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Aggression and Psychopaths

Psychopathy and Aggression

Intro

Psychopathy and disorders of aggression are disorders that not only affect the person diagnosed, but can harm people around them

Through this presentation we hope to give you as Educators and parents confidence in spotting these disorders and resources to help those affected.

Objectives

  • Educators and parents will be able to identify signs and symptoms of psychopathy and several disorders of aggression

  • Educators and parents will know the kind of treatments available once a diagnosis is made

  • Educators and parents will learn some of the common misconceptions of psychopathy

  • Educators and parents will feel confident in knowing when to seek additional treatment if they feel intervention is needed

  • Educators and parents will know the importance of family involvement in treatment

Before we begin please take the quiz to determine what common misconceptions you may have about aggression and psychopathy

Quiz

Please follow the link below to take our short quiz:

https://www.proprofs.com/quiz-school/story.php?title=mjq2mti1nao264

Definitions and Diagnosis

Definition and diagnosis

In this presentation we will be discussing the following disorders:

1.) Psychopathy

2.) Aggression

A.) Conduct Disorder

B.) Intermittent Explosive Disorder

C.) Antisocial Personality Disorder

D.) Oppositional Defiant Disorder

Definition:

Psychopathy

Psychopaths are often intelligent individuals with superficial charm who have poor self-control, a grandiose sense of self-worth, and little or no feelings of remorse and who sometimes commit very violent acts. Compared with controls, psychopaths do not react negatively to words about violence, and they show blunted responses to aversive cues associated with fear conditioning that typically causes strong reactions in other people.

Diagnosis

1.) In general population

a.) In the general population Psychopathy is self-reported

b.) Can be based on tests, which are often like checklists or multiple choice

c.) Here is one of the common tests used:

https://openpsychometrics.org/tests/LSRP.php

2.) In prison settings

a.) Most diagnosis is made in the prison setting

b.) Interview and review of criminal records

c.) PLRV1 and PLRV2 Tests

Diagnosis

Here is a helpful video that addresses common misconceptions you may have.

Common Misconceptions

Aggression

Aggression

Behavior that is intended to case pain or harm (weather physical or emotional) to others, either individually or as a group.

This can include violence, assaults, homicides, verbal (name calling), or symbolic (horn honking or angry glares)

There are many disorders associated with aggression which we will discuss in depth

Conduct Disorder

Conduct Disorder

Conduct disorder is a repetitive and persistent pattern of behavior in children and adolescents in which the rights of others or basic social rules are violated. The child or adolescent usually exhibits these behavior patterns in a variety of settings—at home, at school, and in social situations—and they cause significant impairment in his or her social, academic, and family functioning

Signs and Symptoms

Signs and Symptoms

1.) Aggressive behavior that causes or threatens harm to other people or animals, such as bullying or intimidating others, often initiating physical fights, or being physically cruel to animals.

2.) Non-aggressive conduct that causes property loss or damage, such as fire-setting or the deliberate destruction of others’ property.

3.) Deceitfulness or theft, such as breaking into someone’s house or car, or lying or “conning” others.

4.) Serious rule violations, such as staying out at night when prohibited, running away from home overnight, or often being truant from school.

Diagnosis

Diagnosis

1.) Should be done by a mental health professional, preferrably one familiar with children's mental health

2.) Must be made in consultation of the child's family

3.) The assessment process should include

a.) observation

b.) discussion with the child and family

c.) structured diagnostic interviews

d.) history taking including familial history

What should you do if you suspect a child may need help?

What to do

1.) Learn more about conduct disorder, including recent research on effective treatment approaches.

2.) NMHA for additional resources on conduct disorder or other emotional or behavioral disorders of childhood.

3.) Consult with a mental health professional, preferably one who is trained in children’s mental health.

4.) Explore the treatment options available. Treatment must be individualized to meet the needs of each child and should be family-centered and developmentally and culturally appropriate.

5.) Find a family support group or organization in your community.

Here is a quick video about conduct disorder:

Video

Oppositional Defiant Disorder

Oppositional Defiant Disorder

Oppositional defiant disorder is a childhood disorder that is defined by a pattern of hostile, disobedient, and defiant behaviors directed at adults or other authority figures.

ODD is also characterized by children displaying angry and irritable moods, as well as argumentative and vindictive behaviors.

While all children will display some type of defiant behavior throughout their growing years, children suffering from ODD will display such behaviors much more commonly than that of any other type of behaviors.

