosis is often established after talking to the child and his/her teachers. In adolescents, it is the subjects themselves that are the best source of information.

In the population as a whole, the prevalence of ODD peaks at 8-10 years of age (reaching 3-4%) in both sexes, thereafter dropping (to 1-3%). The prevalence of conduct disorder increases up until 15 years, after which it stabilises in boys (at 5-9%) and drops in girls. Aggressive-type conduct disorder is very rare in girls.

Prevalence of oppositional defiant disorder and conduct disorder (aggressive and non-aggressive types)

Conduct disorder tends to persist, with two-thirds of children thus diagnosed still being diagnosed as having the disorder in adolescence.

Studies in populations of delinquents show prevalence of 30-60% for conduct disorder and of 8-30% for ODD. The scarce data available on delinquent girls tend to suggest that both problems are equally as common in this group as in delinquent boys. The prognosis is usually considered as poorer if the disorder appeared before the age of 10 (childhood-onset) as opposed to later (adolescent-onset). However, among girls in prison, later onset seems to be associated with more severe conduct disorder than in boys.

The results of studies show that the great majority of adults with antisocial personality disorder have a history of conduct disorder, and that about one-half of all young people with conduct disorder will go on to have antisocial personality disorder in adulthood. The risk of developing antisocial personality disorder seems to be higher in young people with a conduct disorder who also abuse psychoactive substances in their teenage years and adulthood.

In France, a single study conducted in 6-11-year-olds in 18 primary schools in Chartres reported a prevalence of 6.5% (9% in boys, 3% in girls) with 2.8% with a severe form. The level was significantly higher in special classes (17%) than in normal classes. No difference emerged between private and public schools.

Conduct disorder is often associated with other mental problems

Conduct disorder is rarely found in isolation. The international literature reports a high level of inter-current morbidity with a great diversity of co-morbid conditions. One of the most commonly associated psychiatric disorders is ADHD, with several epidemiological studies pointing to a continuity between paediatric ADHD and conduct disorder in adolescence. ADHD during childhood seems to be all the more predictive of subsequent conduct disorder if it is combined with ODD. Other more recent studies have suggested that the symptoms of ODD and ADHD are often associated with physical aggression (a symptom of conduct disorder) from very early childhood.

The relationship between ODD and physical aggression in small children could lead to specific problems, both clinical and developmental, in adolescence, thus constituting a prodrome for adult antisocial personality disorder. According to other experts, the clinical picture in which hyperactivity, impulsiveness, and attention deficit are associated with conduct disorder would be characterised by high rates of aggression and criminal violence.

Co-morbid depression is also common. Depression could be involved in the development and persistence of conduct disorder and vice versa, and such a synergy could increase the likelihood of suicide. Studies conducted in clinical populations have shown co-morbidity with bipolar disorder in 17-42% of cases. Some experts believe that bipolar disease in childhood could predispose to the development of conduct disorder, whereas others believe that the simultaneous onset of both problems reveals the existence of a specific subgroup. Co-occurring conduct disorder and depression would increase the likelihood of developing antisocial personality disorder in adulthood as well as increase the chance of dependence on alcohol or other psychoactive substances.

General population studies indicate a fairly high level of co-occurring/co-morbid anxiety disorders. Most studies, of both general populations and patients, indicate that anxiety problems have a moderating effect on the severity of both conduct disorder and antisocial behaviour. However, this effect seems to disappear in severe forms of conduct disorder, especially in prison inmates. One anxiety problem that is commonly associated with conduct disorder is post-traumatic stress disorder. This co-morbidity is most often observed in adolescents who have experienced sexual violence or those with severe conduct disorder (e.g., those in prison). Moreover, adolescents with conduct disorder are at higher risk of post-traumatic stress disorder because they tend to expose themselves to situations in which trauma is likely. Finally, the existence of post-traumatic stress disorder increases the risk of conduct disorder.

Main psychiatric diseases co-occurring with conduct disorder (taken from Angold et al., 1999)

Percentage of subjects with conduct disorder + the inter-current disease

Odds Ratio [95% CI]

Psychoactive substance abuse is commonly associated with conduct disorder. The age of onset and severity of the conduct disorder are key factors in the initiation and maintenance of abusive behaviour, and reciprocally, early substance abuse is associated with more severe forms of conduct disorder. It seems, therefore, that the synergy might act in both directions insofar as the one problem exacerbates the other. In addition, this strong co-morbidity could be the expression of a cumulative continuity: drug abuse promotes delinquent behaviour, and delinquent behaviour involves the use of illicit substances. Substance-abusing teenage girls with co-occurring conduct disorder are more commonly depressed or anxious, whereas boys with a similar clinical profile tend to commit violent or criminal acts.

In the opinion of some experts, the association of conduct disorder and ADHD seems to promote psychoactive substance abuse, whereas others emphasise the association between conduct disorder and ODD. With respect to cannabis, longitudinal studies have shown that conduct disorder is predictive of early use, a link that is stronger in girls. Finally, some studies have shown that the superimposition of depression or anxiety on a developing conduct disorder might increase the likelihood of substance abuse.

Apart from co-morbid psychiatric disease, it has been shown that certain high-risk activities are associated with conduct disorder, including risky games, extreme sports, dangerous driving, bulimia, sexual risk-taking, harassing behaviour, and violent suicidal behaviour. These high-risk behaviour patterns reveal impaired self-control and behavioural inhibition mechanisms, as well as some degree of difficulty or even inability to foresee possible adverse consequences of high-risk behaviour on the part of children and adolescents suffering from conduct disorder.

Studying populations of children to define how the symptoms of conduct disorder develop

To identify factors that predispose to and protect against conduct disorder, it is important to understand how the problem develops. This entails formulating working definitions of the relevant symptoms at different ages and following cohorts longitudinally from birth to the age of 18 in representative samples. Few studies to date have adopted this approach.

Conduct disorder must be considered from a developmental point of view. The developmental aspect is highlighted by the fact that it is a prerequisite to the diagnosis of antisocial personality disorder in adulthood. Moreover, DSM-IV-TR specifies two different types of conduct disorder: that beginning before 10 years of age and that beginning after.

Individuals who develop early-onset conduct disorder (before 10) are usually physically aggressive throughout childhood, and boys are more likely to develop a personality disorder in adulthood. Those who develop conduct disorder later (after 10) are not particularly aggressive and are at low risk of antisocial personality disorder. Thus, the prognoses associated with the two different types are quite different. This underlines the importance of studying how the various symptoms of conduct disorder develop.

Aggression against people and animals includes physical aggression, such as "fighting", "physical cruelty", and "bullying, threatening or intimidating others". Most children begin to commit acts of physical aggression at a very young age with the frequency of such acts increasing around the age of 4. Subsequently, this type of behaviour becomes rarer in most children, but in a minority (3-11%), the level of aggression is sustained into adolescence; this minority includes those children who are identified as suffering from childhood-onset conduct disorder. In these children, the frequency of acts of physical aggression tends to rise again in adolescence, although not back up to the rate seen in young childhood; however, the consequences for the victims are more serious because of the aggressor's greater strength and the possible use of weapons. At the beginning of adulthood, the frequency of acts of physical aggression seems to drop sharply, even in those with a chronic history of conduct disorder with physical aggression. The available data suggest that it is extremely rare that a child who has never manifested any evidence of physically aggressive behaviour before the age of 10 will exhibit such behaviour at a later stage.

Behaviour patterns involving the "destruction of property" have not been studied longitudinally to the same extent as physical aggression. Such acts begin in early childhood and are observed in the majority of children. The frequency of such acts also seems to drop with age although a relatively high level of this type of behaviour is sustained in a minority of children (including those with conduct disorder). With increasing age, the property destroyed tends to be of increasing monetary value and usefulness to the community (e.g., serious vandalism such as the burning of motor cars or school premises).

Theft, either with or without confrontation of the victim, begins in young childhood, and lying is also common in young children. How stealing, lying, and deceitfulness develop in relation to the diagnosis of conduct disorder remains poorly understood. It is likely that those who are identified as suffering from early-onset conduct disorder often lie or steal. Deceitfulness is probably a type of behaviour that appears later in development, although this of course depends on the definition used.

Symptoms corresponding to "serious violations of rules", such as "staying out at night before the age of 13", "running away and staying away from home overnight" and "playing truant from school before the age of 13", can begin in preadolescent children with childhood-onset conduct disorder. In these children, such serious violations of established rules represent an extension of a disorder that first appeared in young childhood. For the others, such violations might be symptoms of adolescent-onset conduct disorder or the expression of other adaptive problems.

Co-morbidity studies show that a diagnosis of conduct disorder is commonly associated with a diagnosis of ODD or ADHD. It has often been suggested that hyperactivity and oppositional problems induce conduct disorder. Longitudinal studies following young people from the beginning of primary school up to the end of adolescence show that early physical aggression is more predictive of violence in adolescence than are either hyperactivity or oppositional behaviour. These findings, together with the association between hyperactivity, physical aggression, and oppositional behaviour at the age of 18 months, suggest that these types of problems often appear simultaneously and interact with one another from early childhood through adolescence. As a result, hyperactivity might be a less reliable predictor of violence during adolescence than physical aggression in young childhood. Physical aggression, antisocial behaviour, and delinquency are not often associated with anxiety, whereas reactive aggression is.

Given that chronic physical aggression begins in early childhood and persists into adulthood in the most serious cases, it is not surprising to see that similar risk factors for the trait are observed in young children, older children, and adolescents. One of the risk factors is the child's gender: although small boys tend to commit more acts of physical aggression than girls, the difference is actually small until primary school, by which time the difference has become more significant; by adolescence, there is a substantial difference between the sexes with respect to rates of arrest for acts of physical violence.

The risk factors for high levels of physical aggression resemble those for conduct disorder, antisocial behaviour, and delinquency-whether evaluated at a single time point or at a series of time points. The main factors are a parental history of antisocial behaviour during adolescence, the mother being young at the birth of her first child, the mother's educational level being low, the mother being a smoker, family conflict, poverty, and coercive behaviour toward the child by the parents.

