Tuesday, March 01, 2005

Aggression and antisocial behavior in youth

Daniel F. Connor, M.D

Aggression and antisocial behavior in children and adolescents are central issues in our time. In the media everyday are stories of public school shootings, young children killing other young children, rising rates of youth crime and delinquency in the community and the growing trend of adjudicating youth charged with violent crimes as adults. This raises questions about the relationship between unrecognized and untreated mental illness and violence in youth.Because school personnel and mental health clinicians may be faced with the task of evaluating and intervening with a potentially aggressive child, the purpose of this article is to highlight some important points about aggression and antisocial behaviors in children and adolescents.Aggression and antisocial behaviors in youngsters are complex, heterogeneous conditions with multiple diverse psychosocial and neurobiological etiologies and consequences extending across the individual, family, and community environments.

Because of this complexity, established antisocial behavior is not easily altered. However, recent research has documented some important findings that may help to guide efforts to diminish serious antisocial behavior in youths.At-risk childrenWhile most aggressive children do not grow up to be aggressive adults, it is now clear that a small percentage of aggressive children are at high risk to continue their aggressive behaviors into adolescence and adulthood. These children are called early starters. They demonstrate an onset of diverse aggressive behaviors (stealing, threats, physical fighting, lying, cheating, vandalism, fire setting, rule defiance) across multiple settings (home, school, community) beginning before age 10 years.


In early starter children, these behaviors are persistent across time and development and do not appear to be transient problems. These children are at risk to follow a trajectory of ever increasing severity and diversity of antisocial behaviors as they develop into adolescents and adults.It is important to recognize that interpersonal conflicts and aggressive behavior are normative for infants, preschoolers, and children. Healthy aspects of aggression facilitate competence in social assertiveness, competition in games, and success in meeting daily life challenges. Observational studies indicate that approximately 50 percent of the social interchanges between children 12 to 18 months of age in a nursery school setting could be viewed as disruptive or conflictual, but by age 2 and 1/2 years the proportion of conflicted social interchanges drops to 20 percent. As children enter school physical aggression decreases and verbal forms of aggression increase. So, if inter-personal conflict is normal for young children how can we recognize the at-risk infant, preschooler, or child?

The preschool child who largely directs aggression towards adults in out-of-home environments such as nursery school does not fit what is presently known about the normative aspects of aggression.
The school-age child, who frequently and repetitively initiates physical attacks on others, rather than beginning to modulate overt aggression with words, may also be deviating from a normative developmental trajectory.
The school-aged child who consistently uses physical aggression to obtain possessions from others may also be at-risk.

The persistently hyperactive/impulsive child is at risk for antisocial behaviors since there is a significant overlap between hyperactivity/ impulsivity and aggression/conduct problems in children, especially in unstructured, unsupervised environments.

At-risk parentingOver the past 50 years research in behavioral science has documented qualities of parenting and parent-child interactions that contribute to risk for continued aggression and antisocial behaviors in offspring. Early recognition and intervention to establish more effective parenting practices is important in interrupting the aggressive trajectory of the at-risk child. These include recognizing:

Coercive parent-child interaction patterns: These occur when a parent sets a limit or asks the child to do something and the child resists or is oppositional and defiant. As the parent persists the child escalates eventually causing the parent to back down. The child then learns that escalating behavior allows them to escape aversive requests or demands (negative reinforcement). At the next parent-child encounter the child will once again use this strategy, and if successful, will be further reinforced. Eventually the child may generalize this oppositional strategy outside of the home into school and the community.

Harsh and inconsistent parental discipline practices: Closely coupled with the above parent-child interaction pattern is the parental use of harsh and inconsistent discipline practices. Occasionally the parent will retaliate on the oppositional child. The child then becomes transiently compliant in the face of harsh punishment. The parent is negatively reinforced for aggressive behavior. The parent-child dyad becomes locked in a spiral of ever-escalating conflicted behavior. The harshness and inconsistency of the parental response further serves to reinforce maladaptive parent-child interactions that contribute to child aggressive behavior by modeling aggression as a means of solving interpersonal conflict.

Failure to monitor and supervise children after school: Children whose parents do not know where they are after school and children whose parents are unaware of their friends and peer group, are at risk for engaging in more antisocial behaviors than closely monitored children.

Early interventionIt is becoming clear that effect sizes for interventions diminish as the at-risk child grows older. Family, educational and community treatments appear to be stronger for younger aggressive children and their families, rather than older aggressive children and teenagers. To the extent that an early starter antisocial trajectory can be modified, the earlier the intervention, the better. Transition points Critical periods of development for diminishing aggressive behavior may be concentrated in the transitions from preschool to elementary school and during the transitions from late adolescence to the young adult years. At each of these points in development, research shows a proportion of antisocial and aggressive individuals desisting from further maladaptive behaviors.Although the effect sizes of interventions diminishes as the antisocial child grows older, these "windows of opportunity" may represent times when concentrated treatment efforts might further interrupt a lifetime anti-social trajectory.Verbal competencyGroups of persistently aggressive and antisocial children and adolescents consistently demonstrate diminished verbal competency relative to non-aggressive control samples. This diminished competency is reflected in overall poorer reading skills, increased incidence of learning disabilities, and poor expressive and receptive language skills in aggressive youngsters.If a child is unable to articulate their moods, feelings, and frustrations verbally, they may be more at-risk to act them out behaviorally. Efforts to decrease antisocial and aggressive behaviors in youngsters need to emphasize early verbal and language skill acquisition as an anti-aggression primary prevention strategy.Community interventionsAlthough the importance of safe neighborhoods, antipoverty efforts and educational access in the prevention of youth violence and antisocial behaviors cannot be under stressed, two other community interventions need emphasis.

