How does the mind work—and especially how does it learn? Teachers’ instructional decisions are based on a mix of theories learned in teacher education, trial and error, craft knowledge, and gut instinct. Such knowledge often serves us well, but is there anything sturdier to rely on?
Cognitive science is an interdisciplinary field of researchers from psychology, neuroscience, linguistics, philosophy, computer science, and anthropology who seek to understand the mind. In this regular American Educator column, we consider findings from this field that are strong and clear enough to merit classroom application.
QUESTION: How can we better understand and support children who are highly aggressive?
ANSWER: Aggression has multiple causes and is part of the typical human’s behavioral repertoire. However, a small percentage of children engage in more severe and more frequent aggressive behavior than is typical, and these children may have differences in several mental processes (rooted in genetics and/or their environment) that require treatment. The good news is that most of these children can be helped—if they have access to therapeutic interventions. In this article, our aim is to increase understanding of these differences so that educators can become stronger advocates for connecting these children to mental health services.
Student aggression causes considerable disruption for both peers and teachers. Aggressive students make it harder for their classmates to learn, diminish teacher job satisfaction, and contribute to educator burnout over time.1 This is not just a US problem. A 2019 report examined data from students ages 9 to 17 from 144 countries and found that, on average, one-third of students reported an incident of peer aggression within the previous month.2 Teachers at a school in the United Kingdom actually went on strike due to concerns that their school was unsafe for staff due to pupil violence.3
Psychologists’ definition of aggression matches its everyday usage: aggression is intentional behavior meant to cause either physical or psychological pain.4 Thus, a student who spreads a rumor about another child on social media with the intention of embarrassing her is acting aggressively. That’s true even if the plan backfires, with the aggressor ending up shunned and the target suffering no consequences. But if a student carelessly bumps another child who then falls and breaks his ankle, no aggression has taken place. Intent, not outcome, is everything for defining aggression (though outcome still matters for students and for educators creating a safe, caring environment).
Of course, there is a multitude of reasons why a child might act aggressively. Even though many of us wish this were not true, aggression is a standard human response—in many situations, it’s perfectly normal. Aggression can be used to achieve dominance, be used to acquire resources in situations where they might not otherwise be readily available, and be seen in response to frustration, a threat, or social provocation. So it’s no surprise that many social variables, such as economic deprivation and a high-stress home environment, can increase the risk for aggression.5 But this type of “normal” aggression—and all the potential systemic, historical, environmental, economic, and political causes—is outside the scope of this article. As cognitive scientists, we’re only focusing on how the risk for aggression can also be increased by neuro-cognitive difficulties—and what we can do about those difficulties. Neuro-cognitive difficulties are mental processes mediated by known brain systems that are not working as well as would be expected for a child of a given age. In this article, we’ll discuss four such processes. At the same time, we acknowledge that the divide between systemic, historical, etc., causes of aggression and neuro-cognitive ones is not as clean as our introduction sounds. Neuro-cognitive difficulties can arise from genetics and from the conditions in which a child is living—often both are involved. Regardless of the cause, the core message of our article remains: most highly aggressive children can be helped, especially if the adults around them know about and advocate for therapeutic interventions.
Two indications of the presence of neuro-cognitive difficulties are the severity and the frequency of the aggression (a fight that ends with bruises is very different from a string of fights that end with several people hospitalized). Of course, severe and frequent aggression may indicate a neuro-cognitive difficulty but not a diagnosis—and even these indicators can be ambiguous because they are open to interpretation and have historically been applied with bias. It’s well documented that in our communities and schools, misbehaviors are judged as more serious if they are committed by a Black child rather than a white child.6
Despite the difficulty in interpretation, it is important not to ignore potential neuro-cognitive difficulties. Unfortunately, biases occur here too, as there are strong indications that Black people are far less likely than non-Hispanic white people to receive the mental health services they need.7
The goal of this article is to provide insight into some of the difficulties faced by some children who show high levels of aggression. Our goal is not to explain the aggression of every child or even of the majority of children who show aggression—as noted, there are myriad social and contextual reasons why an individual might be aggressive. Instead, our goal is to help educators understand those individuals—estimated at perhaps 1 to 2 percent of children—who show aggression regularly and whose aggression is more likely to result in significant harm to victims. We hope that increased understanding will lead to better management, including providing the interventions these children need and deserve, and to a calmer and more productive classroom environment.
