The Hyperaggressive Young Child
Some parents and some child care providers don’t let these children exercise the skills they do have – for example, by overprotecting the child, being intrusive, or failing to provide play opportunities – and anger can be the result. Sometimes, the clue is right in front of you during the office visit when a parent won’t let the child explore the room, take toys you hand her, or even answer your questions. So even though a developmental screen is definitely needed when you evaluate aggression, don’t forget to ask about opportunities for the child to try to master things. Of course, the opposite may also be a factor in aggression: A child who has few limits may be wildly out of control, with aggression the ultimate behavioral result.
• Need for positive emotional tone. Positive attention is important for children as they try to acquire self-regulation. Although playfulness may seem like a far reach for stressed families, your suggestions of ways to have fun with the child – even 10 minutes a day of one-on-one special time – can often start to reset the tone of the relationship.
Aggressive behavior sometimes develops when it is the only way children can get the attention they crave from their caregivers. That’s why first attending to the victim of aggression rather than to the perpetrator can be helpful. Teaching parents to put marks on the child’s hand for little demonstrations of positive behavior (aiming for 10 per hour with a reward for "a bunch") can also shift the interaction from reactions that reinforce bad behavior toward those that acknowledge the good.
Sometimes, the source of aggression is no surprise as you enter the exam room to see the parent smacking or screaming at the child for every little thing. Although the cause of the aggression may seem obvious, the solution may not be; such parenting was likely learned when those parents were children themselves, making the behavior extra hard to change. But just because these habits were acquired early does not mean that the parents are actually happy with them. Even among parents who believe in spanking, 85% say that they would rather not spank their children but did not know an alternative.
Rather than reprimand the parent, you can comment, "He sure seems to be a handful," but then follow up with "How is that for you?" This question alone can be an important first step to uncovering a mother who is depressed (35%-50% of mothers of children younger than age 5 years) or who experiences partner violence (3-10 million in the United States), or a father who is stressed by working long hours plus caring for small children. Problem solving with such parents about ways to take a break, to get some help, or to get out of a negative situation may be needed. Although helping them to connect their stresses with the child’s aggression can sometimes be all that is needed to get them to act, efforts to motivate them by focusing on the need to change "for the child’s sake" have been shown to be less effective than first addressing and empathizing with the parents’ own distress.
A good strategy is to first ask permission to discuss the problem of the child’s behavior. This less-judgmental approach will be more likely to get you an opening to explore their situation, consider alternatives, teach "time out," offer advice, or at least schedule a follow-up appointment that will include relevant family members. Parents who are distressed by an aggressive child won’t know that you can help unless you offer.
Dr. Howard is assistant professor of pediatrics at the Johns Hopkins University, Baltimore, and creator of CHADIS (www.CHADIS.com). She had no other relevant disclosures. Dr. Howard’s contribution to this publication was as a paid expert to Elsevier. E-mail her at pdnews@elsevier.com.
