The aggressive child

Aggressive Behavior in Children and Adolescents With Bipolar Spectrum Disorder: A Systematic Review of the Prevalence, Associated Factors, and Treatment

Objective

Bipolar disorder (BD) in childhood and adolescence is associated with aggressive behaviors, which might be common and in turn associated with poor clinical outcomes. This is the first systematic review to provide a comprehensive view of the current status of the knowledge about aggressive behaviors in youth with BD.

Method

We conducted a PRISMA-compliant systematic review of studies investigating aggressive behaviors in children and adolescents with BD (PROSPERO: CRD42023431674). A systematic multi-step literature search was performed on PubMed and the Web of Science. Literature search and data extraction were carried out independently. We provided a systematic synthesis of the findings from the included studies We assessed risk of bias using a modified version of the Newcastle-Ottawa Scale for cross-sectional and cohort studies.

Results

Of the 2,277 identified records 35 were included; mean age was 12.4 years, and 57.1% were male individuals. 7 studies reported on the prevalence of aggressive behavior among BD children and adolescent population, with 5 of them reporting a prevalence of over 69.0%. Aggressive behaviors were more common in children and adolescents with BD than in those with ADHD or depression. Aggressive behaviors were associated with borderline personality disorder features and poor family functioning. Valproic acid received empirical support for its efficacy in reducing aggressive behavior in BD.

Conclusion

Aggressive behaviors are prevalent among youth with BD and warrant clinical attention and specific evidence-based management. Further research on prognostic factors and psychosocial interventions evaluated prospectively is required.

Diversity & Inclusion Statement

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.

Large-scale meta-analyses and network analyses of neural substrates underlying human escalated aggression

Escalated aggression represents a frequent and severe form of violence, sometimes manifesting as antisocial behavior. Driven by the pressures of modern life, escalated aggression is of particular concern due to its rising prevalence and its destructive impact on both individual well-being and socioeconomic stability. However, a consistent neural circuitry underpinning it remains to be definitively identified. Here, we addressed this issue by comparing brain alterations between individuals with escalated aggression and those without such behavioral manifestations. We first conducted a meta-analysis to synthesize previous neuroimaging studies on functional and structural alterations of escalated aggression (325 experiments, 2997 foci, 16,529 subjects). Following-up network and functional decoding analyses were conducted to provide quantitative characterizations of the identified brain regions. Our results revealed that brain regions constantly involved in escalated aggression were localized in the subcortical network (amygdala and lateral orbitofrontal cortex) associated with emotion processing, the default mode network (dorsal medial prefrontal cortex and middle temporal gyrus) associated with mentalizing, and the salience network (anterior cingulate cortex and anterior insula) associated with cognitive control. These findings were further supported by additional meta-analyses on emotion processing, mentalizing, and cognitive control, all of which showed conjunction with the brain regions identified in the escalated aggression. Together, these findings advance the understanding of the risk biomarkers of escalated aggressive populations and refine theoretical models of human aggression.

Association between maternal antibiotic exposure and emotional and behavioural problems in children at four years of age: A biomonitoring-based prospective study

BACKGROUND

Maternal exposure to multiple antibiotics exposure during pregnancy has attracted extensive attention, but biomonitoring studies linking prenatal antibiotic exposure to emotional and behavioural problems in children are limited.

METHODS

A total of 2475 pregnant women from the Ma'anshan Birth Cohort were included, and the Strengths and Difficulties Questionnaire was completed when their children turned four years of age. The levels of 41 maternal urinary antibiotics and two metabolites were measured during the first, second and third trimesters. Generalized estimating equations and binary logistic regression models were applied to analyse the associations between maternal antibiotic exposure and emotional and behavioural problems in children and to determine the sensitive period, respectively. A quantile-based g-computation (QGC) approach was employed to examine the combined effects of multiple antibiotics on emotional and behavioural problems in children.

