Maladaptive Aggression: With a Focus on Impulsive Aggression in Children and Adolescents

• Type of Material: Article
• Authors: Daniel F. Connor, University of Connecticut; Jeffrey H. Newcorn, Icahn School of Medicine; Keith E. Saylor, NeuroScience, Inc.; Birgit H. Amann, Behavioral Medical Center; Lawrence Scahill, Emory University; Adelaide S. Robb, Children's National Medical Center; Peter S. Jensen, University of Arkansas; Benedetto Vitiello, University of Turin; Robert L. Findling, Johns Hopkins University; Jan K. Buitelaar, Radboud University Medical Center
• Language: English
• Date: 2019-08-27
• Publisher: Mary Ann Liebert
• Publication Version: Final Published Version
• Copyright Statement: © Daniel F. Connor et al. 2019; Published by Mary Ann Liebert, Inc.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1089/cap.2019.0039
• Title of Journal or Parent Work: Journal of Child and Adolescent Psychopharmacology
• ISSN: 1044-5463
• Volume: 29
• Issue: 8
• Start Page: 576
• End Page: 591
• Grant/Funding Information: Editorial support was funded by Supernus Pharmaceuticals, Inc., and was provided by IMPRINT Science, New York, NY, USA.; J.K. Buitelaar was supported by funding from the European Community's Seventh Framework Programme (FP7/2007–2013) under grant agreements no. 602805 (Aggressotype); no. 603016 (MATRICS); and no. 278948 (TACTICS).
• Keywords: psychiatric disorders; CONDUCT DISORDER; maladaptive aggression; OPPOSITIONAL DEFIANT DISORDER; Life Sciences & Biomedicine; ATTENTION-DEFICIT/HYPERACTIVITY DISORDER; Science & Technology; impulsive aggression; Pharmacology & Pharmacy; aggression; Pediatrics; Psychiatry; AUTISM SPECTRUM DISORDERS; PHYSICAL AGGRESSION; PROACTIVE AGGRESSION; CALLOUS-UNEMOTIONAL TRAITS; ANTISOCIAL-BEHAVIOR; neurological disorders; DEFICIT HYPERACTIVITY DISORDER; AFFECTIVE TEMPERAMENTS
• Research Categories: Psychology, Developmental; Psychology, Behavioral

Abstract

Objective: Aggressive behavior is among the most common reasons for referral to psychiatric clinics and confers significant burden on individuals. Aggression remains poorly defined; there is currently no consensus on the best ways to recognize, diagnose, and treat aggression in clinical settings. In this review, we synthesize the available literature on aggression in children and adolescents and propose the concept of impulsive aggression (IA) as an important construct associated with diverse and enduring psychopathology. Methods: Articles were identified and screened from online repositories, including PubMed, PsychInfo, the Cochrane Database, EMBase, and relevant book chapters, using combinations of search terms such as "aggression," "aggressive behavio(u)r," "maladaptive aggression," "juvenile," and "developmental trajectory." These were evaluated for quality of research before being incorporated into the article. The final report references 142 sources, published from 1987 to 2019. Results: Aggression can be either adaptive or maladaptive in nature, and the latter may require psychosocial and biomedical interventions when it occurs in the context of central nervous system psychopathology. Aggression can be categorized into various subtypes, including reactive/proactive, overt/covert, relational, and IA. IA in psychiatric or neurological disorders is reviewed along with current treatments, and an algorithm for systematic evaluation of aggression in the clinical setting is proposed. Conclusions: IA is a treatable form of maladaptive aggression that is distinct from other aggression subtypes. It occurs across diverse psychiatric and neurological diagnoses and affects a substantial subpopulation. IA can serve as an important construct in clinical practice and has considerable potential to advance research.