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Executive Summary
This brief is an examination of the range of reasons why a child might exhibit aggressive behaviour and the ways in which this aggression might be treated. The focus is on understanding the range of categories of cause of aggression—such as disruptive behaviour disorders, cognitive and developmental deficits, psychotic illnesses, and home environment—and then looking at what types of treatment might help. The conclusions are that prevention will always be challenging as the symptom of aggression often points to a primary problem, but that early diagnosis and a multi-variable approach leads to greatest success. Aggression, children, ADHD, CD, ODD, conduct disorder, oppositional, bullying, abuse

Aggression in Children: Causes, Treatment, and Prevention
Aggressive behaviour in children is not the primary issue for the child; instead, it is always a symptom of some underlying issue (Silva, 2012). The underlying problem that is causing the aggressive behaviour can be related a number of different issue—aggressive behaviour can therefore be considered to be a very polymorphic issue, as it is a commonality for any number of a range of different conditions and problems. It is necessary to understand what is at the foundation of the aggressive behaviour before there can be any thought of treating the problem, let alone learning how to prevent it in the first place. If the aggression is treated on its own, then there will continue to be issues on down the line, as the stopping a symptom never changes the cause of the issue. This paper will first look at the different reasons for aggressive behaviour in children—including those of a biological nature and those that are more related to the environment of the child—and will then look at how aggression can be treated. It will conclude by considering some final thoughts on the challenges of treating aggression in children and how aggression might be prevented in the future.

Causes of Aggression in Children
There are several different broad categories of problems and issues which can lead to aggressive behaviour in children. These include mood issues, psychotic illnesses, cognitive and development problems, disruptive behaviour disorders, organic reasons, and finally life situations and stressors. This paper will look more generally at each of these condition categories in turn to recognise some of the common features and some of the issues of cause which might point to the possibility of treatment or prevention in the future. When it comes to mood issues, there are a range of different problems that might lead to aggressive behaviour in children. These include children who suffer from bipolar disorder, who in their manic stages, may frequently become aggressive (Mick, Biederman, Pandina, & Faraone, 2003). When a bipolar child is manic, he or she may lose control over themselves, they become impulsive, and struggle to understand the consequences of their behaviour. This may lead to aggressive behaviours. Although this makes clear sense when considering what happens when a bipolar child becomes manic, it has also been shown that children who suffer from bipolar disorder may become aggressive when they are in the depressed cycle (Kowatch, Fristad, Birmaher, & Wagner, 2005). This is far less common, but it has been shown that for some children, when they become depressed, they become far more irritable and this may lead to them lashing out in an aggressive way (Wozniak, 2005). Related to psychological disorders are psychotic illnesses, such as schizophrenia, which has been shown to lead to aggression in children (Serbin, 2013). Some children with schizophrenia will be responding to internal stimuli that can be disturbing. This may lead to lashing out when they become mistrustful or suspicious of those around them, or if they have a full blown paranoid delusion episode. Their fearfulness and anxiety may lead to them acting aggressively as they take a defensive posture with those around them (Taskiran & Coffey, 2013).

Children with cognitive or developmental problems, such as mental retardation and autism, may also show symptoms of aggression. This is often because children with mental and developmental disorders struggle with dealing with their anxiety or frustration in other ways and are unable to verbalise their feelings the way that others might be able to do (Aman, De Smedt, Derivan, & Lyons, 2014). There are also often instances where aggression in these children is related to a form of impulsivity, where impulse control functions are hampered by their cognitive or developmental impairments (Oliver, Petty, & Ruddick, 2012). Disruptive behaviour disorders—which include such issues as ADHD, which is the most common, and conduct disorder—can lead to problems with impulsivity and poor decision- making (Moeller, Barratt, Dougherty, & Schmitz, 2001). This combination can often lead to behaviours which can be considered to be aggressive. Children with ADHD, for example, very often do not or cannot consider the consequences of their actions (Becker, Luebbe, Stoppelbein, Greening, & Fite, 2012). This may come across as purposefully aggressive or malicious, but that may not be their intentions when they take up an action. On the other hand, children with conduct disorder often have aggressive behaviours in the matric of their illness and may, in fact, be intentionally malicious (Keenan & Wakschlag, 2014). Conduct disorder is characterised by behaviour that can be emotionally and physically violent behaviour and a disregard for other people in general and specifically with the effects that their behaviour has on others. Children who have conduct disorder exhibit signs of cruelty from a very early age, including pushing, hitting and biting, leading towards more aggressive teasing and bullying, possibly hurting animals, getting into fights, and behaviours that break societal norms, such as theft, vandalism, and arson (Kim-Cohen, Arseneault, Caspi, Tomas, Taylor, & Moffitt, 2005). There is an element of satisfaction gained through their aggression, deception, and manipulation that is not seen in disorders such as ADHD or autism.

