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RUNNING HEAD: THE ROLE OF THE AMYGDALA IN CONDUCT DISORDER

The Role of the Amygdala in Conduct Disorder


Elana Cockburn
Lesley University

Author Note
The author is a masters degree candidate in the Counseling and Psychology Program,
Department of Counseling and Psychology, Lesley, Cambridge, MA.

This paper was submitted to Professor Sidney Trantham as partial fulfillment of the
requirements of GPSYC7100.01, Biological Bases of Behavior, December 19, 2014

Correspondence to the author should be sent to cockburn@lesley.edu

RUNNING HEAD: THE ROLE OF THE AMYGDALA IN CONDUCT DISORDER

Abstract
This literature review examines current research that investigates the role of the
amygdala in Conduct Disorder. Conduct Disorder is a heterogeneous psychiatric
condition that is distinguished by a persistent pattern of aggressive and antisocial
behavior. The amygdala is part of the brains limbic system and is responsible for
processing emotions, such as fear and anger. Structural abnormalities in the amygdala
and corresponding brain regions were found to have a correlation with antisocial
symptoms presented in youth with early-onset and adolescent-onset of Conduct Disorder
with or without callous-unemotional (CU) traits. These findings present a moderate to
significant impairment in a youths ability to empathically connect to others, interpret
social and emotional cues, and interact with others in a prosocial manner. Most of the
studies are in concordance with their findings, but there are some inconsistencies
regarding the amygdalas response to affective stimuli among the studies reviewed.
Assessment for CD includes structured and unstructured interviews, direct observation,
and specific evaluations to specify subtypes of the disorder. Effective treatment includes
a multi-modal approach using cognitive-behavioral therapy (CBT) and Multisystem
Therapy. It is suggested that more diverse populations are used in future studies (e.g.,
females), and that longitudinal approaches are utilized to investigate the developmental
component of this disorder.

Keywords: conduct disorder, amygdala, CU traits

RUNNING HEAD: THE ROLE OF THE AMYGDALA IN CONDUCT DISORDER

Conduct Disorder (CD) is a serious disruptive behavior disorder in children and


adolescents. The disorder is characterized by a recurring and pervasive pattern of
disruptive and antisocial behavior in which the fundamental rights of others and ageappropriate cultural norms are infringed upon (Barry, Golmaryami, Rivera-Hudson, &
Frick, 2012). CD is a heterogeneous disorder, as youth with CD can differ greatly on the
course of the disorder and in the potential causal processes leading to the disorder (Barry
et al., 2012, p. 57). Youth with CD show a heightened propensity for aggressive and
antisocial behaviors, and they can pose as a risk to not only others but to themselves.
Children with conduct problems are at risk for developing life-course-persistent
antisocial problems, as well as other mental and physical health problems (Sebastian,
McCrory, Cecil, Lockwood, De Brito, Fontaine, & Viding, 2012, p. 814). They are more
likely to self-harm, develop severe depression, abuse drugs, and die by homicide or
suicide (Passamonti, Fairchild, Fornito, Goodyer, Nimmo-Smith, Hagan, & Calder,
2012). The approximate lifetime prevalence of CD in the US is 9.5% with male youth
being more likely to have a CD diagnosis (12.0%) than female youth (7.1%) at the
median age-of-onset of 11.6 years old (Nock, Kazdin, Hiripi, & Kessler, 2007). The rate
of violent crime in concordance with the diagnosis of CD has been on the climb in the US
and UK, for both males and females (Fairchild, Hagan, Walsh, Passamonti, Calder, &
Goodyer, 2013).
The etiology of Conduct Disorder can be complex and multi-dimensional, and
there may be several risk factors associated with its onset among youth. In a
comprehensive literature review of longitudinal studies of youth with CD, Murray and
Farrington (2010) state numerous independent, interactive, and overlapping risk factors

