May 29, 2000 -- For the first eight months of his life, Matthew cried 18 hours a day.
As he grew older, he terrorized baby-sitters, throwing tantrums or locking them out of the house. At age 4, his response to a time-out in his room was to kick the door down or climb out a window.
His behavior was so difficult that his pediatrician phoned Matthew's mother every morning for a year to find out how she was coping. "I think he called because he was so afraid we would do something to Matthew," says his mother, Diane.
For years, parents and scientists alike have wondered whether some children are born bad and, if so, why. Now research is finally uncovering some of the biological traits that may be the cause of troubled behavior. At the same time, new educational techniques are helping parents steer difficult children away from a path of violence.
About 10% of children are born, like Matthew, with a mix of "challenging traits," says Helen Neville, RN, director of the Inborn Temperament Project at Kaiser Permanente in Oakland, Calif. These children are easily frustrated, very sensitive, emotionally intense, and have difficulty coping with change.
"The parent who thinks this is an obnoxious, stubborn, difficult kid who just needs to get some sense knocked into him or her is going to be in a real war with one of these kids," says Neville. "The child's self-esteem is going to suffer. And that's what we think is the setup for conduct disorder."
Conduct disorder is a complex mix of behavioral and emotional problems in youngsters, according to the American Academy of Child and Adolescent Psychiatry. Kids with conduct disorder typically are cruel to animals and to people. They are destructive, deceitful, and often uncontrollable.
In some children, the bad behavior tapers off as they grow older. But other children will grow up to become violent individuals whose childhood conduct disorder will be reclassified after age 18 as antisocial personality disorder (APD), a diagnosis common to those charged with violent crimes.
Is such violence the result of nature or nuture? The answer is likely both. Recent studies have found that the bodies of pathologically violent people often differ from those of less violent people. Using magnetic resonance imaging, Adrien Raine, DPhil, a psychologist at the University of Southern California, recently found that men with APD had 11% less gray matter in the prefrontal cortex of their brains compared with men without the disorder.
Researchers have long known that people who behave normally may become violently antisocial when their prefrontal cortex is injured in an accident. But Raine's study, published in the February 2000 issue of Archives of General Psychiatry, is the first to suggest that people may be born with this type of brain damage.
Meanwhile, University of Chicago researchers studying boys between the ages of 7 and 12 who had been sent to psychiatrists because of bad behavior found that the boys had lower levels of the stress hormone cortisol than did boys without behavioral problems. The researchers, whose work was published in the January 2000 issue of the Archives of General Psychiatry, speculate that the boys are less sensitive to stress and are therefore less bothered by the consequences of behaving badly.
Does this mean that children are genetically prone to be "bad" and that environment plays no role? Not at all. It may be that drug use poor health care during pregnancy or a difficult childbirth produce these biological traits, says Bruce Perry, MD, PhD, a psychiatrist at Baylor College of Medicine. And one study reported in the April 2000 issue of the Journal of Personality and Social Psychology found that children who played violent video games were more likely to behave violently.
Based on such findings, researchers believe that it's possible to reverse the violent course that many of these children are taking.
Diane and her husband were finally able to help Matthew after they enrolled in one of Neville's classes for parents of "spirited" children at Kaiser Permanente.
"The basis of our program is, 'Let's get in there while the brain is very malleable and do the very best we can for these kids,' " says Neville. The class teaches parents how to understand their child's temperament and to work with, rather than against, a child's strong emotions.
For example, parents of a toddler who refuses to get dressed might learn that the toddler wants to be more independent and is frustrated he can't dress himself. Instead of wrestling with the child, they might learn to offer him a choice of clothes, giving him some feeling of control.
If a child has trouble with transitions, parents would learn to give five minutes warning before asking her to stop one activity and start another. If a child is easily frustrated, parents might learn to break tasks into easily managed parts. Instead of saying, "Clean up your room," the parent would say, "Let's get the toys off the rug."
The techniques were based partly on a study in which psychiatrists Stella Chess, MD, and Alexander Thomas, MD, followed more than 100 babies throughout their childhood to analyze which parenting approaches were most successful. They published their findings in 1986 in the book Temperament in Clinical Practice, published by Guilford Publications.
The advice resembles what you might find in any good parenting book, Neville says. But it isn't easy to put into practice and "the more extreme the child, the more important the techniques."
There are few children as "extreme" as Matthew was. And at 9, he is still a handful, but his mother says he is "delightful, bright, articulate about his feelings, the star of his class and a natural leader. Everybody loves him. And I think that's because he does manage himself so well. He's been taught how to talk about what he needs."
If you ask Diane if the root of Matthew's behavior is biology or environment, she will say it's biology. Her second child, now 6, was "completely different" from the moment of birth. "We're the same two parents in the same house with the same rules, and we have two completely different little beings."
But then she adds that environment -- the one she created to accommodate her son -- has made all the difference.
Christine Cosgrove, a freelance writer based in Berkeley, Calif., specializes in health and medical issues. She has worked as a reporter for UPI in New York and as a senior editor at Parenting magazine.