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«Jo Hariton, Ph.D. Assistant Professor of Social Work in Psychiatry Weill Cornell Medical College WEILL.CORNELL.EDU Mild or moderate aggression in ...»

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What’s Normal

and What’s Not ?

Adolescents and Anger

Jo Hariton, Ph.D.

Assistant Professor of Social Work in Psychiatry

Weill Cornell Medical College

WEILL.CORNELL.EDU

Mild or moderate aggression in early childhood is common.

As children mature they learn skills to control their

aggression before it causes harm to others or becomes

clinically significant.

Children in mid-late stages of puberty show three fold

increase in violence compared to those in early stage of puberty. (Hemphill, Kotevski, Herrenkohl, et al, 2010) Angry and aggressive behavior is on a continuum with normal behaviors at one end and problematic behaviors at the other end.

How do we distinguish between normal versus maladaptive aggression?

 Pathological aggression:

Occurs outside an expectable social context  Either in the absence of antecedent cues  or with an intensity, frequency, duration &/or severity that is disproportionate to its causes It generally doesn’t terminate within an appropriate  timeframe and in response to feedback.

(Newcorn, Ivanov, Chacko, Halperin, 2010) Life-course persistent aggression refers to childhood  onset, before age 10, of severe conduct problems.

It differs from time-limited adolescent  aggression.

Life-course persistent aggression occupies a  small subgroup, 10%, of the larger pool of aggressive youth, yet accounts for more than 50% of crimes committed in the U.S.

(Donnellan, et al. 2005) Why do Adolescents have Difficulties ?

• temperament

• biology / genetics

• family environment

• non-familial stressors

• lack of experience Normal Adolescent Behaviors Problems are transitory, and are resolved by the beginning of adulthood, with few long-term repercussions.

Alcohol / substance abuse experimentation (majority experiment) Many studies indicate that the rate of occasional usual harmless ‘experimentation’ far exceeds rates of enduring problems.

Worrisome Behaviors

• Loss of interest in daily activities

• Feelings of hopelessness and / or helplessness

• Suicidal thoughts or attempts

• Low self-esteem; negative self-appraisal

• Chronic self-blame or guilt Normal Teen Behaviors

• Increase in parent / child conflicts

• Decrease in reported closeness between parents and children especially linked to the time parents and adolescents spend together.

• Adolescents spending increasing amounts of time alone or with friends, not with family.

Worrisome Behaviors

• Preference for time alone, with little to no time spent with peers

• Socially isolated

• Loss of interest in activities once previously enjoyed Normal Teen Behaviors

–  –  –

• Studies have shown parent / adolescent conflicts occurred at a rate of 20 incidents per month, or once every 3 days Typical Parent/Teen Conflicts

• hairstyle, clothes

• choice of friends

• chores

• curfew

• volume and taste in music

• internet use, electronic devices It’s Normal for Adolescents to…

• Argue for the sake of arguing

• Jump to conclusions

• Be self-centered

• Constantly find fault with the adult’s position

• Be overly-dramatic (APA, Developing Adolescents,2002) Worrisome Behaviors

• Conflicts have physical contact

• Intensity of conflicts are high and frequent

• Easily angered or agitated

• Oppositional or defiant

• Irresponsible academic behaviors, e.g., refusal to complete academic responsibilities, or poor follow-through with those responsibilities Normal Adolescent Behaviors Frequency of parent / child conflicts declines from early to late adolescence.

Negative affective intensity peaks in mid-adolescence (15-16).

Mothers are often the brunt of most of these clashes, especially with early adolescent daughters (13-14).

Father / son clashes have greater affective intensity in mid-adolescence.

Early maturation in girls, and problems, such as adolescent depression or substance abuse, increase the likelihood of conflict.

As boys approach puberty, there is a decrease in family communication.

Decrease in parent / child conflict in middle adolescence coincides with decreased time spent with parents, greater involvement and reliance on peers.

Mood Disruptions are Associated with High Levels of Negative Life Events

• On-going family tensions

• Marital separation / divorce

• Peer conflicts or stressors

• Academic stressors

• Family relocation

• Death in the family, or a friend

• Family stressors Worrisome Behaviors

• Depressed mood

• Diminished interest or pleasure in most activities

• Significant change in appetite or weight

• Significant change in sleep pattern

• Extreme agitation

• Loss of energy or fatigue

• Feelings of worthlessness or guilt

• Problems concentrating Anger and Aggression Aggression in youth one of the most frequent reasons for psychiatric referral.