In the absence of data on the developmental pathways of behaviour patterns associated with "deceitfulness, lying, stealing, destruction of property and serious violations of the rules", the relevant risk factors cannot be identified. However, it seems likely that the majority of risk factors for physical aggression will be good predictors for other symptoms of conduct disorder because pathologically aggressive children tend to exhibit the other symptoms. Nevertheless, some children who are diagnosed with conduct disorder do not show a high level of physical aggression, e.g., some are thus diagnosed because they steal, lie, commit fraud, or violate rules without any aggressive component. The risk factors in these cases are as yet unknown, and they may differ from those implicated in children with a high level of physical aggression. Proportionally speaking, more girls than boys are diagnosed as having conduct disorder with no manifestation of physical aggression.

Longitudinal studies that have addressed developmental pathways during the primary school years with a view to predicting medium- and long-term social adaptation show that, in boys, the path toward chronic physical aggression is a better predictor of delinquency-both with and without violence-in late adolescence than it is in girls. These studies also show that children who develop multiple symptoms of conduct disorder are at high risk of failing to adapt socially, possibly leading to academic failure, rejection by their peers, precocious sexual activity, promiscuity, smoking, alcohol or substance abuse, membership in delinquent gangs, depression, suicidal thoughts, child pregnancy, unemployment, and poor physical health.

To our knowledge, there have not been any studies of pathways to physical aggression as a risk factor for antisocial personality disorder in adulthood, although most children who exhibit a high level of physical aggression continue to do so through adolescence and also present most of the other symptoms of conduct disorder. However, from the available information, it seems fairly clear that the older the individual, the less they resort to the types of behaviour that correspond to DSM-IV criteria for conduct disorder or antisocial personality disorder.

Genetic determinance of conduct disorder is around 50 %

As with any other multifactorial disease, the question of genetic determinism revolves around the idea of predisposition. Genetic factors increase the risk, modify how the disorder is expressed, and have to be appreciated in the context of a set of dynamically interacting etiologic factors. Epidemiological data give indications of the relative weight of genetic and environmental factors that specifically predispose to conduct disorder, ODD or ADHD. The same studies have yielded clues as to genetic factors that are common to all three problems.

The first clue that points to a genetic component in these disorders is the fact that relatives of an affected subject are more likely to suffer from the same problem. Family studies find a strong clustering of ADHD in families. Although there are no specific studies on conduct disorder, being related to a hyperactive child is known to increase the risk of conduct disorder and ODD. This clustering in families indicates a common etiologic basis. It actually corresponds to cosegregation of ADHD and conduct disorder. In practice, only those forms of ADHD that are inter-current with conduct disorder increase the familial risk of the latter-and in the relatives, the conduct disorder is itself often associated with ADHD. This cosegregation of conduct disorder and ADHD suggests that there is a familial form of ADHD that is associated with antisocial behaviour; at least some of the etiologic mechanisms of this form would be distinct from those involved in isolated forms of ADHD. This familial impact on the development of conduct disorder cannot be extrapolated to independent forms of ADHD and, moreover, familial clustering does not necessarily imply that genetic factors are involved, which can only be confirmed by quantifying the heritability of the condition.

The genetic component corresponds to the part of the phenotypic variance that can be attributed to genetic factors. This is equivalent to the percentage of the disease that can be accounted for in terms of genomic differences between different individuals, estimated using methods designed to separate the influence of heredity from that of the environment, notably adoption and twin studies.

The type of adoption study that has yielded the most information on paediatric problems is based on comparisons of unrelated siblings who have been adopted with brothers and sisters who have been adopted by the same family. Such studies have resulted in estimates of 40-70% genetic heritability in the case of ADHD and 55% for externalizing problems.

A similar degree of genetic heritability has been found in twin studies, of the order of 50-60% for externalizing symptoms. Such studies also suggest reasons for this average weighting of genetic factors as well as the extreme diversity of the results. In the first place, permanent, non-contextual disruptive behaviour patterns are the most heritable (h²=80%). Secondly, the various different diagnostic categories that cover disruptive behaviour do not share the same degree of genetic heritability: ADHD is strongly heritable (70-80%) with a greater genetic component than in the dimension of motor hyperactivity or in comorbid forms. The minor contribution of environmental factors observed in twin studies does not mean that such factors are not important in the etiology of ADHD because the heritability component includes interactions between genetic factors and the environment. Conduct disorder appears to be less heritable than ADHD, about 50%. This seems to be independent of the child's gender but may vary with age, heritability being higher for antisocial behaviour that begins at school age than for that which begins either earlier or in adulthood, although these findings remain to be confirmed in longitudinal studies. Finally, among the symptoms of conduct disorder, physical aggression is the most heritable (h ²=60-70%), with other symptoms mainly depending on shared environmental factors.

Summary of twin studies on the heritability of different types of disruptive behaviour

Twin studies also reveal the relative genetic and environmental components in etiologic factors common to the different problems. The phenotypic covariance between exteriorised and internalizing problems is predominantly environmental. In contrast, conduct disorder, ODD, and hyperactivity share genetic susceptibility, with up to 87% of the covariance attributable to genetic factors. In addition to these common global factors, there are on the one hand, supplementary genetic contributions in ADHD and in the temperamental trait of the seeking of novel experiences, and on the other hand, specific environmental components in conduct disorder and substance abuse.

These consistent findings justify looking for vulnerability genes. The functional approach involves selecting candidate genes and testing their links with the various disorders. Many such molecular genetics studies have been undertaken, giving highly disparate results. Of the mono-amine-based neurotransmitter systems, attention has focused on the dopamine system, which is known to be involved in motor excitability and concentration. Also, psychostimulants that target dopaminergic neurotransmission have been used to manage ADHD. Recent meta-analyses show a link between ADHD and the genes that encode dopamine receptors D4 and D5, although the correlations are weak and do not by any means fully account for the epidemiological picture with the presence of each of the alleles associated with ADHD increasing the risk by a factor of just 1.25. However, most of these studies have been category-based and have not been conducted on enough subjects to yield information about comorbid forms, although these are the most heritable. A few studies have pinpointed a specific link between the gene for the D4 dopamine receptor and intercurrent ADHD/conduct disorder, and between the D5 receptor and inter-current ODD/substance abuse. Finally, the most recent studies have sought to define cognitive profiles and drug response patterns in children with ADHD in order to identify phenotypes that are particularly tightly linked to certain candidate genes.

An alternative way of identifying genes that predispose to conduct disorder involves the holistic investigation of multiple risk factors. Genetic factors are all the more difficult to define because their frequency varies in parallel to the variability of environmental factors. Exposure to a particular type of environment might exacerbate the situation in a genetically predisposed child to a greater extent than would result from the simple addition of risk factors. Moreover, certain genetic or environmental factors might be protective. There are many reasons for studying interactions between genes and the environment. Firstly, that such interactions do indeed occur is illustrated by the fact that the same genetic factors are associated with conduct disorder, ADHD, and ODD, whereas the relevant environmental factors are specific to each of these conditions. Secondly, adoption studies based on a parent-child model show that physiological susceptibility can be revealed by life events and interacts with the parents' child-raising practices: the child-raising strategies of adoptive parents tend to be less successful with children from a biological family with a history of antisocial behaviour. Such studies also point to a link between disruptive behaviour and biological history emerging only if the child is removed from the adoptive home. It is therefore logical that interactions between genes and environment be taken into account when we are looking at the genetics of conduct disorder-and such approaches are yielding valuable information. The allele that is associated with reduced monoamine oxidase A activity appears to be associated with the development of antisocial behaviour, but only in subjects who have been mistreated during childhood. This does not correspond to a simple superimposition of risk factors but rather a synergistic effect between different vulnerability factors. Taking interactions between life events and genes into account could help shed light on why the results of different studies are so divergent and could reveal the type of susceptibility conferred by genes in multifactorial problems such as disruptive behaviour, making it a potentially useful approach to the genetics of behaviour.

Temperament and personality may be factors that predispose to conduct disorder

For many years, the impact of personality and temperament were neglected in favour of sociological explanations for conduct disorder and delinquency. However, many studies have shown that personal variables such as temperament and personality are key factors in the development, maintenance, and severity of conduct disorder.

In children, the existence of a set of traits that collectively constitute a difficult temperament (e.g., negative mood, lack of perseverance, inability to adapt to situations, readiness to be distracted, intense emotional reactions, hyperactivity and social withdrawal) is strongly predictive of impaired psychosocial adaptation in adolescence and adulthood. A difficult temperament is especially predictive of conduct disorder if the child comes from a dysfunctional family. However, it is not specific to conduct disorder because it is also found in ADHD and internalised problems such as anxiety and depression. In fact, a difficult temperament seems to be a common precursor for mental problems in general.

On the other hand, of the full range of temperament-related behavioural characteristics that can be ascertained at an early age, aggression against others, weak emotional self-control, and disobedience are most predictive of adolescent conduct disorder, independently of both the family environment and the nature of the child's peer group. Impulsiveness is also predictive of this type of problem, as well as delinquency insofar as this paediatric temperamental dimension may inhibit socialisation processes, e.g. by entailing difficulties with relationships or poor social adaptation. Although impulsiveness is far from specific to conduct disorder (it is also associated with ADHD and ODD), it is particularly marked in the more severe forms (e.g., among prison inmates).

Impaired behavioural control has been shown to be involved in conduct disorder and antisocial behaviour in both boys and girls. But this type of temperamental trait is involved in a non-specific way and is broadly predictive of exteriorised problems such as ADHD. However, it seems that it is mostly the coupling of a strong need for behavioural activation with weak behavioural inhibition that is predictive of conduct disorder. The involvement of both these systems (activation/inhibition) could promote the expression of certain personality dimensions (e.g., psychoticism).

In terms of emotional dimensions, it has been shown that a lack of guilt feelings in a child is strongly predictive of physical aggression, delinquency, and conduct disorder. The individuals concerned are less empathetic, less able to recognise emotions such as anger and sadness in others, and have a lower level of affective morality. Self-esteem does not seem to be a significant risk factor for conduct disorder insofar as it is not specific to a type of trait. On the other hand, egocentrism (the tendency to relate everything to oneself) and narcissistic personality could be typical of certain forms of conduct disorder with physical aggression.