How Do Psychologists Understand Aggression?
Psychologists distinguish between two types of aggression: instrumental and reactive. Instrumental aggression is chosen to achieve a particular goal. For example, a preschooler might punch a peer to make him relinquish a swing on the playground. Reactive aggression, in contrast, is associated with anger and occurs in response to provocation, a threat, or frustration. Causes of frustration can be varied—from a sense of the injustice of a particular situation to the experience of a classroom computer not turning on.
Both forms of aggression can be within the scope of “healthy” social interactions. We see instrumental aggression when football players try to physically hurt opposing players, or when basketball players seek psychological damage through trash-talking. These are accepted by all involved as part of the games. Moreover, all mammals show reactive aggression if provoked by a strong enough threat (and again, this may be within socially accepted norms). For example, US President Andrew Jackson faced an assassination attempt in 1835 as he left the US Capitol. When the assassin’s gun misfired, Jackson attacked the man with his cane (and survived because the assassin’s second gun also misfired). Many Americans today would likely see that instance of reactive aggression as understandable.
But instrumental or reactive aggression may not be within social norms—that is, either may be out of proportion to the context. Hitting someone with your cane is proportionate if your target just tried to kill you, but not if your target merely criticized your hat.
Is This Typical or Clinical Aggression?
Educators and researchers alike are much more concerned about acts of disproportionate aggression than typical aggression, and isolated acts are not likely to be cause for long-term concern. But when such acts are part of a persistent pattern, they may be a sign of a child in need of significant support. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), published by the American Psychiatric Association, is the widely accepted authority on definitions and diagnostic criteria for mental disorders.8 It lists two diagnoses specifically associated with aggression during childhood: oppositional defiant disorder and conduct disorder.
Oppositional defiant disorder is seen primarily before age 10, and the symptoms are a combination of angry/irritable mood, vindictiveness, and defiant behavior, all lasting at least six months. Children with this disorder often don’t comply with requests from authority figures, deliberately annoy others, and blame others for their mistakes or misdeeds.
Conduct disorder usually applies to children ages 10 to 18 and is defined by the commission of aggressive acts toward people and animals, destruction of property, deceitfulness, and the violation of community rules (e.g., skipping school or running away from home). These behaviors demonstrate a persistent tendency to violate the rights of others and to flout the rules of society.
A third diagnosis worth mentioning is attention deficit hyperactivity disorder (ADHD). Symptoms of ADHD include inattention (difficulty to focus), hyperactivity (excess movement that is not appropriate for the setting), and impulsivity (actions engaged in without thought). Children with ADHD are at increased risk for aggression9 and often also meet criteria for conduct disorder. Up to 70 percent of children with conduct disorder also receive diagnoses of ADHD.
The criteria we listed for oppositional defiant disorder, conduct disorder, and ADHD are categories of behavior, and the DSM-5-TR provides guidance about how to interpret everyday behaviors to judge whether they fit any categories. Still, in many respects, these diagnoses are not terribly helpful. Both conduct disorder and oppositional disorder have been used to guide interventions, but neither diagnosis is successful in predicting whether an individual will benefit from any specific intervention. Moreover, possession of a diagnosis does not inevitably mean the individual has neuro-cognitive difficulties. Contextual reasons for aggression—such as being exposed to aggression among peers and/or family members or enduring long-term poverty—can lead to diagnoses in the absence of neuro-cognitive risk. Moreover, many other diagnoses, such as depression, posttraumatic stress disorder, and forms of anxiety disorder, are also associated with at least some increased risk for aggression.
