Elsevier

Aggression and Violent Behavior

Volume 5, Issue 6, November–December 2000, Pages 509-528
Aggression and Violent Behavior

Review
The relationship of neuropsychological impairment to conduct disorder in adolescence: A conceptual review

https://doi.org/10.1016/S1359-1789(98)00035-4Get rights and content

Abstract

This review is an attempt to expand the understanding of the neuropsychological mechanisms that may influence the expression of violent or aggressive behavior in adolescents. Although a relative large literature of adult studies examining the relation of neuropsychological impairment and aggression exists, the research literature investigating this relationship in adolescents is much smaller. With a few exceptions, the delinquent literature suffers from methodological problems, including biased sampling methods, small numbers of subjects, failing to objectively diagnose conduct disorder, incorrect use of specific statistical procedures, and lacking of appropriate control groups. In general, a mixed pattern of neuropsychological deficits are displayed across studies, depending on the sampling method, methodological design, statistics employed, control groups, and assessment tools that were utilized. Verbal deficits have been frequently displayed across the literature, while evidence for executive dysfunction varies, depending on the specific construct being evaluated (e.g., attention, cognitive flexibility, concept formation, planning abilities) and the specific population. Relatively inconsistent findings have been observed for visuospatial, sensory, and motor deficits. This article provides a critical review of this literature and discusses the varying impact that any neurological insult will have, depending on premorbid personality and cognitive functioning, location of the lesion, age at which the injury occurred, child's pre- and postinjury environment, and ability of the brain to adapt to acquired deficits as the result of the insult. On the basis of this review and neuropsychological theory, four subgroups within this population are proposed (i.e., adolescents with subcortical injuries, dominant hemisphere temporal-parietal injuries, nondominant hemisphere temporal-parietal injuries, and injuries to the prefrontal regions), which may better explain the neuropsychological and behavioral outcomes exhibited by this heterogeneous population. Recommendations for future research are offered.

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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