Treatment for Aggressive Behaviors

What is Aggression?

Aggression is very broadly defined as a behavior that is hostile, destructive, or violent and has the potential to inflict deliberate damage to a person or object. It is worth noting that while many people interchangeably use the terms aggression and conflict, aggression is not the same as conflict, which occurs when two or more people have opposing interests or goals. Conflict can be resolved in a number of ways, such as persuasion, negotiation, or taking turns. Aggression can be a way that some people manage conflict, however, not all conflicts involve aggression.

People can engage in either direct or indirect aggression, or some combination of the two. Direct aggression includes hitting, biting, kicking, pinching, spitting, hair-pulling, pushing, or other physical behaviors. Indirect aggression involves the creation of friction between two or more people and can include bullying, teasing, spreading rumors, gossiping, exclusion of others, name-calling, and ignoring others.

Often hostile behaviors are divided into two separate categories: hostile and instrumental aggression. People who display hostile aggression, also called “affective aggression” or “retaliatory aggression”, often do so with the addition of strong emotions – most notably anger. Hostile aggression is associated with impulsivity, spur-of-the-moment, unplanned, overt, and uncontrolled behaviors. Hostile aggression is direct aggression that is used to emotionally or physically harm another person— in fact, harm to the target of aggression is the goal. Instrumental aggression, often termed “predatory aggression”, is often seen as a means to an end; any harm to the person is used to obtain another goal – such as money. Another form of aggression, relational aggression, is used to socially exclude, spread rumors, gossip, or engage in other forms of social aggression.

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What is Childhood and Adolescent Aggression?

Childhood and teen aggression is a very important focus for mental health professionals and parents alike as it is often relatively stable over time and has a reliable link to a variety of negative outcomes later in life that may become chronic. Additionally, physical and verbal aggression are often the first signs, and later the hallmark symptoms, of several serious childhood mental health disorders, including both oppositional defiant disorder and conduct disorder.

Occasional outbursts of anger and aggression are common – even normal – but aggressive behaviors are problematic because they occur frequently or in a pattern. In children and teens, aggressive behaviors stem from an inability to control behaviors or a misunderstanding of what appropriate behaviors are. It’s important to remember that aggressive behavior can also be self-directed. The key to handling aggressive behaviors is to understand the underlying cause.

Aggression in children and teens is often the result of weak parenting skills or lack of social skills. In many cases, a child or teen faces exposure to aggression or violence in the home or environment and imitates that behavior. These aggressive behaviors often incite attention from parents, caregivers, and teachers, which unknowingly rewards and reinforces this behavior.

What Causes Aggression in Teens and Children?

Aggression, a symptom of many other disorders and problems in a child or teen’s life, is not thought to have a simple cause. In fact, it’s believed that there are a huge number of conditions, risk factors, illnesses, and environmental stressors that may trigger aggression in certain children and teens.

Genetics: Children and teens who are aggressive may have inherited this tendency through their genetics. This genetic predisposition means that a child may, under certain environmental triggers, become angry, aggressive, depressed, and violent.

Physical: The delicate limbic system of the brain, which is in overdrive during adolescence, can lead to changes in the emotional responses of a child, including those responsible for fear, anxiety, and panic. During childhood and adolescence, the brain experiences major changes in the neural pathways, the connections between neurons (which can impact emotional skills). Any interruption to this development – such as low levels of the neurotransmitter serotonin or the usage of drugs – can impede emotional development during these important years.

Risk Factors: Typically, the more risk factors a child or teen has, the higher the likelihood the child will behave in an aggressive manner. However, different risk factors decrease or increase in importance during different developmental stages.

  • Family structure – Children and teens who come from homes in which parents are manipulative or coercive with their children, provide little support, do not monitor their activities, or use harsh or inconsistent discipline are at a greater risk for becoming aggressive
  • Relationships with peers – As children and teens who are aggressive often lack social skills, these children are often rejected by their peers. Early rejection can trigger later aggressive behaviors.
  • Scholastic failure – Early behavioral problems can lead to poor scholastic achievement and school failure, which can increase risk factors for delinquency during teenage years
  • Societal or socioeconomic factors – Poverty, joblessness, discrimination, and acceptance of aggression by the community increases the risks for aggressive behaviors. The societal factors that increase the chances a child will become aggressive include exposure to violence, availability of drugs, alcohol, and firearms, extreme poverty, and neighborhood disintegration. Additionally, the views by others that activities of violence and misbehavior are tolerable increase the risk for aggressive behavior.
  • Individual characteristics – Difficult temperament as babies, low intelligence, hyperactivity, impulsivity, problems with attention, and challenges problem-solving. Many times aggressive children have poor social skills, often misinterpreting peer behaviors as hostile, and are unable to find non-aggressive solutions.

Health-Related Causes for Aggression in Children and Teens:

Aggression can be a symptom of many different things, including psychiatric and medical conditions. One of the most important things to keep in mind while learning to manage aggression in a child or teen is to understand the root cause for aggression. No child or teen is “always bad,” and an effective, individualized treatment plan that focuses upon more than just treating the symptoms is needed to incur more positive outcomes.

