In May 1997, the U.S. House of Representatives passed a new bill
designed to "crack down" on juvenile crime by rewarding states that
agree to prosecute more under-age perpetrators as adults. Prosecuting children
as adults satisfies our urgent desire to do something about adolescent aggressors
who kill parents, classmates, even total strangers. Conveniently, it also covers
up our own failure to pay attention. Teenage murderers do not rise up fully formed
on their thirteenth birthday. Their deterioration began years before, in a childhood
custom-designed to bring out the worst in them.
It's not as if these troublemakers
were invisible. Aggressive, angry children typically command more than their fair
share of attention-from families struggling to manage them, schools frustrated
by efforts to educate them, angry communities sick of enduring them. In fact,
of all the problems common to troubled children-defiance, lying, stealing, truancy,
academic failure-none is more likely to translate as a cry for help than aggression.
is the number one problem in child psychiatry," contends Carl Feinstein,
director of clinical services for child and adolescent psychiatry at Stanford
University Medical School and former medical director of the Center for Autism
and Related Disorders at Baltimore's prestigious Kennedy Krieger Institute. Other
experts who treat childhood behavior problems concur. Tony Rostain says of the
children he treats for AHDH at the Philadelphia Child Guidance Center, "probably
75% aren't brought here for their attentional problems, but because of their aggressive
behavior." Karen Bierman, a psychologist at Penn State University who heads
a research team evaluating a comprehensive intervention program for troubled children,
believes that persistent aggression "is one of the most prevalent and intractable
mental health problems of childhood and adolescence," and that teenage delinquency,
as well as antisocial aggression in adults, "rarely. . . begin without warning
signs in early childhood."
How can we be so aware that
some children are already too aggressive, and yet so powerless to stop them from
evolving into violent adolescents? Are indulgent, preoccupied, self-centered,
divorced, or unmarried parents to blame? Television? An extinction of family values?
Or have we also overlooked the biological significance of childhood?
who has taken a psychology course or read a newspaper has heard that "today's
child victims are tomorrow's perpetrators." The idea that violence is recycled
across generations has been repeated so often that it's taken for granted. But
not all abused children grow into juvenile delinquents or antisocial adults. And
not all studies that have looked for a link between abuse and subsequent violent
behavior have found one.
A recent study, sponsored in
part by the National Institute of Justice, provides the best evidence yet that
children who are abused and neglected are at greater risk of arrest for a violent
crime later in life. Children who had documented evidence of abuse or neglect
were nearly twice as likely to be arrested as juveniles than children with no
history of abuse, one and a half times more likely to be arrested as adults, and
significantly more likely to have committed a violent offense. Children who had
been physically abused were the most likely to be arrested for violent crimes.
But surprisingly, children who had merely been neglected (who constitute 52 percent
of the million-plus confirmed cases of child maltreatment each year) were only
a percentage point behind.
and an exaggerated response to perceived threats are the behavioral consequences
of the strain imposed by the need to compensate for such a heavy load. Even if
"abuse excuses" try our patience, it is clear that trauma and abandonment
cannot be good for the developing brain.
"Trauma effects are especially important early in development because they encourage adaptation,"
observes stress researcher Frank Putnam. "And early adaptation resets physiological
systems in ways that leave them very different from normal."
mother on the other end of the line was trying to strike a balance between sounding
calm enough to avoid being judged incompetent and desperate enough to get the
talk show host, a local child psychologist, to take her seriously. The problem,
she explained, was her two-and-a-half-year-old son, a difficult baby who had matured
into a tyrannical toddler.
"He's just unmanageable," she pleaded.
"I know two-year-olds have tantrums. But he won't do anything we ask him
to without a fight. I've tried asking him politely, saying please and thank you-and
he hits me. If I put him in timeout, we end up fighting about him staying in the
chair. I've tried being firm, I've tried demanding, I've even bribed him-I admit
it. All he does is yell and scream."
"Two is such
as exciting age," coos the psychologist ingratiatingly. "Your son can
do so many things all by himself now. But he still needs you."
doubt about it. The exciting little person in question can be heard voicing his
need for Mom at stadium-concert volume.
If the psychologist
hears, she's not responding. "He's trying to come to terms with his new-found
maturity," she prattles on. "You should just spend lots of time playing
and having fun. Take him out to places like the mall, so he can try out his new
way of looking at the world. He needs to know that someone is celebrating the
joy of childhood with him."
