664 CHAPTER 14
factors: Parents who develop substance use disorders or antisocial personality disor-
der may have temperaments (infl uenced by genes) that increase the likelihood that
these disorders will emerge; however, such parents may also pass the genes to their
children, making it diffi cult to distinguish among the different infl uences.
Other social factors related to oppositional defiant disorder and conduct
disorder—with or without comorbid ADHD—are intertwined with psychological
factors (Levy & Orlans, 1999, 2000; Ogloff, 2006). Children exposed to neglect or
violence—in the neighborhood, among peers, or at home—observe others showing
a disregard for social norms; through observational learning, they may come to imi-
tate those behaviors (psychological factor). Parental neglect or inconsistent parenting
is also associated with a child’s disruptive behavior: Children may receive positive
attention or praise rarely and negative attention more frequently—when breaking
rules or being disruptive. They then learn to obtain attention by acting up. More-
over, parents may be inconsistent in setting limits on inappropriate behavior, and
so children learn that nothing bad usually happens if they break rules (and if par-
ents do intervene, the children receive attention!) (Dodge & Pettit, 2003; Loeber &
Farrington, 2000; Moffi tt, 2003; Raine, 2002). Thus, as we saw with antisocial per-
sonality disorder and psychopathy, genes may predispose someone toward certain
types of behavior, but the environment in which a child is raised and how the child
is treated infl uence whether such behavior is exhibited (Caspi et al., 2002; Mednick,
Gabriella, & Hutchings, 1984).
Finally, social factors can indirectly infl uence the development of these dis-
orders. For example, children typically are raised in homes selected by their
parents—based on various social factors such as parents’ fi nancial status, proxim-
ity to extended family, and community resources. If children are raised in a house
where lead paint has been applied, they may be more vulnerable to ADHD. In fact,
children whose hair contains higher levels of lead (which is a measure of exposure
to lead, perhaps from lead paint in one’s home environment) are more likely to
have ADHD than are children who have lower levels of lead in their hair (Tuthill,
1996). Even children who were exposed to very low levels of lead in their environ-
ment are more likely to develop ADHD than are children who were not exposed
(Nigg, 2006).
FEEDBACK LOOPS IN ACTION:
Attention-Defi cit/Hyperactivity Disorder
In this section, we examine how the different factors related to attention-defi cit/
hyperactivity disorder create feedback loops (see Figure 14.4). Current research
suggests that psychological and social factors contribute to the development of
ADHD in those who are neurologically vulnerable to the disorder because of genetics,
prenatal factors (such as the mother’s smoking), or environmental factors (such as
exposure to lead in early childhood; Laucht et al., 2007).
Consider the fi nding that children with ADHD are less accurate at recognizing
sad and angry facial expressions (Pelc et al., 2006). Such defi cits, particularly dif-
fi culty in recognizing anger, are associated with more interpersonal problems. These
results suggest that when peers or adults (typically parents or teachers) show—rather
than tell—their displeasure about the behavior of a child who has ADHD, that child
is less likely to perceive (psychological factor) the social cue (social factor) than is a
child who does not have the disorder. The inability to perceive others’ displeasure in
turn creates additional tension for both the child and those who interact with him
or her. In fact, children with ADHD are more likely than those without the disorder
to be rejected by their peers (Mrug et al., 2009). Moreover, other people’s responses to
the child’s behavior (social factor) in turn infl uence how the child comes to feel
about himself or herself (psychological factor; Brook & Boaz, 2005).
Other research results suggest that the family environment is associated with
ADHD. In particular, family conflict is higher in families that include a child
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