RUNNING HEAD: THE ROLE OF THE AMYGDALA IN CONDUCT DISORDER

that may correlate and attribute to CD, but it is not clear if they all have direct causal
effects. This review of findings specifically suggests that there are predominant
individual, familial, and social risk factors that may predict CD. The individual factors
include impulsiveness, low IQ, and low school achievement (Murray & Farrington,
2010). A plausible explanatory factor underlying the link between low IQ and
delinquency is the ability to manipulate abstract concepts (2010, p. 636). The authors
explain that children who lack this skill do poorly on IQ tests, schoolwork, and are more
likely to impulsively commit offenses due to not predicting the outcome of their actions.
Additionally, there are several components of family risk factors, including poor
child-rearing practices (e.g., poor parental supervision, authoritarian parenting style),
child abuse (e.g., brain injury from abuse, desensitization to pain), parental conflict (e.g.,
father-initiated fighting) and disrupted families (e.g., divorce, parental loss), antisocial
parents (e.g., parental imprisonment), and large families (e.g., birth order; 2010). The
authors believe that young people from dysfunctional families seem to be at a heightened
risk for developing conduct problems due to victimization and/or reinforced antisocial
behaviors from their caregivers.
Murray and Farrington (2010) reveal that there are social risk factors that also
play a role in predicting the development of CD in young people, such as socioeconomic
status, peer, school, and community influences. Murray and Farrington have found in
their review that antisocial children disproportionately come from low socioeconomic
status (SES) families (2010, p. 638), which the authors infer may be linked to other
social mediating factors such as low-income, subsidized housing, and employment
instability. When it comes to peer influences, interactions with other deviant peers

RUNNING HEAD: THE ROLE OF THE AMYGDALA IN CONDUCT DISORDER

produce reciprocal effects with delinquent peer bonding causing delinquency and
delinquency causing association with delinquent peers (2010, p. 638), but are thought to
be a correlation to misconduct rather than a cause. In schools, Murray and Farrington
found studies that attest to a schools organization, climate, and practices (2010, p.
639) being a main influencer on behavior. Lastly, the authors reviewed one study
characterizing that the important relationship between the erratic environmental structure
of the community (e.g., concentrated poverty, lack of economic resources, increased
crime rates) and individual aggression was interceded by parenting practices, gang
membership, and peer violence (2010, p. 639).
From a historical perspective, both children and adolescents with delinquent
behaviors were firmly considered as wayward deviants of society who simply lacked
morals and required lawful reprimand (Hill & Maughan, 2001). Within the past two
centuries, the distinction between litigating ill-behaved youth in court as children or
adults based on the severity of their crimes was more or less ambiguous. However, by the
beginning of the twentieth century in the Western English-speaking world, juvenile court
systems were created and implemented to deal exclusively with minors. As Hill &
Maughan surmise, the creation of these separate juvenile systems was more sensitive to
childrens developmental stage, and more focused on prevention and rehabilitation than
on punishment (2001, p. 15), and therefore treated defiant children in a civil rather than
criminal manner. From the psychoanalytical framework in the 1930s, psychoanalyst
August Aichhorn believed that youth with behavioral problems were seen as inherently
dissocial and in need of training to help them to adjust to the demands of society (Hill
& Maughan, 2001, p. 20). Aichhorn stressed that the child must stifle her/his instinctual

RUNNING HEAD: THE ROLE OF THE AMYGDALA IN CONDUCT DISORDER

desires so that they are forever denied. Additionally, the role of the therapist was to
educate the educators on how to make the delinquent youth find her/his place in society
and, if need be, seek out psychoanalytic treatment for ongoing neuroses.
By the mid-twentieth century, Conduct Disorder was not included in the
Diagnostic and Statistical Manual until its second edition in 1968, and then subsequently
categorized as an antisocial behavior along with Oppositional Disorder in the DSM-III in
1980 (Hill & Maughan, 2001). An important distinction was made between Oppositional
Disorder (later renamed Oppositional Defiant Disorder in the DSM-IV) and Conduct
Disorder in order to distinguish the constellation of age-related symptoms between
behaviorally troubled youth. The symptoms that define Oppositional Defiant Disorder
are those of negative, hostile, or defiant behavior, while the symptoms specified for
Conduct Disorder concentrate on behaviors that violate the basic rights of others or
major age-appropriate societal norms or rules (Hill & Maughan, 2001, p. 21).
It is important to note that the DSM-V (2013) has recently included an additional
specifier to characterize youth with CD if they exhibit two or more callous-unemotional
(CU) traits, otherwise known as psychopathic traits, persistently for at least 12 months:
lacking of remorse or guilt, absent empathy, apathetic when performing important tasks,
and/or showing low affect (American Psychiatric Association, 2013). About 30% of
youth with CD have co-existing CU traits (Marsh, Finger, Fowler, Adalio, Jurkowitz,
Schecter & Blair, 2013). The literature reviewed in this paper extensively examines
the neural substrate of CD youth who possess and do not possess CU traits. In either case,
with the recent advancement of functional magnetic resonance imaging (fMRI),
researchers have confidently proposed that the predisposition for aggressive behavior can

