Aggressive and violent behavior among children of adolescence

Mean Genes

Media and Child Health

Aggressive and violent behaviour is very common in the hospital setting. Simple agitation may unpredictably progress to overt aggression and violence by any patient in the emergency centres (ECs). Aggressive behaviour often manifests in forms of verbally abusive language, verbal threats and intimidating physical behaviour. Violent behaviour comprises the intentional use of physical force or power, threatened or actual, against self (suicidal), or another (homicidal) or properties, group or community, that could potentially result in injuries, death, psychological harm or deprivation. Therefore, individuals with unusual agitation and aggression should be treated as an emergency in both the community and healthcare settings in order to mitigate the progression to physical violence. Whilst the incidence and prevalence of aggressive and violent behaviour are higher in individuals with an underlying mental disorder, substance use disorder or comorbid mental disorder and substance use disorder, other individuals can also present with these behaviours in the ECs. Therefore, the front-line clinicians must be knowledgeable and competent in managing patients with aggressive behaviour with a view to de-escalate the situation and preventing or curtailing violence. This paper presents an evidence-based approach for managing patients with aggressive and violent behaviour, including a review of the steps for admitting patients for assisted or involuntary care.

Violence and aggression in children and adolescents is of worldwide public health concern.1 Given the multitude of serious implications associated with violent crime such as costs to victims, taxpayer dollars and heightened safety concerns; early intervention is particularly important.2 Psychiatry is at an important juncture with few psychiatric pharmaceuticals on the horizon and unfavourable, long-term, risk-benefit profiles for many of the existing agents. The use of pharmaceuticals in violent and aggressive children and adolescents is limited due to the negative impact on growth and development, risk of adverse effects and lack of safety and efficacy data available.3 Evidence-based effective and safe therapies for the management of youth with violent and aggressive behavioural disorders are crucially needed. In recent years there has been an increase in both the quantity and methodological quality of research exploring the relationship between micronutrients and mental health.4 Neuroscientists have identified nutrients required for the synthesis of neurotransmitters, gene regulation and antioxidant protection.5,6 Changes in concentrations of different micronutrients as well as other organic and inorganic compounds may contribute to aggressive behaviour.7,8 The need for novel diagnostic techniques and interventions for children and adolescents with violent and aggressive behavioural disorders has been identified.9,10 Micronutrients that target biochemical imbalances that are identified by clinical examination and pathology may be a novel therapeutic option to improve behaviour, with minimal side effects.10,11 Due to the individualised nature of diagnosis and treatment, the use of micronutrient therapy to target biochemical imbalances has primarily anecdotal evidence. A retrospective review of prescribing patterns, diagnostic instruments and patient outcomes was conducted to evaluate available evidence and identify key trends for micronutrient therapy in violent and aggressive males. This study led to the development of a data collection instrument, and highlighted elevated urinary hydroxyhemopyrroline-2-one (HPL) and elevated plasma copper/zinc ratios as common biochemical imbalances present in violent and aggressive youth. It was also identified in the retrospective review that micronutrients such as zinc, vitamin B6, vitamin E, vitamin C and chromium were often prescribed at doses above the Australian recommended daily intake12 and paediatric guidelines,13,14 but appeared to be well tolerated. There is no ‘gold-standard’ outcome measure for the evaluation of violent and aggressive behaviours in youth receiving pharmacological intervention.9,15 In addition, findings from the retrospective review emphasised the need to identify appropriate efficacy outcome measures used in this population. Therefore, a review to evaluate the psychometric and administrative properties, and the applicability of instruments used to measure the efficacy of pharmacotherapy in violent and aggressive youth was conducted. The review identified that the majority of instruments contained few items specific to violent and aggressive behaviours, and that these behaviours were often conflated with oppositional and defiant symptoms. It was found that all items in the Children’s Aggression Scale (CAS) and the Modified Overt Aggression Scale (MOAS) could be used to measure violent and/or aggressive behaviours. The CAS was the most psychometrically sound and useful instrument that could be used to exclusively measure aggressive behaviours in youth. A 16 week, open-label, clinical trial of 31 males aged four to 14 who displayed ongoing violent and aggressive behaviours was conducted. The participants received a standardised micronutrient intervention containing vitamin E, vitamin C, biotin, chromium, pyridoxal-5-phosphate, vitamin B6, selenium and zinc. Primary outcomes were ratings of violent and aggressive behaviours, measured using the CAS and the MOAS. Secondary outcomes were health-related quality of life (HRQoL) and family functioning. Plasma zinc, plasma copper, copper/zinc ratio and urinary HPL tests were conducted at baseline and endpoint. Micronutrient therapy significantly improved parent reported aggressive and violent behaviours measured using the CAS for all domains except the use of weapons, with medium to large effect size, and the MOAS, with large effect size. Parent reported HRQoL and family functioning also significantly improved. Micronutrient therapy appeared well tolerated, with a favourable side effect profile. The feasibility study identified important strengths in the open-label study that should be replicated in future studies and suggestions for the successful conduct of future research including randomised controlled trials, longitudinal or follow-up studies. This is the first investigation of a standardised micronutrient intervention for violent and aggressive behaviour disorders in male children and adolescents. Significant improvements in parent reported violent and aggressive behaviours as well as HRQoL and family functioning were found which could potentially bridge a therapeutic gap and change current practices in mainstream medicine. Results from the systematic review, evaluation of outcome measures and feasibility analysis should assist, and have an impact on, future research and clinical trials.