Some experts believe that all these emotional characteristics express a personality trait defined by affective coldness, insensitivity, and a tendency to charm. Adolescents with conduct disorder coupled with this personality trait tend to be relatively aggressive and violent and exhibit more symptoms of ODD (92% of cases) and ADHD (48%). This trait associated with conduct disorder might correspond to a specific group which constitutes a predictor of psychopathy in adulthood, especially if the subject exhibits high impulsiveness.

The profile-combining both temperament and character-that would be specifically characteristic of conduct disorder would be one of strong "novelty seeking" (exploratory excitability, impulsiveness, extravagance) coupled with relatively low levels of "pain avoidance" dimensions (i.e., low levels of fatigability, timidity, fear of the unknown, and anticipatory anxiety), "dependence on compensation" (lack of empathy, little sensitivity to social reinforcement), and "determination" (low level of individual maturity and sense of responsibility).

Psychoticism (tough-mindedness, interpersonal hostility, self-centredness, affective coldness) seems to be predictive of conduct disorder and antisocial behaviour in both boys and girls insofar as this dimension reflects a tendency toward antisocial attitudes and impulsive behaviour. Extraversion and neuroticism seem to be particularly important in delinquent girls and less serious delinquent behaviour, whereas people who commit extremely violent acts are usually relatively introverted.

A longitudinal study has shown that character traits such as affective coldness, a tendency to manipulate, cynicism, and aggression could significantly influence the age at which aggressive behaviour is manifested, the stability of conduct disorder through adolescence, and antisocial personality disorder in adulthood.

A number of studies have set out to analyse links that might exist between the temperament of the child and parental attitudes. To a greater or lesser extent, all findings point to the centrality of the "goodness of fit" phenomenon between parents and child in the development of conduct disorder. According to this hypothesis, conduct disorder is the consequence of incompatibility between the child's temperament (e.g., one who is impulsive without great inhibitory capacities) and the demands of those close to him (e.g., child-raising style). Thus, a boy with a "resistant" temperament (who has trouble concentrating, a tendency to oppose, and little capacity for inhibition) would only be susceptible to conduct disorder if his parents adopt a broadly "permissive" child-raising style, and the outcome would be quite different if they were to exert adequate control. In addition, according to some studies, mother-child interactions that are typified by reciprocal anger and poor emotional adjustment (laughing/anger) or, in contrast, emotional insensitivity could lead to conduct disorder but only in boys.

The involvement of personality and temperamental traits in the occurrence and maintenance of conduct disorder should be situated in a dynamic developmental perspective in which physiological and environmental factors interact with one another.

Perinatal events might be involved in the pathogenesis of conduct disorder

Various antenatal and perinatal events have been proposed as possibly exacerbating the risk of conduct disorder. Nevertheless, it seems unlikely that such events would have any very specific impact; rather, interactions with other risk factors (notably genetic) would determine the form of the disorder.

It is generally accepted that the mother's life style, especially if psychoactive substances were used during a critical period of the pregnancy, can affect cerebral development in the foetus with long-term repercussions upon the child's neuro-behavioural future. In this context, a large number of studies have consistently shown that the offspring of mothers who smoke are more likely to develop conduct disorder; a significant correlation has emerged in several longitudinal studies between maternal smoking and the occurrence of conduct disorder, especially in boys.

With respect to drinking, the worst manifestations are seen when the mother's alcohol consumption during pregnancy is very high, leading to a set of physical and neurological problems collectively referred to as foetal alcohol syndrome. However, a number of longitudinal studies have suggested that prenatal exposure to even moderate levels of alcohol can have adverse effects on a child's cognitive and behavioural development.

In longitudinal studies, a correlation has been observed between cannabis smoking during pregnancy and behavioural problems in the child, notably impulsiveness and impaired concentration. An increased level of exteriorised problems has also been reported, especially in boys whose mothers took cocaine during pregnancy: these boys scored two times higher in tests for aggressive behaviour and delinquency than did those in a control group.

Premature birth and low birth weight have both been suggested as possible risk factors for conduct disorder, and a relationship has been identified between health problems in premature babies and the incidence of exteriorised problems at the age of 5, notably oppositional behaviour and hyperactivity. Similarly, low birth weight correlates with ADHD and antisocial behaviour.

Complications during delivery can also lead to neurological deficit which itself is associated with neuro-behavioural problems. Recent studies conducted on large populations have shown that there is a correlation between obstetric complications and antisocial behaviour in childhood or adolescence. Among the various problems that may arise during delivery, experts have singled out foetal asphyxia as a specific risk factor for conduct disorder.

There is now clear evidence of an association between the mother's age at pregnancy and the likelihood of conduct disorder in the child. In a study conducted at a special centre, it was shown that pregnancy at a young age (before 20 and to an even greater extent before 18) directly correlated with the number of symptoms of conduct disorder in sons between the ages of 6 and 13. If the mother had a history of conduct disorder, the likelihood of her becoming pregnant at a young age was higher, as was the incidence of the diagnosis of conduct disorder in her children.

In addition, it emerged that head injury, even mild, during early childhood may be associated with an increased rate of ADHD and conduct disorder between 10 and 13 years of age.

Other risk factors, such as maternal smoking and complications during delivery have been identified in methodological robust studies however they seem to be relatively non-specific, and the correlations with pathology in later life could involve other parameters, such as disturbance of the mother-child relationship or parameters related to the family environment in general.

The pathogenesis and persistence of conduct disorder are affected by familial and environmental factors

Various contextual factors, essentially related to family or psychosocial environment, are associated with conduct disorder in adolescence and adulthood. Adverse environmental conditions are all the more important in that they are commonly systematic, long term, and associated with other risk factors. Poverty in itself is not a risk factor, but extreme poverty is associated with multiple risk factors, which have impact on parenting behavior.

Quite a lot of studies have addressed the impact of parental problems, be it behavioural problems in the father or mother, dysfunction in the couple, maternal post-natal depression, parental alcoholism, or other forms of dependence. These studies have consistently identified a link between conduct disorder in the offspring and antisocial personality disorder in one of the parents. The children of fathers who are substance dependent, particularly to alcohol, and also have an antisocial personality are at higher risk of both conduct disorder and ADHD; and the sons are at greater risk of themselves becoming addicted. Similarly, if the mother has an antisocial personality, the likelihood of the children developing conduct disorder is enhanced, a fact that was underestimated for a long time.

Maternal depression is known to have an effect on the development of the child although the magnitude of such effects in conduct disorder remains controversial. However, it can be readily appreciated that depression-related disturbances of the relationship between mother and baby could have adverse long-term consequences on the ability of the child to concentrate and control his/her emotions. The children of mothers who experience post-natal depression may constitute a specific high-risk group.

Adolescent pregnancy is associated with conduct disorder in the offspring. The risk of conduct disorder with aggressive behaviour is particularly high among boys whose mothers were very young and whose educational level is low.

In several longitudinal studies of a high risk population, insecure attachment and disturbances or disruption of relationships within the family significantly exacerbated the risk of behavioural problems among children. Insecure attachment between child and both parents seemed to increase the risk of conduct disorder substantially, specifically if associated with temperamental difficulties, adverse family events, and disturbances in parent-children relationships. A child whose relationship to principal attachment figures has been disrupted at a very young age tends to exhibit aggressive and directive behaviour toward their parents, particularly if the child has been subjected to violence or sexual abuse. Disorders of attachment, compounded with other dimensions (e.g., temperament, unsuccessful parental strategies, a dysfunctional family environment, etc.) exacerbate the future risk of conduct disorder. Attachment could be involved in gene/environment interactions as a resilience factor when the attachment is secure and as a risk factor when it is insecure, especially if attachment is disorganized. Many experts have drawn attention to a link between disruption of the family structure, through divorce and subsequent aggressive behaviour, conduct disorder, and delinquency. However, it has been shown in longitudinal studies that this factor acts long before the actual separation of the parents, and it may be more closely related to the conflict between the parents rather than to the divorce itself. Thus, the long-term impact of a divorce on subsequent problems in the child may be more due to conjugal discord than to the eventual separation. Parental conflict disrupts children's capacities to regulate their emotions and, as a result, inhibits their ability to learn how to control aggressive behaviour. If one of the parents has an antisocial personality or is substance dependent, or if there is conjugal violence, the separation may help protect the child.

Various studies have shown that deleterious parental attitudes and inappropriate child-raising strategies emerge as a family characteristic linked to delinquency. Parenting style seems to be more important when it comes to predicting aggressive and oppositional behaviour patterns than for ADHD. Results agree that a failure on the part of the parents to provide adequate control of their child's behaviour is primordial, as is also inconsistency or overly strict discipline. Parental indifference to truancy from school or to the absence of the child from the family home is predictive of antisocial behaviour and delinquency, particularly in underprivileged settings.

The influence of siblings cannot be ignored. Various studies have shown that a child with a brother or sister (especially if he or she is older) who has been convicted for an act of delinquency is significantly more likely to come before the courts. It may be that, in a family in which there is already a child with conduct disorder, his or her siblings may be directly influenced, independently of any other risk factors. This association is significantly amplified in underprivileged settings. Similarly, the fact of having older brothers or sisters who perform well at school may be protective.

Many experts agree that the type of aggressive and violent behaviour patterns that are common in underprivileged settings depend on the concurrence of diverse risk factors. Concentrations of gangs of children and adolescents with conduct disorder in certain neighbourhoods tend to attract other young people from the same neighbourhood, and mixing with delinquents doubles the risk of aggressive or delinquent behaviour patterns being sustained through adolescence. Young misfits reinforce each others' antisocial behaviour patterns, sometimes in response to rejection by their better-adjusted peers.

The available data suggest that schooling experiences need to be taken into account when evaluating risk factors for conduct disorder-truancy, rudeness at school, and academic failure have all been related to conduct disorder and delinquency. When children are presenting symptoms of both ADHD and early-onset conduct disorder, they are very likely to fail at school.

