Paper Example on Physical Aggression in Children: Health Risks & Prevention

Objectives

Physical aggression in children is a major public health problem. Not only is childhood physical aggression a precursor of the physical and mental health problems that will be visited on victims, but also aggressive children themselves are at higher risk of alcohol and drug abuse, accidents, violent crimes, depression, suicide attempts, spouse abuse, and neglectful and abusive parenting. Furthermore, violence commonly results in serious injuries to the perpetrators themselves. Although it is unusual for young children to harm seriously the targets of their physical aggression, studies of physical aggression during infancy indicate that by 17 months of age, the large majority of children are physically aggressive toward siblings, peers, and adults. This study aimed, first, to identify the trajectories of physical aggression during early childhood and, second, to identify antecedents of high levels of physical aggression early in life. Such antecedents could help to understand better the developmental origins of violence later in life and to identify targets for preventive interventions.

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Methods

A random population sample of 572 families with a 5-month-old newborn was recruited. Assessments of physical aggression frequency were obtained from mothers at 17, 30, and 42 months after birth. Using a semiparametric, mixture model, distinct clusters of physical aggression trajectories were identified. Multivariate logit regression analysis was then used to identify which family and child characteristics, before 5 months of age, predict individuals on a high-level physical aggression trajectory from 17 to 42 months after birth.

Results

Three trajectories of physical aggression were identified. The first was composed of children who displayed little or no physical aggression. These individuals were estimated to account for ~28% of the sample. The largest group, estimated at ~58% of the sample, followed a rising trajectory of modest aggression. Finally, a group, estimated to comprise ~14% of the sample, followed a rising trajectory of high physical aggression. Best predictors before or at birth of the high physical aggression trajectory group, controlling for the levels of the other risk factors, were having young siblings (odds ratio [OR]: 4.00; confidence interval [CI]: 2.2-7.4), mothers with high levels of antisocial behavior before the end of high school (OR: 3.1; CI: 1.1-8.6), mothers who started having children early (OR: 3.1; CI: 1.4-6.8), families with low income (OR: 2.6; CI: 1.3-5.2), and mothers who smoked during pregnancy (OR: 2.2; CI: 1.1-4.1). Best predictors at 5 months of age were mothers' coercive parenting behavior (OR: 2.3; CI: 1.1-4.7) and family dysfunction (OR: 2.2; CI: 1.2-4.1). The OR for a high-aggression trajectory was 10.9 for children whose mother reported both high levels of antisocial behavior and early childbearing.

Conclusions

Most children have initiated the use of physical aggression during infancy, and most will learn to use alternatives in the following years before they enter primary school. Humans seem to learn to regulate the use of physical aggression during the preschool years. Those who do not, seem to be at highest risk of serious violent behavior during adolescence and adulthood. Results from the present study indicate that children who are at highest risk of not learning to regulate physical aggression in early childhood have mothers with a history of antisocial behavior during their school years, mothers who start childbearing early and who smoke during pregnancy, and parents who have low income and have serious problems living together. All of these variables are relatively easy to measure during pregnancy. Preventive interventions should target families with high-risk profiles on these variables. Experiments with such programs have shown long-term impacts on child abuse and child antisocial behavior. However, these impacts were not observed in families with physical violence. The problem may be that the prevention programs that were provided did not specifically target the parents' control over their physical aggression and their skills in teaching their infant not to be physically aggressive. Most intervention programs to prevent youth physical aggression have targeted school-age children. If children normally learn not to be physically aggressive during the preschool years, then one would expect that interventions that target infants who are at high risk of chronic physical aggression would have more of an impact than interventions 5 to 10 years later, when physical aggression has become a way of life.