Introduction: Puppets are an important educational and therapeutic agent, and an impetus for creative expression in children. Therefore, educators in kindergarten should be familiar with puppets as a medium which is able to stimulate the development of the children. The main goal of this study was to answer the question: are there differences in prosocial and aggressive behavior in preschool children in relation to the frequency of the teacher’s use of puppets in her educational work? Materials and methods: Twenty teachers in kindegartens assessed the level of prosocial or aggressive behavior in 248 children, from kindergartens in the Split-Dalmatia County, aged 5.5 to 7 years (each teacher assessed the children in the educational groups of children in the study themselves). The children were placed in an experimental (in which the educator often uses a paper doll) or a control group (in which the educator very rarely used a paper doll). Teachers assessed the behavior of the children in their own educational group in the kindergarten using a scale for assessing prosocial and aggressive behavior in children (Žužul and Vlahovic-Štetić). Results: Results of the variance analysis showed that children in the experimental and control groups differed significantly in the prevalence of aggressive and prosocial behavior. Aggressive behavior was significantly more frequent in the control group and prosocial in the experimental group. In both groups, these two types of behaviors were negatively and significantly correlated. Discussion: The main finding of this research suggests that regular use of different methods of using puppets in educational work in kindergartens is correlated with the appearance of two forms of social behavior of children (prosocial and aggressive). These results can provide guidance for practical work, with a potential desirable impact on children, preferably using puppets in educational work. Conclusion: Children in the experimental group (more frequent use of puppets in educational work), were assessed by the teachers as more prosocial and less aggressive than in the control group of children. The relationship between prosocial and aggressive behavior in children is negative and statistically significant in the experimental, as well as in the control group.

