The development of conduct disorder is not immutable or predetermined. A number of interactive risk and protective factors exist that can influence and change outcomes, and in most cases conduct disorder develops due to an interaction and gradual accumulation of risk factors.[21] In addition to the risk factors identified under cause, several other variables place youth at increased risk for developing the disorder, including child physical abuse[21] and prenatal alcohol abuse and maternal smoking during pregnancy.[22] Protective factors have also been identified, and most notably include high IQ, being female, positive social orientations, good coping skills, and supportive family and community relationships.[23]