Numerous studies have revealed a significant link between exposure to media violence and aggressive behaviour in young people. Recent studies have confirmed that 8-year-old children who watch violent shows on television are far more likely to act aggressively in the long term (11 to 22 years later). This correlation is independent of intelligence quotient (IQ) and socio-economic status. Televised violence may not only lead to real violence but it also leads to desensitisation, entailing trivialisation and habituation, resulting in a passive reaction to and tolerance of violent acts. In certain children, playing violent games enhances physiological excitation, exacerbates aggressive attitudes, and inhibits positive social behaviour patterns. The inundation of children-who might already be vulnerable by virtue of their family or social environment, or who might already be presenting signs of nascent conduct disorder-with violent stimuli such as are so ubiquitously and continuously dispensed via television and video games, enhances the attraction of violence, all the more so because the violent behaviour is at best trivialised or exempted of any feeling of guilt, and at worst glamorised and encouraged. It is nevertheless important to remember that it is children who already have problems with real violence who are the most affected by exposure to virtual violence in the media.

Neurocognitive deficits are associed with conduct disorder

Two types of neurocognitive deficit seem to be associed with conduct disorder in children and adolescents, namely impaired verbal skills and impaired executive inhibition mechanisms.

It has long been recognised that children and adolescents with conduct disorder perform poorly on the verbal components of psychometric tests compared with their performance as a whole. Adolescents with severe conduct disorder, particularly characterised by violence, tend to have a lower Verbal Intelligence Quotient (VIQ) than those without any significant conduct problem. Furthermore, poor verbal skills represent one of the most important risk factors for delinquent behaviour in adulthood. The fact that this deficit persists over time from childhood through adulthood is probably evidence that language functions play a key role in the development of so-called disruptive behaviour patterns. For example, retrospective analysis often identifies delayed language acquisition in children with ADHD. These children also exhibit many verbal difficulties, including poor comprehension, limited vocabulary, and low verbal fluency. Similarly, particularly aggressive children tend to have greater difficulty with both oral expression and written language than their non-aggressive peers. Both of these types of difficulty are also seen in delinquent adolescents and are good predictors of criminal behaviour in adulthood.

Three explanations could account for the functional importance of verbal deficit in the cognitive mechanisms that underlie conduct disorder. The first concerns the regulatory function of language in human behavioural control processes. It is now generally accepted that the steady improvement in self-control that is seen in the course of development is associated with parallel improvement in children's capacities for understanding and verbal expression. The progressive internalisation of language during development, in the form of an "internal dialogue", allows the child not only to plan and guide his behaviour more effectively but also, and more importantly, to acquire an understanding of what he should do and what he should not do according to aim and context-before the action is executed. Verbal deficits can inhibit the development of the child's or adolescent's ability to formulate symbolic and abstract representations, resulting in a lesser understanding of situations in which social understanding is called for. The idea of "rules" is also integrated into an individual's psychological functioning in the form of mental representations constructed around language-based concepts such as "You can do this but not that". Adequate language development is therefore essential to establishing prosocial behaviour patterns, and this necessitates anticipating the consequences of actions and referring to accepted norms of conduct in a given socio-cultural environment.

The second explanation pertains to the capacity of language to express the subject's emotions in an accurate fashion and also to decode the emotions being expressed by others (i.e. empathy). Verbal deficit can therefore restrict a child's ability to express his own emotional experiences as well as his ability to process and express the emotions felt by those around him. A low level of empathy has been documented in children and adolescents with conduct disorder: any such deficit will compromise the quality of communication and trigger defensive or aggressive reactions in the child.

The third explanation emphasises the high correlation known to exist between verbal skills and academic abilities. Impaired verbal skills are associated with poor academic performance, and the subsequent school career of children arriving at kindergarten with poor verbal skills is characterised by difficulty in learning to read and learning disorders in general.

In parallel to poor verbal skills, many empirical observations also suggest that children and adolescents with conduct disorder have impaired executive functions. The idea of executive function covers a whole set of complex, disparate cognitive processes that are necessary for the performance of goal-driven tasks, including concentration, the ability to select and refine a course of action, the inhibition of automatic responses, the monitoring of an action under way, and checking the efficacy of the response in view of the goal envisaged and the context. In accordance with this definition, impaired executive skills in a child or adolescent would compromise his capacities for analysis, for abstract reasoning, for formulating appropriate responses in the context of the relevant demands, and motor control (impulsiveness).

A number of studies have suggested that children and adolescents with conduct disorder exhibit poor executive control, particularly those with a tendency to violent behaviour. The correlation between executive deficit and conduct disorder is stronger if the latter begins at a relatively early stage of development. Executive deficit could also account for the severity of the conduct disorder and its persistence into adulthood. However, many experts minimise the strength of the link between executive dysfunction and conduct disorder because ADHD was not taken into account in most of the relevant studies. Further studies are needed in which executive performance is evaluated in children and adolescents with isolated conduct disorder, conduct disorder plus ADHD, and controls.

These two types of cognitive deficit, verbal and executive, are as common in boys as in girls, but in the opinion of some experts, their impact may not be identical in the two sexes in the course of development, as a result in particular of the modulation of their effects by environmental factors that may be gender dependent. There are presently, however, insufficient data for age- and gender-based comparison, so it is difficult to draw any conclusions on this point.

In terms of brain anatomy, poor verbal skills in children and adolescents with conduct disorder are probably due to impaired function in the temporal regions of the left hemisphere. Executive deficit is associated with the frontal lobes, and more broadly speaking with fronto-striato-thalamic circuits. However, precise morphological magnetic resonance imaging (MRI) data or functional magnetic resonance imaging (fMRI) data in children and adolescents with conduct disorder are presently lacking. Recording of cerebral activity (e.g., by evoked potential) should also shed light in coming years on the neuro-physiological processes underlying conduct disorder. By way of illustration, some interesting experimental results have shown a significant reduction in the amplitude of P300 waves in adolescents with conduct disorder. The degree of attenuation is closely related to the severity of the disorder and appears to be more specifically related to cases in which conduct disorder is associated with rule violation. Before the age of 16, this electrophysiological abnormality is focused in the posterior regions of the cerebral cortex but later shifts to the anterior regions. It is observed in both affected boys and girls and might possibly reflect delayed maturation of the frontal regions responsible for executive functions, as opposed to a frank defect. Although such perturbation of the P300 wave is not specific to conduct disorder (being also observed in ADHD and schizophrenia), it supports the idea that neurodevelopmental factors are involved in the pathogenesis of the condition in children and adolescents.

A diagnosis of conduct disorder requires rigorous multimodal evaluation

Before a child or adolescent can be diagnosed with conduct disorder, the diverse nature of the symptoms and the frequency of inter-current problems require that a multimodal investigation be undertaken by a multidisciplinary team based on diverse sources of information, and taking into account the history of the family and its functioning.

Categorical and dimensional measures have been developed in English to review the patient's history and to identify and grade the clinical manifestations of conduct disorder. The value and relevance of these instruments-be it a standardised interview, a behavioural scale, or a questionnaire to be completed by the patient-varies according to their psychometric validity and how ease of use in daily practice. Most of the scales designed to evaluate behaviour or aggression are available in versions for both parents and teachers. Diverse instruments should be used in parallel to ensure as global an overview of the symptoms as possible.

Results should be interpreted in the light not only of the symptoms of the child or adolescent with suspected conduct disorder but also of the parents' tendency to minimise the gravity of the problem. It is thus important to compare the information given by the child and his/her parents with information from other sources, such as teachers or peers. In the same way, it is important to take into account the child's level of cognitive development when he is asked to evaluate his own behaviour (especially his verbal understanding, which will affect his perception of the problem as well as how he expresses his experiences). In addition, given the variability over time of behavioural manifestations in developing children, it is important to perform regular assessments in a child at risk of conduct disorder, e.g., one who is exhibiting high levels of physically aggressive activity and/or showing the symptoms of ADHD.

Instruments used to evaluate conduct disorder

Most of these instruments have yet to be translated into French and validated in populations of French-speaking children and adolescents-a task requiring a significant amount of work.

Preventive measures will depend on vulnerability factors

A distinction may be made between three classes of preventive measure dependent on the degree of vulnerability of the subjects being targeted. "Universal" preventive measures concern the population as a whole or those in the population who present no particular risk of conduct disorder. "Selective" preventive measures target individuals or groups who are at high risk by virtue of environmental, social, or family factors: in the case of conduct disorder the targets might be people living in underprivileged urban neighbourhoods, poor children and parents, the children of young, single mothers, children growing up in a conflict-ridden family environment, and the children of alcoholics or drug addicts. "Indicated" preventive measures target individuals or groups with personal risk factors or who are already exhibiting early symptoms of conduct disorder. Indicated prevention programmes may target young people with learning disorders, children manifesting impulsive and/or aggressive behaviour, and children who have already been diagnosed with ADHD or ODD.

There are few specific programmes aimed at conduct disorder. The majority of programmes are designed to combat delinquency, aggressive behaviour, or violence in general, and neither DSM-IV nor ICD criteria are ever used in evaluations. The efficacy of programmes is judged on the basis of measurements of aggressive and/or antisocial behaviour patterns derived from standardised questionnaires and official reports from the judicial system or the police.

Hundreds of programmes designed to combat violence are already in use, especially in Britain and America, although only about 20 have been validated. For a programme to be validated and qualified as evidence based, certain criteria must be fulfilled: intervention modalities must be based on a reference theory; the intervention programme must be stipulated in a protocol, and there should be monitoring of subject adherence to the programme; interventions must be demonstrated to have been effective in an empirical context (a rigorous, quasi-experimental plan, significant positive effects, results duplicated in at least two different sites, available scientific data, etc.).

Validated conduct disorder prevention programmes require special intervention modalities. These modalities can be classified according to the age of the subject (very young children, children, and adolescents) and the target (affected subject, parents, teachers or the subject's environment). One or more preventive measures may be planned in a given programme, which is thus classified as either unimodal or multimodal. Such measures are integrated into a preventive programme that might be universal, selective, or indicated; although in the prevention of conduct disorder, a distinction is rarely made between the last two, the same programmes targeting both groups.