For these kids, it can seem like nothing can be done to make them happy. These children will not only do things to purposely cause conflict or to purposely annoy the people around them, but they will oftentimes place the blame on others.

DIAGNOSIS

DIAGNOSIS

Your child's evaluation will likely include an assessment of:

1.) Overall health

2.) Frequency and intensity of behaviors

3.) Emotions and behavior across multiple settings and relationships

4.) Family situations and interactions

Strategies that have been helpful — or not helpful — in managing problem behaviors

5.) Presence of other mental health, learning or communication disorders

Behavioral Symptoms

BEHAVIORAL SYMPTOMS

1.) Easily losing one’s temper / throwing repeated temper tantrums

2.) Arguing

3.) Fighting

4.) Refusing to follow rules

5.) Deliberately acting in a way that will annoy others

6.) Blaming others

7.) Blatant hostility towards others

8.) Being unwilling to compromise or negotiate

9.) Willingly destroying friendships

10.) Being spiteful and seeking revenge

11.) Blatant and repeated disobedience

Cognitive Symptoms

COGNITIVE SYMPTOMS

1.) Frequent frustration

2.) Difficulty concentrating

3.) Failure to think before speaking

Psychosocial symptoms

PSYCHOSOCIAL SYMPTOMS

1.) Difficulty making friends

2.) Loss of self-esteem

3.) Persistent negativity

4.) Consistent feelings of annoyance

Intermittent Explosive Disorder

Intermittent Explosive Disorder

Intermittent explosive disorder is an characterized by sudden episodes of unwarranted anger. The disorder is typified by hostility, impulsivity, and recurrent aggressive outbursts.

People with IED essentially “explode” into a rage despite a lack of apparent provocation or reason. Individuals suffering from intermittent explosive disorder have described feeling as though they lose control of their emotions and become overcome with anger.

People with IED may threaten to or actually attack objects, animals, and/or other humans. IED is said to typically begin during the early teen years.

Diagnosis

Diagnosis

To determine a diagnosis of intermittent explosive disorder and eliminate other physical conditions or mental health disorders that may be causing your symptoms, your doctor will likely:

1.) Do a physical exam

2.) Rule out physical problems or substance use that could be contributing to your symptoms. Your exam may include lab tests.

3.) Do a psychological evaluation. Your doctor or mental health professional will talk to you about your symptoms, thoughts, feelings and behavior patterns.

Use the criteria in the DSM-5. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, is often used by mental health professionals to diagnose mental conditions.

Behavioral Symptoms

Behavioral Symptoms

  • Physical aggressiveness
  • Verbal aggressiveness
  • Angry outbursts
  • Physically attacking people and/or objects
  • Damaging property
  • Road rage

Physical Symptoms

Physical Symptoms

  • Headaches
  • Muscle tension
  • Chest tightness
  • Palpitations
  • Tingling
  • Feelings of pressure in the head
  • Tremors

Cognitive Symptoms

Cognitive Symptoms

  • Low frustration tolerance
  • Feeling a loss of control over one’s thoughts
  • Racing thoughts

Psychosocial Symptoms

Psychosocial Symptoms

  • Feelings of rage
  • Uncontrollable irritability
  • Brief periods of emotional detachment

Antisocial Personality Disorder

Antisocial Personality Disorder

Antisocial personality disorder is a mental condition in which a person consistently shows no regard for right and wrong and ignores the rights and feelings of others. People with antisocial personality disorder tend to antagonize, manipulate or treat others harshly or with callous indifference. They show no guilt or remorse for their behavior.

Individuals with antisocial personality disorder often violate the law, becoming criminals. They may lie, behave violently or impulsively, and have problems with drug and alcohol use. Because of these characteristics, people with this disorder typically can't fulfill responsibilities related to family, work or school.

