Criterion validity and the utility of reactive and proactive aggression: comparisons to attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, and other measures of functioning

The ripple effect of trauma: Evaluating vulnerability, post-traumatic stress symptoms, and aggression within a child and adolescent population

BACKGROUND

The deleterious effects of experiencing adverse childhood experiences (ACEs), especially those associated with child abuse and neglect (CM-ACEs), is well documented. Two common behavioral and emotional concerns observed in children following CM-ACEs is post-traumatic stress and aggression. While support for cognitive models explaining both of these outcomes exists, little is known about any shared cognitive vulnerabilities that may explain the presence of both.

OBJECTIVE

The purpose of the current study was to evaluate a cognitive model of vulnerability/safety as a shared underlying mechanism for the development of post-traumatic stress symptoms (PTSS) and aggression following the occurrence of CM-ACEs in children.

METHODS

Male youth between the ages of 6 and 14 attending school within a residential setting participated in a school-based performance improvement program. As a part of the program, data were collected on the child's history of abuse, PTSS, aggression, and feelings of safety and vulnerability.

RESULTS

The results of the SEM suggested that there was a significant serial indirect effect of vulnerability and PTSS on the relation between CM-ACEs and reactive aggression. This was not true for proactive aggression.

DISCUSSION

The current results suggest that that there may be a shared schema-based model in which feelings of vulnerability and cognitive models promoting the world as an unsafe place may contribute to the maintenance and development of both PTSS and reactive aggression among children who have experienced abuse/neglect.

Examining bidirectional associations between sleep and behavior among children with attention-deficit/hyperactivity disorder

Background

Children with attention-deficit/hyperactivity disorder (ADHD) have more sleep problems than their peers which contribute to behavioral and functional impairments. This study examines the bidirectional relationship between nightly sleep (i.e., total sleep time and sleep efficiency) and daily behavior of children with ADHD.

Method

Forty-three children (ages 6-13 [mean = 9.05, 54% male, 77% medicated]) participated in a 2-week study during an ADHD Summer Treatment Program (STP). Sleep was measured with actigraphy. Behavior was assessed using STP clinical data and daily parent and counselor ratings of ADHD symptoms, oppositional defiant disorder behaviors, and emotion regulation (e.g., difficulty regulating emotional disposition and controlling emotions). We hypothesized that healthier night's sleep measured by actigraphy (i.e., sleep efficiency and total sleep time [TST]) would relate to less ADHD symptoms, less emotional dysregulation, and better academic performance the next day. Additionally, we hypothesized that less ADHD symptoms, less emotional dysregulation, and greater academic performance would relate to healthier sleep that night.

Results

Higher nightly sleep efficiency was related to improved parent-ratings of ADHD the next day (R 2 = 0.04, p = 0.04) and improved parent-ratings of ADHD during the day lead to higher sleep efficiency that night (R 2 = 0.002, p = 0.02). Higher rates of daily assignment completion were related to higher sleep efficiency at night (R 2 = 0.035, p = 0.03). TST was not related to any behavioral outcomes.

Conclusion

Sleep efficiency may be more relevant than TST to behavioral performance the next day. Additionally, a bidirectional relationship exists between sleep efficiency and parent ratings of ADHD. Findings highlight the importance of assessing for manifestations of poor sleep efficiency, waking minutes, and wakings after sleep onset when diagnosing and treating ADHD.

Understanding the Social Relationships of Youth with Callous-Unemotional Traits Using Peer Nominations

OBJECTIVE

The current study investigated the social and interpersonal correlates of callous-unemotional (CU) traits using peer nominations.

METHOD

Participants (N = 289) were children in Grades 3, 6, and 8 (Mage = 11.47 years, 40.1% male, 64.7% self-identified racial/ethnic minority) from two public school systems in the southern United States. Participants were asked to identify peers they believed fit a number of different characteristics hypothesized to be related to CU traits, in addition to individuals they "liked most" and "liked least." We also obtained self- and teacher ratings of CU traits and parent and teacher ratings of conduct problems (CP).

RESULTS

Factor analyses extracted three dimensions from peer nominations developed from past research describing social characteristics related to CU traits-being mean and aloof (Mean/Cold), untrustworthy and not nice (Not Nice), and dominant and manipulative (Desire for Dominance). Results indicated that CU traits were significantly associated with fewer "liked most" and greater "liked least" nominations, but not after controlling for CP. In contrast, both CP and CU traits were significantly independently associated with Mean/Cold nominations, and only CU traits were associated with Not Nice nominations when controlling for CP.

CONCLUSIONS

The findings from the current study suggest that CU traits are largely associated with traditional indices of peer rejection because of their level of CP. However, they contribute independently to perceptions of being mean, aloof, and untrustworthy. Thus, interventions focused on strengthening the social skills of children with elevated CU traits should consider ways to change these negative peer perceptions.