Measures to prevent conduct disorder and examples of validated programmes targeting young children (0-3 years of age)

Validated preventive measures for small children (0-3 years of age) mainly focus on the parents and on the children's capacities to control themselves and their own behaviour. This involves home visits and support to the parents in the form of health education and counselling on parenting skills. At crèches and kindergartens, the emphasis is on developing social, cognitive, and emotional skills. The Elmira Home Visitation Study and the Perry Preschool/Preschool Curriculum Comparison Study have proven effective in this field. Both are selective/indicated programmes, the first aimed at children up to 2 years of age, and the second focusing on 3-4-year-olds.

Other validated methods are integrated into preventive programmes aimed at children and adolescents between 3 and 16 years of age. Interventions focused on these young people are designed to develop their social, cognitive and emotional skills through such modalities as conflict-resolution, anger-management, emotional understanding, and the fostering of prosocial attitudes and reasoning ability. Most of the validated programmes are based on this type of intervention strategy, whether combined with another type of modality or not. Some of these programmes ( Linking the Interests of Families and Teachers, Seattle Social Development Project, Montreal Prevention Experiment, and Fast Track) include interventions aimed at the parents as well as their offspring. In most cases, this involves training to help develop emotional control, the establishment of a positive disciplinary routine, and improved communication. Training programmes can also be formulated for teachers, and programmes like the Seattle Social Development Project and The Incredible Years Series are designed to promote co-operative teaching, proactive management, positive reinforcement, and conflict resolution, among other goals.

A few preventive programmes have focused on the environment. Two such methods have been validated, one based on interventions at school (e.g., the School Transitional Environmental Project and the Olweus Bullying Programme) and the other on a mentoring system (the Big Brother/Big Sister of America programme).

Apart from these validated methods, scientific data built up over the last 20 years in this field make it possible to identify the characteristics of successful preventive programmes. Interventions which have been proven to be effective have integrated interactions with experienced counsellors that go well beyond the simple transmission of information. The successful programmes also tend to be long term and intensive, running for many years with an annual investment of at least 20 hours. Programmes involving different methods and targeting several different factors (the young person, parents, teachers, etc.) have proven particularly effective. The same is true of those that match the intervention method to the target population. The extent of presence on the ground is also crucial: the idea of an "effective programme" only has meaning if it is closely associated with tight control of the intervention processes. Finally, the latest information about the development of aggression and associated factors highlights the importance of the early (post-natal and pre-school) implementation of selective and indicated interventions focusing on promoting the mother's parenting skills.

Measures to prevent conduct disorder and examples of validated programmes targeting children and adolescents (3-16 years of age)

In conclusion, it seems that at the international level, many different measures have been developed for the assessment of conduct disorder, and numerous validated preventive programmes are currently in use. However, the situation in France remains problematic. No results from any French programme designed to prevent either conduct disorder or violence in the broader sense have been published in the scientific literature to date. It might be that interventions are currently under way in France in the framework of the prevention of violent behaviour, but if this is so, they remain isolated, one-off instances, the results of which have not been published. Moreover, such studies are generally not scientifically validated, and outcomes are not rigorously evaluated-evaluation in France seems to be confined to descriptive parameters, which give no real information about the effects of a given measure or its success.

Psychotherapy incorporates various treatment approaches

The management of conduct disorder should involve different, complementary treatment approaches whenever possible. So-called psychosocial management strategies include interventions focusing on the parents, aimed at the child him- or herself and, in some cases, his/her teachers. The global goals of management can be summarized under four objectives:

establishing a system to provide back-up and social support for the entire family

promoting the child's contacts with "prosocial" peers

reducing the child's contacts with "antisocial" peers

stepping up support in school and contacts with teachers

The treatment approaches that have been shown to be the most successful in controlled studies in Great Britain and America have been based on providing support for the whole family of the young person with the conduct disorder. The Functional Family Therapy (FFT) programme is supervised by trained, experienced therapists and involves three phases spread out over a dozen sessions over a period of 3 months, often conducted at home in the most difficult cases. The purpose of the "commitment and motivation" phase is to establish a therapeutic bond with every family member by minimising distancing factors (cultural and/or social). In this phase, availability and respect are essential to fostering confidence and promoting collaboration. The second "parent training" phase aims to modify how family members interact with one another by facilitating communication and working on ways of resolving conflicts. The third "generalisation" phase aims at extending or broadening any positive interactional changes that have occurred in the family to their relationships with other community systems, including mental health and legal authorities. Taken together, the results show that this programme has significantly reduced the rate of relapse of serious antisocial behaviour patterns in young people with conduct disorder. Even among those with persistent antisocial behaviour, the programme reduces the severity of the acts. Improvement was sustained, with results stable over 5 years.

Books (e.g. "Living with Children") and video tape recordings can help to reinforce the parents' daily efforts and therefore increase confidence and compliance with the programme. Success rates are enhanced if the video aid is used in a discussion group supervised by a therapist. Daily, structured exercises help parents generalise and apply at home the principles and methods that they have learned at the therapeutic unit, relating to positive reinforcement of the child's behaviour, the setting of limits, a non-violent disciplinary approach, the respect of rules, conflict resolution...

Although the programme is aimed at the child, it is designed to foster empathy, anger management, friendship, communication, and positive relationships with the school and teachers. Incorporation of a teacher-centred component into the child-centred intervention enhances the outcome in personal programmes in terms of capacities of adaptation, behaviour, and conflict resolution.

Multisystemic therapy (MST) involves a precise evaluation of the overall environment in which the young person lives and grows up (family, school, friends, neighbours, and neighbourhood) and his/her interactions with all these systems with the aim of identifying the main factors underlying the problems. The goals of management are to: try to keep the child away from unsuitable friends (who set a poor example); reinforce his/her relationships with conventional institutions such as family or school; enhance the family's ability to monitor the child and enforce discipline; and enhance the adolescent's social and academic skills. The therapists may use various methods, including family therapy and interventions at school as well as cognitive and/or behavioural techniques. The programme is conducted by a team of three or four trained therapists who are closely supervised and are available to intervene around the clock, 7 days a week. The programme lasts 3 to 5 months on average, representing a total of about 60 hours of intervention time, mostly with the young person and the family but including the social network. It is crucial that a collaborative relationship be established between parents and teachers. Multisystemic therapy has been shown in controlled studies to be effective in the long-term at reducing criminal activity, violent acts, arrests for substance abuse, assignments to special centres, and the incarceration of subjects with conduct disorder. Relapse is also substantially reduced.

Special schools and centres, often located in out-of-the-way places, have been used for decades as a social, "therapeutic" response for young delinquents and aggressive adolescents. Apart from the high cost of this type of strategy (which requires a high ratio of supervisory and security personnel), far from attenuating behavioural problems, bringing troubled young people together seems to broaden the "misfit's" repertoire of aggressive behaviour patterns. Disappointing outcomes led to a switch toward foster care programmes for young people with conduct disorder. Foster care treatment programmes use methods based on parental guidance, both for the biological family and the foster family. Such programmes are run by therapists and a full-time experienced supervisor. The supervisor contacts the foster family every day to review the subject's behaviour that day and, if necessary, adjust the treatment regimen. A set of procedures aims at improving the subject's behaviour in a sustained way. The foster families are also taught how to work together with the programme personnel and with the school. Whenever possible, they are asked to participate in family therapy sessions together with the biological (or adoptive) family because the ultimate goal is for the child to go back to his/her own home. Outcomes have been far better with this sort of programme than with placement in a special centre, with better compliance on the part of the troubled young people who run away less often and more often complete the treatment programme. Over the follow-up period, fewer days of incarceration are recorded, and the rate of relapse is reduced. As for other treatment models, changes in the way the family manages the child's behaviour (following parental training) and distancing the subject from "misfit" peers seem to be the key determinants of general improvement.

Finally, the purpose of individually focused interventions is to enhance the child's social skills, i.e. his sociability. Working in collaboration with a therapist, the child learns conflict resolution strategies through role playing and situational scenarios. In a more general way, cognitive/behavioural interventions focusing on the child have a slight-to-moderate effect on aggressive and antisocial behaviour patterns, particularly in children over 10. It seems that combining this type of treatment (which has proven successful in other problems like hyperactivity) with a parental training component helps normalise the child's behaviour in a sustainable way.

Drugs can be useful as second line strategies

Drugs may have a place in a global, priority-ranked, multimodal treatment strategy. They are usually prescribed following the failure of other strategies-apart from emergency situations (e.g., violence or aggression against others or self).

No specific drugs exist for conduct disorder, but certain drugs can moderate aggressive behaviour. Various pharmacological classes have been tested in this context, often on the basis of knowledge about the neurobiology of impulsiveness and aggression, both of which are known to involve dopamine, serotonin, and GABA pathways (among others). Most of the information on efficacy and safety was first established in adults, in most cases in the context of problems other than conduct disorder. As is the case for psychopharmacology in children and adolescents in general, there is little specific data from controlled studies in this age group. A review of the last 20 years of publications yields about 30 relevant articles, but only 10 describing studies based on rigorous methodology (with at least 500 subjects of between 6 and 18). Fewer than 10 studies report any efficacy with regard to conduct disorder.

Three major classes of drugs have been evaluated, namely antipsychotic drugs, central nervous system stimulants, and thymoregulatory drugs.

Although antipsychotic drugs are in widespread use for aggressive behaviour, only four controlled studies have been carried out focusing on conduct disorder, two with neuroleptics (haloperidol and molindone) and two with new-generation drugs (risperidone and olanzapine). The last two have a promising pharmacological profile in that they inhibit both serotonin and dopamine receptors, both systems being closely associated with aggressive behaviour. They are also better tolerated than the classic neuroleptics, especially with respect to neurological side effects such as tardive dyskinesia. All reports indicate efficacy against aggressive behaviour that is supported by the results of open studies and case histories. Classic side effects are observed, notably weight gain, drowsiness, and dystonia. Numerous medium-term studies conducted with risperidone for other indications (such as invasive developmental problems) indicate broadly satisfactory tolerance. In contrast to lithium and anticonvulsive drugs, antipsychotic drugs act immediately on the dimensions of aggression and agitation and are particularly useful in acute or emergency situations.