BackgroundEarly aggressive behaviour is a risk factor for later violence and criminal behaviour. Despite over 20 years of violence prevention interventions being delivered in the school setting, questions remain regarding the effectiveness of different interventions for children exhibiting aggressive behaviour.ObjectivesTo examine the effect of school based violence prevention programmes for children identified as aggressive or at risk of being aggressive.Search strategyWe searched CENTRAL, Cochrane Injuries Group specialised register, MEDLINE, EMBASE, other specialised databases and reference lists of articles. We also contacted authors and organisations to identify any further studies.Selection criteriaWe included trials meeting the following criteria; 1) participants were randomly assigned to intervention and control groups; 2) outcome data were collected concurrently; 3) participants comprised children in mandatory education identified as exhibiting, or at risk of, aggressive behaviour; 4) interventions designed to reduce aggression, violence, bullying, conflict or anger; 5) school based interventions; 6) outcomes included aggressive behaviour, school and agency responses to acts of aggression, or violent injuries.Data collection and analysisData were collected on design, participants, interventions, outcomes and indicators of study quality. Results of any intervention to no intervention were compared immediately post‐intervention and at 12 months using meta‐analysis where appropriate.Main resultsOf 56 trials identified, none reported data on violent injuries. Aggressive behaviour was significantly reduced in intervention groups compared to no intervention groups immediately post intervention in 34 trials with data, (Standardised Mean Difference (SMD) =‐0.41; 95% confidence interval (CI) ‐0.56 to ‐0.26). This effect was maintained in the seven studies reporting 12 month follow‐up (SMD =‐0.40, (95% CI ‐0.73 to ‐0.06)). School or agency disciplinary actions in response to aggressive behaviour were reduced in intervention groups for nine trials with data, SMD =‐0.48; 95% CI ‐1.16 to 0.19, although this difference may have been due to chance and was not maintained, based on two studies reporting follow‐up to two to four months (SMD =0.03; 95% CI ‐0.42 to 0.47). Subgroup analyses suggested that interventions designed to improve relationship or social skills may be more effective than interventions designed to teach skills of non‐response to provocative situations, but that benefits were similar when delivered to children in primary versus secondary school, and to groups of mixed sex versus boys alone.Authors' conclusionsSchool‐based secondary prevention programmes to reduce aggressive behaviour appear to produce improvements in behaviour greater than would have been expected by chance. Benefits can be achieved in both primary and secondary school age groups and in both mixed sex groups and boys‐only groups. Further research is required to establish whether such programmes reduce the incidence of violent injuries or if the benefits identified can be maintained beyond 12 months.Plain language summaryAre school‐based programmes aimed at children who are considered at risk of aggressive behaviour, effective in reducing violence?Violence is recognised as a major global public health problem, thus there has been much attention placed on interventions aimed at preventing aggressive and violent behaviour. As aggressive behaviour in childhood is considered to be a risk factor for violence and criminal behaviour in adulthood, violence prevention strategies targeted at children and adolescents, such as school‐based programmes, are considered to be promising interventions.Some school‐based prevention programmes target all children attending a school or class, whilst others confine the intervention to those children who have already been identified as exhibiting, or threatening, behaviour considered to be aggressive, such an approach is known as 'secondary prevention'. A wide variety of school‐based violence prevention programmes have been implemented over the last 20 years, yet we are still without a full understanding of their effectiveness.The objective of this systematic review was to determine the effectiveness of school‐based secondary prevention programmes to prevent violence (that is those interventions targeted at children identified as aggressive or at risk of being aggressive) .The authors examined all trials investigating the effectiveness of secondary violence prevention programmes targeted at children in mandatory education compared to no intervention or a placebo intervention.The authors found 56 studies; the overall findings show that school‐based secondary prevention programmes aimed at reducing aggressive behaviour do appear to produce improvements in behaviour. The improvements can be achieved in both primary and secondary school age groups and in both mixed sex groups and boy‐only groups.Further research is needed to investigate if the apparent beneficial programmes effects can be realised outside the experimental setting and in settings other than schools. None of the studies collected data on violent injury, so we can not be certain of the extent to which an improvement in behaviour translates to an actual injury reduction. In addition, more research is needed to determine if the beneficial effects can be maintained over time, and if the benefits can be justified against the costs of implementing such programmes.

In the last decade a great amount of progress has been made in the field of the neurobehavioural genetics of aggression and violence. To analyse and summarise the main genetic influences related with these behaviours in human beings. The importance of genetic factors in the variation of aggressive behaviour in children, teenagers and adults is highlighted. The genetic and environmental origins of stability in the development of aggressive behaviour are then discussed. The article concludes by reporting on several studies focused on the search for aggressiveness genes. Although considerable progress has been made in our understanding of the role played by genes in aggressive, violent and antisocial behaviour, as well as the interaction between genetic and environmental factors, today the exact mechanisms by which genetic factors contribute to these behaviours are still not fully understood. Genetic aspects probably influence biological factors, such as arousal, levels of hormones and neurotransmitters, among other things, which in turn have an effect on behaviour. Analysing and understanding each of these parameters is essential to gain a better understanding of the biological mechanisms underlying aggressive or violent behaviour. Moreover, other environmental factors such as abuse and response to stress exert an important effect on the expression of specific genes and, as a result, on people's aggressive behaviour.

In recent years, a number of functional and structural neuroimaging studies have investigated the neural bases of aggressive and violent behaviour in children and adolescents. Most functional neuroimaging studies have persued the hypothesis that pathological aggression is a consequence of deficits in the neural circuits involved in emotion processing. There is converging evidence for abnormal neural responses to emotional stimuli in youths with a propensity towards aggressive behaviour. In addition, recent neuroimaging work has suggested that aggressive behaviour is also associated with abnormalities in neural processes that subserve both the inhibitory control of behaviour and the flexible adaptation of behaviour in accord with reinforcement information. Structural neuroimaging studies in children and adolescents with conduct problems are still scarce, but point to deficits in brain structures in volved in the processing of social information and in the regulation of social and goal-directed behaviour. The indisputable progress that this research field has made in recent years notwithstanding, the overall picture is still rather patchy and there are inconsistencies between studies that await clarification. Despite this, we attempt to provide an integrated view on the neural abnormalities that may contribute to various forms of juvenile aggression and violence, and discuss research strategies that may help to provide a more profound understanding of these important issues in the future.

