19.3.3: Anger and Aggression

Learning Objectives

1. Distinguish between anger and aggression.
2. Describe characteristics and diagnostic criteria for ODD, DMDD, and Conduct Disorder.
3. Explain the role of family dynamics and intervention strategies in managing behavioral disorders.
4. Discuss the influence of media exposure on aggressive behavior in children

Anger and aggression are common emotional experiences in middle childhood. Anger is an internal emotional response to frustration or perceived injustice. Aggression is a behavioral expression of anger, involving actions intended to harm or control others (Tremblay, 2000). Aggression may be physical or verbal/emotional and is activated, in large part, by the amygdala, while being regulated by the prefrontal cortex. While anger is typical and often short-lived, persistent or intense aggression can signal a risk for behavioral disorders.

As children grow, most learn to regulate their anger through strategies such as verbal problem-solving or seeking adult support. Physical aggression, common in early childhood, usually declines during middle childhood, with verbal or relational forms of aggression (such as exclusion or rumor-spreading) becoming more prominent (Underwood, 2003).

However, when aggressive behaviors continue, intensify, or cause significant problems at home, school, or with peers, they may indicate the presence of a behavioral disorder.

Figure \(\PageIndex{1}\): This boy is threatening physical aggression. Image by Philippe Put is licensed under CC BY 2.0.

Disorders Related to Anger or Aggression

Oppositional Defiance Disorder (ODD)

Oppositional Defiant Disorder is a condition characterized by a frequent and persistent pattern of angry, irritable mood, argumentative or defiant behavior, and vindictiveness toward authority figures (American Psychiatric Association, 2013). These behaviors extend beyond typical childhood oppositional behavior and persist for at least six months.

Criteria for diagnosing ODD include symptoms such as:

• Frequent temper loss
• Active defiance or refusal to comply with requests
• Deliberately annoying others
• Blaming others for mistakes
• Being spiteful or vindictive at least twice in six months

The behavior must occur more often than is typical for the child's developmental level and cause significant problems in social, educational, or family functioning.

Research has linked ODD to patterns of negative family interactions, often described as a coercive family process. In these families, the behaviors of parents and children mutually negatively reinforce each other. For example, a child may refuse to comply with a request, and the parent may escalate threats or give in, teaching the child that oppositional behavior is effective (Patterson, 2002).

Figure \(\PageIndex{2}\). A school-age girl seems to be tuning her parents out while mom is talking and dad looks disconnected. Image by Tima Miroshnichenko is licensed by Pexels.

Intervention programs for ODD often focus on improving parenting practices. Effective programs include parent management training, which teaches consistent discipline, positive reinforcement, and communication skills. Cognitive-behavioral therapy for children can also help develop anger management and problem-solving skills (Eyberg et al., 2008).

Disruptive Mood Dysregulation Disorder (DMDD)

Disruptive Mood Dysregulation Disorder is a newer diagnosis introduced to address children with severe and chronic irritability and frequent temper outbursts. Unlike ODD, DMDD emphasizes persistent negative mood between outbursts, not just oppositional behavior (American Psychiatric Association, 2013).

Children with DMDD display:

• Severe temper outbursts three or more times a week
• Irritable or angry mood every day
• Symptoms present for at least one year, in multiple settings

DMDD is considered when mood disruption is pervasive and ongoing, not just situational or reactive to specific events.

Conduct Disorder (CD)

When aggression becomes more severe, including behaviors that violate the rights of others or major social rules, it may be diagnosed as Conduct Disorder. Children with CD may engage in bullying, physical fights, theft, destruction of property, and serious rule violations like truancy or running away.

Conduct Disorder represents a more serious level of behavioral disturbance. It is associated with a higher risk of later criminal behavior, substance use problems, and mental health issues in adolescence and adulthood (Frick & Viding, 2009).

Multisystemic Treatment

For children and adolescents with serious conduct problems, intensive approaches like Multisystemic Treatment have been developed. MST is a family- and community-based intervention targeting the various systems influencing the child, including family, school, and peers (Henggeler et al., 2009)- such as empowering caregivers to improve parenting skills, promoting school engagement, strengthening family relationships as a whole, and removing the child from deviant peer groups. MST has been shown to reduce rates of out-of-home placements and criminal behavior in youth with severe conduct problems.

Media Exposure

Figure \(\PageIndex{3}\). First-person shooter games are one type of high-violence video game. A study published in the Journal of Youth and Adolescence found that approximately 18.1% of preadolescents reported playing high-violence video games, with 12.9% engaging in such games for two or more hours per day (Tortolero et.al, 2014). Image by Hahnchen is licensed CC BY-SA 3.0.

Media exposure has also been linked to aggressive behavior in children. Research shows that frequent viewing of violent television, movies, video games, and online content is associated with higher levels of aggression (Anderson et al., 2017). Children who are repeatedly exposed to media violence may become desensitized to aggression, view it as an acceptable way to solve problems, or imitate aggressive behaviors they observe. While the media is not the sole cause of aggression, it is recognized as an important contributing factor.

References, Contributors and Attributions

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology, 37(1), 215–237. https://doi.org/10.1080/15374410701820117

Frick, P. J., & Viding, E. (2009). Antisocial behavior from a developmental psychopathology perspective. Development and Psychopathology, 21(4), 1111–1131. https://doi.org/10.1017/S0954579409990071

Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (2009). Multisystemic therapy for antisocial behavior in children and adolescents (2nd ed.). Guilford Press.

Patterson, G. R. (2002). The early development of coercive family process. In J. B. Reid, G. R. Patterson, & J. Snyder (Eds.), Antisocial behavior in children and adolescents: A developmental analysis and model for intervention (pp. 25–44). American Psychological Association. https://doi.org/10.1037/10468-002

Tortolero, S. R., Peskin, M. F., Baumler, E. R., Cuccaro, P. M., Elliott, M. N., Davies, S. L., Lewis, T. H., Banspach, S. W., Kanouse, D. E., & Schuster, M. A. (2014). Daily violent video game playing and depression in preadolescent youth. Cyberpsychology, behavior and social networking, 17(9), 609–615. https://doi.org/10.1089/cyber.2014.0091

Tremblay, R. E. (2000). The development of aggressive behaviour during childhood: What have we learned in the past century? International Journal of Behavioral Development, 24(2), 129–141. https://doi.org/10.1080/016502500383232

Underwood, M. K. (2003). Social aggression among girls. Guilford Press.