The benefit of a diagnosis is that it increases the chance that the individual will receive the help of mental health professionals. And yet, we must be mindful of the well-established problems of inappropriate diagnosis, particularly of young Black males. For example, compared with their white peers, youth of color are less likely to be diagnosed with ADHD and more likely to be diagnosed with oppositional defiant disorder or conduct disorder, even after controlling for confounding variables (like prior juvenile offenses or adverse experiences). This is problematic because misdiagnosed youth may not have access to needed medications, in-school accommodations, or community-based therapies.10
What Underlies Clinical Aggression?
Because the diagnoses don’t provide much help with respect to guiding interventions, we believe that greater attention should be paid to the range of underlying mental processes that can give rise to an increased risk for aggression rather than the diagnoses per se. A more detailed understanding of these underlying processes offers the promise of more individualized interventions.
Behavioral and neuroscientific data point to four mental processes that, if operating atypically, can lead to aggression. We describe each in turn. Children with heightened levels of aggression most often do not show problems in all four of these processes. Indeed, some may show none. But many clinically aggressive children do show at least one. Just what causes dysfunction in these mental processes is not well understood, although both genetics and the conditions in which a child is living are implicated.
1. Acute threat response. There is a brain system that organizes the basic mammalian response to threat: freezing for mild threats, fleeing for more serious threats, and reactive aggression for strong threats. If all is going well, reactive aggression will only occur in response to extreme threats (perhaps a human attacker or a rabid animal). But there are factors that can increase the responsiveness of this system, making reactive aggression more likely in response to threats that would prompt most people to freeze or flee. These factors can be genetic but also environmental; in particular, exposure to a threatening environment or to abuse.11 Of course, one may then ask what level of exposure is sufficiently toxic to impact brain function? This is a complex issue and is different for each individual. More severe and frequent exposure increase risk, but resilience factors—within the individual, such as their ability to self-regulate their emotions, and within their social environment, such as the availability of supportive family or friends—reduce risk. In the classroom, over-responsiveness of the acute threat response brain system might manifest as explosive rage in response to what for other children would feel like a mild threat, such as being frustrated (perhaps following the denial of a toy or, in an older child, a phone) or being socially challenged by a peer or teacher.
2. Response control/behavioral disinhibition. Considerable evidence points toward the role of the several brain regions in control of behavior.12 This control is necessary when, for example, a child knows she should be attentive to the teacher, but a cute dog is visible outside the classroom window. Problems with response control may increase the risk for aggression,13 but the increase will probably show only if there is already some propensity to be aggressive. For instance, if the child felt the urge to rage or grab another child’s belongings, difficulties in response control make it more likely that the child will actually do those things.
3. Reward- and punishment-based decision-making. Several brain regions are important for reward-based decision-making; these regions allow us to anticipate what a reward or punishment will feel like and respond to rewards or punishments once received. That’s crucial to allow us to make good decisions—that is, to choose the behaviors that will give us the most reward. If these systems are not working well, the individual will make poorer decisions—choosing, for example, a small reward now rather than a much larger reward in the future (like playing truant for the day as opposed to attending school regularly to ensure graduation). Such poorer decision-making increases the risk the individual will engage in aggression and also increases the risk for future substance abuse.14 These problems in judgment may occur over a long period (being truant rather than trying to excel) or a short period (taking a drum from the school band room to play with for the afternoon, even though it’s likely you’ll get caught and face consequences).
4. Empathy. The brain regions important for empathy—specifically, for responding to the distress of other individuals—together with those involved in decision-making, reduce the probability that we will harm others. If these systems are not working well, the individual will be more willing to harm others to achieve their goals.15 They may be more likely to use weapons at school (rather than simply threaten to use them) and continue to attack another child even when that child is attempting to disengage.
What Makes Children Prone to Clinical Aggression?
There are genetic contributions to the risk for aggression,16 which presumably prevent typical functioning of the four mental processes described above.17 However, the details of these contributions—which specific sets of genes play a role and how they influence development—remain mostly unknown.18
There are also many social and environmental variables—including home and community variables (many with systemic, historical, etc., causes) as well as environmental toxins such as lead exposure—that influence brain development and increase the risk for aggression. While there are too many variables to review here, educators should be aware of the potential impact of abuse and neglect. Physical, sexual, and emotional abuse all increase sensitivity of the acute threat response, particularly if the abuse is persistent and severe.19 Neglect (physical and emotional) appears to reduce the brain response to reward.20
How Can We Reduce Clinical Aggression?
