|
Abstract
|
Summary
Health professionals play a unique and important role in the identification and treatment of destructive aggression in children. Through their knowledge of the developmental changes of aggression in childhood and adolescence and their therapeutic access to the entire family unit, physicians are in a favorable position to prevent the emergence of the more serious forms of aggression and violence. Epidemiologically, 15-20% of boys and 5-10% of girls have been found to have aggressive problems.
The eight types of destructive violence discussed are developmental violence, reactive violence, delinquent and antisocial violence, sadism, firesetting, suicide, homicide and episodic dyscontrol. The developmental and reactive varieties probably account for 90% of the cases physicians encounter in practice, and the great majority of these children and their families can be worked with successfully without referral to specialized child mental health services.
Diagnosis and treatment of aggressive children is best guided in the present state of our knowledge by focusing upon environmental etiologic forces. In particular, this means working with childhood aggressive behavior as a symptom of disturbed relationships between the child and his siblings and one or both partents. By viewing destructiveness and violence as symptoms that are learned, provoked by and/or maintained by the child's important human relationships, the physician is able to approach violence as not merely a symptom but also as adaptive behavior--an attempt to solve a problem.
Within this framework of aggression as environmentally determined, symptomatic, problem-solving behavior there are some simple concepts that should aid in treating most aggressive problems. These, illustrated by case examples, are (1) to focus on the total family unit; (2) to be flexible, start with what is seen by the family as a problem and work from there; (3) to begin with the common and developmental normal aspects (motives, therapeutic interventions) before tackling the more difficult and complex elements; (4) that even if one or both parents are resistive to treatment, the child himself can often be helped either individually or by way of school or community programs; (5) that a behavior modification approach can be very valuable in clinical practice.
There is now a considerable amount of practical clinical knowledge available to physicians that will be valuable in recognizing, diagnosing and treating the major preventable forms of destructive aggression and violence in children. |