Reactive and proactive aggression in clinical adolescents with attention-deficit/hyperactivity disorder: The moderating role of gender and comorbidities

Aggression is well-known problem in adolescent with Attention-Deficit/Hyperactivity Disorder (ADHD), but the precise relation of reactive and proactive aggression by gender and comorbidities has not been characterized in this population. The aim of this study was to assess the level of reactive and proactive aggression in adolescents with ADHD and in matched non-ADHD clinical controls. The level of aggression was assessed by the Reactive and Proactive Aggression Questionnaire in 391 adolescents with ADHD and in 391 matched non-ADHD clinical controls. The selection of adolescents with ADHD was representative for a three-year-long period in Vadaskert Child Psychiatry Hospital. General Linear Model was used to assess the difference by ADHD, gender, and comorbidities on the level of reactive and proactive aggression. The presence of ADHD was associated with higher levels of reactive and proactive aggression. In girls, the effect of ADHD on reactive aggression was more profound. The presence of oppositional defiant disorder or conduct disorder in both groups resulted in higher levels of aggression. Our data suggest that adolescents with ADHD have higher level of aggressive behavior, and girls are especially vulnerable in terms of reactive aggressive behavior.

Functions of Aggression and Peer Likeability in Elementary School Children Across Time

We examined associations between proactive and reactive aggression and peer likability across two academic years. Analyses were based on a sample of 442 elementary school children. Proactive and reactive aggression were assessed through self-report and peer likability was assessed via a peer nomination inventory. Data were collected in the fall and spring of two academic years. Findings from cross-lagged multiple group longitudinal panel models where pathways were freely estimated for boys and girls provided evidence that the relation between reactive aggression and reciprocated liking and received only liking nominations was negative and transactional for girls. Proactive aggression had mixed associations with likability between boys and girls. Our findings suggest that preventative interventions that focus on reducing reactive aggression or increasing peer likability have the potential to shift children away from trajectories of long-term maladjustment.

Social skills moderate the time-varying association between aggression and peer rejection among children with and without ADHD

Although childhood aggression is typically associated with peer rejection, some children concurrently employ coercive and socially skilled behavior and successfully avoid negative peer outcomes. However, research on children's dual use of coercive and social behavior has largely employed cross-sectional designs with nonclinical populations and, as a result, little is known about the covariation of aggression with social skills, particularly among high-risk samples. We directly addressed this limitation by testing childhood aggression and social skills as separate time-varying predictors of prospective change in peer rejection in a sample of children with and without attention-deficit/hyperactivity disorder (ADHD). Two hundred and two 5-10-year-old children (M = 7.9 years, SD = 1.2) with and without ADHD were followed prospectively for 6 years. Key constructs, including children's overt aggression, social skills, and peer rejection, were collected at each of the three waves using multiple methods and informants. Controlling for demographic factors and time-varying ADHD symptoms, longitudinal change in child-, parent-, and teacher-reported aggression positively predicted prospective change in parent- and teacher-reported peer rejection. Importantly, predictions were moderated by parent- and teacher-reported social skills, such that aggression inversely predicted peer rejection for children with high social skills. These results demonstrate that social skills meaningfully alter trajectories of peer rejection predicted from cross-time variation in aggression. We discuss the theoretical and empirical implications of these findings within a developmental psychopathology framework, including recommendations for directions for future research.

Variability in Positive and Negative Affect Among Adolescents with and without ADHD: Differential Associations with Functional Outcomes

INTRODUCTION

This study examined whether adolescents with and without attention-deficit/hyperactivity disorder (ADHD) differed in affect variability and whether variability in positive and negative affect was associated with functional outcomes.

METHOD

Participants were 302 adolescents (12-14 years, Mage=13.17, 55% male; 54% diagnosed with ADHD; 82% white) and their caregivers who each completed the 10-item Positive and Negative Affect Scale via daily diaries for approximately two weeks. Multi-informant ratings of emotional, behavioral, social, and academic outcomes were assessed.

RESULTS

Adolescents with ADHD were found to experience greater variability in self- and parent-reported positive affect, fear, and distress. For adolescents with ADHD, greater variability in self- and parent-reported positive affect, fear, and distress were associated with more internalizing symptoms, greater variability in parent-reported positive affect was associated with worse social functioning, and greater variability in self- and parent-reported fear was associated with more externalizing symptoms. In contrast, greater variability in self- and parent-reported positive affect, fear, and distress were associated with better social functioning in adolescents without ADHD.

LIMITATIONS

Future work should examine affect variability in adolescents with ADHD within the same day rather than across days. The limited age range and demographic diversity of our sample may limit generalizability of findings.