When people hear that there is a genetic influence on a propensity to behave aggressively, they sometimes conclude that nothing can be done. The word “genetic” is equated with inevitability. But that’s inaccurate. Consider that there are genetic risk factors for depression and for obesity, but that doesn’t mean children suffering from these health issues cannot be helped.
A number of different interventions may reduce children’s clinical aggression, and they are usefully divided into psychosocial and pharmacological interventions. Note that the ones we describe below were designed by mental health professionals for use by psychologists and/or psychiatrists. Our purpose in describing a few of the more commonly used interventions is to give educators a better understanding of how clinically aggressive children—no matter what the underlying causes are—can be helped.*
Psychosocial interventions. Two main psychosocial interventions used for aggression, as well as anger/irritability, are cognitive-behavioral therapy and parent management training.21 Cognitive-behavioral therapy targets deficits in emotion regulation and social problem-solving skills that are associated with aggressive behavior.22 Interventions are conducted with the child and use structured strategies to produce changes in thoughts, feelings, and behaviors.23 Common techniques include helping the child learn to identify the antecedents and consequences of their aggressive behavior, learning strategies for recognizing angry feelings and regulating expressions of anger, generating new ways of thinking about things that trigger aggression, and modeling and rehearsing socially appropriate behaviors that can replace angry and aggressive reactions. Cognitive-behavioral therapy has been successful in helping children who have experienced abuse; it seems most effective for children who have difficulty managing the acute threat response.24
Parent management training aims to change family interactions, specifically to reduce parenting behaviors that prompt the child’s irritability and aggression. It assumes that some forms of irritable behavior and aggression are reinforcing for the child. For example, a child who doesn’t want to go to school (perhaps because another child has been teasing him) may throw a violent tantrum. The parent concludes, “We can’t send him to school like this,” and allows him to stay home—and the child learns that a violent tantrum allows an escape.
During parent management training, parents (or the primary caregivers) are taught to identify the function of maladaptive behavior, to give praise for appropriate behavior, to communicate directions effectively, to ignore maladaptive attention-seeking behavior, and to use consistent consequences for disruptive behaviors. Parent management training is conducted with parents, though sometimes in conjunction with their children.25 It primarily targets aggression the child learned through previous less-than-optimal social interactions. It is not specifically designed to address the mental process difficulties described above (acute threat response, disinhibition, decision-making, and empathy). However, by reducing some particularly maladaptive parenting strategies (e.g., harsh and inconsistent discipline, such as excessive scolding and corporal punishment), it may reduce environmentally induced hyper-responsiveness to acute threats (and thus reduce irritability and/or rage-based aggression).
Considerable research indicates that cognitive-behavioral therapy and parent management training reduce irritability and aggression.26 These improvements in child behavior can be stable over time and prevent antisocial behavior in adulthood.27 However, they do not benefit all children equally. This may reflect that these interventions have yet to be optimized to address other difficulties that some aggressive children struggle with. Recent work demonstrated that children who did not benefit from one of the most successful forms of parent management training showed particular difficulty in their empathic responding to the distress of others.28 Interventions will need to be adjusted individually to help all children.
Pharmacological interventions. The most commonly used pharmacological medications for reducing children’s risk for aggression are neuroleptic (antipsychotic) medications. These are reported to have some impact on reducing aggression.29 However, the mechanism by which they have an impact remains unclear. Far more research needs to be done. Currently, it is not certain whether neuroleptic medication beneficially impacts any of the mental processes outlined above.