Introduction. Child aggression is one of the significant problems in pedagogy, psychology, and law. Despite the fact that aggressive behavior of children is most often considered as a quite common phenomenon, the inability to overcome and control it leads to serious problems and consequences with age. The analysis of the issue of responsibility for causing harm to the health of other pupils by a child in a preschool educational institution leads to an understanding of the uncertainty of the legal basis of the actions of the institutionʼs specialists. This uncertainty is exacerbated by the lack of a clear legal status of a preschool educational institution and the lack of legal culture of teachers when faced with predeviant – maladaptive behaviors of preschoolers. Taken together, this creates ambiguity in the reactions and actions of preschool education specialists, and may exacerbate the problems of pupils and the consequences of their aggressive behavior. The purpose of the article – to determine the legal basis of responsibility of preschool educational institution specialists in the situation of illegal behavior of young children, as a key substantive component of a new educational program in the system of additional education for teachers. Methodology. As the main ones, such theoretical research methods are used as: analysis of available theoretical data on the problem; generalization of data related to the research topic and which are reliable. Results. In their previous work, the authors identified the phenomena of child aggression and violence as a psychological and pedagogical problem on the one hand, and as a legal problem on the other. Based on the conducted research, a description and definition of the illegal behavior of young children is given, based on legal pedagogy and the psychology of aggression. The analysis of the legal status of a preschool educational institution and the legal position of its employees in the occurrence and resolution of situations related to child aggression is carried out. A pedagogical innovation is proposed in the form of a program of additional professional education for teachers of preschool educational institutions on the prevention and adequate response to childrenʼs aggressive behavior. Conclusions. The definition of aggressive behavior of minors in a preschool educational institution is given from the perspective of law, age psychology and legal pedagogy. The conclusion is made about the importance of psychological and pedagogical prevention of aggressive behavior in pre-school conditions. The legal basis for the responsibility of preschool specialists in situations of illegal behavior of young children and the legislative acts regulating them have been clarified. The necessity and expediency of introducing a new program of additional professional education for teachers of preschool educational institutions is substantiated.

This article selectively reviews the biological bases of antisocial and aggressive behavior in children with a focus on low autonomic functioning, prefrontal deficits, and early health factors. Low resting heart rate is thought to be the best-replicated biological correlate of antisocial and aggressive behavior in child and adolescent populations and may reflect reduced noradrenergic functioning and a fearless, stimulation-seeking temperament. Evidence from neuropsychological, neurological, and brain imaging studies converges on the conclusion that prefrontal structural and functional deficits are related to antisocial, aggressive behavior throughout the lifespan. A prefrontal dysfunction theory of antisocial behavior is advanced. This argues that social and executive function demands of late adolescence overload the late developing prefrontal cortex, giving rise to prefrontal dysfunction and a lack of inhibitory control over antisocial, violent behavior that peaks at this age. Birth complications and minor physical anomalies are selectively associated with later violent behavior, especially when combined with adverse psychosocial risk factors for violence. Cigarette smoking during pregnancy may increase the risk for antisocial and violent behavior in later life by disrupting noradrenergic functioning and enhancement of cholinergic receptors that inhibit cardiac functioning. Malnutrition during pregnancy is associated with later antisocial behavior and may be mediated by protein deficiency. It is argued that early health intervention and prevention studies may provide the most effective way of reversing biological deficits that predispose to antisocial and aggressive behavior in children and adults.

Does Doing Media Violence Research Make One Aggressive?

Instruments for evaluating pharmacotherapy intervention efficacy in violent and aggressive behavior and conduct disorder in youth

