DrAamirJeewa, MBBCH, FAAP, Pediatrics in Review Editorial Fellow
Anytime you start to peruse the varying social and traditional media outlets, it seems
there is no shortage of stories centering on violence and aggression, with many of
these incidents involving the young. There is a normal developmental peak to aggression,
as many parents have witnessed with their “terrible 2-year olds,” and then the gradual
decrease in that aggression as the child matures. However, excessive aggression—that
which is out of keeping from the norm—is a concern to parents, caregivers, schools,
and society as a whole.
It is very disheartening to hear that a quarter of children surveyed engaged in aggressive
acts, and that almost 1 in 5 report being bullied, either verbally or physically,
on school property! Such data often under-report the true incidence of bullying and
violence in children. Breaking down the problem of aggression into either impulsive
or premeditated types is the first step into then going down the “rabbit hole” to
a very complex and multifaceted problem.
Tackling aggressive behavior in children requires pediatricians to be knowledgeable
about the causes of aggression, be aware of risk assessment strategies, and become
partners in the therapeutic plan that often can involves the community, schools, mental
health specialists, child protective services, and even law enforcement.
I very much appreciated Dr. Austerman’s metaphor for aggression: “Aggression, analogous
to the physical symptom of a cough, is a nondiagnostic symptom with multiple and possible
cumulative etiologies.” Much like the cough, it signals clinicians to dig deeper for
the cause of the problem and then employ the appropriate therapies.