The role of violent media: American children are awash in violent images from television, magazines, movies, music and the Internet. While exposure to violent media does not cause violence or aggression de novo, it contributes through three mechanisms. Constant exposure to media violence may engender desensitization and a numbing of emotional response to real violence. Being submerged in a sea of media violence may contribute to a feeling that all people are more violent than they actually are and that the world is a very threatening place.

Finally, violent media glamorize conflict resolution strategies emphasizing aggression - strategies that are easily adopted by impressionable youngsters. Communities might facilitate regulation of highly violent media as a primary youth violence prevention strategy.
The role of handguns: At last estimate 60 million American homes contained at least one handgun. Having easy access to a gun at the point of interpersonal conflict increases risk for violent outcomes. Communities might facilitate handgun regulation as a primary youth violence prevention strategy.

Effectively intervening in the epidemic of youth antisocial behavior and aggression will require public health strategies coordinating evaluation and interventions across multiple educational, mental health, community, public policy, public safety and juvenile justice institutions.The individual professional can help by supporting early recognition of at-risk children and families and supporting effective psychoeducational and parenting interventions delivered early in the at-risk child's development.Dr. Connor is Associate Professor of Psychiatry, Director of Ambulatory Child and Adolescent Psychiatry, and Co-Director of Research in the Division of Child and Adolescent Psychiatry, University of Massachusetts Medical School, Worcester, MA. Connor DF: Aggression & Antisocial Behavior in Children and Adolescents: Research and Treatment. New York, NY: The Guilford Press, 2002, 480 pages. To order, call 1-800- 365-7006; or e-mail: info@guilford.com

The Brown University Child and Adolescent Behavior Letter
September 2002
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UO Researchers Eye Youngsters' Behavior

The Register Guard, October 25, 1961

If you are a parent, one of the strongest influences you have on your children's behavior is your own approval or disapproval.

Studies by psychologists at the University of Oregon are showing that approval given by parents is a major factor in influencing the behavior of their children.

The data collected by the research gives scientific support to theories that children acquire traits and mannerisms through learning processes, first from their parents and later also from other children and from teachers.
One example of these theories is a basic psychological belief that aggressive acts by children are caused by frustrations. The Oregon studies show that although frustration may set the occasion for aggression, children who receive social approval for aggressive acts have a marked increase in aggression.

This is a part of research which is being carried on at the Child Study Center maintained by the university's psychology department. A unique factor of the center is a mobile laboratory which can be taken right to schools and homes to test responses of parents and children.

The laboratory is a trailer with one section filled with simple games, and another section fitted for a psychologist who may observe children and parents through a one-way glass and record data with electronic equipment.
The trailer was acquired this year to make it easier to test children without taking them to a central laboratory. This research has been conducted at the university for about six years. Directing the research are Richard A. Littman, professor of psychology, and Gerald R. Patterson, assistant professor of psychology.

This fall they received a one-year research grant for $21,352 from the National Institute of Mental Health to continue their studies of how children learn from their parents, and how parents influence children in learning.
They received the grant as a result of work they had done previously under a one-year grant for $7,150. The Institute has also approved a grant of $24,610 for future support of the project next year, provided funds are appropriated by Congress, giving approved support totaling $45,962 for two years.
Recordings of results of simple games played by children are tabulated in an electronic computer at the university's Statistical Laboratory and Computing Center.

One of the main problems of the psychologists has been to develop laboratory procedures and short-cut techniques in psychological tests.

"By going with the trailer to homes and schools we can find out whether these general principles work in settings outside the laboratory," Littman said.

The trailer interior was fitted for the research by Cecil Hinsey. Many of the tests have been conducted by Mrs. Beverly Sonoda. Both are research assistants in psychology.

One report on aspects of aggression in children concluded that "aggression is taught." A paper about this study was written by Gina Lerner, junior in psychology from Eugene, as an undergraduate research project under the supervision of Patterson.

In this study a group of 12 children were observed while playing individually with a set of several toys. For half of the children, the observer said nothing when a child made an aggressive act with the toys, but for the other half the observer would reinforce aggressive acts with comments indicating approval.
Those children who received approval for aggressive acts showed a marked increase in aggressive responses compared to the other group, the study showed.