Stimulants, like Adderall, are another pharmacological intervention that has been shown to reduce aggression risk, in particular in youth with ADHD.30 Mechanistically, this might occur via reducing general response control problems; this is seen in at least some youth diagnosed with ADHD.31 Because of how stimulants affect the brain,32 they might make the aggressive child more responsive to the distress of others and, in turn, better able to restrain themselves. There have been provocative data indicating that for children with reduced empathy, stimulant medication can amplify the effects of psychosocial interventions.33 But individuals whose increased aggression risk might relate to enhanced acute threat responsiveness are unlikely to benefit from stimulant intervention—they may actually become more aggressive.
What Can Educators Do?
So, what does all this information imply for educators? There are three points we’d emphasize.
First, when you have a student who shows aggressive behavior, your instinct may be to try to work with the student—for example, to talk with and observe the student—in an effort to discern what triggers their aggression. That’s of course appropriate, but it’s also essential to remember that every public school district is required by federal law to have a process in place to identify students who need additional support. We recommend that you contact the school administrator who is in charge of that process the first time you are suspicious the child may need help. Even though many school systems do not have enough staff for this process to operate as well as it should, it is still crucial to start the process. That way you can get information about how you can best support the child and ensure they get the services they need as soon as possible.† In addition, that first moment of concern should also lead to record-keeping on your part: document the frequency, timing, duration, apparent trigger, and specific actions of each aggressive episode. It makes sense to start this record-keeping even before you are certain about the seriousness of the problem, because the formal process will require documentation. If you wait to initiate the process until you’re sure you can’t handle the child’s behavior on your own, you’ll be frustrated by the delay.
Second, even if aggression reaches clinical levels—that is, it requires mental health support—it’s important to keep in mind that the majority of aggressive children can be helped. There are no “bad kids” who are beyond help. In particular, the stereotype about boys of color from lower-income families as being violent and beyond help is incorrect.34 Many children showing aggression can be helped—and early intervention is always better.
Genetic and other biological factors can affect one’s propensity to act aggressively, but this is the case for all health problems—whether heart disease, asthma, diabetes, or aggression. Any identified biological factors provide us with treatment targets, even though we do not yet have the scientific understanding or ability to act on all of them (that too is the case for many health problems).
For this reason, clinically aggressive children should not be excluded from regular school settings unless absolutely necessary to protect themselves or others from harm. Many show emotional difficulties, and their reactive aggression can be helped by psychosocial interventions. These same interventions can also help some of the more generally or typically aggressive children. Those whose aggression is a byproduct of ADHD may be helped by stimulant medication. But there are some—in particular, those children who lack empathy—for whom we really need to develop better treatments.
The third thing we suggest educators keep in mind is that minimizing the problem helps no one. We’ve seen educators and families shrink from the suggestion that a child’s aggression might be a symptom of mental illness. This shrinking away fosters the stigmatization of mental illness and prevents the child from receiving needed help. There should be no shame in a mental health diagnosis, whether it is depression, anxiety, or conduct disorder. Recognizing problems for what they are is the first necessary step to addressing them, and in many districts, for accessing the services that will help the child thrive in school.
In short, additional resources and interventions are needed. But there should be no blanket responses—each child with aggression is an individual with their own strengths and weaknesses. Teachers are in a great position to try to understand these children—and to help connect them and their families with resources, including clinical care.
R. J. R. Blair is a professor of translational psychiatry at the University of Copenhagen in Denmark and a member of the board of scientific advisors for the US-based National Courts and Sciences Institute. His previous positions include serving as the director of the Center for Neurobehavioral Research in Children with Boys Town National Research Hospital and as the chief of the Section on Affective Cognitive Neuroscience at the National Institute of Mental Health. Daniel T. Willingham is a professor of cognitive psychology at the University of Virginia. He is the author of several books, including the bestseller Why Don’t Students Like School? and Outsmart Your Brain: Why Learning Is Hard and How You Can Make It Easy. Readers can pose questions to “Ask the Cognitive Scientist” by sending an email to ae@aft.org. Future columns will try to address readers’ questions.