Mental health-related disorders that may include aggression as a symptom include:

Attention-deficit hyperactivity disorder (ADHD): Children and teens who have ADHD may have problems making good decisions, which, when combined with impulsivity, can lead to aggressive behaviors. It’s important to note that these aggressive behaviors are not done maliciously; the child displaying them is simply not able to fully understand the implications of his or her actions.

Autism/autism spectrum disorders (ASDs): ASDs are characterized by the inability of a child or teen to properly process his or her emotions. This means that children and teens with ASDs are often unable to handle their frustration and anxiety as their peers do – which can lead to outbursts of aggression. Additionally, aggressive behavior in children and teens with ASDs may be the result of impulsivity without thought to the consequences.

Childhood/adolescent bipolar disorder: During the manic cycles of bipolar disorder, children and teens may lose control of their emotions and lash out. While children or teens are in the depressive cycle, they may become irritable, which can lead to aggression.

Conduct disorder (CD): Conduct disorder is characterized, in large part, by aggression. However, unlike children who simply do not consider the consequences of their actions, children who are diagnosed with conduct disorder are calculatedly malevolent toward others, intending to cause harm.

Oppositional defiant disorder (ODD) is characterized by a persistent behavioral pattern of irritable moods, argumentative and defiant behavior towards those in authority, and maliciousness. Children and teens with ODD often are aggressive toward others.

Schizophrenia: Schizophrenia is accompanied by hallucinations and delusions that are so real a child or teen cannot determine what is real and what is not. Many times, these hallucinations or delusions will provoke a child or teen to lash out aggressively toward others in the throes of a full-blown psychotic episode.

As each of these disorders will present differently in child to child, it’s imperative that a proper diagnosis from a trained child and adolescent psychiatrist is attained to allow for the very best possible effects of treatment.

If you feel that you are in crisis, or are having thoughts about hurting yourself or others, please call 9-1-1 or go to the nearest emergency room immediately.

Effects of Childhood and Adolescent Aggression:

The effects of childhood and teen aggression will vary based upon the reason behind the aggression, the duration of behaviors before treatment, the presence of a solid support system, and the genetic makeup of the child. What is known is that aggression has a consistent link to a number of negative long-term consequences that, without proper treatment, can lead a child or teen to face some very serious effects. The most common effects of unmanaged childhood and teen aggression include:

  • Delinquency
  • Conduct problems
  • Poor ability to adjust and/or adjustment disorders
  • Poor grades in school
  • Suspension from school
  • Expulsion from school
  • Dropping out of school
  • Challenges finding – and keeping – gainful employment
  • Substance abuse and addiction
  • Violence
  • Legal consequences of aggressive behaviors
  • Self-harm
  • Suicide

Treatment of Aggression in Children and Teens

Children and teens who are struggling with severe aggression should always seek the knowledge and experience of a psychiatrist who has much experience working with aggressive teens and children. As aggression is a symptom, not a disorder, a thorough medical and psychiatric evaluation of the child or teen will allow a pediatric specialist to gain full insight into the challenges the child is facing.

Individualized treatment plan: After a multidisciplinary team is able to review the child or teen’s symptoms and the results of the evaluations, they will work with the child or teen’s family in order to create a plan of care. This individualized plan of care should include all needs of the child, not simply the presenting symptom of aggression, as proper treatment requires treatment of all disorders and behaviors.

Medication management: Depending upon the results of the evaluations and the recommendations of the pediatric specialists, medication may be used as a part of the treatment plan. Medications may be used in the short term to manage symptoms to allow the child to fully participate in the treatment process and be slowly tapered down as the child learns more and better coping mechanisms for frustration and other overwhelming emotions. Other children may need more long-term medication management to help manage any medical or psychiatric disorders.

Behavioral counseling: Depending upon the child’s age and his or her ability to understand a system of rewards and consequences, a therapist may work one-on-one with the child or teen to create a behavior contract. This contract will very clearly specify outcomes for certain types of behaviors. For positive behavior choices, a child will receive a reward, while negative behavior choices – such as aggression – will earn the child a consequence. Behavioral counseling can also provide children struggling with depression the ability to work with a therapist who can help the child learn better, more appropriate ways to handle aggressive thoughts and develop positive social skills.

Group therapy: As much of the work that is to be done for children and teens who are aggressive involves interactions with others, a group setting can be ideal for children and teens who are aggressive. Groups can help a child learn to manage his or her aggression, learn new ways of coping with emotions, and teach the child or teen more about his or her underlying diagnosis.

Family therapy is very important for children and teens struggling with aggression. All family members are able to participate in creation of the treatment plan, which can help the professionals learn a bit more about family dynamics and the child’s struggles. Family sessions will help to discuss the behavior contracts and make sure that parents and caregivers are providing the same types of rewards and punishments as spelled out in the behavior contract.

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