Pediatric Annals


Wicked Children - A New Perspective for Pediatricians

Stanford T Shulman, MD


Pediatricians should be aware of physiologic correlates of misconduct in childhood and newer treatments for aggression.


Pediatricians should be aware of physiologic correlates of misconduct in childhood and newer treatments for aggression.

It's not every day that we pediatricians encounter medical articles with titles such as "Evaluating Wickedness in Children" as appears in this issue of Pediatrie Annals. This issue is devoted to the problems of juvenile delinquency, aggression in children, wickedness, and child misconduct, and is guest edited by Dr. Ansar Haroun. Dr. Haroun is clinical professor of psychiatry and pediatrics as well as adjunct professor of law at the University of California, San Diego. 1 confess to having learned a number of interesting concepts and facts from the articles in this issue. For example, in the psychophysiology article by Drs. Scarpa and Raines, I was fascinated to learn of the physiologic correlates of misconduct in childhood. The finding of a low resting heart rate, especially in those with earlyonset life-coursepersistent antisocial and disruptive behaviors, has been attributed to excessive vagai tone. Alterations in skin conductance as well as increased EEG slow wave activity, particularly in the frontal lobe regions, clearly serve as clues to these disorders.

The article on psychopharmacologic treatment of aggression by Drs. Ruths and Steiner highlights the frequent comorbidities present among children with disorders such as attention-deficit/hyperactivity disorder (ADHD), conduct disorder, and depression. The low CSF levels of the serotonin metabolite 5-HIAA in adults with affective and personality disorders and impulsive destructive behavior, and in children with disruptive behavior disorders, again highlights that physiologic abnormalities may underlie these conditions. As an infectious diseases specialist, I was particularly interested in learning that the often underused antiinfluenza A drug amantidine is effective in treating impulsive aggression in children. I have yet to find an infectious diseases physician who is aware of this.

The article concerning neuropsychological aspects of juvenile delinquency by Ahmad and colleagues highlights the relationship between juvenile delinquency and substantially lower verbal IQ than performance IQ scores. Perhaps pediatricians of the future will use low heart resting rate and screening procedures to find particularly low verbal IQ scores in order to identify young children who are at particularly high risk for serious misbehavior problems.

Stamps highlighted this month include a Chinese stamp that shows a stylized EKG rhythm strip, serving as a reminder of the slow heart rate associated with antisocial behavior. Also shown are other stamps that warn against behaviors that are closely associated with childhood wickedness, including drunk driving (China), drugs (Santa Lucia), and smoking (San Marino). The latter stamp is one of my all-time favorites.


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