Diagnosis

Diagnosis

  • People with Antisocial Personality Disorder are not likely to seek help on their own, but may seek help for other symptoms

  • May be proceeded by conduct disorder in the teens

  • Referral to a mental health specialist will lead to a diagnosis based on:

1.) A psychological evaluation that explores thoughts, feelings, relationships, behavior patterns and family history

2.) Personal and medical history

3.) Symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

  • In most cases this is not diagnosed before age 18, but the earlier the diagnosis the better the longterm outcomes

Symptoms

Symptoms

  • Disregard for right and wrong
  • Persistent lying or deceit to exploit others
  • Being callous, cynical and disrespectful of others
  • Using charm or wit to manipulate others for personal gain or personal pleasure
  • Arrogance, a sense of superiority and being extremely opinionated
  • Recurring problems with the law, including criminal behavior
  • Repeatedly violating the rights of others through intimidation and dishonesty
  • Impulsiveness or failure to plan ahead
  • Hostility, significant irritability, agitation, aggression or violence
  • Lack of empathy for others and lack of remorse about harming others
  • Unnecessary risk-taking or dangerous behavior with no regard for the safety of self or others
  • Poor or abusive relationships
  • Failure to consider the negative consequences of behavior or learn from them
  • Being consistently irresponsible and repeatedly failing to fulfill work or financial obligations

Sounds kind of like psychopathy right? Here's a video outlining the differences.

Video

Note the video refers to antisocial personality disorder with the term sociopath

Psychopathy

Prevalence

Conduct Disorder

Prevalence

Intermittent Explosive Disorder

In this section we will discuss how prevalent disorders of Aggression and Psychopathy are

These Include:

Psychopathy

Conduct Disorder

Intermittent Explosive Disorder

Antisocial Personality Disorder

Oppositional Defiant Disorder

When you read these numbers consider all of the students you see every day in your classrooms and how many could potentially be dealing with these issues.

Psychopathy

  • Most cases of psychopathy are diagnosed in a prison setting so it is hard to know how many cases exist in the general population
  • Within the United States out of prison populations studied 1% reflect true psychopathy
  • Outside of the prison community it is unknown the number of individuals with psychopathy
  • This is inferred from self-reporting and behavioral observation but tests are needed for a formal diagnosis
  • Formal diagnosis requires both the PLRV1 test, and an interview/examination of criminal records
  • Males demonstrate higher levels of psychopathic tendency than females
  • Across cultures different traits are valued and so in cultures where a lack of emotion is valued, psychopathy may be harder to diagnose. Also some cultures have different indicators associated with psychopathy.

Conduct Disorder

  • General population of boys is 6-16%
  • General population of girls is 2-9%
  • Children who have early onset conduct disorder (before age 10) are at greater risk of persistent difficulties
  • One of the most diagnosed disorders of children in a mental health setting
  • Estimates of Conduct Disorder worldwide range from .5% to 4%
  • Cultural differences and tolerance for behavior at different life stages greatly affect the accuracy of worldwide results however.

Intermittent Explosive Disorder

  • Lifetime prevalence is 7.3% with an average of 43 attacks over lifetime
  • Lifetime prevalence worldwide is 2.7%
  • Onset over a 12 month period has a prevalence of 3.9%
  • These people were not diagnosed with lifelong IED and only had episodes for 12 months or less
  • Mean age at onset was 14 years for both groups
  • Most common among males, young people, socioeconomically disadvantaged people, and those who have been exposed to violence

Antisocial Personality Disorder

Antisocial Personality Disorder

  • Lifetime prevalence ranges from 1-4% of the population
  • Numbers are a range because the diagnosis is predicated on a diagnosis of conduct disorder prior to age 15
  • Males are 3-5 times more likely to be diagnosed
  • 6% of men are diagnosed
  • 2% women are diagnosed
  • Like Psychopathy diagnosis is likely to be made in a prison setting
  • worldwide in prisons 47% of men and 21% of women are diagnosed

Oppositional Defiant Disorder

  • Lifetime prevalence in adults is 10.2%
  • Women 9.2%
  • Men 11.2%
  • Community samples of children range from 2-16%
  • National average is 2-3% in children
  • Worldwide
  • Difficult to assess as different cultures have different standards for behavior
  • For example in China there is great importance in the suppression of anger and so there many be less tolerance for the symptoms of ODD
  • Pooled prevalence worldwide is 3.3%

Oppositional Defiant Disorder

Causes

Causes

There are many causes that can affect disorders of psychopathy and aggression. These can be environmental, genetic, or psychological

Causes of Psychopathy

Psychopathy

1.) Neural areas associated with psychopathy are markedly different in three areas critical for moral judgement

a.) ability to recognize moral issues

b.) ability to have a response to a moral issue

c.) ability to reach a decision on a moral issue

2.) The areas involved in these kinds of moral judgement are located in the paralimbic areas, which are markedly smaller in the brains of psychopaths