Across town, Laurel's parents have talked
to three different doctors in two years, trying to understand why their eight-year-old
daughter slaps, kicks, and insults her five-year-old brother relentlessly. They've
heard from one psychologist that they're "too authoritarian"-but another
insisted they were "too indulgent." They're simultaneously "inconsistent"
and "overly rigid," "too detached" and '(too overinvolved."
They've learned how to improve their parenting skills and set up "incentive
programs," but Laurel's hostility seems impervious to time-out, sticker charts,
and lost privileges. The one thing they haven't learned is how to end the fighting.
As for Laurel, the only thing she's learned from any of these experts is that
her parents are incompetent. "If we can't control her now," her mother
worries, "what will we do when she's a teenager?"
examples demonstrate how we fail troubled children so consistently: we
refuse to see childhood aggression for what it is, when we can no longer overlook
it; we don't know what to call it; and when we finally think we've identified
it, we still don't know what to do about it. Intervention often focuses on reforming
the parents, while sidestepping the question of why the child is lagging in his
or her social development or how the relationship between parent and child has
Look behind an aggressive child and you may well
find parents who are preoccupied, incompetent, or negligent. Or you may find parents
who recognized trouble but prayed that the child would "grow out of it."
You may find parents who asked for help and were told that nothing was wrong or
that it was their fault, or confused, frustrated, disappointed parents who have
tried to follow through on expert advice and failed, even seen the problem grow
worse. What you're certain to find is an ignorance of the fact that aggressive
adults often start as children who hurt others, children whose social ineptitude
already reflects destructive interactions between the brain and an environment
that is threatening, unfulfilling, or incomprehensible. Worse, you're likely to
find a failure to appreciate that unlike adults, children have nervous systems
that are still immature, and their behavior, as a result, is still wide open to
Kids are aggressive for the same reason as adults-a
vicious circle between brain, behavior, and environment-and they're aggressive
in the same ways. Some overreact, to people and situations they perceive as threatening;
some underreact, especially to punishment. The spiral may be set in motion by
loss, abuse, neglect, fear-or it may have more insidious roots in the temperamental
traits that require special management skills.
a slow-to-arouse, fearless temperament, for example, can be easily mismanaged
into antisocial tyrants. Because their sluggish sympathetic nervous system assigns
lower emotional values to negative events, they seem impervious to punishment.
They're more interested in rewards, but the motivational power of candy and gold
stars eventually pales in contrast to the thrill of conflict. Intellectually,
these children may come to recognize that a system of rules governs social conduct,
but the rules themselves hold about as much meaning for them as the tax code.
development researchers who study children with autism say that they lack a "theory
of mind"-the ability to recognize that other people have their own thoughts,
beliefs, and feelings. Uninhibited children on their way to an antisocial personality
also fail to recognize that others have feelings. Because the world of emotion
is incomprehensible to them, they remain indifferent, cognizant only of their
own needs and wants.
Poor emotional understanding results
in a social learning deficit. Without emotions to guide them, insensitive
children can't seem to figure out how to tailor their behavior to mesh with others,
and their negligence often results in inappropriate reactions to emotional situations.
For example, if a playmate falls, skins a knee, and starts to cry, a socially
aware child will also become distressed or attempt to comfort her companion. Emotionally
insensitive children, on the other hand, may act aggressively instead.
is an essential part of changing inappropriate behavior. But unless environmental
interventions include the intensive remedial instruction in social skills emotionally
insensitive children need to catch up with their more socially sophisticated peers,
the aggressive behavior is going to persist. And without relief from the relentless
stress of living with the aggression, parents and siblings are going to find it
increasingly difficult to cope.
Experts who work with physically
disabled children have developed exercises designed to improve mobility, strength,
and fine motor control. Similarly, professionals who work with the social, emotional,
and cognitive challenges of developmental disorders like autism have come up with
strategies to teach social skills to children who need extra help. These techniques
include visual aids, such as charts and storyboards, which outline an easy-to-follow
script for social interactions; videos illustrating appropriate behavior; modeling;
and role playing. The goal is to create a consistent, structured environment in
which children are surrounded by examples of acceptable social behavior and opportunities
to practice non-aggressive solutions to social problems.
- Niehoff PhD, Debra,
The Biology of Violence; The Free Press: New York, 1999
Reflection Exercise #9
The preceding section contained information
about communication breakdown. Write three case study examples regarding how you
might use the content of this section in your practice.
According to Carl Feinstein what is the number one problem in child psychiatry?
Record the letter of the correct answer the .