Unlike the antipsychotic drugs, central nervous system stimulants promote executive cognitive functions. They attenuate impulsiveness by inducing inhibition mechanisms and enhancing self-control. They mainly act by stimulating dopamine-based transmission in the brain but also have some stimulatory activity in noradrenaline and serotonin pathways. They are prescribed to treat ADHD, which is known to be the most common co-morbidity of conduct disorder. Therapeutic trials (seven controlled studies) have been conducted to evaluate the efficacy of methylphenidate against conduct disorder (with inter-current ADHD in six of the seven studies). Methylphenidate was found to have some degree of efficacy against aggression in moderately severe conduct disorder, and the treatment proved quite safe (with side effects confined to negative effects on appetite and sleep).

Seven controlled trials conducted to evaluate the efficacy of thymoregulatory drugs, notably lithium, have yielded mixed results in that in three cases, no efficacy was detected. Data on safety were more consistent with a high incidence of adverse reactions (weight gain, acne, gastrointestinal upset and polyuria), some of them serious (kidney failure and hypothyroidism). Such reactions entailed compliance problems in a population which is in any case resistant to restrictions. This was compounded by the fact that lithium's low therapeutic index means that regular blood testing is necessary to monitor the concentration of the drug in the blood throughout the course of treatment. Nevertheless, lithium is a preferred drug in conduct disorder associated with bipolar disease.

Other thymoregulatory drugs belonging to the anticonvulsive class have also been evaluated. Recently, very promising outcomes were obtained in two controlled studies of sodium valproate. Regular blood testing is required with this drug as well but not so often as lithium because of its higher therapeutic index. As with lithium, this drug is indicated in subjects with inter-current bipolar disease or who experience mood swings.

Because the serotonin system is known to be intimately involved in the pathogenesis of aggression and impulsiveness, trials have been carried out to investigate the efficacy of selective serotonin reuptake inhibitors (SSRIs) and non-selective serotonin receptor stimulants like buspirone. Only two clinical trials have been conducted in children and adolescents, but both these reported efficacy against aggression: an open study of trazodone which addressed several symptoms of conduct disorder; and a study of citalopram in aggressive children and adolescents with conduct disorder. Side effects were moderate-mainly headache, drowsiness and nightmares.

Anecdotally, small, uncontrolled trials have been reported on alpha 2-adrenergic receptor stimulants (clonidine), beta-adrenergic inhibitors, benzodiazepines, and opioid inhibitors such as naltrexone. Clonidine gave promising results in an open, pilot study, with reduced aggression correlating with decreased GABA levels in the blood after treatment.

In a confirmed case of conduct disorder, the treatment strategy should be formalised and matched to the subject, based on an accurate evaluation of the disorder itself as well as any inter-current problems.

Animal models can be of use in investigating behaviour patterns associated with conduct disorder

Of all the types of behaviour that interest ethologists and behavioural scientists, it is aggression that has generated the greatest number of publications-which is to be expected because this type of behaviour represents one of the key factors driving evolution and the establishment of territory. However, in the laboratory, choices have to be made about which parameters are to be studied because the experimenter must simplify the model to be able to make meaningful measurements reflecting the influence of any given factor.

Studies of agonistic conduct patterns in animals have revealed numerous behavioural correlations that are helping us to understand human conduct disorder, especially in the context of motor hyperactivity, attention-deficit and anxiety, all questions that have been studied in depth in laboratory animals.

Ethologists, and more recently biologists and geneticists, have traditionally divided agonistic conduct patterns into two broad classes, making a distinction between "defensive" aggression in response to attack and "offensive" aggression, which is typical of the interactions between males of a species. The latter includes predatory aggression in which the victim is killed and eaten, not necessarily for reasons of pure hunger. Other types of aggression exist, e.g., prepubertal playful aggression and the aggression of the breast-feeding mother-the purpose of which is to protect her offspring against male aggression. These various forms of aggressive conduct, which are easily differentiated by specific associated behaviour patterns, have been carefully characterised and described.

Investigation of exogenous etiologic factors that lead to aggressive conduct in laboratory animals, both prenatal and postnatal factors, has focused on the paradigm of stress. Physical or social stress can be used to modulate an animal's reactions. It is important to highlight the importance of the temporal dimension in the effects of stress on agonistic conduct: the literature shows that chronically stressed animals are more aggressive than controls, whereas animals who experience a single, highly stressful event tend to become more passive. The fact that the consequences of stress differ according to whether it is acute or chronic provides reference points when it comes to dissecting the pathogenic mechanisms underlying conduct disorder, notably with respect to the temporal dimensions-duration, repetition-of relevant life events.

The duration and the intensity of stress also seem to be important parameters in the pathogenesis of motor hyperactivity, attention deficit, and impaired behavioural inhibition which all commonly co-occur with conduct disorder in humans.

In rodents, 3 to 8 weeks of chronic exposure to repeated, unpredictable, moderately intense stressors stimulates activity and exploratory behaviour. In contrast, exposure to varied, unpredictable stressors of much greater intensity leads to reduced physical activity. Acute exposure to a severe stressor over a much shorter time frame increases locomotion without any effect on exploratory behaviour, but if this type of stress is sustained for a longer period, the rats' global level of locomotor activity drops within 24 hours.

There appears therefore to be a link between stress and motor activity. Depending on the intensity of the stressor, the victim's motor activity either increases or decreases. The effect of chronic stress seems to have a converse and more complex effect, pushing the victim toward the "impulsive" end of the "psychomotor" dimension; this is compatible with the idea of a drop in cerebral serotonin levels.

Unawareness of the environment entails indifference to danger. This is clearly observed in chronically stressed animals exposed to high-risk situations (e.g., being placed on an unstable surface where there is a risk of falling off). This type of behaviour associated with "unawareness of the danger" is typical of impaired inhibition mechanisms, and it resembles in some ways the effects of certain anxiolytic drugs. In the same way, in stressed animals performing free exploratory tasks, hyperactivity manifests as impaired habituation, in other words as a failure to ignore irrelevant information from the environment. Thus, relatively mild but chronic stress (modelling chronically stressful life events) has a major effect on selective attention and leads to serious impairment of behavioural inhibition mechanisms. The enhanced psychomotor reactivity of these animals can be addressed, as in the hyperactive child, from the perspective of attention-related processes and their consequences on inhibitory mechanisms.

Moreover, the aggressive responses to such environmental effects (i.e., stress) depend on the state of the subject (age, endocrine parameters, etc.). Experiments in which animals are confronted with a violent environment (e.g., living with aggressive peers) at different ages reveal the existence of a relatively short sensitive period around puberty during which exposure to violence can lead to vulnerability. Living with violent subjects around the age of puberty leads to the transformation of perfectly well-characterised, playful-type aggression into adult-type aggression which is itself perfectly well-characterised. The same is true for social isolation, which seems to have opposite effects according to whether it occurs before this critical period (in which case aggression is exacerbated) or after (in which case passivity is increased).

Comparison of the findings on aggression in small laboratory animals and epidemiological and neurobiological data on conduct disorder in children and adolescents underlines the inverse relationship between anxiety and aggressive behaviour. Psychobiological correlations with aggressive behaviour, together with the results obtained in rats and mice, are providing explanations that are of great heuristic value because they make it possible to isolate the effects of two variables that are fundamental to aggression, namely fear (which is difficult to address in human experiments) and anxiety. The fact that these two variables can be separated in animals has shown aggression and anxiety to be independent of one another (as are aggression and the effects of anxiolytic drugs), whereas aggression and fear are directly related, the latter being independent of anxious reactions. This line of research may lead to new pharmacological options for the treatment of conduct disorder.

Research in biology, neurobiology, and brain imaging is enhancing our understanding of conduct disorder

In biology, the study of aggression and violence is a relatively recent endeavour currently indicating parameters that might be relevant to conduct disorder.

Abnormally low cholesterol levels have been observed in the blood of men who have committed violent acts and in people who have attempted suicide by violent means. A possible causal relationship between low blood cholesterol levels and aggressive or violent behaviour is suggested by the fact that monkeys on a low-cholesterol diet tend to be more aggressive. Moreover, people taking cholesterol-lowering drugs (statins) have reported episodes of severe irritability, aggression, and even impulses to torture and murder. However, other studies have failed to confirm these results, showing that the relationship between blood cholesterol and aggressive or violent behaviour is a complex one, probably under the control of many as yet undefined factors that vary substantially from one individual to another.

Episodes of behavioural perturbation associated with low levels of blood cholesterol could result from changes induced in neurotransmission in serotonin, dopamine, and GABA circuits in the brain, although solid data are scarce.

It is generally accepted that peripheral sympathetic hypoactivity could be associated with social indifference, low emotional reactivity (e.g., in response to punishment), attention deficit, and impulsiveness. Children and adolescents of 6-16 years of age with conduct disorder have been shown to have abnormally low levels of dopamine beta-hydroxylase activity in their blood. This enzyme is released along with noradrenaline in response to sympathetic stimulation. Consistent with this finding, the average heart rate (which is under the direct control of the sympathetic system) in young boys (11-12) with conduct disorder and aggressive/impulsive behaviour patterns has been shown to be lower than in their non-aggressive peers. However, this relationship between heart rate and antisocial or aggressive behaviour seems to disappear in the course of development and is no longer observed in adulthood.

Other observations consistent with those concerning the sympathetic system suggest that conduct disorder could be related to hypoactivity in stress systems, probably in relation to the emotional deficit and social indifference observed in affected subjects. On the basis of results reported in animals, there could also be a causal relationship between low blood cortisol levels and conduct disorder.

On the other hand, early studies pointed out the existence of a positive link between elevated blood testosterone levels and aggressive or violent behaviour but no systematic trend has really been observed. It might be that this profile may be relevant in a sub-population of subjects, but no such group has yet been characterised in terms of genetics, temperament, or biological characteristics.