RUNNING HEAD: THE ROLE OF THE AMYGDALA IN CONDUCT DISORDER

be explained by the impaired functionality of certain brain regions responsible for


aggressive behavior and perception of emotions, namely the amygdala (Sterzer, Stadler,
Krebs, Kleinschmidt, & Poustka, 2005).
The amygdala is a small, almond-shaped structure in the anterior poles of the
temporal lobes of the brain and it enacts in several functions of emotional processing
(Pardini et al., 2014). It operates in concert with other critical areas of the brain such as
the orbitofrontal cortex and striatum (Finger, Marsh, Blair, Reid, Sims, Ng & Blair,
2011), the anterior cingulate cortex (Sterzer et al., 2005), the anterior insula (Fairchild et
al., 2013), the prefrontal cortex (Fairchild, Passamonti, Hurford, Hagan, von dem Hagen,
van Goozen & Calder, 2011), and the uncinate fascicle (Passamonti et al., 2012). The
amygdala is a critical mechanism in the brains limbic system as it performs the fight-orflight response and thereby sends alert signals to the hypothalamus, indicating fear or
threat from a triggering stimulus (Sebastian, McCrory, Cecil, Lockwood, De Brito,
Fontaine, & Viding, 2012). For individuals who possess defective amygdala
functionality, such as youth with CD, it is believed these individuals have a heightened
predisposition for violent behavior and trouble identifying distress signals from others
(Pardini et al., 2014).
The amygdalas underlying role in aggressive behavior and atypical responses to
emotions in youth diagnosed with Conduct Disorder has garnered much interest within
the last ten years. Furthermore, CD is a particularly interesting disorder to study, as it is
believed to potentially be a precursor to Antisocial Personality Disorder given the
presence of CU traits in youth with CD (Decety, Michalska, Akitsuki, & Lahey, 2009).
Although there seems to be no current theory connecting the amygdala as a causal factor

RUNNING HEAD: THE ROLE OF THE AMYGDALA IN CONDUCT DISORDER

for CD, the amygdalas neural role in emotional processing and cognitive control of
affective behavior gives a convincing motive to explore its neurobiological influence on
the disorder.
Given recent advancements in technology, a lot of current research has used fMRI
and other neuroimaging techniques in examining structural abnormalities of the brain. In
an attempt to investigate the relationship between CD symptoms and structural
abnormalities, Fairchild et al. (2011) studied the gray matter volume in the amygdala and
other brain regions responsible for processing socioemotional stimuli in male youth with
both onset subtypes of CD, early (n=36) and adolescent (n=37). The researchers found
that regardless of the age of the participants CD onset, the amygdala gray matter volume
was lower compared to the healthy comparison group (n=27; Fairchild et al., 2011). A
key novel finding of this study is that reduced gray matter volume in limbic regions
putatively involved in pathophysiology of CD (e.g., the amygdala) is also observed in the
adolescent-onset subtype. Reduced volume therefore appears to be a general
characteristic of male adolescents with CD, irrespective of age of onset (Fairchild et al.,
2011, p. 630). In addition to an apparent abnormality of the amygdala, Fairchild et al.
(2011) also observed structural abnormalities in the insula and the prefrontal cortex in
CD participants with increased severity. This is notable because the insula has a
prominent role in processing negative stimuli (e.g., disgust) and empathy, while the
prefrontal cortex is involved in mentalizing oneself and others and practicing executive
control (2011). These combined structural abnormalities grant insight into the
dysfunction in the neural mechanisms involved in affective behavior and decisionmaking in both subtypes of youth with CD. Fairchild et al. believed that these

RUNNING HEAD: THE ROLE OF THE AMYGDALA IN CONDUCT DISORDER

abnormalities might be correlated with dulled cortisol responses to stressful stimuli,