CONCLUSIONS

Findings suggest the significant affect variability found among children with ADHD is also present in adolescents with ADHD and is associated with social and behavior impairment. Interventions for adolescents with ADHD should target emotion regulation abilities to help reduce the extremes of and shifts in affective experiences in this population.

Irritability and Limited Prosocial Emotions/Callous-Unemotional Traits in Elementary-School-Age Children

Affective traits, including irritability and limited prosocial emotions/callous-unemotional traits (LPE/CU), each explain significant variance in youth conduct problems but few studies have examined these constructs simultaneously. This study examined whether irritability, LPE/CU, or their combination explained significant variance in measures of internalizing or externalizing psychopathology, aggression, peer problems, impairment, or parenting. Participants were 219 elementary-school-age children, including 178 with attention-deficit/hyperactivity disorder, oppositional defiant disorder, and/or conduct disorder and 41 typically developing children. Results of analyses showed that irritability and LPE/CU had significant and sometimes unique associations with measures of child behavior, impairment, and parenting. There was also evidence that the interaction between irritability and LPE/CU was significantly associated with aggression and impairment. These findings suggest that irritability and LPE/CU should be examined together when assessing and treating conduct problems in youth.

Relationship Between Body Habitus and Aggression Subtypes Among Healthy Young Adults from the American Midwest

This study examined associations between body habitus and functions of aggression, in a sample of 474 college students from the Midwestern region of the United States (age range = 18-25y; 73% Caucasian). Two instruments of aggression, the Reactive-Proactive Aggression Questionnaire from Dodge & Coie 1987 (DC) and Raine et al. 2006 (RPQ) were given as self-assessments. Body habitus measures standardized by age and gender specific weight and height were collected. Subjects considered to have a large body habitus in our study had both weight and height measures above the 75th percentile. Large body habitus was positively correlated with both proactive and reactive functions of aggression among adult males but not females; however, regression analyses indicated that body habitus was most strongly and robustly associated with proactive aggression. Findings suggest that even in a healthy homogeneous population, large body size in males is associated with aggression, particularly proactive aggression including bullying rather than retaliatory aggression. The presence of a large body physique may reinforce aggressive behavioral traits acquired through life experiences and activities evoking physical dominance. Alternatively, the relationship may reflect neurological processes related to size influenced by genetic factors and hormones leading to antisocial behaviors requiring future research on the role of genes for aggression.

The Revised Child Anxiety and Depression Scales (RCADS): Psychometric Evaluation in Children Evaluated for ADHD

Co-occurring internalizing symptoms are common and important to assess in children with attention-deficit/hyperactivity disorder (ADHD). One frequently used child self-report measure of internalizing symptoms is the Revised Child Anxiety and Depression Scales (RCADS), yet the psychometric properties of the RCADS remain unexamined in children referred for ADHD specifically. The present study evaluated the RCADS in 117 children (ages 8-12; 66% male) evaluated for suspected ADHD at an ADHD specialty clinic (83% met criteria for ADHD). In addition to the RCADS, children completed measures of social anxiety and depression. Parents completed the RCADS-Parent Version (RCADS-P) in addition to other measures of internalizing and externalizing symptoms. Children and parents both completed a measure of aggression. Factor structure, reliability, and convergent/discriminant validity of the RCADS were examined. Results supported the six-factor structure of the child-report RCADS (Separation Anxiety, Social Phobia, Generalized Anxiety Disorder, Panic Disorder, and Obsessive Compulsive Disorder, Major Depressive Disorder). The RCADS demonstrated adequate reliability as well as convergent and discriminant validity with other child ratings. The total anxiety score on the RCADS also demonstrated convergent and discriminant validity with parent measures, though the depression score on the RCADS did not. Findings provide preliminary psychometric support for the RCADS in children referred for ADHD.

Serotonin and aggressive behaviour in children and adolescents: a systematic review

OBJECTIVE

The role of serotonin (5-HT) in human aggression has been the subject of a large number of studies, mostly with adults. Meta-analyses indicate a small but significant inverse relationship between central nervous 5-HT availability and aggression, but genetically informed studies suggest two pathways: one to reactive aggression and the other to proactive aggression.

METHOD

We conducted a systemic review on central nervous 5-HT function in children and adolescents, with attention to the function of aggression.

RESULTS

In total, 675 articles were screened for relevance, with 45 reviewed. These included blood assays (e.g. plasma, 5-HIAA; platelet 5-HTR_2A ), epigenetic studies, retrospective PET studies and 5-HT challenge paradigms (e.g. tryptophan depletion). Overall, findings were mixed, with support both for negative and for positive associations of central nervous 5-HT function with aggression in children and adolescents.

