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Aggression in Children – Causes, Behavioral Manifestations and Management

Submitted by on November 16, 2014 – 7:25 PM

aggressive-boyAggression in children is the first step on the slippery slope to the misbehavior. Occasional outbursts of aggression in children are normal but if it occurs frequently in a pattern it is considered as a problem. Aggression is a forceful, inappropriate, non adaptive verbal or physical action designed to pursue personal interest (Stuart, 2009).


Aggressive behavior can be self-directed, reactive, or in revenge. It can also be proactive, overt or secretive (Pouw, Rieffe, Oosterveld, Huskens & Stockmann, 2013). Aggressive behavior can be well explained in the example given below.


A 10-years-old boy appears irritable, impulsive and restless. He is argumentative and verbally aggressive. He screams, bites, hits and breaks things to release his frustration. He is often disobedient and resentful to his parents and teachers. He has been a high achiever at school but now shows lack of interest and poor performance in studies.


His aggressive behavior disrupts lessons in school and threatens other children in the class. He also responds to his friends angrily and shows distress which is hard to calm by his parents. His aggressive behavior is now a matter of concern for his parents. Worried parents wonder if they lacked something in the upbringing of the child or society is the reason of their child being so aggressive.


The aggression prevalence rate in children was reported as 35% in South Asian countries in 2010. The prevalence of aggression in children is 49.6% in Pakistan. Among them 56% is the aggression prevalence rate of the children in Sind in 2010 (Kanne & Mazurek, 2011). The current statistics demands a lot of hard work for the behavior modification of the children.


The key to handle aggressive behavior is to understand the factors which trigger aggression.  The neurobiological theories suggest that the low serotonin levels and increased activity of dopamine and nor epinephrine are associated with aggressive behaviors. Whereas,  neuro imaging studies indicate that the aggressive behaviors are associated with abnormalities in limbic, frontal and temporal lobes of cerebral cortex  (Siever, 2008).


The aggressive conduct can result from media violence, prior experiences and actual traumas that trigger the fight response in the nervous system. Thus the children responds aggressively to the perceived threat (Kliem & Rehbein, 2014).  Secondly, an unhealthy relationship or communication gap  between parents and children also affects their  behavior. Ineffective, authoritarian, harsh and rejecting parenting styles contribute to such behaviors (Fikkers, Piotrowski, Weeda, Vossen & Valkenburg, 2013).  Psychological problems in parents such as depression, drug abusing and misusing, and alcoholism can also contribute to aggression in children.


Thirdly, aggressive actions in children are the effects of the attention-deficit hyperactivity disorder (ADHD), manic stage of bipolar disorder, schizophrenia, paranoia or other psychotic conditions (Stuart, 2009). Sometimes, children behave cobative due to fear of inability to deal with emotions, especially frustration and are incapable to verbalize the situation efficiently. Other factors including environmental influences, unrelieved stress, lack of appropriate problem solving skills and coping strategies can also result in aggressive behaviors (Kanne & Mazurek, 2011).


Aggression imposes adverse impacts on the child’s health. Physically, there is hormonal imbalance resulting in an increased risk for self harm or suicide. In addition, aggressive children are at risk of developing serious anti-social behavioral disorders. Socially, they are unable to communicate effectively, resulting in disruptive relationships leading to social isolation.


Psychologically, aggressive children remain unhappy, upset and distressed. They always indulge in fights with others and end their conversations in conflicts. These children are at risk of developing psychiatric problems (Pouw, Rieffe, Oosterveld, Huskens & Stockmann, 2013).


Aggression in children is a significant concern of our society. Some measures can be taken to improve the behavior.  Initially, by using General Aggression Model, I as a nurse can first identify the primary cause or underlying factors of aggressive behaviors in children. It emphasizes on three critical stages of aggression i.e. personal factors, situational inputs and present internal states (i.e., cognition, arousal, affect, including brain activity) and outcomes of appraisal and decision-making processes(Denson, 2011).


In addition, screening can be done to rule out hormonal imbalance leading to aggression. I as an educator can teach parents about the nonaggressive techniques to deal with the situations. Parents can find age appropriate ways of explaining, teaching and reinforcing these techniques to their children.


At institutional level, I as a counselor can enhance the use of psychotherapies for behavior modification. Cognitive behavioral therapy (CBT) can be used to teach the ways to control the aggressive behavior of the children. (Stuart,2009). In addition, talking therapy can help in understanding the causes of aggression and work with the feelings leading to such attitude.  (Kliem & Rehbein, 2014).  These therapies help to regulate emotions, identify etiological factors, and develop coping skills in children.


Moreover, discipline strategies teach children new methods to handle their negative feelings and behaviors. Time out strategy and withdrawal of privileges (i.e. taking away something the children enjoys, or missing out on a favorite activity, like watching television) can also be helpful (Gini, Pozzoli & Hymel, 2014).


Positive discipline such as reward system and praising can motivate children to withdraw the aggressive behavior. Moreover, calm, consistent response from parents can teach the children  to react evenly to life’s frustrations.  I as a collaborator can work with policy makers and the government to ensure the implementation of the non-aggressive techniques to deal with aggressive children.


In conclusion, aggression in children is the issue that needs to be addressed. The current statistics demands a lot of hard work and dedication in promoting and educating parents about dealing with aggressive children. Health care provider with the collaboration of parents can assist in behavior modification of children. It is important to resolve the issue to help children in maintaining their health.



Denson, T. (2011). A social neuroscience perspective on the neurobiological bases of aggression.

The American Journal of Psychiatry, 161.Retrieved from:

Fikkers, K., Piotrowski, J., Weeda, W., Vossen, H., & Valkenburg, P. (2013). Double

Dose: High Family Conflict Enhances the Effect of Media Violence Exposure on

Adolescents’ Aggression. Societies3(3), 280-292.Retrieved from:;jsessionid=D53002AA167C409C1A4867FF3C3FF2A6?doi=

Gini, G., Pozzoli, T., & Hymel, S. (2014). Moral disengagement among children and youth: A

meta-analytic review of links to aggressive behavior. Aggressive Behavior40(1), 56-68. Retrieved from:

Kanne, S., & Mazurek, M. (2011). Aggression in children and adolescents with ASD: prevalence

and risk factors. Journal of Autism and Developmental Disorders41(7), 926-937. Retrieved from:

Kliem, S., & Rehbein, F. (2014). Longitudinal Effects of Violent Media Usage on Aggressive

Behavior—The Significance of Empathy. Societies4(1), 105-124. Retrieved from:


Pouw, L., Rieffe, C., Oosterveld, P., Huskens, B., & Stockmann, L. (2013). Reactive/proactive

aggression and affective/cognitive empathy in children with ASD. Research in Developmental Disabilities34(4), 1256-1266.Retrieved from:

Siever, L. J. (2008). Neurobiology of aggression and violence. The American Journal of

Psychiatry, 165. 429-442. doi: 10.1176/appi.ajp.2008.07111774. Retrieved from:

Stuart, G.W. (2009). Principles and practice of psychiatric nursing (9th ed.). St. Louis: Mosby.


About the Author: Shamsa Hadi is a third year student of Bachelors of Science in Nursing at Aga Khan University, Pakistan. Her area of interest is public health management. She can be reached at [email protected]


About this article: This article is competing for the JPMS International Medical Writing Contest 2014.

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