According to extensive work in the field of clinical biology, an important factor in conduct disorder and the commission of violent acts could be serotonin (5-hydroxytryptamine or 5-HT), the levels of which are determined by fluctuations of its precursor tryptophan at the periphery. As a general rule, a reduction in the concentration of this essential amino acid (which is exclusively derived from food in humans and rodents) exacerbates aggressive behaviour; inversely, an increase in tryptophan intake can moderate aggressive conduct. However, such effects remain relatively modest and are not systematically reproducible.

It has been established however that specific biological patterns are related to certain neurobiological patterns, notably affecting neurotransmitter systems in the central nervous system.

Findings from this type of research have been compared with data on how neuroactive and psychotropic substances work to attenuate this type of behaviour, especially neuroleptic drugs, antidepressants, and anxiolytics. Consideration of the molecular targets of various classes of drug have led to the conclusion that serotonin, the catecholamines (especially dopamine), and GABA are involved in impulsiveness, aggression, and possibly the other traits of antisocial personality disorder. Studies performed in humans (including school children) and laboratory animals tend to confirm this conclusion. However, other neuroactive compounds-in particular neuropeptides like substance P, arginine-vasopressin, and corticotropin releasing hormone (CRH)-also play important roles in the neurobiological mechanisms that underlie behaviour, including impulsive behaviour and aggression.

In parallel, the development of relevant animal models, especially in rodents (rats and mice, including genetically modified lineages) but also in primates, has refined our understanding of how the various neuromediators (e.g., neurotransmitters such as the monoamines and neuropeptides) might be involved in regulating the expression of impulsive and aggressive behaviour and violent manifestations. Impulsiveness and aggression have been observed to be exacerbated in mice in which the 5-HT1B serotonin receptor has been knocked out. This has triggered a search for agonists of this receptor that might attenuate such behaviour patterns. Effective agonists have been generated (called "serenics"), but prolonged administration of these candidate drugs leads to tolerance and reduced responsiveness, so no clinically useful psychoactive compounds have as yet been identified.

Finally, recent advances in brain imaging techniques are paving the way toward a new era in research into neurobiological mechanisms through identification of the key neural circuits involved, including those associated with impulsive, aggressive, and violent behaviour.

Limbic structures (the hippocampus, the hypothalamus, the septum, the amygdala, and the bed nucleus of the stria terminalis) and the anterior cingulate and orbito-frontal areas of the pre-frontal cortex have been pinpointed as being the parts of the brain in which activities are altered in association with impulsive, aggressive, and violent manifestations. In consequence, it is now known that limbic structures play a key role in controlling emotions and self-control mechanisms, whereas motivation and passage to violent action is associated with activation of the anterior cingulate and orbito-frontal areas of the pre-frontal cortex. In patients, these are the very areas in which changes are observed in the activity of neural networks implicating monoamines and other neuropeptides, which clearly play a central role in the expression and regulation of these types of behaviour. The deficit in serotonin that has been associated with impulsiveness and aggression might well affect the anterior cingulate and orbito-frontal areas of the pre-frontal cortex, where certain serotonin receptors are known to be particularly dense. This deficit could result in a decrease in the cortical efferent capacity to inhibit the subcortical structures that are responsible for aggression and passage to violent action. Consolidation of serotonin-based regulatory systems in particular, and monoamine-based systems in general, through diverse environmental and/or pharmacological interventions could therefore correct a functional deficit in the frontal cortex. At this time, the most likely hypothesis is that this functional deficit appears in childhood or adolescence. It is known that the prefrontal cortex is the last part of the brain to be differentiated in humans, with definitive connections only ultimately becoming established by the end of adolescence, under the control of multiple genetic and environmental influences. Childhood and adolescence are therefore critical periods in the construction of personality via the progressive maturation of different neurotransmitter systems, especially in this particular part of the brain. In other words, conduct disorder could be related, at least in part, to impaired development of the cortico-subcortical circuits involved in the control of impulsiveness, aggression, and social interactions. It is reasonable to believe that progress in functional brain imaging techniques-coupled with the elucidation of the mechanisms of action of those neurobiologically active and psychotropic agents which are known to have some degree of efficacy in the treatment of conduct disorder, ADHD or ODD-will help advance our understanding of the etiology of these conditions and may open the way toward new therapeutic options.

Created: 2005.

# data[].attributes.attachment_link.title
Conduct: Disorder in children and adolescents

# data[].attributes.attachment_link.description
This document presents the summary and recommendations of the expert group brought together by INSERM (the French National Medical Research Institute) within the framework of the collective expertise procedure to answer the questions raised by the Caisse Nationale d'Assurance Maladie des travailleurs indépendants (CANAM; French Health Insurance Fund) concerning the screening, management, and prevention of conduct disorder in children and adolescents.

# data[].attributes.body
Early intervention services as laid out in the Individuals with Disabilities Education Act (IDEA) are for children 2-3.  These are rarely offered by any school directly but are relevant as these services lay the ground work for what follows.  Early intervention services involve physical therapy, occupational therapy, and speech and language therapy to ameliorate many of the impacts of autism from the social deficits to the cognitive and sensory processing, communicative deficits.  After these services or if they were never engaged children move onto...

Special Education Services From 3 and up the IDEA requires that each state should provide all eligible children with an individualized education plan (IEP.)  The IEP needs to be created to meet the needs of the autistic child to allow him to exist in the school and classroom environment with as much general classroom and normal interaction as possible.  These are the principles of Free and Appropriate Education (FAPE) and Least Restrictive Environment (LRE).
The most important thing to remember about LRE is that the primary goal is not to keep the child in the classroom but to provide the most effective and comprehensive education for the student, and that as much as is possible this is to be accomplished in the classroom but that out of general ed interventions are to be used if there is no alternative.

Çakmak, K. (2017, May 30). Legal Education Rights of Children with Autism in the USA. Otsimo. https://otsimo.com/en/autism-legal/#:~:text=Legal%20Education%20Rights%20of%20Children%20with%20Autism%20in

‌

# data[].attributes.attachment_link.readable_text
The prevalence of autism in the United States increases day by day with newly found information. It may be confusing on what to focus in terms of your child's education. Although there are many ways to get information and help, many parents of children with autism are unfamiliar with the legal rights and protections that their children have by law. It is important to know your child's rights in order to provide them with a better education life to lead them in life. Here are some general topics to give an idea.

This information prepared for a general overview. They may change with coming updates. It is recommended to take legal assistance in the matter.

Right to Public Education

Children with special needs have the right to a free and appropriate education. The Individuals with Disabilities Education Act (IDEA) requires that each state should provide all eligible children with a public education that meets their needs.

It is stated in IDEA that children with various disabilities including autism are entitled to an intervention and special education. The parents need to be an equal partner in the child's education dialogue. Parents should be a part of their child's education plan in order to be a strong advocate for their children.

It is important to know that your child is entitled to an education that is made to meet his/her special needs. This is Free and Appropriate Education (FAPE). Your child is also entitled to experience the Least Restrictive Environment (LRE), that is your child needs to be placed in the environment where he/she will have the best possible opportunity to interact with other children without disabilities. This is also called inclusion or mainstreaming. There are many ways this can be achieved in the general education settings with a general education curriculum. The only thing to make sure of is that if this is the best way to follow for your child's needs.

Early Intervention Services

The Individuals with Disabilities Education Act provides grants for early intervention programs. Through these programs, every child younger than three with the developmental, physical or mental condition can be eligible.

Programs vary from state to state. However, the key point is to address the child's special and unique needs. They aim to minimize the impact of disabilities on the child's development. Some of these programs are speech and language instruction, occupational therapy and Applied Behavior Analysis (ABA). Families also get counseling in order to help them adapt the new way of life.

Special Education Services

These services begin after the early intervention phase when the child is older than 3. Local school districts have devoted special education services to provide this service. The purpose of special education is different from early intervention. While in early intervention your child gets an education regardless of the disability, in special education, your child's specific and unique needs are addressed. There is a document that states your child's needs and how these needs will be met; the Individualized Education Program (IEP). IEP spells out your child's strengths and weaknesses and sets goals and objects and states how these objects will be met in detail. This document is specially made for your child, so you and the school district's contributions are essential. Knowing your legal rights will increase the chance of a better educational outcome. (Learn more about IEPs here)

You are the advocate for your child. It is of essence that you know both your and your child's rights. If you think your child is not getting the right and suitable education, you may need to enter into mediation to resolve the issue. There was a pure example , where a family of a teenager with autism, won a court-order mediation because a private school in NJ failed to provide him with an Individualized Education Plan.

To get more information, visit IDEA's website

Sources:

- Findlaw:

http://blogs.findlaw.com/law_and_life/2014/04/5-legal-tips-for-parents-of-autistic-children.html
Last Updated: December 30, 2022

# data[].attributes.attachment_link.title
Legal Education Rights of Children with Autism in the USA | Otsimo

# data[].attributes.attachment_link.description
The prevalence of autism in the United States increases day by day with newly found information. It may be confusing on what to focus in terms of your child's education. Although there are many ways to get information and help, many parents of children with autism are unfamiliar with the legal rights and protections that their children have by law.

# data[].attributes.body
DISFLUENCY

Stuttering is the most common type of disfluency.

Symptoms of disfluency can include:

Repetition of sounds, words, or parts of words or phrases after age 4 (I want...I want my doll. I...I see you.)

Putting in (interjecting) extra sounds or words (We went to the...uh...store.)

Making words longer (I am Boooobbby Jones.)

Pausing during a sentence or words, often with the lips together

Tension in the voice or sounds

Frustration with attempts to communicate

Head jerking while talking

Eye blinking while talking

Embarrassment with speech

ARTICULATION DISORDER

The child is not able to produce speech sounds clearly, such as saying "coo" instead of "school."

Certain sounds (like "r", "l", or "s") may be consistently distorted or changed (such as making the 's' sound with a whistle).

Errors may make it hard for people to understand the person (only family members may be able to understand a child).

PHONOLOGICAL DISORDER

The child does not use some or all of the speech sounds to form words as expected for their age.

The last or first sound of words (most often consonants) may be left out or changed.

The child may have no problem pronouncing the same sound in other words (a child may say "boo" for "book" and "pi" for "pig", but may have no problem saying "key" or "go").