CONCLUSION

We propose factors that may be blurring the picture, including problems in the conceptualization and measurement of aggression in young people, the lack of prospective designs and the bias towards clinical samples of boys. Research needs to account for variance in the both motivation for and implementation of aggression, and look to the behavioural economics literature to consider the roles of reward, vengeance and self-control more clearly.

Testing the exacerbation and attenuation hypotheses of the role of anxiety in the relation between ADHD and reactive/proactive aggression: A 10-year longitudinal study

Both anxiety and aggression commonly co-occur with ADHD symptoms. Two competing hypotheses describing the role of anxiety in aggression associated with ADHD symptoms have previously been advanced. The exacerbation hypothesis proposes that the presence of anxiety increases the risk of aggression in the context of ADHD symptoms. The attenuation hypothesis proposes that the presence of anxiety protects against aggression in the context of ADHD symptoms. We tested these hypotheses using moderated cross-lagged panel models in the Zurich project on social development from childhood to adulthood (z-proso) sample using both self-report (3 waves) and informant-report (8 waves) data spanning ages 7-17. We found evidence that anxiety protects against both reactive and proactive aggression; however, the effect was direct: there was no evidence for anxiety moderating the strength of ADHD symptom-aggression links. Results suggest that anxiety likely plays an important role in inhibiting aggression but does not interact with ADHD symptoms in the manner predicted by either the exacerbation or attenuation hypothesis.

Functions of Aggression and Peer Victimization in Elementary School Children: the Mediating Role of Social Preference

This study examined whether social preference was a mechanism that explained the relation between proactive and reactive aggression and peer victimization. Participants were 494 children in grades 2-5. Proactive and reactive aggression was assessed via a self-report measure and indices of social preference and peer victimization were assessed via a peer nomination inventory. Data was collected during the fall and spring of two academic years. The relations among aggression, social preference, and peer victimization varied as a function of aggression and gender. For girls, reactive aggression was a significant negative predictor of social preference. Findings also revealed social preference mediated the relation between reactive aggression and peer victimization for girls. This pathway did not hold for boys. There was some evidence that proactive aggression was negatively associated with peer victimization, but only for girls. Findings from the current study suggest social preference may be a key mechanism through which reactive aggression is associated with future victimization for girls. Boys' aggression was not related to subsequent peer victimization. Future research and intervention efforts should consider gender differences and the function of aggression when investigating children's peer victimization experiences.

Reactive Aggression and Suicide-Related Behaviors in Children and Adolescents: A Review and Preliminary Meta-Analysis

The empirical literature on the association between reactive aggression and suicide-related behaviors in children and adolescents was reviewed. A narrative review of seven studies that met inclusion/exclusion criteria is followed by a preliminary meta-analysis to provide insight into the strength of the association between reactive aggression and suicide-related behaviors. Each of the seven studies reported a statistically significant association between reactive aggression and suicide-related behaviors, including suicide, nonfatal suicide attempt, and suicide ideation. Results from the meta-analysis indicated a consistent, medium-sized association (k = 7; N = 4,693; rbar = .25). The narrative review and results of the preliminary meta-analysis support the promise of pursuing future research on reactive aggression and suicide-related behaviors in children and adolescents. A theoretical model is proposed to guide the development of future research.

The Role of Parenting Styles in the Relation Between Functions of Aggression and Internalizing Symptoms in a Child Psychiatric Inpatient Population

Psychiatric inpatient hospitalization is a costly intervention for youth. With rates of hospitalization rising, efforts to refine prevention and intervention are necessary. Aggression often precedes severe internalizing behaviors, and proactive and reactive functions of aggression are differentially associated with internalizing symptomatology. Thus, further understanding of the links between functions of aggression and internalizing symptomatology could aid in the improvement of interventions for hospitalized youth. The current study examined parenting styles, gender, and age as potential moderators of the relations between proactive and reactive aggression and internalizing symptoms. Participants included 392 children, 6-12 years of age admitted consecutively to a psychiatric inpatient unit. Reactive aggression was uniquely associated with anxiety symptoms. However, proactive aggression was associated with internalizing problems only when specific parenting styles and demographic factors were present. Although both proactive and reactive subtypes of aggression were associated with internalizing symptoms, differential associations were evident. Implications of findings are discussed.

Rating Scale Assessment of Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD): Is there a Normal Distribution and Does it Matter?

