Anytime you start to peruse the varying social and traditional media outlets, it seems there is no shortage of stories centering on violence and aggression, with many of these incidents involving the young. There is a normal developmental peak to aggression, as many parents have witnessed with their “terrible 2-year olds,” and then the gradual decrease in that aggression as the child matures. However, excessive aggression—that which is out of keeping from the norm—is a concern to parents, caregivers, schools, and society as a whole.
It is very disheartening to hear that a quarter of children surveyed engaged in aggressive acts, and that almost 1 in 5 report being bullied, either verbally or physically, on school property! Such data often under-report the true incidence of bullying and violence in children. Breaking down the problem of aggression into either impulsive or premeditated types is the first step into then going down the “rabbit hole” to a very complex and multifaceted problem.
Dr. Joseph Austerman has done a great job of detailing the causes, evaluation, and possible treatments for the problem of aggression in children in this month’s Pediatrics in Review article titled “Violence and Aggressive Behavior in Pediatrics.”
Psychosocial factors, neurohormonal imbalances, genetic predisposition, and mental illness such as ADHD and autism (side note: vaccines are safe, vaccines are effective, vaccines save lives!) all play a role in pediatric aggressive behavior and can be interrelated, creating a challenging construct.
Tackling aggressive behavior in children requires pediatricians to be knowledgeable about the causes of aggression, be aware of risk assessment strategies, and become partners in the therapeutic plan that often can involves the community, schools, mental health specialists, child protective services, and even law enforcement.
I very much appreciated Dr. Austerman’s metaphor for aggression: “Aggression, analogous to the physical symptom of a cough, is a nondiagnostic symptom with multiple and possible cumulative etiologies.” Much like the cough, it signals clinicians to dig deeper for the cause of the problem and then employ the appropriate therapies.
References:
August 2011, VOLUME 32 / ISSUE 8 Aggressive Behavior in Children and Adolescents
Dawn M. Zahrt, Marlene D. Melzer-Lange
