One of the symptoms of<unk>  is a lower level of fear. Research performed on the impact of toddlers exposed to fear and distress shows that negative emotionality (fear) predicts toddlers' empathy-related response to distress. The findings support that if a caregiver is able to respond to infant cues, the toddler has a better ability to respond to fear and distress. If a child does not learn how to handle fear or distress the child will be more likely to lash out at other children. If the caregiver is able to provide therapeutic intervention teaching children at risk better empathy skills, the child will have a lower incident level of<unk> . Increased instances of violent and antisocial behavior are also associated with the condition; examples may range from pushing, hitting and biting when the child is young, progressing towards beating and inflicted cruelty as the child becomes older.<unk>  can present with limited prosocial emotions, lack of remorse or guilt, lack of empathy, lack of concern for performance, and shallow or deficient affect. Symptoms vary by individual, but the four main groups of symptoms are described below. Aggression to people and animals * Often bullies, threatens or intimidates others * Often initiates physical fights * Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun) * Has been physically cruel to people * Has been physically cruel to animals * Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery) * Has forced someone into sexual activity (rape or molestation) * Feels no remorse or empathy towards the harm, fear, or pain they may have inflicted on others Destruction of property * Has deliberately engaged in fire setting with the intention of causing serious damage * Has deliberately destroyed others' property (other than by fire setting) Deceitfulness or theft * Has broken into someone else's house, building, or car * Often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others) * Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery) Serious violations of rules * Often stays out at night despite parental prohibitions, beginning before age 13 years * Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period) * Is often truant from school, beginning before age 13 years The lack of empathy these individuals have and the aggression that accompanies this carelessness for the consequences is dangerous- not only for the individual but for those around them. Developmental course Currently, two possible developmental courses are thought to lead to<unk> . The first is known as the "childhood-onset type" and occurs when<unk>  symptoms are present before the age of 10 years. This course is often linked to a more persistent life course and more pervasive behaviors. Specifically, children in this group have greater levels of ADHD symptoms, neuropsychological deficits, more academic problems, increased family dysfunction and higher likelihood of aggression and violence. There is debate among professionals regarding the validity and appropriateness of diagnosing young children with<unk> . The characteristics of the diagnosis are commonly seen in young children who are referred to mental health professionals. A premature diagnosis made in young children, and thus labeling and stigmatizing an individual, may be inappropriate. It is also argued that some children may not in fact have<unk> , but are engaging in developmentally appropriate disruptive behavior. The second developmental course is known as the "adolescent-onset type" and occurs when<unk>  symptoms are present after the age of 10 years. Individuals with adolescent-onset<unk>  exhibit less impairment than those with the childhood-onset type and are not characterized by similar psychopathology. At times, these individuals will remit in their deviant patterns before adulthood. Research has shown that there is a greater number of children with adolescent-onset<unk>  than those with childhood-onset, suggesting that adolescent-onset<unk>  is an exaggeration of developmental behaviors that are typically seen in adolescence, such as rebellion against authority figures and rejection of conventional values. However, this argument is not established and empirical research suggests that these subgroups are not as valid as once thought. In addition to these two courses that are recognized by the DSM-IV-TR, there appears to be a relationship among oppositional defiant<unk> ,<unk> , and antisocial personality<unk> . Specifically, research has demonstrated continuity in the<unk> s such that<unk>  is often diagnosed in children who have been previously diagnosed with oppositional defiant<unk> , and most adults with antisocial personality<unk>  were previously diagnosed with<unk> . For example, some research has shown that 90% of children diagnosed with<unk>  had a previous diagnosis of oppositional defiant<unk> . Moreover, both<unk> s share relevant risk factors and disruptive behaviors, suggesting that oppositional defiant<unk>  is a developmental precursor and milder variant of<unk> . However, this is not to say that this trajectory occurs in all individuals. In fact, only about 25% of children with oppositional defiant<unk>  will receive a later diagnosis of<unk> . Correspondingly, there is an established link between<unk>  and the diagnosis of antisocial personality<unk>  as an adult. In fact, the current diagnostic criteria for antisocial personality<unk>  require a<unk>  diagnosis before the age of 15. However, again, only 25-40% of youths with<unk>  will develop an antisocial personality<unk> . Nonetheless, many of the individuals who do not meet full criteria for antisocial personality<unk>  still exhibit a pattern of social and personal impairments or antisocial behaviors. These developmental trajectories suggest the existence of antisocial pathways in certain individuals, which have important implications for both research and treatment. Associated conditions Children with<unk>  have a high risk of developing other adjustment problems. Specifically, risk factors associated with<unk>  and the effects of<unk>  symptomatology on a child's psychosocial context have been linked to overlapping with other psychological<unk> s. In this way, there seems to be reciprocal effects of comorbidity with certain<unk> s, leading to increased overall risk for these youth. Attention deficit hyperactivity<unk>  ADHD is the condition most commonly associated with<unk> s, with approximately 25-30% of boys and 50-55% of girls with<unk>  having a comorbid ADHD diagnosis. While it is unlikely that ADHD alone is a risk factor for developing<unk> , children who exhibit hyperactivity and impulsivity along with aggression is associated with the early onset of<unk>  problems. Moreover, children with comorbid<unk>  and ADHD show more severe aggression. Substance use<unk> s<unk>  is also highly associated with both substance use and abuse. Children with<unk>  have an earlier onset of substance use, as compared to their peers, and also tend to use multiple substances. However, substance use<unk> s themselves can directly or indirectly cause<unk>  like traits in about half of adolescents who have a substance use<unk> . As mentioned above, it seems that there is a transactional relationship between substance use and<unk>  problems, such that aggressive behaviors increase substance use, which leads to increased aggressive behavior. Substance use in<unk>  can lead to antisocial behavior in adulthood. Schizophrenia<unk>  is a precursor to schizophrenia in a minority of cases, with about 40% of men and 31% of women with schizophrenia meeting criteria for childhood<unk> .
Conduct disorder
Attention deficit hyperactivity disorder
Tourette syndrome
Antisocial personality disorder  Antisocial personality disorder  1
Oppositional defiant disorder
Obsessive–compulsive disorder
High-functioning autism
Klismaphilia