Wednesday, September 20, 2017
Aggressive, Disturbing Child Behavior? Think Conduct Disorder, Not RAD
Very young children, sometimes even infants, accidentally hurt other people or pet animals. They may do this by sticking their fingers up your nose or in your eye, yanking on earrings, biting when they are teething and have itchy gums, whacking you in the mouth or on the nose with their hard little heads—and of course they have not yet learned the advice given by Dave Barry, “never put your finger in that part of the doggy”.
Generally, young children learn not to hurt people or animals as a result of the experiences that follow the infliction of pain. These may (but do not need to) include punishment, but they usually do include sudden withdrawal by a person or animal, exclamations of distress, and admonitions not to do that any more. Pets learn to avoid toddlers, and adults develop skill in moving their heads away from glasses-grabbing and earring-yanking, so children who unintentionally caused pain simply don’t manage to do those things after a while.
All children begin in the early years to act aggressively when angry, and adults spend a good deal of time working to teach them to speak their anger rather than to hit or bite. Most learn this lesson well, although all human beings retain throughout life the ability to express anger physically. Good development in young children means that they are less likely to hit or bite, but that they can still carry out forceful actions toward other children, like grabbing a toy that has been taken away.
However, a small number of children move from accidental harm to others toward frequent intentional, aggressive acts when they are angry, or even for no apparent reason. Unlike most children, they do not learn between ages 2 and 4 to modulate their aggressive behavior to an acceptable level, and they are on a developmental pathway that leads to later antisocial behavior, including violence. Their problems are not part of Reactive Attachment Disorder, which is not itself associated with aggressive behavior, but are aspects of conduct disorders.
According to a discussion of this issue by Daniel Shaw and Lindsay Taraban (“New directions and challenges in preventing conduct problems in early childhood”, Child Development Perspectives, 11(2), 85-89, 2017), family and child risk factors help to determine children’s developmental progress toward conduct disorders and later serious antisocial behavior. Living in poverty, with its attendant stresses and emotional responses, is a major factor connected with the development of conduct disorders, and is especially associated with living in “projects” where gang and other interpersonal violence is probable. Maternal depression (also associated with poverty) is a second important factor in the development of childhood conduct disorders.
Is it possible to reach families with aggressive young children and help them avoid serious antisocial behavior in later life? Shaw and Taraban suggest that this can be done, and that in fact early intervention can be most effective. (Although it is questionable whether very early treatment is always the best answer for problems of development, this may be a case where parents and children are most optimistic and most malleable while the children are quite young. )
Treating maternal depression seems to be one of the most effective ways to reduce child conduct disorders. Depressed mothers may be harsh and overcontrolling in their parenting style, but at the same time easily give up on efforts to find resources the family and children need—employment, appropriate housing, and good-quality child care outside the home. General family stress and angry interactions result from maternal depression combined with poverty, and are major causes of unusual child aggressive behavior culminating in conduct disorders and antisocial attitudes and actions.
These facts suggest that it is important to note and address aggressive behavior in the preschool years, but that treatment needs to involve not just the child, but the family and even the community. Conduct disorders are not caused by attachment problems and cannot be solved by efforts to create secure attachment. Maternal depression and poverty can also cause atypical emotional attachment (for instance, by moving an abused or neglected child into and out of foster care multiple times), but the effects of this are separate from conduct disorders.
When the preschool period has passed, an unusually aggressive child has been exposed to additional factors that are likely to increase the probability of antisocial behavior. These include rejecting attitudes on the part of adults, such as expulsion from preschool or from community activities like library read-aloud sessions, often accompanied by further harsh behavior from embarrassed and stressed parents who need to find new child care arrangements. By school age, aggressive children are likely to find themselves rejected by more typically-developing peers and accepted only by other aggressive children, who encourage oppositional and defiant behavior toward adults. The influence of peers soon becomes paramount, and improvement of the family situation has less effect on child conduct than it did earlier. By this point, efforts to influence attachment have become not only ineffective but irrelevant to the child’s developmental stage, and labeling aggressive behavior as a manifestation of RAD, rather than as a conduct disorder, is counterproductive as well as incorrect.