RESULTS

Overall, florfenicol and preferred-as-veterinary antibiotic (PVA) exposure during pregnancy increased the risk of emotional problems in children, and ofloxacin exposure increased the risk of hyperactivity-inattention. Maternal exposure to trimethoprime, ciprofloxacin, florfenicol, other antibiotics and PVA exposure during the first trimester was positively associated with emotional problems in children. Second-trimester trimethoprime concentrations and third-trimester ciprofloxacin concentrations were positively associated with hyperactivity-inattention. Third-trimester veterinary antibiotic (VA) exposure was negatively associated with hyperactivity-inattention, and second-trimester VA and PVA exposure was negatively associated with peer problems. The QGC model revealed that mixed antibiotic exposure in the first trimester exacerbated the risk of childhood emotional problems (the contribution of ciprofloxacin is prominent), and mixed antibiotic exposure in the second trimester increased the risk of hyperactivity-inattention (the contribution of trimethoprime is prominent).

CONCLUSION

Maternal mixed antibiotic exposure during the first and second trimesters increases the risk of emotional problems and hyperactivity-inattention in children at four years of age.

Disgust sensitivity and psychopathic behavior: A narrative review

Humans live under constant threat from pathogenic microorganisms and minimizing such threat has been a major evolutionary selective force in shaping human behavior and health. A particular adaptive mechanism against the harm caused by parasites and their infectiousness is disgust sensitivity, which has evolved to detect and avoid poisonous foods as well as bodily secretions harboring virulent microorganisms. This ubiquitous and reflexive behavior requires the integration of several internal and external sensory signals between the brain, the autonomic nervous system (ANS), and the gastrointestinal tract. Although the emotional expression of disgust is experienced by almost all individuals, the neural mechanisms of sensory signals underlying disgust sensitivity may differ in certain psychiatric conditions. Psychopathy, for instance, is a personality disorder in which disgust sensitivity to contagious bodily secretions is apparently absent or downregulated from its atypical personality temperament. In this review, we provide convergent behavioral, anatomical, and cellular evidence to suggest that a fractured experience of disgust sensitivity might be an additional feature of psychopathic behavior. First, we discuss the neural networks of certain brain regions mediating the emotional states of disgust and then discuss the intersection of the ANS and gastrointestinal tract in the processing of disgust and its relevance to aberrant antisocial behavior. Together, this work highlights the interconnections between the brain and the bilateral body plan as an integrated cell network that is relevant for understanding common principles underlying function and dysfunction of disgust levels in psychiatric domains.

Caring in the Context of Systems: Service Provider Perspectives on the Mental Health Needs of Newcomer Young Men

In this study, we applied an intersectional framework to explore service providers' perspectives on the mental health needs of newcomer young men. We conducted focus groups and interviews with 26 service providers in Edmonton, Calgary, and Vancouver, Canada. Findings show that service providers made sense of young men's mental health needs and service access in the context of systems. We identified three interconnected themes: newcomer young men's senses of self in relation to macro-systems, including racism and economic marginalization; settling well as a determinant of mental health; and systems capacities and interdependent resilience. While service providers are engaged in cross-sectoral work in support of newcomer young men's mental health, this work is not being sufficiently supported. Further work is needed around cross-sector capacity bridging and advocacy, as well as the tailoring of services to young men without the assumption and reinforcement of gender stereotypes.

Differential susceptibility to parenting influences on reactive and proactive aggression: The role of testosterone and cortisol in children

This study explored whether cortisol and testosterone moderate the effect of parenting style on children's aggressive behavior, in accordance with the diathesis-stress or differential susceptibility theory; i.e., whether children are vulnerable to negative parenting styles (diathesis-stress) or, in addition to this vulnerability, also benefit more from positive parenting (differential susceptibility). The sample group comprised 279 eight-year-old children (154 boys and 125 girls) from Spain. Aggressive behavior was assessed using the "Reactive and Proactive Questionnaire" (RPQ) and parenting styles were measured using the "Parenting Styles and Dimensions Questionnaire" (PSDQ). Additionally, three saliva samples were collected to measure testosterone and cortisol levels, which were analyzed using ELISA. The results revealed that girls' high testosterone levels moderated the association between mothers' authoritarian parenting style and reactive aggression. This result can be explained by the differential susceptibility model. None of the interactions were statistically significant in boys' proactive aggression. The study emphasizes the importance of investigating biological and social factors that may influence aggressive behavior.