A behavior rating scale for evaluating both exceptionally high and exceptionally low levels of ADHD and ODD symptoms was developed. Mothers, fathers, and teachers in seven elementary schools completed ratings. Resulting data were psychometrically sound, with high internal consistency and test-retest reliability and evidence of factorial, convergent, and discriminant validity. About 25% of children were rated by mothers, fathers, and teachers as having lower than average levels of ADHD, and about 50% were rated as having lower than average ODD symptoms. Children with moderate and severe levels of ADHD and ODD differed from other children on measures of symptom impairment, need for treatment, quality of teacher-student relationship, and peer nominations. Children with exceptionally low levels of ADHD and ODD differed from children with average levels of ADHD and ODD on teacher-completed measures but less so on peer-completed measures. Advantages of evaluating both lower and higher levels of ADHD and ODD are discussed.

Teacher-Classified Peer Social Status: Preliminary Validation and Associations with Behavior Ratings

This study investigated whether teacher ratings may be a valid alternative measure of social status in elementary school children, and whether teacher social status ratings are distinct from their disruptive behavior ratings. Participants were 1,596 elementary school children in seven schools in eastern Canada. Teacher ratings of social status and of disruptive behavior were collected for all children, along with positive peer nominations for a large subset. Results showed that children rated by teachers as rejected and ignored received the fewest positive peer nominations, whereas children rated as popular received the most positive nominations. Analyses of covariance showed that inattention was more highly associated with peer problems than was hyperactive-impulsive, oppositional, or conduct problems, but none of these behaviors accounted for the association between teacher-rated social status and peer positive nominations. Results provide preliminary support for the validity of teacher-rated social status in elementary-aged children.

Associations between Peer Nominations, Teacher Ratings, Self-Reports, and Observations of Malicious and Disruptive Behavior

This study evaluates the validity of two aggression scales for predicting observations of malicious or disruptive behavior at school. Subgroups of a sample of 1,560 children (age 8.6 ± 1.5 years) were assessed using (a) peer nominations of aggression, (b) teacher reports on the Teacher Report Form (TRF) of the Child Behavior Checklist (CBCL) Aggression scale and the peer nomination items, or (c) self-reports on the peer nomination items. Criteria were observations of physical, verbal, initiated, retaliatory, malicious, and disruptive behaviors. Teacher report peer nominations predicted observed physical, verbal, initiated, and retaliatory aggression and disruptive behavior. Peer nominations predicted physical aggression, verbal aggression, initiation and disruptive behavior, and TRFs predicted verbal, initiated, and disruptive behavior. Self-reports did not significantly predict any behavior. Implications for assessment of aggression are discussed.

Latent Profiles of Externalizing Psychopathology and Their Relation to Children's Aggression and Social Behavior

OBJECTIVE

This study identified profiles of clinic-referred children with disruptive behavior and determined the association between identified profiles and children's aggression, peer problems, and prosocial skills.

METHOD

Parents and teachers of 208 children (163 boys) aged 6 to 12 years (Mage = 8.80, SD = 1.75) completed measures to assess children's callous-unemotional (CU) traits, inattentive-impulsive-overactive (IO) and oppositional-defiant (OD) behavior, aggression, and social behaviors. Latent class analysis was used to identify the profiles, and the pseudoclass draw method to test the equality of means for each of the aggression and social behavioral outcomes across the latent classes.

RESULTS

Five profiles were identified: (1) Low (35.6% of children), with relatively low levels of CU traits and IO and OD behavior; (2) Low-Moderate (30.8%), with low-moderate levels of CU traits, low IO and moderate OD behavior; (3) Moderate (21.6%), with moderate levels of CU traits and IO and moderate-high OD behavior; (4) Moderate-High (7.2%), with moderate-high levels of CU traits, high IO and moderate-high OD behavior; and (5) High (4.8%), with high levels of CU traits, IO and OD behavior.

CONCLUSION

Children categorized into profiles showed important differences in level of aggression and social behavior. The overlap between CU traits, IO, and OD behavior add to understanding of child psychopathology that influences behavior and clinical outcomes.

Proactive and reactive aggression in childhood and adolescence: A meta-analysis of differential relations with psychosocial adjustment

Aggressive behavior in childhood has long been separated into that which is proactively motivated and that which is reactive. We report a meta-analytic review of the existing empirical literature that examines the associations of each type of aggression with six indices of psychosocial adjustment: internalizing problems, emotional dysregulation and ADHD-type symptoms, delinquent behaviors, prosocial behavior, sociometric status, and peer victimization. Even though not detectable in most single studies, meta-analytic combination revealed that reactive aggression was more strongly related to most of the indices of adjustment than was proactive aggression. This difference was small, however, and we argue that the difficulty in detecting differential correlates is due to the high intercorrelation between the functions of aggression, which appears to be an artifact of traditional measurement procedures. It is recommended that future research use measures that provide distinct assessment of the functions in order to more clearly distinguish the correlates of proactive and reactive aggression.

