Nobody’s perfect and all children will have bouts of bad behavior. For example, a child may be tempted to take a dollar out of mother’s purse, but feels guilty later. He or she may become sassy and answer back. Occasional outbursts of anger and aggression do occur in otherwise healthy children and adolescents.
Usually, it is the persistence of the behaviour problems that provides a good rule of thumb about whether or not to seek help, but caution should be exercised here. Children can start acting out when there are other stresses in their lives, so it is important to know if the behaviour problem started when mother became sick, or when grandma died, or when the child’s parents announced their divorce. Sometimes, their behaviours may be manifestations of other disorders. For example, aggressive behaviours may occur in children who are anxious. Professional help might be in order if reassurance and extra care during stressful times don’t alleviate the child’s symptoms. It’s time to get professional help, too, if these behaviours start to escalate, when friendships are negatively affected, or when siblings or the whole family are distressed.
Children who are angry and aggressive may be frustrated and upset, but not have skills necessary to understand how to get along with others or how to solve problems. They are at high risk for school failure because their behaviours interfere with their learning and because they may have underlying learning disabilities. Children with severe behaviour problems are often suspended or expelled from school, further disrupting their education.
When children display angry outbursts or behave aggressively towards their peers or teachers they cause problems in the classroom. Not only is the education of other students jeopardized because of disrupted lessons, but the other students may experience anxiety about the on-going chaos caused by acting-out kids.
Continual anger and aggression can be symptoms of Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD).
Oppositional Defiant Disorder: If a child repeatedly steals money from his/her parents or has started to shoplift, or if there is a consistent pattern of disobedience, nastiness, or argumentativeness, these can be signals of oppositional defiant disorder.
Conduct Disorder: When serious problems emerge with a child engaging in physical or social aggression towards other children or adults, a diagnosis of conduct disorder may be warranted. Conduct disorder, or its beginnings, can be identified in preschoolers. While most children with the aggressive behaviours eventually “grow out” of them, there is a significant group who do not who then go on to develop conduct disorder. Children and adolescents with conduct disorder are at risk for school and job failure. They have an increased likelihood of becoming involved with the criminal justice system. Their hostility and aggression cause them to be rejected by other children and it is difficult for them to make enduring friendships.3 Surveys have shown that many children in juvenile detention facilities and older teens or young adults in prisons meet the criteria for a diagnosis of conduct disorder and most adult criminals were children with conduct disorder.
Although not always the case, behaviour problems like ODD and CD tend to flourish in homes where
- discipline is inconsistent,
- there is little supervision,
- parenting practices are coercive, and
- there are parental mental health problems such as depression or a history of conduct disorder.
Both genetics and environment play a role. There is some evidence that children with CD have deficits in their ability to understand social interactions or the social use of language. The same symptoms are often seen in their parents, making it difficult to sort out whether it is genetics or the environment that is at work producing the condition. There is likely an interplay the two.
Children who are treated aggressively or punished or criticized harshly are more likely to show symptoms of conduct disorder. Parents may react to their child’s challenging behaviours by using inappropriately aggressive discipline because that is how they were treated as children, themselves. Other risk factors include rejection by mother during infancy, institutionalization, and parental mental illness such as depression, or parental drug abuse. Children who suffer neglect or who are not adequately supervised are also at risk. Children born into poverty are more likely to develop the condition.
In ODD, Cognitive behavioural therapy helps with mood and anger management. Social skills training may also be helpful to the child with ODD. For treatment to be successful, it is very important to identify other conditions. Children who have ADHD, depression, or anxiety tend to lose their oppositional symptoms when their other disorders are successfully treated.
Family therapy that helps change how the family functions can also help. Many parents of children with ODD punish their children harshly and are very critical of them, usually because of their own life experience and their current depression. Changing these parenting practices can help the child and benefit the family as a whole. If the parents, particularly the mothers, are unable to develop new ways of parenting, their children may go on to develop the more serious condition, conduct Disorder.
Conduct disorder is harder to treat than ODD and worsens as an affected child ages, so early intervention is important. Multisystemic Therapy, parent training programs, and family therapy have sometimes been found to be effective in treating the symptoms and causes of CD.4 Programs like “Scared Straight” that are punitive or threatening in nature have been found to be either ineffective or to cause more harm than good.5
- Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM IV).1994. Washington, DC: American Psychiatric Association.
- Waddell C, McEwan K, Shepherd C, Offord DR, Hua JM. 2005. A Public Health Strategy to Improve the Mental Health of Canadian Children. Canadian Journal of Psychiatry; 50:226-233.
- U.S. Department of Health and Human Services. 1999. Mental Health: A Report to the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services.
- Lillienfeld SO. Scientifically Unsupported and Supported Interventions for Childhood Psychopathology: A Summary. 2005. Pediatrics; 115(3): 761-764.
- Petrosino A, Turpin-Petrosino C, Buehler J. "Scared Straight" and other juvenile awareness programs for preventing juvenile delinquency. The Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD002796. DOI: 10.1002/14651858.CD002796.