*Yet another topic that is outside the scope of this article, but educators should be aware of, is that sometimes the best intervention is targeting the root cause of aggression—such as trauma, abuse, neglect, and/or depression—with the hope that the aggression will fade once its catalyst has been addressed. (return to article)
†When the process is operating slowly, educators may be tempted to tell families that their children need therapy or medication. Such conclusions can only be reached by mental health professionals. However, educators may be able to help families learn about community-based supports. (return to article)
Endnotes
1. J. Turanovic and S. Siennick, The Causes and Consequences of School Violence: A Review (Washington, DC: US Department of Justice, Office of Justice Programs, National Institute of Justice, February 2022), search.library.wisc.edu/catalog/9913486097202121; and T. Winding, B. Aust, and L. Andersen, “The Association Between Pupils’ Aggressive Behaviour and Burnout Among Danish School Teachers—the Role of Stress and Social Support at Work,” BMC Public Health 22, no. 1 (2022): 316.
2. United Nations Educational, Scientific and Cultural Organization, Behind the Numbers: Ending School Violence and Bullying (Paris: UNESCO, 2019), unesdoc.unesco.org/ark:/48223/pf0000366483.
3. B. Dale and P. Harrison, “Teachers Strike Again Over Threats and Violence,” BBC News, November 28, 2023, bbc.com/news/articles/c88dy5478neo.
4. L. Berkowitz, Aggression: Its Causes, Consequences, and Control (New York: McGraw-Hill Book Company, 1993).
5. D. Farrington, “Early Predictors of Adolescent Aggression and Adult Violence,” Violence and Victims 4, no. 2 (1989): 79–100; and P. Piotrowska et al., “Mechanisms Underlying Social Gradients in Child and Adolescent Antisocial Behaviour,” SSM – Population Health 7 (2019): 100353.
6. J. Okonofua and J. Eberhardt, “Two Strikes: Race and the Disciplining of Young Students,” Psychological Science 26, no. 5 (2015): 617–24.
7. J. Hamilton et al., “Racial Disparities During Admission to an Academic Psychiatric Hospital in a Large Urban Area,” Comprehensive Psychiatry 63 (November 2015): 113–22.
8. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Washington, DC: 2022), doi.org/10.1176/appi.books.9780890425596.
9. K. Saylor and B. Amann, “Impulsive Aggression as a Comorbidity of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents,” Journal of Child and Adolescent Psychopharmacology 26, no. 1 (2016): 19–25.
10. M. Fadus et al., “Unconscious Bias and the Diagnosis of Disruptive Behavior Disorders and ADHD in African American and Hispanic Youth,” Academic Psychiatry 44, no. 1 (February 2020): 95–102; M. Baglivio et al., “Racial/Ethnic Disproportionality in Psychiatric Diagnoses and Treatment in a Sample of Serious Juvenile Offenders,” Journal of Youth and Adolescence 46, no. 7 (July 2017): 1424–51; and E. Clark, “Conduct Disorders in African American Adolescent Males: The Perceptions That Lead to Overdiagnosis and Placement in Special Programs,” Alabama Counseling Association Journal 33, no. 2 (Fall 2007): 1–7.
11. E. McCrory, M. Gerin, and E. Viding, “Annual Research Review: Childhood Maltreatment, Latent Vulnerability and the Shift to Preventative Psychiatry—the Contribution of Functional Brain Imaging,” Journal of Child Psychology and Psychiatry 58, no. 4 (2017): 338–57.
12. R. Hannah and A. Aron, “Towards Real-World Generalizability of a Circuit for Action-Stopping,” Nature Reviews Neuroscience 22, no. 9 (2021): 538–52.
13. S. Young et al., “Behavioral Disinhibition: Liability for Externalizing Spectrum Disorders and Its Genetic and Environmental Relation to Response Inhibition Across Adolescence,” Journal of Abnormal Psychology 118, no. 1 (2009): 117–30.
14. R. Blair, “The Motivation of Aggression: A Cognitive Neuroscience Approach and Neurochemical Speculations,” Motivation Science 8, no. 2 (2022): 106–20.
15. Blair, “The Motivation of Aggression.”
16. H. Ip et al., “Genetic Association Study of Childhood Aggression Across Raters, Instruments, and Age,” Translational Psychiatry 11 (2021): 413.