because the amygdala has an important role in engaging the hypothalamic-pituitaryadrenal axis reaction to stress (2011). This impairment could result in inappropriate
and/or misinterpreted cognitive responses to affect-laden situations.
Passamonti et al. (2012) studied a small group (n=13) of male youth with
adolescent-onset CD, and advanced their research to investigate the white-matter
pathways connecting the amygdala and orbitofrontal cortex (OFC), the area of the brain
responsible for decision-making and error prediction (Finger et al., 2011). These whitematter pathways, officially known as the uncinate fascicle (UF), are critical in regulating
normative emotional behavior (Passamonti et al., 2012). Passamonti et al. found that the
UF showed microstructural abnormalities in the CD youth studied, suggesting weak
maturation of connective tissue between the amygdala and OFC. In light of this finding,
Passamonti et al. suggest given the pivotal role of the amygdala and the OFC in
emotional behavior, abnormalities in the anatomical pathway linking these regions are
likely to result in functional disturbances (2012, p. 6). These disturbances include
obscurities in emotional regulation within social situations, especially regarding conflict
and aggression. This finding may provide a starting point in understanding how the
structure of the brain offers a partiality for aggressive behavior in youth with CD.
In a similar stratum of study, Pardini et al. (2014) examined the volume of the
amygdala in men with varied and longstanding antisocial and violent histories. This study
also examined the presence of psychopathic traits (e.g., deceitful, manipulative, callousunemotional, impulsive) in their subjects. At the time of the study, 56 men (age 26) were
selected from a longitudinal study of 503 males since the 1st grade, who were assessed

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with antisocial behavior at the age of seven. The study found that men with lower
amygdala volume exhibited higher levels of aggressive behavior and psychopathic
features from childhood to early adulthood (Pardini et al., 2014, p. 78). Interestingly,
after a three-year follow-up, 21 of these male participants engaged in violence and it was
found that their lower left and right amygdala volume was linked to an increased risk in
aggression, violence, and psychopathic traits. This is the first longitudinal study to
associate decreased amygdala volume with distinct affective psychopathic features in
childhood through adulthood.
The aforementioned studies regarding structural abnormalities of the amygdala
and other important brain regions involved in emotional processing and aggressive
behavior had not only corresponding findings, but unfortunately were limited by using
similar subjects: males. Females with CD have been found to be more subject to teenage
pregnancy, are at a higher risk for developing Antisocial Personality Disorder, and
vulnerable to suffer from mental and physical health issues later in adulthood (Fairchild
et al., 2013). Fairchild et al. (2013) examined the neural structural abnormalities in
female adolescents with CD (n=22), specifically examining any discrepancies in gray
matter volume of the amygdala compared to a healthy group (n=20). Indeed, their
findings found not only reduced volume in the amygdala in the female adolescent CD
group, as consistent with their previous findings with adolescent males with CD
(Fairchild et al., 2011), but also reduced gray matter volume in the bilateral anterior
insula and right striatum as well areas that are responsible for empathic processes and
reward aspects of behavior (2013).

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As seen in these studies, reduction in volume in critical areas of the brain
responsible for emotional processing and affective behavior could affect a range of
processes involved in self-control, decision-making and the ability to consider future
consequences, thereby increasing risk for [impulsive] aggression (Fairchild et al., 2013,
p. 92). Whats more, structural abnormalities of the amygdala and its associated regions
in youth with CD may subsequently shed light on the underlying reasons for why
responses to empathic and affective stimuli are atypical among this population.
Lacking the ability to empathize has been regarded as a chief characteristic in CD,
as it is the capacity to understand and appreciate the emotional states and needs of others
in reference to oneself (Decety et al., 2009, p. 203). Simply observing an individual in
anguish can elicit an empathic reaction, promoting prosocial rather than antisocial
behavior (2009). However, an absence of empathy in individuals who possess a
propensity for aggressive behavior may be a consequence of a failure to be aroused by
the distress of others (Decety et al., 2009, p. 204). Decety et al. (2009) conducted a
study to investigate this phenomenon present in adolescents with CD. They found that
youth with CD had lower activation in the amygdala while watching visual stimuli
portraying people experiencing pain relative to increased activation in the control group.
This finding suggests that youth with CD indeed have a blunted empathic response to
merely viewing others in pain.
Fairchild, Van Goozen, Calder, Stollery, & Goodyer (2009) found a similar
finding in terms of identifying specific facial expressions. As atypical facial expression
perception may indicate a proclivity for aggression for youth with CD, the authors of this
study therefore investigated the association between impaired facial expressions