3.) When a psychopath must mimic a moral response they must use observed knowledge from their prefrontal cortex

Free Will and Psychopathy

While this video goes into the topic of free will it also gives a good look into the neurological causes behind psychopathy

Video

Causes of Aggression

Aggression

1.) Evolutionary

a.) Aggression has been evolutionarily desirable because it can increase access to survival resources

b.) Animals and humans are only selectively aggressive however because it is not beneficial in all situations

2.) Biological

a.) Aggression does appear to be linked to genetics, this is evidenced in the fact that if you breed two aggressive animals they will produce aggressive offspring

b.) Aggressive behaviors are largely brought on by the amygdala and controlled by the prefrontal cortex

3.) Environmental

a.) The environment in which one grows up can have tremendous effects on learning to manage and control aggression

b.) Children exposed to ACES in their childhood may be more prone to aggressive behaviors

c.) Take the ACES test: https://americanspcc.org/take-the-aces-quiz/?gclid=Cj0KCQjwh6XmBRDRARIsAKNInDHjf_QYgiUweJHlsQrShMCjV9QLuRK5eN0pUdd6wwtnZdNdDw5RNS4aAt1vEALw_wcB

Causes of Conduct Disorder

Conduct Disorder

Risk factors for development of conduct disorder include:

1.) Parental drug or alcohol abuse

2.) Child abuse or neglect

3.) Family conflict

4.) Genetics

5.) Poverty

6.) Traumatic life event

7.) Diagnosis of similar behavior disorder

Causes of Conduct Disorder

Oppositional Defiant Disorder

1.) Causes

a.) Genetics - may be caused by natural dispositions or temperament

b.) Environment - lack of supervision, neglect, harsh punishment

2.) Risk Factors

a.) Temperament

b.) Parenting - can include abuse, neglect, or inconstant punishment

c.) Family Issues - can include mental health or substance abuse problems of parents

d.) Environment - can be strengthened or reinforced by peers and inconsistent discipline from authority figures

3.) Complications

a.) poor school or work performance

b.) antisocial behavior

c.) impulse control problems

d.) substance abuse

e.) suicide

IED Causes

Intermittent Explosive Disorder

1.) Causes

a.) Environment - verbal and physical abuse are common precursors to this disorder

b.) Genetics - there is thought to be a genetic component causing the disorder to be passed to children

c.) Brain Structure - There is thought to be differences in structure and function in individuals with the disorder

2.) Risk Factors

a.) History of other mental disorders

b.) History of mental and physical abuse

IED Complications

Complications

1.) Impaired interpersonal relationships

a.) They're often perceived by others as always being angry. They may have frequent verbal fights or there can be physical abuse. These actions can lead to relationship problems, divorce and family stress.

2.) Trouble at work, home or school

a.) Other complications of intermittent explosive disorder may include job loss, school suspension, car accidents, financial problems or trouble with the law.

3.) Problems with mood

a.) Mood disorders such as depression and anxiety often occur with intermittent explosive disorder.

4.) Problems with alcohol and other substances

5.) Physical health problems

a.) high blood pressure, diabetes, heart disease and stroke, ulcers, and chronic pain

6.) Self Harm

APD Causes

Antisocial Personality Disorder

1.) Causes

a.) Currently the exact causes are unknown

b.) There is believed to be a genetic link to APD

c.) There is also believed to be changes in brain function during development which affect vulnerability

2.) Risk Factors

a.) Diagnosis of childhood conduct disorder

b.) Family history of antisocial personality disorder or other personality disorders or mental illness

c.) Being subjected to abuse or neglect during childhood

d.)Unstable, violent or chaotic family life during childhood

APD Complications

Complications

1.) Spouse abuse or child abuse or neglect

2.) Alcohol or substance abuse

3.) Being in jail or prison

4.) Homicidal or suicidal behaviors

5.) Having other mental health disorders such as depression or anxiety

6.) Low social and economic status, and homelessness

7.) Gang participation

8.) Premature death, usually as a result of violence

Treatment

Treatment

While not all of the disorders we have discussed have treatments, there are many ways of managing symptoms. In some cases however, there are affective treatments available. Of course their effectiveness is highly dependent on the individual.