Keywords: physical aggression, early childhood, trajectories, predictors

Physical aggression in children is a major public health problem. Longitudinal studies show that aggressive school children are at very high risk of being violent in adolescence and beyond.1-3 Not only is childhood physical aggression a precursor of the physical and mental health problems that will be visited on victims, but also aggressive children themselves are at higher risk of alcohol and drug abuse, accidents, violent crimes, depression, suicide attempts, spouse abuse, and neglectful and abusive parenting.4-9 Furthermore, violence commonly results in serious injuries to the perpetrators themselves.10,11Although media attention is focused on instances of extreme violence during adolescence and beyond, longitudinal studies show that violence later in life is rarely an isolated event in the perpetrator's life. Children who show high levels of physical aggression during the elementary school years are at greatest risk of physical violence during adolescence and adulthood.1 Much research has been done on risk factors for high levels of aggression in school-aged children and in adolescents. Psychological characteristics include low IQ, impulsivity, hyperactivity, lack of empathy, and fearlessness.12,13 Parental risks include low levels of education, antisocial behavior, poor parenting skills, maternal early onset of child-bearing, and family discord.14-20 There is evidence of an intergenerational transmission of these problems through both genetic and environmental channels.18,19,21-24 Developmental research also shows that the spontaneous onset of physical aggression in school-aged children is highly unusual.1,7,25 Instead, the developmental precursors of chronic physical aggression are present before school entry. Although it is unusual for young children to harm seriously the targets of their physical aggression, studies of physical aggression during infancy indicate that by 17 months of age, the large majority of children are physically aggressive toward siblings, peers, and adults.26-30Because most children seem to learn to inhibit physical aggression during the preschool years, this period of life may be the most appropriate for preventive interventions. Olds et al31 showed that nurse home visitation during pregnancy and infancy can prevent child abuse and neglect, as well as juvenile delinquency. However, this study also showed that the program did not have an impact on families with high levels of domestic violence.32 These results suggest that we need better knowledge of the early development of physical aggression to guide preventive interventions with families at high risk of physical violence, yet, although much work has been done on developmental precursors of physical aggression in school-aged children, comparable evidence on the developmental course of physical aggression in preschool-aged children is extremely limited.

This article reports results from a longitudinal study of children's physical aggression development from 17 to 42 months after birth. Our aims were 1) to identify the trajectories of physical aggression during early childhood and 2) to identify antecedents of high levels of physical aggression early in life. Such antecedents could help us to understand better the developmental origins of violence later in life and to identify targets for preventive interventions. Antecedents selected as putative predictors were shown in other studies to predict antisocial behavior in school-aged children, adolescents, and adults: family income,33,34 mother's level of education,14,16 mother's age at birth of the child,16,18,20,35 mother's smoking and use of alcohol and drugs,36-40 family dysfunction,14,15,41,42 child temperament,43,44 and mother's parenting practices.14,15,37,45Go to:METHODS

Subjects

A total of 504 children were followed from 5 to 42 months of age to assess the developmental course of physical aggression. Mothers were interviewed at home 4 times, when their child was 5, 17, 30, and 42 months of age. Subjects were selected using the Quebec Ministry of Health and Social Services registry of new births. A random sample of single births was selected with a stratified procedure on the basis of the mother's area of residence and gender of the child. Area of residence was limited to a 1-hour drive by car from the 2 main urban centers in the province of Quebec; also, families were excluded when parents did not understand French or English. Demographic characteristics of the 572 families, first assessed in 1996 when the target child was 5 months of age, differed slightly from a population sample (N = 2223) representing 5-month-olds in the province of Quebec in the fall of 1997 and the spring of 1998. Compared with the latter, mothers and fathers of the 1996 sample had higher educational attainment (10.3% vs 16.0% did not finish high school; 57.1% vs 50.4% had a postsecondary education), and mothers were slightly older (29.9 vs 28.8 years). The samples did not differ on variables such as the father's age (32.3 vs 31.8 years), family income <$30 000 (Canadian; 25.5% vs 29.3%), and the number of children in the family (42.0% with 1, 37.8% with 2, 20.3% with 3 or more, in the present sample). A signed informed consent was obtained from mothers when they were visited at home by the interviewer. Ethical approval for the study was obtained form the ethic board of Sante Quebec, the governmental agency responsible for data collection.

Measures

Physical Aggression at 17, 30, and 42 Months After Birth

To assess physical aggression, we selected items from rating scales that were used in longitudinal studies with older children.1 A number of these longitudinal studies have shown that 3 items were sufficient to assess reliably physical aggression in children.1,46 Mothers were asked to indicate whether the child never (0), sometimes (1), or often (2) hits, bites, kicks; fights; and bullies others (scores on this 3-item scale may range from 0 to 6). The internal consistency value (a) was .55, .61, and .76 at 17, 30, and 42 months, respectively. Using father ratings at 42 months, the intra-class correlation among mothers and fathers was .61 (N = 355).

Child Temperament at 5 Months After Birth

The interview with the mother at 5 months included 7 items from the difficult tem...