Impacts of the psychological stress response on aggression in adolescents during the COVID-19 epidemic in China

The sudden outbreak of COVID-19 has exerted a tremendous impact on the psyche of people around the world, especially adolescents. In order to provide a valuable theoretical basis for effective measures to prevent psychological problems in adolescents during public health emergencies in the future, this study examined the mediating effect of coping style (CS, including positive coping style (PCS) and negative coping style (NCS)) and the moderating effect of emotional management ability (EMA) on the relationship between the psychological stress response (PSR) and aggression (AGG) in adolescents during the COVID-19 epidemic in China. The Buss–Warren Aggression Questionnaire, Simplified Coping Style Questionnaire, and Emotion Management Questionnaire were employed to investigate the mental health of Chinese adolescents from April 10–20 (Time point 1, T1) and May 20–30 (Time point 2, T2), 2020. A total of 1,931 adolescents (aged 10–25 years, M = 19.18 years, 51.4% male) were examined at T1 and 334 adolescents (aged 11–25 years, M = 19.97 years, 48.7% male) were reinvestigated at T2. Overall, 17.6% of the participants at T1 and 16.8% at T2 reported obvious PSR activation. NCS partly mediated the relationship between the PSR and AGG, and the indirect effect was moderated by EMA reported at T2. There were regional differences in the moderated mediation model in low-risk areas at T1. The moderated effects of EMA at T1 and T2 were opposite. Specifically, high EMA resulted in a stronger relationship between NCS and AGG at T1, whereas high EMA resulted in a weaker relationship between NCS and AGG at T2. Psychological reactions resulting from sudden public health events may trigger AGG in younger individuals. However, EMA may have a buffering effect on the onset of AGG. This research expands our understanding of the development of AGG in adolescents during the pandemic.

The Moderating Role of Surgency, Behavioral Inhibition, Negative Emotionality and Effortful Control in the Relationship between Parenting Style and Children’s Reactive and Proactive Aggression

The principal aim of this study is to explore the moderating role of temperament in the relationship between parenting style and the reactive and proactive aggressive behavior of 8-year-old children. The participants are 279 children (154 boys and 125 girls). To measure reactive and proactive aggression, children completed the reactive and proactive questionnaire (RPQ). Child temperament and parenting styles were evaluated by both parents using the temperament in middle childhood questionnaire (TMCQ) and the parenting styles and dimensions questionnaire (PSDQ). The results revealed that boys with high surgency levels and authoritarian fathers displayed more reactive aggression, whereas behaviorally inhibited boys with mothers who scored low for authoritarian parenting displayed less reactive aggression. Finally, girls with high levels of effortful control and mothers who scored low for authoritative parenting displayed more proactive aggression. The results highlight the value of studying the moderating role of temperament in the relationship between children’s aggressive behavior and both mothers’ and fathers’ parenting styles, and underscores the importance of doing so separately for boys and girls.

Differential Susceptibility or Diathesis-Stress: Testing the Moderating Role of Temperament and Cortisol Levels between Fathers' Parenting and Children's Aggressive Behavior

Aggression is a multidimensional behavior that could be caused by different biopsychosocial variables. The aim of this study was to explore whether temperament, cortisol and sex moderate the relation between fathers’ parenting style and aggressive behavior in school-aged children, and whether this corresponds to differential susceptibility or diathesis-stress. Participants were 158 children (88 boys and 70 girls) aged 8 years. Aggressive behavior was measured using the Direct and Indirect Aggression Scale and fathers informed about their child’s temperament and their own parenting style through the Children’s Behavior Questionnaire and the Parenting Styles and Dimensions Questionnaire (respectively). Children’s’ baseline saliva cortisol levels were analyzed through an enzyme immunoassay technique. The results revealed that high cortisol levels moderated the relation between fathers’ low levels of authoritative parenting and boys’ aggression. Moreover, high negative emotionality moderated the relation between permissive paternal parenting and girls’ aggressive behavior, with both these relations being consistent with the diathesis-stress theory.

Monitoring of metabolic side-effects in children and adolescents prescribed antipsychotic medication: A systematic review

OBJECTIVES

Prescribing antipsychotic medications to children and adolescents with severe mental and developmental disorders is common; however, there is a lack of consensus on appropriate metabolic monitoring for this population. This review systematically evaluates studies examining metabolic monitoring of children and adolescents prescribed antipsychotic medication to understand the clinical practice of metabolic monitoring and identify opportunities to improve the safety of antipsychotic prescribing in this population.