Self-Reported Emotion Reactivity Among Early-Adolescent Girls: Evidence for Convergent and Discriminant Validity in an Urban Community Sample

Emotion reactivity, measured via the self-report Emotion Reactivity Scale (ERS), has shown unique associations with different forms of psychopathology and suicidal thoughts and behaviors; however, this limited body of research has been conducted among adults and older adolescents of predominantly White/European ethnic backgrounds. The present study investigated the validity of ERS scores for measuring emotion reactivity among an urban community sample of middle-school-age girls. Participants (N = 93, ages 11-15, 76% African-American, 18% Latina) completed the ERS and measures of emotion coping, internalizing problems, proactive and reactive aggression, negative life events, and lifetime suicidal ideation and substance use. As hypothesized, ERS scores were significantly associated with internalizing problems, poor emotion coping, negative life events, reactive aggression, and suicidal ideation (evidence for convergent validity), but showed little to no association with proactive aggression or lifetime substance use (evidence for discriminant validity). A series of logistic regressions were conducted to further explore the associations among internalizing problems, emotion reactivity, and suicidal ideation. With depressive symptoms included in the model, emotion reactivity was no longer uniquely predictive of lifetime suicidal ideation, nor did it serve as a moderator of other associations. In conjunction with previous research, these findings offer further support for the construct validity and research utility of the ERS as a self-report measure of emotion reactivity in adolescents.

The Role of Hostile Attributions in the Associations between Child Maltreatment and Reactive and Proactive Aggression

The present study examined the relations between child maltreatment and reactive and proactive functions of aggression, and whether hostile attribution biases partially accounted for these associations in a sample of 339 college students (mean age = 19; 51% male). Child maltreatment was associated with reactive, but not proactive, aggression, and instrumental hostile attribution biases accounted for this association. Relational hostile attributions were correlated with both reactive and proactive aggression, but did not play a role in the link between child maltreatment and reactive aggression.

The Role of Reactive Aggression in the Link Between Hyperactive-Impulsive Behaviors and Peer Rejection in Adolescents

Attention-deficit/hyperactivity disorder (ADHD) symptoms and aggressive behaviors are both associated with peer rejection, but little is known the nature of this association with respect to the two symptom dimensions of hyperactivity-impulsivity and inattention and different types of aggression. The present study examines the relations between dimensions of ADHD symptomatology, proactive and reactive aggression, and peer rejection in adolescence. Teacher-reported data were obtained for 200 high school students (grades 9-12; 48% female; predominately Latino). In structural equation modeling path analyses, the indirect effects of reactive aggression accounted for the link between hyperactivity-impulsivity and peer rejection. Within the same model, neither inattention nor proactive aggression were associated with peer rejection. These findings suggest that reactive aggression may be a key mechanism through which hyperactive-impulsive behavior is associated with peer rejection. Future research and intervention efforts should address the role of reactive aggression among youth with ADHD symptomatology.

Clinical Profiles of Children with Disruptive Behaviors Based on the Severity of Their Conduct Problems, Callous-Unemotional Traits and Emotional Difficulties

This study identified clinical profiles of referred children based on the severity of callous-unemotional (CU) traits, emotional difficulties, and conduct problems. Parents of 166 children (132 males) aged 6-12 years referred to a hospital clinic because of disruptive behavior completed measures to assess these key indicators, and person-centered analysis was used to identify profiles. Four distinct profiles were identified that include: (1) Children low in severity on the three domains, (2) Children high in severity on the three domains, (3) Children high in severity in conduct problems and CU traits with minimal emotional difficulties, and (4) Children high in severity in conduct problems and emotional difficulties with minimal CU traits. Profiles differed in degree of aggression and behavioral impairment. Findings show that clinic-referred children with disruptive behaviors can be grouped based on these important indicators into profiles that have important implications for assessment and treatment selection.

The role of cortisol and psychopathic traits in aggression among at-risk girls: tests of mediating hypotheses

Multiple etiological factors (e.g., biological and personality predispositions) have been linked to the development of aggression. The purpose of the present study was to examine the relation between proactive/reactive aggression and biological (HPA-axis functioning) and personality characteristics (subdimensions of psychopathy) among girls at risk for aggressive behavior. Participants included girls (N = 158) admitted for acute psychiatric inpatient treatment (M age = 9.72; SD = 1.99). Parents completed a measure of proactive/reactive aggression and psychopathy upon admission. Fasting plasma cortisol levels were obtained the morning following the child's admission. Correlational analyses revealed a significant negative correlation between cortisol and the narcissism and impulsivity subdimensions of psychopathy as well as proactive/reactive aggression. A significant positive relation between proactive and reactive aggression and the three subdimensions of psychopathy was also observed. Path analyses revealed that only narcissism was uniquely and positively related to proactive and reactive aggression. Tests of indirect effects from cortisol to aggression through subdimensions of psychopathy indicated significant pathways via narcissism to proactive and reactive aggression. The findings support previous research linking narcissism uniquely to aggression for girls and suggest that the relation between cortisol and proactive/reactive aggression is mediated by narcissism.