VOICE DISORDERS

Other speech problems include:

Hoarseness or raspiness to the voice

Voice may break in or out

Pitch of the voice may change suddenly

Voice may be too loud or too soft

Person may run out of air during a sentence

Speech may sound odd because too much air is escaping through the hose (hypernasality) or too little air is coming out through the nose (hyponasality)

# data[].attributes.body
AACAP. (n.d.). Oppositional Defiant Disorder. Retrieved June 2, 2023, from https://www.aacap.org/aacap/families_and_youth/facts_for_families/fff-guide/Children-With-Oppositional-Defiant-Disorder-072.aspx
Conduct Disorder. (2023, May 8). https://www.hopkinsmedicine.org/health/conditions-and-diseases/conduct-disorder
INSERM Collective Expertise Centre. (2005). Conduct: Disorder in children and adolescents. Institut national de la santé et de la recherche médicale. http://www.ncbi.nlm.nih.gov/books/NBK7133/
School-Based Services. (n.d.). Child Mind Institute. Retrieved June 3, 2023, from https://childmind.org/care/areas-of-expertise/adhd-and-behavior-disorders-center/school-based-services/

# data[].attributes.attachment_link.readable_text
- Journal of Speech Disorders, March 1936
Dr. G. Oscar Russell of Ohio State University was appointed editor of ASHA's first journal and assumed total responsibility for its production. Just as ASHA's first secretaries performed their duties without paid help, so did Russell who personally handled all the routine tasks related to editing a professional journal. Upon his recommendation, the Journal of Speech Disorders would be given to each member as part of their membership privileges. The first issue appeared March 1936 and consisted of 34 pages and contained four articles: Correcting the Mechanism Causing Most Foreign Brogue; Etiology of Cleft Palate and Harelip; Study of the Heart Rate During Stuttering; and Speech, Voice and Hearing Disorders Bibliography for Years 1933 to 1936. Seventy-five percent of the Association's gross annual income in addition to all advertising and subscription revenues was devoted to the new journal and Russell served as editor from 1936-1943.

In 1947, in response to the increasing number of members interested in audiology after WWII, the Association changed its name to the American Speech and Hearing Association. With this came a change in the title of the journal to the Journal of Speech and Hearing Disorders. A feature that appeared in the journal during World War II was entitled "War Notes," that reported on the activities of two committees; a Committee on Civil Defense, and a Committee on Rehabilitation that had been formed within the Association. The Committee on Civil Defense was concerned with speech correction needs arising from congested conditions in defense areas, emotional reactions of children and adults to war conditions and pre-induction speech correction in high schools, colleges and elsewhere. The Committee on Rehabilitation was concerned with helping to serve the needs of returning soldiers with hearing loss due to war conditions. The journal at this time published research reports, tutorial articles, clinical notes, clinical reports, book reviews, in addition to Association activities and official business.

# data[].attributes.attachment_link.description
Journal of Speech Disorders, March 1936 Dr. G. Oscar Russell of Ohio State University was appointed editor of ASHA's first journal and assumed total responsibility for its production. Just as ASHA's first secretaries performed their duties without paid help, so did Russell who personally handled all the routine tasks related to editing a professional journal.

# data[].attributes.body
Speech therapy has always been a growing concern that aims to help individuals develop their speech and communication skills. The development of different trends in speech therapy has enabled this industry to grow immensely by focusing on Modern and state-of-the-art functions that help advance this industry.Treatment for speech deficits and other associated problems includes speech therapy. Exercises for the body, speech practice and sound production exercises are some of the treatment's several techniques.

# data[].attributes.attachment_link.readable_text
Speech therapy has always been a growing concern that aims to help individuals develop their speech and communication skills. The development of different trends in speech therapy has enabled this industry to grow immensely by focusing on Modern and state-of-the-art functions that help advance this industry.

Treatment for speech deficits and other associated problems includes speech therapy. Exercises for the body, speech practice and sound production exercises are some of the treatment's several techniques.

Various speech abnormalities can affect both adults and children. 17.9 million American individuals age 18 and older (7.6 percent), according to statistics from the National Institute on Deafness and Other Communication Disorders, report having experienced a voice issue in the previous 12 months.

Overall, 2.3 percent to 24.6 percent of school-aged children were projected to have speech delay or speech sound problems, according to data from the American Speech-Language-Hearing Association.

All facets of oral motor skills, including swallowing, are included in SLP training. Speech therapy might be beneficial for senior citizens who experience dysphagia, a medical term for trouble swallowing. Coughing when drinking or immediately after doing so is one of the initial indications of dysphagia.

Effects of speech therapy

When breathing and swallowing are not coordinated, or if you are drinking liquid and breathing at the same moment, you are aspirating that liquid. By introducing swallowing techniques, an SLP can reduce the likelihood of this occurring. Take smaller sips and bites, tuck your chin into your chest, and chew your food 32 times before swallowing are a few of these techniques.

What transpires in speech therapy relies on several variables, including your age and the nature of your speech issue. It typically incorporates play, including language-based board games or activities that require sequencing for kids. It focuses on enhancing or repurposing specific skill sets for adults.

A speech-language therapist will advise the best course of action depending on your particular circumstances. Your healthcare professional will choose the speech therapy method that is most effective for you from among the many various categories and techniques available.

Trends in speech therapy

Modern technological Innovations have shaped speech therapy Sessions into idealistic and versatile projects which aim to incorporate AI into finding Logical Solutions. For instance, digital downloads have changed the speech therapy profession by providing downloadable material for individuals as opposed to only having them online. Individuals can save and secure different speech therapy sessions and store them for later use.

Young patients can also usually benefit from the different innovations that have shaped this industry. For instance, children can navigate through the various speech therapy tools available on phones and iPads. These tools are customised depending on each particular group and aim to improve pronunciation and attention span.

Over the past ten years, a lot of mobile and iPad apps have gained popularity that use AAC techniques. AAC technology is now available to millions of sufferers around the world thanks to these apps. Avaz App, DynaVox Compass, and Touchchat are a few famous instances.

Clients have access to a vast amount of information to aid in their learning through the use of video, audio recorders, digital flashcards, photos, and words on demand. In the workplace, students can readily and conveniently master practical daily chores that most of us take for granted, such as checking the weather and sending emails. With the direction and assistance of a therapist, adaptive programs can meet the learner where they are and move them to the next level.

Virtual reality is driven by artificial intelligence to help speech therapists develop Communication and documentation materials required for them to efficiently develop customised plans for their patients. These tools also assist speech therapists to develop concrete and predictive Processes that point out any speech Disorders early enough for treatment.

Paediatricians will intervene earlier and achieve better results if they are more aware of the importance of early detection in newborns and young children. Early speech therapy services for children can help them prevent academic deficits and the difficulties that come with them.

Virtual reality also helps patients spend more time with their speech therapists, as integrated tools are available for communication. It is, therefore, faster and more accurate to diagnose common speech disorders and find ways of helping individuals overcome them.

At the end of the day, technical improvements continue regardless of our opinions and feelings. It is in our best interests to become aware of the changes already underway so that we can comprehend them and get ready to take full advantage of them.

Technological advancements have also aimed at helping patients with Parkinson's disease develop the ability to project and communicate with a strong voice. One of the symptoms of Parkinson's disease is delayed swallowing and communication. However, modern technology has enabled patients with Parkinson's Disease to develop efficient and robust understanding thereby being able to efficiently articulate and articulate any word they need.

With the help of Sinatra speech therapy, patients can speak with intent thereby formulating speech as an intentional act. This technology has aimed in making speech sessions with patients much more engaging and relatable.

For a while now, telemedicine has been a hot topic in the medical community. Most of us imagine how wonderful it will be to be able to see our doctor remotely through a device rather than having to physically visit the clinic. However, telemedicine goes beyond mere convenience by providing speech therapy services to children and adults in rural areas who would not otherwise have access to them.

These include preferential seating, assisted listening devices, and special education and related programs for kids who qualify. This makes it possible for more people to access the necessary hearing aids and language services.

With the advent of improved internet access and engaging interactive platforms, Telemedicine is becoming increasingly popular all over the world. Seeing its scope and promising future, different countries have come up with various health acts and policies to ensure ethical practices.

# data[].attributes.attachment_link.description
Speech therapy has always been a growing concern that aims to help individuals develop their speech and communication skills. The development of different trends in speech therapy has enabled this industry to grow immensely by focusing on Modern and state-of-the-art functions that help advance this industry.

# data[].attributes.body
Speech and language support services are provided for students who exhibit communication disorders in the area of articulation, language, fluency and/or voice. Evaluations are conducted for any student whose communication disorder appears to be impacting his/her progress within the general education curriculum. If the student is determined to meet eligibility criteria for services and to need specially designed instruction, an Individual Education Program (IEP) is developed to meet that student’s specific needs.

Service delivery models include direct individual or small group pull out therapy, classroom based therapy, and consultative services.

There are many useful downloads in this web.

# data[].attributes.attachment_link.description
Speech and language support services are provided for students who exhibit communication disorders in the area of articulation, language, fluency and/or voice

# data[].attributes.body
Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.

Speech impairment is falls within the definition of “disability” under the American with Disabilities Act (ADA), and individuals living and working with speech impairments are protected against discrimination.

Any impairment under subrule (2)(a) of this rule shall be evidenced by both of the following:
(a) A spontaneous language sample demonstrating inadequate language functioning.
(b) Test results on not less than 2 standardized assessment instruments or 2 subtests designed to determine language functioning which indicate inappropriate language functioning for the student's age.

(4) A student who has a communication disorder, but whose primary disability is other than speech and language may be eligible for speech and language services under R 340.1745(a).

(5) A determination of impairment shall be based upon a full and individual evaluation by a multidisciplinary evaluation team, which shall include a teacher of students with speech and language impairment under R 340.1796 or a speech and language pathologist qualified under R 340.1792.

# data[].attributes.attachment_link.provider_name
Individuals with Disabilities Education Act

# data[].attributes.attachment_link.title
Sec. 300.8 (c) (11) - Individuals with Disabilities Education Act

# data[].attributes.attachment_link.description
(11) Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance. Severe Discrepancyidea_regulations-template-default single single-idea_regulations pos…