METHODS

A systematic search for original research on metabolic monitoring in children and adolescents prescribed antipsychotics was conducted in six databases (PubMed, EMBASE, PsycINFO, The Cochrane Library [Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CENTRAL], Cochrane Methodology Register and Web of Science [Science and Social Science Citation Index]) from inception to February 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were assessed for quality and findings summarised using narrative synthesis.

RESULTS

Fifteen papers were identified. Studies agreed on the need for metabolic monitoring; however, there was a gap between guideline-recommended practice and clinical practice. Variable rates of baseline and subsequent monitoring were reported for both physical and biochemical parameters, with particularly low rates for monitoring requiring venesection. Younger age was also associated with lower monitoring rates. Implementation of quality improvement activities (new guidelines, staff education and checklists) improved monitoring rates although the measurement of biochemical parameters still occurred in only a minority of children.

CONCLUSION

Despite widespread awareness and concern regarding metabolic side-effects, monitoring occurred inconsistently and infrequently, particularly for biochemical parameters requiring venesection. Monitoring of anthropometric measures (weight, body mass index and waist circumference) with escalation to more laboratory testing where metabolic concerns are identified may improve monitoring. Minimising iatrogenic harm, through reduced antipsychotic prescription where possible, is a clinical priority in this population.

Maternal prenatal thyroid function and trajectories of offspring emotional and behavioural problems: findings from the ALSPAC cohort

Maternal thyroid hormone may have impact on fetal brain development and consequently lead to offspring mental health problems. This study examined the role of maternal prenatal thyroid function on trajectories of offspring emotional and behavioural problems. Data were taken from the Avon Longitudinal Study of Parents and Children. A total of 4839 mother-child pairs were included. Thyroid-stimulating hormone (TSH) levels, free thyroxine (FT4), and thyroid peroxidase antibodies (TPO-Ab) were assessed during the first trimester of pregnancy. Childhood emotional and behavioural problems were assessed using the Strengths and difficulties questionnaire. A group-based modelling approach was used to identify the different trajectories of offspring emotional and behavioural problems reported by parents over four waves of measurement at age 3.5 (42 months), 6.75 (81 months), 9 and 11 years. Multinomial logistic regression was then used to test for an association between hormone levels and class membership. We identified four trajectories of offspring emotional and behavioural problems; normative-decreasing (49.7%), moderate-decreasing (35.7%), moderate-static (8.4%), and high-decreasing (6.2%) trajectory. There were no significant differences in the mean values of mother's FT4, TSH, and the proportion of mothers with positive TPO-Ab between trajectories. Univariable and multivariable multinomial logistic models showed no association between maternal thyroid function (FT4, TSH, and TPO-Ab) and the trajectories of offspring emotional and behavioural problems. The results of our study show that maternal thyroid parameters in a community population are not associated with trajectories of offspring emotional and behavioural problems.

Family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD)

PURPOSE

To evaluate the associations between family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD).

METHODS

We conducted a matched case-control study. Data were retrieved from medical records at a psychiatry center in northern Taiwan. School-aged boys with ADHD who first visited the outpatient department at the psychiatric center between 2000 and 2011 were identified. The Child Behavior Checklist was used for aggressive behavior assessment. Boys with ADHD with T scores higher than 70 on the aggressive subscale were classified as cases and others with T scores lower than 70 were classified as controls at a 1:4 ratio. After controlling for other familial, personal, and parental factors, a multivariate conditional logistic regression was performed to evaluate the effects of family structure and birth order on aggressive behaviors of boys with ADHD.

RESULTS

277 cases and 1108 controls were included in the final analysis. Compared with living in a traditional family with both parents, living in a non-traditional family in which one or both parents were absent increased the risk of aggressive behaviors by 1.47-fold, with the highest risk for those in single parent families. Being the firstborn increased risk by 1.45-fold and the risk was higher when the firstborn had siblings.

CONCLUSIONS

Living in non-traditional families in which one or both parents were absent, and being the firstborn increased risk of aggression in school-aged boys with ADHD. Identification of this high-risk population and development of adequate preventive strategies are warranted.