Callous-unemotional traits, proactive aggression, and treatment outcomes of aggressive children with attention-deficit/hyperactivity disorder

OBJECTIVE

Stimulant treatment improves impulse control among children with attention-deficit/hyperactivity disorder (ADHD). Decreased aggression often accompanies stimulant pharmacotherapy, suggesting that impulsiveness is integral to aggressive behavior in these children. However, children with high callous-unemotional (CU) traits and proactive aggression may benefit less from ADHD pharmacotherapy, because their aggressive behavior seems more purposeful and deliberate. This study's objective was to determine whether pretreatment CU traits and proactive aggression affect treatment outcomes among aggressive children with ADHD receiving stimulant monotherapy.

METHOD

We implemented a stimulant optimization protocol with 160 children 6 to 13 years of age (mean [SD] age of 9.31 [2.02] years; 78.75% male) with ADHD, oppositional defiant or conduct disorder, and significant aggressive behavior. Family-focused behavioral intervention was provided concurrently. The primary outcome was the Retrospective Modified Overt Aggression Scale. The Antisocial Process Screening Device and the Aggression Scale, also completed by parents, measured CU traits and proactive aggression, respectively. Analyses examined moderating effects of CU traits and proactive aggression on outcomes.

RESULTS

In all, 82 children (51%) experienced remission of aggressive behavior. Neither CU traits nor proactive aggression predicted remission (CU traits: odds ratio [OR] = 0.94, 95% CI = 0.80-1.11; proactive aggression, OR = 1.05, 95% CI = 0.86-1.29). Children whose overall aggression remitted showed decreases in CU traits (effect size = -0.379, 95% CI = -0.60 to -0.16) and proactive aggression (effect size = -0.463, 95% CI = -0.69 to -0.23).

CONCLUSIONS

Findings suggest that pretreatment CU traits and proactive aggression do not forecast worse outcomes for aggressive children with ADHD receiving optimized stimulant pharmacotherapy. With such treatment, CU traits and proactive aggression may decline alongside other behavioral improvements. Clinical trial registration information--Medication Strategies for Treating Aggressive Behavior in Youth With Attention Deficit Hyperactivity Disorder; http://clinicaltrials.gov/; NCT00228046; and Effectiveness of Combined Medication Treatment for Aggression in Children With Attention Deficit With Hyperactivity Disorder (The SPICY Study); http://clinicaltrials.gov/; NCT00794625.

A longitudinal assessment of the associations among response access, attention problems, and aggression during childhood

Children with ADHD symptoms often display social competence deficits, yet mechanisms for their social difficulties remain unclear. Using data from the normative sample of non-intervention respondents (N = 387; 50 % male; 49 % non-European-American; age at initial assessment: M = 6.5 years, SD = 0.48) in the Fast Track project (Lochman and CPPRG Journal of Consulting and Clinical Psychology 63:549-59, 1995), the social-information processing ability of accessing responses for social situations was modeled across four time points from kindergarten to third grade. Teacher-rated aggression and ADHD symptoms were included as predictors of the intercept and slope. Low ADHD symptoms were associated with a decline in aggressive responses across childhood, whereas high ADHD symptoms were linked to an increase in aggressive responses that decelerated between second and third grade. Regarding competent responses, low ADHD symptoms predicted increases in competent responses, but this increase decelerated between second and third grade. High ADHD symptoms were also associated with a slight increase in competent responses into first grade, but competent responses decreased from first to third grade. Neither aggression nor the interaction of ADHD symptoms and aggression accounted for a significant amount of variance in aggressive or competent responses. Future research should identify if differences in response access associated with high and low ADHD symptoms link to difficulties making and keeping friendships.

Oppositional defiant disorder symptoms in relation to psychopathic traits and aggression among psychiatrically hospitalized children: ADHD symptoms as a potential moderator

Oppositional defiant disorder (ODD) is associated with elevated rates of psychopathic traits and aggression. However, it remains unclear if attention-deficit/hyperactivity disorder (ADHD) symptoms exacerbate these relations, particularly in samples of children who are severely clinically distressed. The purpose of the present study was to test ADHD symptoms as a potential moderator of the relations of ODD symptoms to psychopathic traits (i.e., callous-unemotional [CU] traits, narcissism) and to aggressive subtypes (i.e., proactive, reactive aggression) in a large sample of children in an acute psychiatric inpatient facility (n = 699; ages 6-12). Multiple regression analyses indicated that, after controlling for child demographic variables, ADHD symptoms marginally exacerbated the relation between ODD symptoms and CU traits. Both ODD and ADHD symptoms had an additive, but not a multiplicative effect, in predicting narcissism. In addition, for a subset of the full sample for whom data were available (n =351), ADHD symptoms exacerbated the relation between ODD symptoms and both reactive and proactive aggression. These results suggest that ADHD symptoms tend to have a negative effect on the relation between ODD symptoms and markers of antisociality among children receiving acute psychiatric care.