When a professional or parent is attempting to determine the foundational cause of the behaviour, it is necessary to determine if the behaviour is a negative adaptation to a troubled environment, whether the child has ‘learned’ this behaviour from a poor life situation, or if the child is getting actual gratification from the aggression that seems to come from internal motivations. This will be important when considering how to go about treating aggression because their behaviours may well look very similar to other aggressive behaviours, but with the different intention comes a very different focus for the treatment (Frick, Developmental Pathways to Conduct Disorder: Implications for Future Directionsin Research, Assessment, and Treatment, 2012). There are often an organic reason behind a child’s aggressive outburst or behaviour (Lazar & Frank, 1998). For children with frontal lobe damage or particular types of epilepsy, there can be physical acting out that appears aggressive in nature. There is often no comprehensible reason for the aggression and it can be explosive and unexpected in nature (Potegal, 2012).

Treatment of Aggressive Behaviour in Children
With each of these categories, it is clear that it is very important to recognise what is leading to the aggression and to pick up on this explanation as early on as possible so that the treatment chosen is appropriate and more likely to work for the child. It would not make sense, for example, to treat an organic brain injury with mood stabilising drugs, as that has no bearing on where the behaviour is coming from. Similarly, taking a behaviour strategy approach alone is unlikely to work for a child with a chemical imbalance which is leading to the behaviours that are wanted to change. This paper will now take a closer look at how aggression in children can be treated and the challenges faced therein. When treating children who suffer from disruptive behaviour disorders, the treatment is often a combination of psychotherapy and behavioural therapy which involves the entire child’s family and support network. This is because such disorders are believed to have both a genetic and environmental in nature. Children with conduct disorders are believed to have genetic vulnerabilities towards the disorder alongside a range of environmental factors, such as an abusive or unsupportive home environment, and potentially brain abnormalities. The earlier that the condition is diagnosed, the more successful that the treatment appears to be (Johnson, Cohen, Smailes, Kasen, & Oldham, 2000). There are, however, some indications that a ‘too early’ diagnosis can have a negative effect, as the child becomes labelled as a ‘problem’ very early on (Frick & Nigg, 2012). In a younger child, treatment will often focus on parent- child interaction therapy or another type of parent management training. The focus here is to teach parents how to encourage more positive behaviours and to discourage the negative, disruptive ones. The focus for the child is to help them to learn to control his or her behaviour more effectively to cut down on negative impulsive behaviours. As the child gets older, it may be necessary to focus on how the child is supported and engaged with also in the school environment.

Conduct disorder is often also seen with other conditions that can be treated pharmacologically, so there may be a medication associated with his or her treatment. There is quite a pervasive pattern of treatment of children with disruptive behaviour disorders with pharmacological treatments, although the research has been largely unimpressive in regards to the efficacy of these treatments in consideration of the side effects and implications of the treatment (Wilkes & Nixon, 2015). For children with developmental issues such as autism, the treatment of aggression may take a multi- factorial approach, including looking at self- injury reduction, assistance with sleep problems, and sensory enhancement treatment to help them acclimate to unexpected sensory input that may otherwise set off aggressive behaviours (Mazurek, Kanne, & Wodka, 2013). For children who are diagnosed with ADHD, Oppositional Defiant Disorder, Conduct Disorder, or ADHD with co- occurring ODD or CD, it is exceedingly common to treat the child with pharmacological interventions. In the five years that this study covered, the rates of antipsychotic treatments for ADHD had more than tripled. There was an increase of 114% in prescribing SGAs and increases shown for psychostimulants and selective serotonin reuptake inhibitors. SGA was primarily prescribed for ADHD, mood disorder, conduct disorder, and psychotic disorder. Where aggressive behaviours had been noted, it was far more likely that the child will receive a prescription for a medication to deal with his or her mood.

One of the biggest challenges that face treating aggression in children is the fact that the aggressive behaviours almost never ‘stand-alone’ with just a single biological factor that is causing the issue (Harold, Rice, Hay, Boivin, van den Bree, & Thapar, 2011). Nearly always, there is also an environmental factor wherein the child is learning negative behaviours or is living in a home environment that is unsupportive or abusive in nature (Hudziak, Derks, Althoff, & Rettew, 2005). As there is no single approach to treating aggression that works effectively in every case, it is exceedingly important to recognise the value of bringing the family and support network into treating the child’s behaviour all together. A child who is supported at school, for example, may not show the benefits of this support if he or she is going home to an abusive situation. Similarly, a child who is being well treated at home and supported by a therapist may still struggle if he or she is going into a school environment that is not appropriate or supportive.

Prevention of Aggression and Concluding Thoughts
There is no clear answer to how to treat a child’s aggression. What has been made clear in this paper is that aggressive behaviour in a child is always a symptom and never the primary problem. That means that in order to best treat the condition, it is necessary to understand what is driving the aggression in the first instance. Knowing what is driving the symptom of aggression is necessary to make decisions about how to treat the problem. For children who have aggression related to biological and chemical issues, this may well mean a pharmacological treatment. For children who suffer from behavioural issues or who are suffering from the effects of brain injury or damage, it may be more important to focus on behavioural strategies and therapy. Nearly in all cases, it is necessary to look at what is happening at home and support the child’s family and support network to best help the child. Children who have aggression based on co- morbid issues may require a package of care which looks at several different factors at once. Preventing aggression in children may not always be possible. There are some issues which may not even come to the attention of professionals without the symptom of aggression being present. But what is known is that better education for parents on how to treat their children and best support them can lead to a decrease in the prevalence in aggression.

References

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