First Things First Stop Aggression in ADHD Children

Here is the logic on a conceptual level.  Conduct Disorder and Oppositional Defiant Disorder are precursors of substance abuse and dependence in ADHD teens.  Conduct disorder and oppositional defiant disorder are both at their core related to aggression. So, the logic is clear if you prevent conduct disorder and oppositional defiant disorder from developing you are preventing what most would consider some of the worst co-morbid ADHD problems.  So, let’s prevent these aggression problems as early as possible. Why don’t we start in preschool?

The question is:  Does the research support this logic?  The resounding answer is yes.

A very large study, a developmental trajectory study by Broidy et al., 2003 was conducted in 2003.  A way to think about developmental trajectory is the study of the pathway that a child takes over time in his development and what critical factors relate to that trajectory.  A good trajectory would be to finish college and get a job.  A bad trajectory would be to end up in jail. 

When considering research the logic again is fairly simple. Consider a scale. When you look at data studies that have a larger number of subjects get proportionally weighted more heavily. Similarly, studies with better research design get weighted more heavily.  Studies with fewer subjects and poorer research design might be on the other side of this scale and therefore be outweighed by the results of a study like this.  This is why study size and design must be considered when reviewing research.  It is also why one can make conclusions on “trends of research” even though within the trend a few studies might contradict some of the other studies.  Otherwise much smaller studies that are poorly designed, yet emotionally compelling, like the anecdotal story my neighbor jus told me about his sister’s daughter get taken with much more gravitas then they merit.  Certainly personal stories are compelling. I tell them about my work.  It is what engages our heart and soul as human beings.  They are persuasive.  However, if those stories lack any empirical foundation they remain just that from a research point of view, stories.  They go on the weaker side of empirical weight. 

Obviously in a blog post, we will not consider all existing research on this topic but keeping this scale in mind is useful when reviewing individual studies and deciding how seriously to take them. 

This study had both a very large sample size and a good research design.  Simply put, it is a very impressive study. As such of the results should be taken very seriously and they are very educational in understanding a possible critical point of prevention for later problems by intervening earlier. 

This developmental trajectory study had a sample size of 6176 children (boys) and was conducted across six countries. They started collecting data on disruptive behavior problems between the ages of 5 to 7 years old. Yearly assessments were done until the children were ages 15 to 17 at those sites but as old as 26 at one site.  Teacher reports were used at all sites and at most sites used mother reports of externalizing behavior (e.g. aggression) were obtained also. That is a phenomenal data set.  These results are very informative and should be taken with a comparatively heavy load of empirical weight.

Results:

In the United States disruptive behavior scores tended to show increases over time. What’s that about in our culture?  Not sure, but something to think about.  In contrast in Canada they tended to show declines. In New Zealand mean disruptive behavior scores were stable.  This result should make all of us Americans wonder.

At all the sites it was a small group of less than 10% who were the high aggressors over time.

The next result is much more eye-opening. At all the sites it was a small group of less than 10% who were the high aggressors over time. The majority of children 15 to 60% showed no physical aggression over time. So typically, contrary to the “boys will be boys” theory, among most boys there is very little physical aggression over time. However for this small group of high aggressors that can be identified between ages 5 to 7 and those poor souls continue to be aggressive for the next decade or more. There was no evidence of a sudden and dramatic change in disruptive behavior over time. There is a caveat to this in that there is some evidence from other studies that shows that there sometimes can be a short-term increase in aggression during junior high. However, this data set did not support that conclusion.  So, what you have here is less than 10% of the boys committing all the aggression!  Maybe not that surprising, but it is the same boys who when they are much are older are still aggressive.  So, why not do something about it when they are not twice the size of their mothers?

MOST IMPORTANT FINDING #1: Chronic aggression by boys during elementary school increases the risk for continued violence and other forms of delinquency during adolescence.

This top group of aggressors or is at risk for these continued problems not everyone else.

MOST IMPORTANT FINDING #2: Hyperactivity was not associated delinquency at any site.

Physical aggression was a distinct risk factor for violent and nonviolent delinquency in boys.  Many studies have found that hyperactivity is not correlated with criminal outcomes once the influence of other conduct problems is taken into account (Farrington, Loeber, and VanKammen, 1990; Fergusson, Horwood, and Lynskey, 1993; Fergusson, Lynskey, and Horwood, 1996; Lahey, McBurnett, and Loeber, 2000; and Lynskey and Fergusson, 1995).  Trajectories reflect patterns of gradual change as opposed to sudden increases or decreases in these behaviors in this study there was no evidence of late onset of physical aggression.  These results supported the conclusion that the “onset” of physical aggression occurs during the preschool years, prior to the initial assessments in these data sets, before ages 5 to 7 years old.  This really gives a whole new meaning to the idea that everything you need to learn you learned in kindergarten. That is, unless you didn’t. Unfortunately the ones who don’t learn those lessons in kindergarten appear to be in a great deal of trouble. 

In my next blog post I will consider preschoolers and aggression.

Dr. Charles Shinaver

Located in Carmel, Indiana near Indianapolis, Noblesville, Fishers, Zionsville, and Westfield.

Parent of Children at Guerin Catholic and Our Lady of Mount Carmel Schools.

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