Treatment of Psychopathy

Psychopathy

Mostly we know what NOT to do from studies:

  • Psychotherapy has been proven ineffective

  • Can produce some behavioral change , but this is dependent on the participants willingness to change

  • Most will revert back because the underlying condition has not been changed

  • Most talk based therapy is geared towards people who know they need to change and at least in some capacity want to change

Decompression Treatment

Decompression Treatment

  • Developed at UW Madison through a study on juvenile psychopaths

  • Based on the idea that psychopaths respond better to rewards for good behavior rather than punishments for bad behavior

  • It is an intense treatment that lasts hours every day

  • Increased rewards play to the desire to win

  • Works best for young psychopaths

  • In the original study only 10% who received this treatment were re-offenders as opposed to 20% who had talk therapy and 70% from the group who received no treatment

  • Not necessarily a “cure” just learning to control or hide their behavior

Here is a video that goes more in depth into reward circuits in the psychopathic brain:

Video

Treatment for general aggression:

Aggression

1.) Medication

a.) medication may be used to treat and manage physical and mental disorders that may be causing aggressive behaviors. This can lead to a reduction in symptoms and aggressive behavior.

2.) Group Therapy

a.) Through group therapy you can learn anger management skills, coping mechanisms, relaxation exercises, and guided imagery to help learn new ways of expressing your feelings.

3.) Family Therapy

a.) Family therapy can be a big help for adults struggling with aggression to mend broken bonds with loved ones that may have occurred as a result of their aggressive behavior.

4.) Individual Therapy

a.) Individual therapy helps adults learn how to regulate emotions, identify triggers, and develop better coping strategies.

Conduct Disorder Treatment

Conduct Disorder

1.) Psychotherapy and behavioral therapy that ideally involves the child’s entire family and support network

2.) The earlier the condition is diagnosed, the more successful the therapy will be

3.) In younger children, parent-child interaction therapy or another parent management training is used to teach parents how to encourage desired behaviors and discourage disruptive one, and the child to control his behavior more effectively

4.) In adolescents, therapy may target not just the home life but interactions with authority figures at school, and peers

5.) Since conduct disorder is often (but not always) diagnosed along with other conditions that can be treated pharmacologically, a child may also go on medication as part of his therapy

ODD Treatment

Oppositional Defiant Disorder

1.) Parents and children must work to meet goals together, in many cases there is a missing link between parent and child that must be repaired

2.) Helping parents to find a middle ground between being permissive and authoritarian

3.) Parents learn to use strategies consistently

4.) Setting clear expectations

5.) Following through and using effective consequences

6.) Sticking to the program long enough to see change

7.) Offering praise when the right actions are taken by the child

ODD Medication

Medication

1.) There is no FDA approved drug specifically for ODD but there are others that can be used to lessen aggression

a.) Abilify

b.) Risperdal

2.) It is recommended that medication only be used in situations where the child is at risk of being removed from the school or home

ODD Programs:

Programs

1.) Parent-child interaction therapy

2.) Parent management training

3.) Positive parenting program

IED Treatment:

Intermittent Explosive Disorder

Two factor treatment:

1.) Psychotherapeutic treatment

a.) Cognitive behavioral therapy

I.) Helps the child identify their triggers and how to manage or avoid those triggers

II.) This should involve parents and teachers

2.) Pharmacological

a.) Anti-anxiety medications are often used to cope with symptoms

APD Treatment

Antisocial Personality Disorder

1.) Psychotherapy

a.) Psychotherapy, also called talk therapy, is sometimes used to treat antisocial personality disorder.

b.) Therapy may include, for example, anger and violence management, treatment for substance abuse, and treatment for other mental health conditions.

c.) But psychotherapy is not always effective, especially if symptoms are severe and the person can't admit that he or she contributes to serious problems.

2.) Medication

a.) There are no medications currently for APD

b.) Doctors may prescribe medications for conditions sometimes associated with antisocial personality disorder, such as anxiety or depression, or for symptoms of aggression

Summary

Summary and application

Many times when a child or adolescent is aggressive or violent we may give up on them believing they are simply a bad child. However, there are physiological disorders which may be the cause of this behavior. It is important that every student be given the opportunity to receive the help they need rather than be ignored by a system that classifies them as simply a “bad kid”. With this knowledge at hand, we hope for educators and parents to become more empathetic and learn how to seek treatment if they believe their child or student is struggling with one of these disorders.