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recognition and CD. Fairchild et al. (2009) found that there were indeed deficits in
recognizing facial expressions of explicitly anger and fear with their male adolescent
subjects of both early-onset (n=42) and adolescent-onset (n=39) subtypes compared to
their healthy control counterparts (n=40). The subset of subjects with CD who were high
in CU traits displayed deficits in not only fear, but in sadness and surprise recognition
(2009). Being unable to recognize certain facial expressions such as anger or disgust in
another person may increase an aggressive attribution bias for individuals with CD, and
therefore they may be apt to misconstrue ambiguous social prompts as threatening and
resort to aggressive/violent behavior (Fairchild et al., 2009). The researchers suggested
that regardless of this finding, participants showed reduced, rather than increased,
sensitivity to social signals of punishment (Fairchild et al., 2009, p. 633), which may
explain the prominent CD symptom of disregarding others feelings and basic rights.
This disruption of accurate interpretation of social cues may result in an
inadequacy in feeling empathic concern for others, fear, and guilt, which are thought to
hinder violent responses in otherwise normally-developed individuals (Sterzer et al.,
2005). In their study, Sterzer et al. (2005) measured the amygdala responses in a small
group of adolescent males (n=13) with CD when showing neutral or strong negative
emotional visuals. Their results indicated that there was reduced activity in the left
amygdala in response to the affective-laden stimuli. For the neutral stimuli, the anterior
cingulate cortex (ACC), an area of the brain responsible for higher cognitive functioning
and regulating emotional behavior, also had reduced activity. Given these two results,
Sterzer et al. gathered that the propensity for violent and aggressive behavior in youth
with CD might originate from an impairment of both the recognition of emotional

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stimuli and the cognitive control of emotional behavior (2005, p. 7). However, in a
similar study, Herpertz, Huebner, Marx, Vloet, Fink, Stoecker & Herpertz-Dahlmann
(2008) found increased left-sided amygdala activation in their sample of 22 participants
with CD when they viewed negatively affect-laden visuals. Herpertz et al. proposed that
increased rather than reduced amygdala activation found in our study may indicate
enhanced response to environmental cues leading to reaction aggression (2008, p. 788)
as opposed to youth with CD having hypo-activity in the amygdala and thereby not being
able to perceive affective information correctly, if at all. These two inconsistent findings
bring up questions regarding the role of the amygdala in youth with CD, and their
subsequent response to stimuli with positive, neutral, and negative valence.
Finally, when just investigating youth with CD and CU traits, Marsh et al. (2013)
expanded on the impairment of the empathic pain response. In their study, Marsh et al.
found that CD youth with CU traits displayed a lack of amygdala response to the
escalation of others pain, but interestingly not to the participants own pain. In other
words, this subset of CD youth with CU traits has a lower empathic response to anothers
anguish when the amount of their perceived pain increases. Additionally, the study also
correlated the severity of the CU symptoms with the perceived responsiveness to others
pain. This association captured the severity of the affective and interpersonal component
[but not the antisocial behavior component] of psychopathy (Marsh et al., 2013, p. 907).
In another earlier and similar study, it was found that CD youth with CU traits
also exhibited reduced activation in the right amygdala, as well as in the anterior insula,
when completing theory of mind tasks (Sebastian et al., 2012). Theory of Mind (ToM)
involves memory, joint attention, complex perceptual recognition (such as face and gaze

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processing), language, executive functions (such as tracking of intentions and goals and
moral reasoning), emotion processing-recognition, empathy, and imitation (Korkmaz,
2011, p. 101). In their study, Sebastian et al. (2012) found that CD adolescent males with
CU traits (n=31) who completed complex affective and cognitive ToM judgment tasks,
which included an empathy factor, had reduced amygdala and anterior insula
responsiveness.
These studies, as well as the aforementioned literature in this review, all indicate
that there is indeed a dysfunction in empathic responsiveness on a neurological level
involving the amygdala, and thus, it may contribute to this populations deficiency in
successfully perceiving and responding to others emotional valence and social cues. The
amygdalas inability to function properly may provide convincing substantiation that it
has a neural role in CD.
When assessing and treating a child for Conduct Disorder, it is important to first
make a proper and exact diagnosis. The Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV-TR) lists the various behaviors that make up CD as aggression
towards people and animals (e.g., bullying, initiating fights, cruelty to animals),
destruction of property (e.g., fire-setting, vandalism), theft or deceitfulness (e.g.,
shoplifting, conning others) and serious violations of the rules (e.g., running away from
home, school truancy; American Psychiatric Association, 2000). The diagnosis of CD is
specified as either the childhood-onset type, of which at least one CD criterion
characteristic is present prior to the age of 10, or the adolescent-onset type, where there is
an absence of any criteria characteristic of CD prior to the age of 10 (American
Psychiatric Association, 2000). Clinicians use several methods of assessment starting

