child’s behavior caused the parents to act in a more hostile manner toward the child, if the
parents’ hostility led to the ch ild’s problematic behavior, or if there was so me combination
of both. Whether or not the clinician can sepa rate the relative contributions of potential
causal factors should not influence whether or not the diagnosis is made. In the event that
the child may be living in particularly poor conditions where neglect or mistreatment may
occur (e.g., in institutional settings), clinical attention to reducing the contribution of the