ReviewThe relationship of neuropsychological impairment to conduct disorder in adolescence: A conceptual review
Section snippets
Brain damage and aggression
As in the adult literature (e.g., Elliott 1992, Golden et al. 1996, Jones 1992), neuropsychological dysfunction has been documented in a number of studies relating adolescent aggression to brain injury. For example, Lewis, Shanok, Pincus, and Glaser (1979) divided 97 incarcerated juvenile delinquents into groups labeled as “less violent” and “more violent.” This division was made by three nonblind clinicians who rated each subject's behavior from 1 (least violent) to 4 (most violent). The
Frontal lobe deficits in adolescent delinquents
Numerous studies have examined the relationship between frontal lobe dysfunction and aggression. Comprehensive examinations of these findings for adults are presented in several reviews (see Elliott 1992, Golden et al. 1996, Jones 1992) that strongly suggest a positive association between frontal lobe damage and disinhibition of violent behavior. Patients with such lesions tend to be impulsive, have poor insight into their behavior, lack planning ability and good judgement, exhibit inflexible
Verbal deficits in adolescent delinquents
Numerous studies have consistently demonstrated that adolescent delinquents score higher on the “performance” subtests of the Wechsler intelligence test as compared to “verbal” subtests Moffit 1990, Prentice & Kelly 1963, West & Farrington 1973. This significant PIQ > VIQ difference has been hypothesized as an indicator of left hemispheric dysfunction. It is, however, important to note that although the PIQ > VIQ split has been repeatedly shown in numerous research studies, the PIQ of
The incidence of illicit drug use in adolescents
Neuropsychological impairment, both acute and chronic, may arise from illicit drug use Carlin 1986, Millsaps, Azrin, & Mittenberg 1994, Rosselli & Ardilla 1996. This is important since one of the most frequent associated features of conduct disorder is the use of illicit drugs and alcohol, often resulting in a comorbid substance abuse diagnosis Johnston 1991, Kandel 1996, Kandel et al. 1997, Wagner 1996. The “National Household Survey on Drugs,” conducted by the United States Department of
Discussion
The review of the literature reveals neuropsychological deficits in aggressive adolescents. However, it is clear that the nature of these deficits differ across investigations, partially due to methodological and sampling issues that have been highlighted in the review, but also because of obvious differences within the population itself.
This is not surprising, since modern neuropsychological theories (e.g., Luria, 1980) recognize that any complex behavior, like aggression, is not the result of
Subcortical injuries
The adult and child literatures clearly point to the subcortical areas of the brain in the regulation of arousal, attention, emotion, and aggression Luria 1980, Poston et al. 1994, Jones 1992, Otnow-Lewis et al. 1985. These areas of the brain are well-developed at birth or shortly thereafter so that only more serious injuries will impair functioning after early childhood. Such later injuries to these areas have rarely by themselves been associated with violence or aggressive behavior (Golden et
Dominant temporal-parietal injuries
These injuries can be subdivided into several subtypes. The first of these are injuries limited to the anterior temporal lobe and subcortical areas, but which spare the more posterior speech areas, commonly known as “Wernicke's Area.”
Several limbic system structures that are important in regulating aggressive behavior are located within this part of the temporal lobe. Damage to the medial portion of the temporal lobes where these limbic structures are located have been related to a lack of
Nondominant temporal-parietal injuries
Injuries to the nondominant temporal-parietal area produce both similar and dissimilar patterns of dysfunction, as compared to parallel injuries to the dominant hemisphere. When the injury is confined to the anterior and medial temporal lobes, there may be many of the same impulsive, explosive, and seizure-like activities that are seen in injuries to the dominant hemisphere. However, injuries to the posterior areas have very different effects. Overlearned verbal skills are spared, but more
Prefrontal group
The development of aggression in adolescents with only prefrontal dysfunction generally comes as a surprise, since such problems are not evident until the advent of adolescence. Prior to this time, such injuries will remain “quiet” and the child will show normal development, unless other brain areas are injured as well.
The functions of the prefrontal cortex include sustaining attention and concentration, abstract reasoning and concept formation, hypothesis testing, goal formulation, programming
Relationship of the environment to brain injury
Environmental events, such as chaotic families, physical abuse, sexual abuse, violence within the home, low SES, and poor parental monitoring are well-documented environmental factors related to conduct disorder (see reviews by Kazdin 1993, McMahon & Wells 1989, Wagner 1996). Many adolescents from such environments exhibit serious conduct problems reflecting a pattern of learned behaviors, serious emotional disturbances, or, most likely, a combination of both. Various-risk taking behaviors may
Conclusions
While a relatively large literature of adult studies examining the relation of neuropsychological impairment and aggression exists, a much smaller body of research investigating this relationship in delinquents is present. With a few exceptions, most of the delinquent literature suffers from methodological problems, including biased sampling methods, small numbers of subjects, failure to objectively diagnose conduct disorder, incorrect use of specific statistical procedures, and general lack of
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