Aggression as positive reinforcement in people with intellectual disabilities

From an applied behavior-analytic perspective, aggression in people with intellectual disabilities is mostly maintained by social reinforcement consequences. However, nonsocial consequences have also been identified in functional assessments on aggression. Behaviors producing their own reinforcement have been labeled "automatic" or "nonsocial" in the behavior-analytic literature, a label that bares a striking resemblance to biobehavioral explanations of reward-seeking behaviors. Biobehavioral studies have revealed that aggression activates the same endogenous brain mechanisms as primary reinforcers like food. Therefore, integrating brain-environment explanations would result in a better understanding of the functional mechanisms associated with nonsocial aggression. The purpose of this paper was to explore aggression as a reinforcing consequence for reinforcement-seeking behaviors in people with intellectual disabilities. First, the literature establishing aggression as reinforcement for arbitrary responding will be reviewed. Next, the reward-related biological process associated with aggression was described. Finally, the paper discusses what might be done to assess and treat aggression maintained by nonsocial reinforcement.

Associations between effortful control, psychological control and proactive and reactive aggression

The current study examined relations between effortful control (ones ability to focus and shift attention in an adaptive manner), psychological control (caregiver attempts to manipulate the child's internal world) and proactive and reactive aggression. Participants were 69 children (54% male) ranging from 9 to 12 years of age (M = 10.35, SD = 1.14) and their primary caregivers from a community-recruited sample. Results indicate that psychological control and effortful control interacted and contributed to proactive aggression. At high levels of effortful control psychological control was positively associated with proactive aggression, whereas at low levels of effortful control psychological control was unrelated to proactive aggression. In contrast, although both effortful control and psychological control were correlated with reactive aggression, only effortful control was uniquely negatively associated with reactive aggression. Implications for prevention and intervention are discussed.

Interactive links between theory of mind, peer victimization, and reactive and proactive aggression

This study investigated the relation between theory of mind and reactive and proactive aggression, respectively, as well as the moderating role of peer victimization in this context. The 574 participants were drawn from a longitudinal study of twins. Theory of mind was assessed before school entry, when participants were 5 years old. Reactive and proactive aggression as well as peer victimization were assessed a year later in kindergarten. Results from multilevel regression analyses revealed that low theory of mind was related to a high level of reactive aggression, but only in children who experienced average to high levels of peer victimization. In contrast, a high theory of mind was related to a high level of proactive aggression. Again, this relation was especially pronounced in children who experienced high levels of peer victimization. These findings challenge the social skills deficit view of aggression and provide support for a multidimensional perspective of aggressive behavior.

Reactive and proactive aggression in childhood and adolescence: precursors, outcomes, processes, experiences, and measurement

This paper reviews and critiques the growing literature on the distinction between reactive and proactive aggression in children and adolescents. Empirical findings suggest that the subtypes of aggression are (a) preceded by different familial precursors, (b) associated with different behavioral outcomes, (c) driven by different social-cognitive and emotional processes, and (d) related to different social experiences. Because measurement difficulties have been a prominent concern in the study of reactive and proactive aggression, a discussion of various assessment approaches is included. Suggestions are made for future research directions, including a greater use of observational and laboratory-based methods, more longitudinal designs, and a greater focus on the careful assessment of the subtypes of aggression.

Aggression and the risk for suicidal behaviors among children

Two subtypes of aggression--reactive and proactive--were examined to see how they relate to suicidal behaviors among young children admitted for acute psychiatric inpatient care. The children and their parents completed self-report questionnaires/interviews. Regression analyses revealed that depressed girls who scored higher on reactive aggression reported more suicidal behaviors; whereas proactive aggression did not relate to suicidal behaviors for either boys or girls.

Child abuse and aggression among seriously emotionally disturbed children

Abused children may be at risk for problems with aggression. In a sample of 397 seriously emotionally disturbed children, reactive aggression was associated with documented history of physical abuse but not sexual abuse. Girls were equally likely to be classified as reactively aggressive regardless of physical abuse history, but boys with physical abuse histories were 50% more likely to be classified as reactively aggressive than boys with no physical abuse history. Proactive aggression was unrelated to physical or sexual abuse history. The association of physical abuse and reactive aggression warrants further scientific study and attention in clinical assessment and treatment with seriously emotionally disturbed children.