Objectives

Objectives

1.) Educators and parents will be able to identify signs and symptoms of psychopathy and several disorders of aggression

2.) Educators and parents will know the kind of treatments available once a diagnosis is made

3.) Educators and parents will learn some of the common misconceptions of psychopathy

4.) Educators and parents will feel confident in knowing when to seek additional treatment if they feel intervention is needed

5.) Educators and parents will know the importance of family involvement in treatment

What can teachers do if they suspect a student has one of these disorders?

Teachers

1.) Review the symptoms of the specific disorder

2.) Contact your school counselor or mental health personnel

3.) Work with counselors, parents, and the students to develop an IED plan which will benefit the student

4.) Always be transparent and work with parents

5.) Keep the student in the classroom as much as possible

What can parents do if they believe their child may have one of these disorders?

Parents

1.) Contact your doctor for an appointment and referral to a mental health specialist

2.) Explore treatment options

3.) Keep the family involved in all therapy and/or treatment

4.) Make all of the authority figures in your child's life aware of the treatment

5.) Provide resources to these people so they can provide help in line with your child's care plan

Works Cited:

Works cited

(2019). Conduct disorder: Risk for other disorders. Child Mind Institute. Retrieved from:

https://childmind.org/guide/guide-to-conduct-disorder/

Boat, T, F., & Wu, J, T. (2015). Mental disorders and disabilities among low-income children. The National Academies Press

Canino, G., Polanczyk, G., Bauermeister, J, L., Rohde, L, A., & Frick, P, J. (2010). Does the prevalence of CD and ODD Vary across Cultures? U.S. National Library of Medicine National Institutes of Health, 45, 395-704. doi: 10.1007/s00127-010-0242-y

Chester, D, S., & DeWall, C, N. (2016). The pleasure of revenge: Retaliatory aggression arises from a neural imbalance toward reward. U.S. National Library of Medicine National Institutes of Health, 11, 1173-1182. doi: 10.1093/scan/nsv082

Conduct Disorder. (n.d.) Retrieved from:

http://www.mentalhealthamerica.net/conditions/conduct-disorder

Kessler, R, C, Coccaro, E, F., Fava, M., Jaeger, S., Jin, R., & Walters E. (2006). The prevalence and correlates of DSM-IV intermittent explosive disorder in the National Comorbidity Survey Replication. U.S. National Library of Medicine National Institutes of Health, 63, 669-78.

Kiehl, K, A., & Hoffman, M, B. (2014). The criminal psychopath: History, Neuroscience, Treatment, and economics. U.S. National Library of Medicine National Institutes of Health, 51, 355-397.

Lim, Y, L. (2009). Cross-Cultural generalizability of psychopathic personality disorder: Differences between individualistic versus collectivistic cultures.

Mayo Clinic Staff. (2018). Oppositional defiant disorder (ODD). Mayo Clinic Retrieved from:

https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/symptoms-causes/syc-20375831

Mayo Clinic Staff. (2018). Intermittent explosive disorder. Mayo Clinic Retrieved from:

https://www.mayoclinic.org/diseases-conditions/intermittent-explosive-disorder/symptoms-causes/syc-20373921

Turgay, A. (2004). Aggression and disruptive behavior disorders in children and adolescents. U.S. National Library of Medicine National Institutes of Health, 4, 623-32.

Mayo Clinic Staff. (2018). Antisocial personality disorder. Mayo Clinic Retrieved from:

https://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/diagnosis-treatment/drc-20353934

Psychotherapy for children and adolescents: Different types. (2019). American Academy of Child & Adolescent Psychiatry. Retrieved from:

https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Psychotherapies-For-Children-And-Adolescents-086.aspx

Scott, K, M., Lim, C. C. W., Hwang, I., Adamowski, T., Al-Hamzawi, A., Bromet, E., Bunting, B., Ferrand, M,P., Florescu, S., Gureje, O., Hinkov, H., Hu, C., Karam, E., Lee, S., Villa, J, P., Stein, D., Tachimori, H., Viana, M, C., Xavier, M., & Kessler, R, C. (2016) The cross-national epidemiology of DSM-IV intermittent explosive disorder. U.S. National Library of Medicine National Institutes of Health, 46, 3161-3172. doi: 10.1017/S0033291716001859

Werner, K, B., Few, L, R., & Bucholz, K, K. (2015). Epidemiology, Comorbidity, and behavioral genetics of antisocial personality disorder and psychopathy. U.S. National Library of Medicine National Institutes of Health, 45, 195-199. doi: 10.3928/00485713-20150401-08

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