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with matching associated features of early-onset CD and adolescent-onset (Barry et al.,
2013). Barry et al. (2013) distinguish these features as neuropsychological (e.g., deficits
in executive function), temperamental/personality (e.g., CU traits, fearlessness),
contextual (e.g., family dysfunction, SES, delinquent per affiliations), behavioral (e.g.,
aggression, severity-persistence of antisocial behavior), developmental processes (e.g.,
problems in conscience development), and gender.
It is highly recommended that clinicians use the following methods of collecting
information regarding the childs specific behavioral issues before any diagnosis is made.
Interviews with the parent(s)/caregiver(s) of the child include unstructured clinical
interviews and structured diagnostic interviews (e.g., Diagnostic Interview Schedule for
Children). Interviews are able to gather comprehensive client-specific information.
Broad-band rating scales (e.g., Behavior Assessment System for Children, 2nd Edition)
are also used to collect data concerning the severity of the childs presentation of
symptoms compared to peers of the same age, and if necessary, narrow-band rating scales
of CU traits (e.g., Inventory of Callous-Unemotional Traits) to indicate the presence of
this particular risk factor (Barry et al., 2013). Lastly, it is imperative to conduct direct
observation of the child in her/his natural setting in order to gain a first-hand view of
potential factors that may contribute to conduct problems (Barry et al., 2013). The
ensuing results from these modalities of assessment have direct implications for which
treatment for CD should be prescribed.
Treatment for CD is a multi-modal, and requires involvement from the childs
family. Parent Management Training hones in on the parent-child relationship and
interactions, and focuses on how the parents/caregivers behavior can directly influence

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or change the childs pattern of behavior (Powell, Lochman, Boxmeyer, Alberto,
Jimenez-Camargo, & Stromeyer, 2014). Similarly, one predominant style of therapeutic
intervention used for youth with CD is Multisystemic Therapy, which is an intensive
family- and community-based treatment program that focuses on addressing all
environmental systems that impact chronic and violent juvenile offenders their homes
and families, schools and teachers, neighborhood and friends (Multisystemic Therapy
Services, n.d.). This holistic approach to treating the child with conduct problems has
been proven effective, as it focuses on each system (e.g., family, school, community) that
the child interacts with on a daily basis and includes them all in her/his treatment through
improving family relations, parent management training, social skills training,
participating in positive activities, and so on (Multisystemic Therapy Services, n.d.).
Other areas of therapeutic treatment involve Cognitive Behavioral Therapy (CBT) in
which components of building emotional awareness, management of anger, problem
solving, and social skills development are address (Powell et al., 2014). For example,
Anger Control Training is used for school-age youth, and is intended to have children
consider her/his environment, understand her/his immediate surroundings, and then
create goals (e.g., assess consequences for each action and pick the best response).
An alternative method of treatment involves behavior modification by means of
Wilderness Therapy. Wilderness Therapy typically involves immersion in wilderness
comparable lands, group living with peers, individual and group therapy sessions, and
educational and therapeutic curricula (Russell & Phillips-Miller, 2002, p. 415). In their
qualitative study to assess the effectiveness of Wilderness Therapy, Russell & PhillipsMiller (2002) found that adolescents with conduct behavioral issues who participated in

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four different wilderness programs had positive outcomes that included confronting their
problematic behavior and developing a desire to change. The findings of this study
narrowed down the influential factors in the aforementioned results, such as being
physically active, learning how to interact with nature in a primitive setting, reception of
peer feedback via group therapy, and the therapeutic alliance (2002).
In this literature review, it has been examined that youth with CD exhibit
abnormalities in the structure and functionality of the amygdala amongst other brain
regions. It is not known whether this deficit in the amygdala is a causal factor or
consequence of CD, however, these findings clearly display a moderate to significant
impairment in a childs or adolescents ability to empathically connect to others, to
correctly understand and respond to social and emotional cues, and respond/interact in a
prosocial manner. Although many studies found similar findings regarding the structural
abnormalities of the amygdala in youth with CD, there were some discrepancies
regarding increased or decreased activation of the amygdala in response to affective
stimuli.
Much of the research conducted around CD and underpinning neurological
substrates include male participants. It is suggested that for future studies, more females
with CD are included in neuroimaging studies, as the research involving female
participants is scant. Investigating gender differences may offer more insight into the
parallel and conflicting results concerning the amygdalas prominent role in CD and
nuanced antisocial behaviors among females and males (e.g., risky sexual behaviors).
Similarly, many of the studies used only a small sample of participants and typically for
short durations of time. It is suggested that more longitudinal studies with larger samples

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of youth with CD of all subtypes be investigated to better understand the developmental
components involved in the disorder, as well as the structural differences of the amygdala
and its associated implications for treatment.

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