Prevalence rates can also be affected by cultural factors related to the degree to which CD and ODD symptoms are considered dysfunctional and or are differentially tolerated in various cultures and across age groups. For example, suppression of aggression, anger and strong emotions or overt behaviors is part of the Chinese culture as well as the Thai culture. This cultural suppression may lead parents to have a lower threshold (or tolerance) for externalizing behaviors and to curb this behavior more often than in other cultures where these behaviors are more accepted. In fact, studies of case vignettes comparing Thai and American parents showed very different thresholds for internalizing versus externalizing behaviors with Thai parents more concerned about internalizing, over-controlled behavior than American parents [81]. Given these cross cultural differences in parental perceptions and expectations of children’s behaviors, it is not surprising that comparisons of children’s syndromes across 16 different regions of the world as ascertained by the Child Behavior Checklist (CBCL) showed higher prevalence rates of internalizing syndromes and lower rates of externalizing syndromes in the Asian countries as compared