The study also indicated that boys were generally more aggressive than girls. Boys tended to begin playing immediately when introduced to the toys, while girls tended to examine all of the toys before playing.
Reprinted with permission. Copyright 1981, The Register Guard

Poison Control: Of toxins and violent behaviour

By Prof Dzulkifli Abdul Razak

WHEN the issue of "gangsterism" among youngsters, especially in schools, made the headlines early this year, it seemed a relevant topic for this column.But because the viewpoints to be expressed were rather unconventional, the idea was shelved. Conventionally one would think in terms of peer pressure, poor self-esteem, lack of discipline and also education, as well as poverty.Nevertheless with a second school-related arson, purportedly involving a group of "problematic" students (NST, June 6), it would be useful to state the unconventional viewpoint, even if only to provide some new perspectives for public discussion.With the scientific evidence available today, the association between "problematic" students (in the academic sense) and that of "violent" behaviour (such as burning the school) is too much of a coincidence to be overlooked.Last week, this column reviewed the association between environmental pollutants, including lead, and IQ.This week, it will dwell on new research findings suggesting that not only millions more children than previously thought might have lead-linked mental impairment, but that there is also a strong link between lead exposure and juvenile delinquency. This was revealed during the joint conference of the American Academy of Pediatrics and Pediatric Academic Societies recently.An increasing number of scientists have found substantial evidence that environmental toxins such as lead are implicated in juvenile behaviour, particularly when children are exposed early in life.Lead is a toxic metal found in a variety of sources and can be detected in blood and bones many years after exposure. It can affect development of the central nervous system, and in severe cases, cause seizures and death.In most cases, however, lead poisoning is not readily detected, although the situation can sometimes be treated. Even then it has been suggested that "the more subtle declines in mental functioning linked to lead are persistent and may be permanent".The influence of toxins on brain functions is therefore critical for human personality and behaviour, not unlike other drugs.According to Dr Herbert L. Needleman of the School of Medicine at University of Pittsburg, lead is "a brain poison". It creates biochemical changes that can result not only in lower IQ, but also reading and language problems, as well as "an inability to sit still". Much of the work linking the effects of lead on behaviour and learning can be attributed to Dr. Needleman. He is among the early researchers who established that children with elevated lead levels had lower IQs, poor reading skills and problems paying attention. His research did much to influence the decision to ban lead in fuel in the US, way back in 1979. Needleman recently conducted a study among youngsters and found significantly higher lead levels in those convicted of delinquency in comparison to those with no juvenile convictions.After adjusting for conventional factors such as race, parental education, occupation, family size and crime rate in the neighbourhood the youths came from, he found those with high lead levels were twice as likely to be delinquent than those with low levels. While this is true among the boys, the "risk for girls was even higher, partly because only a small number of female delinquents" was studied. The study further suggests a possible link between early lead exposure and 11 to 37 per cent of arrested delinquents. Lead exposure may be one of the most preventable causes of criminal behaviour, said Needleman, whose other research also linked aggressive and anti-social behaviour to lead.Anti-social behaviour has also been linked to video games. A recent issue of the Journal of Personality and Social Psychology said the interactive and increasingly graphic nature of some video games can be "potentially more dangerous" than violence-charged television and movies.It further suggests that "playing violent video games can have immediate and lasting effects on a person's thoughts and behaviour". In one study, students who more frequently played violent video games during junior high and high school were found to be more likely to have engaged in "aggressive delinquent behavior". In another, students who played either a violent or benign video game revealed that the violence-packed game increased subjects' aggression immediately afterward.The study found that students who considered themselves aggressive were also more likely to play violent video games. Students with aggressive personalities and those who played violent video games more often, were more prone to real-life aggression. Since aggressive people may seek out violent games, the researchers note, coming to the conclusion that the video games caused real-life delinquency is "risky at best". In the second study, video game violence seems to be linked with "immediate increases in aggression". In the study, students play either a violent game (Wolfenstein 3D) or a non-violent game (Myst). The students were led to believe they were playing against an opponent in another cubicle. On completing the game, participants played a competitive-reaction game with imaginary opponents. In this game, the victor was allowed to punish the loser with a noise blast. Students who were fresh from the violent video game blasted their opponents longer than those who played the non-violent game.While the studies cited above may not be conclusive, they provide invaluable clues that the problem of "aggression" and "anti-social" behaviour among youngsters could be more complex than conventionally thought.That environmental factors can impact "academic" performance is somewhat new to many of us; more so their association with violent behaviour. But now we have grounds to suspect their involvement.Taken in totality the two key factors, namely pollutants and violent video games, must be considered in looking for a lasting solution. Both are equally pervasive and real in today's environment. Thus before attempting any solution to such a complex situation it is imperative to understand thoroughly the make-up of the "violent outlook" in our society today. It is no longer sufficient to confine ourselves to the realm of conventional paradigms alone. A cross-over between the various disciplines of behavioural, environmental and toxicological sciences may be needed for a permanent solution.In the words of Needlemen, "If you don't have a high school diploma and you can't read, you are going to have a hell of a time making a living". The solution extends beyond just punishment, if the environment in the broader sense of the word stays the same.For more information contact National Poison Centre at Universiti SainsMalaysia, tel. 04-6570099, fax. 04-6568417, email. prnnet@prn.usm.my.Source: New Sunday Times, June 11, 2000