17. A. Moore et al., “The Genetic Underpinnings of Callous-Unemotional Traits: A Systematic Research Review,” Neuroscience & Biobehavioral Reviews 100 (2019): 85–97.
18. Ip et al., “Genetic Association.”
19. M. VanTieghem and N. Tottenham, “Neurobiological Programming of Early Life Stress: Functional Development of Amygdala-Prefrontal Circuitry and Vulnerability for Stress-Related Psychopathology,” in Current Topics in Behavioral Neurosciences, vol. 38, ed. E Vermetten, D. Baker, and V. Risbrough (Cham, Switzerland: Springer, 2018).
20. K. Blair et al., “Different Forms of Childhood Maltreatment Have Different Impacts on the Neural Systems Involved in the Representation of Reinforcement Value,” Developmental Cognitive Neuroscience 53 (2022): 101051.
21. D. Sukhodolsky et al., “Behavioral Interventions for Anger, Irritability, and Aggression in Children and Adolescents,” Journal of Child and Adolescent Psychopharmacology 26, no. 1 (2016): 58–64.
22. K. Dodge and J. Godwin, “Social-Information-Processing Patterns Mediate the Impact of Preventive Intervention on Adolescent Antisocial Behavior,” Psychological Science 24, no. 4 (2013): 456–65.
23. A. Muñoz-Solomando, T. Kendall, and C. Whittington, “Cognitive Behavioural Therapy for Children and Adolescents,” Current Opinion in Psychiatry 21, no. 4 (2008): 332–37.
24. N. Kar, “Cognitive Behavioral Therapy for the Treatment of Post-Traumatic Stress Disorder: A Review,” Neuropsychiatric Disease and Treatment 7 (2011): 167–81.
25. S. Scott et al., “Randomised Controlled Trial of Parent Groups for Child Antisocial Behaviour Targeting Multiple Risk Factors: The SPOKES Project,” Journal of Child Psychology and Psychiatry 51, no. 1 (2010): 48–57; and E. Zarakoviti et al., “The Efficacy of Parent Training Interventions for Disruptive Behavior Disorders in Treating Untargeted Comorbid Internalizing Symptoms in Children and Adolescents: A Systematic Review,” Clinical Child and Family Psychology Review 24, no. 3 (2021): 542–52.
26. K. Smeets et al., “Treatment Moderators of Cognitive Behavior Therapy to Reduce Aggressive Behavior: A Meta-Analysis,” European Child & Adolescent Psychiatry 24, no. 3 (2015): 255–64.
27. S. Scott, J. Briskman, and T. O’Connor, “Early Prevention of Antisocial Personality: Long-Term Follow-Up of Two Randomized Controlled Trials Comparing Indicated and Selective Approaches,” American Journal of Psychiatry 171, no. 6 (2014): 649–57.
28. A. Sethi et al., “Selective Amygdala Hypoactivity to Fear in Boys with Persistent Conduct Problems After Parent Training,” Biological Psychiatry 94, no. 1 (2023): 50–56.
29. K. Munshi et al., “The Use of Antiepileptic Drugs (AEDs) for the Treatment of Pediatric Aggression and Mood Disorders,” Pharmaceuticals 3, no. 9 (2010): 2986–3004.
30. K. Rubia, “Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation,” Frontiers in Human Neuroscience 12 (2018): 100.
31. Rubia, “Cognitive Neuroscience.”
32. A. Tessitore et al., “Dopamine Modulates the Response of the Human Amygdala: A Study in Parkinson’s Disease,” Journal of Neuroscience 22 (2002): 9099–103.
33. S. Helseth et al., “Aggression in Children with Conduct Problems and Callous-Unemotional Traits: Social Information Processing and Response to Peer Provocation,” Journal of Abnormal Child Psychology 43, no. 8 (2015): 1503–14.
34. D. Thomas and H. Stevenson, “Gender Risks and Education: The Particular Classroom Challenges for Urban Low-Income African American Boys,” Chapter 6, Review of Research in Education 33, no. 1 (March 2009): 160–80.
[Illustrations by Stuart Briers]