<p id="p00015">Aggressive behavior plays an important role in the social, emotional and psychological adjustment of children and adolescents. Children and adolescents with aggressive behavior are prone to violate social moral norms, and even commit crimes in serious cases. It is noted that peer victimization is an important predictor of aggressive behavior. Peer victimization refers to that individuals have experienced attacks by peers, such as physical and verbal victimization, attacks on property and social manipulation. Children and adolescents who have been victimized by peers will characterize the attacker as hostility, which will be generalized to the whole peer group, thus showing more aggressive behavior in future interpersonal communication. Several previous studies have examined the relationship between peer victimization and aggressive behavior in children and adolescents. However, due to differences in research design and inconsistent results, there is still some uncertainty about the relationship between peer victimization and aggressive behavior in children and adolescents, and the moderating effect on this relationship is not fully clear. Therefore, the present study employed a three-level meta-analysis to quantitatively synthesize the results of original literatures to obtain reliable estimates of effect sizes and examined a range of moderators (sample, publication, study design, outcome, and assessment characteristics). Through the retrieval of articles published before October 2020, the current meta-analysis identified 40 studies, with 25,605 participants (range of mean age: 6 ~ 19 years) and 333 independent effect sizes. The funnel plot and Egger's test results suggested an absence of publication bias in current meta-analysis. Analysis revealed a significant positive association between peer victimization and aggressive behavior in children and adolescents (<italic>r</italic> = 0.295, <italic>p</italic> &lt; 0.001), implying that children and adolescents showed a higher level of aggressive behavior when they experienced higher level of peer victimization. In addition, the present study found a significant moderating effect of peer victimization variable. Compared with physical victimization (<italic>r</italic> = 0.219, <italic>p</italic> = 0.005), the association between relational victimization (<italic>r</italic> = 0.298, <italic>p</italic> = 0.005) and aggressive behavior in children and adolescents was stronger. Moreover, the overall association was influenced by region. Aggressive behavior in children and adolescents was more strongly associated with peer victimization in Asia (<italic>r</italic> = 0.351, <italic>p</italic> = 0.006) than in South America (<italic>r</italic> = 0.149, <italic>p</italic> = 0.006). Study design was also a significant moderator. The association between peer victimization and aggressive behavior in children and adolescents was smaller in longitudinal (<italic>r</italic> = 0.234, <italic>p</italic> = 0.014) than in cross-sectional studies (<italic>r</italic> = 0.339, <italic>p</italic> = 0.014). Finally, the moderator analyses also showed that the informant of peer victimization was a significant moderator. The strength of the association between peer victimization and aggressive behavior in children and adolescents was significantly stronger when peer victimization was reported by teachers (<italic>r</italic> = 0.476, <italic>p</italic> = 0.023) than by peers (<italic>r</italic> = 0.290, <italic>p</italic> = 0.023). In addition, the present study found that the overall association between peer victimization and aggressive behavior in children and adolescents did not differ in strength across gender, age, publication, variable and informant of aggressive behavior. Moreover, to eliminate the multicollinearity between moderators, the current study built a multivariate model by including all significant moderators that had been identified in the bivariate models. The result indicated that at least one of the regression coefficients of moderators significantly deviates from zero (<italic>F</italic> (12, 316) = 3.973, <italic>p </italic>&lt; 0.001). In sum, the results of the current meta-analysis contribute to a better understanding of the association between peer victimization and aggressive behavior in children and adolescents. These results also provide a reference for future empirical studies on explaining aggressive behavior in children and adolescents.

In China, the relationship between sleep quality and delinquencies such as aggressive behavior of Chinese high school seniors (CHSSs) has rarely been paid attention to. This research on the impact of sleep quality on aggressive behavior of CHSSs has filled the gaps in previous research on aggressive behavior of adolescents. Based on 2140 CHSSs samples collected from the southern cities in mainland China in 2024, the correlations between sleep quality and aggressive behavior were analyzed by using the multivariable regression models. According to the empirical results of this research, it can be known that sleep duration of most CHSSs in the total sample was less than 6 h, which was lower than the 2022 official statistics results that the average sleep of Chinese CHSSs was 6.5 h; CHSSs with poorer sleep quality may be more likely to involvement in aggressive behavior. Importantly, this study identified gender as a statistically significant moderator in the relationship between sleep quality and aggressive behavior including physical aggressive behavior, while the moderating effect of school types was not found to be statistically significant. These findings indicate that interventions and preventive measures should be tailored to different genders to effectively address the occurrence of aggressive and violent behavior among CHSSs with poor sleep quality. Also, the most CHSSs have reached the age for full assumption of civil and criminal responsibilities stipulated in the Chinese Civil and Criminal Law, and a considerable proportion of CHSSs may have poor sleep quality. Therefore, the high schools and relevant departments of government should formulate feasible and effective differentiated measures for different genders to improve sleep quality of CHSSs, for preventing and reducing the delinquent behavior including aggressive and violent behavior that may occur subsequently.

The problem of aggression and violence in modern societies has stimulated the search for factors that may predispose to aggressive behaviour. Despite the undisputable importance of socio-economic and political factors, the understanding of pathological aggression should benefit from identifying its biological basis (Davidson et al., 2000). The advent and ongoing refinement of modern neuroimaging techniques such as positron emission tomography (PET) and especially structural and functional magnetic resonance imaging (sMRI and fMRI, respectively) over the past twenty years has considerably increased our knowledge about possible neural underpinnings of aggressive and violent behaviour. A number of neuroimaging studies have sought to identify structural and functional brain abnormalities in adult psychopaths and criminal offenders (for review, see McCloskey et al., 2005). To further the understanding of the neurobiological factors that predispose towards aggressive and violent behaviour, it seems particularly useful to investigate individuals in whom pathological aggression manifests as early as in childhood or adolescence. The purpose of this chapter is to selectively review brain imaging studies that investigated structural and functional brain abnormalities associated with aggressive behaviour in children and adolescents.