Adolescent aggression represents a major public health concern.

 44% of guns used in crimes were owned by persons younger than 25, with 11% belonging to those younger than 17.





An estimated 1,400 homicides involved a juvenile  offender.

(Center for Disease Control and Prevention, 2000.) Males commit more violent crimes than females  Yet aggression more prominent in girls than previously  thought.

Prevalence rates 4-9% for girls. Recent survey found  23% increase in violent crime arrests for adolescent females. vs. 11% in males.

Morbidity and mortality rates increase 300% between  middle childhood and late adolescence.

(Centers for Disease Control and Prevention, Nat’l Center for Chronic  Disease prevention and HealthPromotion, 2000;

Nat”l Longitudinal Study on Adolescent Health, JAMA, 1997) 

Red Flags for Violent Behavior:

• Playing with weapons

• Obsessively playing violent video games, watching violent movies, enjoying websites that promote violence

• Threatening or bullying others

• Fantasizing about committing a violent act

• Cruelty to pets and animals

Anger problems are frequent among:

1. ADHD

2. Conduct Disorder

3. Oppositional Defiant Disorder

4. Mood Disorders

Left untreated anger and aggression can lead to:

1. Delinquency and crime

2. Academic failure

3. Antisocial problems and conduct problems

4. Substance abuse Etiology of Heightened Emotions in Adolescence

Brain Remodeling:

Brain circuitry involved with self regulation and emotional control undergoes dramatic changes in adolescence. Frontal brain regions are not fully mature and a pruning process, involving the neurotransmitter system occurs.

Subcortical regions of brain involved in emotion processing mature earlier than prefrontal region that regulates decision making, planning and impulse control. The mismatch of maturation rates is linked to behavioral changes in puberty: increases in thrill seeking and risk taking, increased emotionality, and mood fluctuations. Sensitivity to rewards is peaking while cognitive control is relatively immature.

This can lead to difficulties in emotional regulation and in the postponement of immediate rewards.

Psychosocial Factors:

Childhood trauma is risk factor for subsequent violent behavior.

Family based risk factors such as child neglect, parental conflict, poverty, harsh discipline practices, poor supervision, parental criminality.

School environment and community violence.

Peers: delinquent peer membership or repeated victimization by peers.

Difficult Temperament :

Aggression tends to run in families.

Under-arousal of the autonomic nervous system.

Chess and Thomas longitudinal study (1986) of “normal” children found that 10% of children studied showed difficult temperament: irregularity, negative responses or withdrawal from novel stimuli, slow or poor adaptability to change and intense, often negative mood.

Chess and Thomas talk of the importance of the “good fit” between parenting style and child’s temperament.

Other Factors Influencing Mood …

•Hormones, influence the physical changes at puberty, and affect moods and teen emotionality

•Concerns about physical changes are a source of sensitivity and heightened emotions.

•Irregular meal patterns, skipping breakfast, and fasting to lose weight can affect mood.

•Inadequate sleep can lead to moodiness, irritability, gloominess, and tendency to overreact.

•The normal ups and downs of social relationships, especially romance, can influence a teen feeling anything from elation to abject despair. (McNeely,C., Blanchard, J., The Teen Years Explained, Bloomberg Sch. Pub. Health)

Ineffective Parenting:

1. Lack of parental involvement

2. Absence of parental warmth

3. Inconsistent and harsh discipline

4. Physically aggressive punishment Bidirectional: poor parenting stimulates negative responses in adolescent and good parenting deteriorates in response to escalating aggressive behaviors.

Parents need to understand that adolescents still need them and don’t want to break the emotional bond they have with them.

They do need and want a different balance in the relationship.

Parents are sometimes slow to catch on to this need, and can feel “stuck” and angry by their teen’s behavior.

The more controlled teens feel by their parents, the more turbulent this time can be, with peers turned to as a “second family”. (Taffel, 2005) “Letting go” and “Staying connected” Renegotiating rules and limits is important in this phase and without it, rebellion will intensify.

Teens have moments of great maturity and adult like behavior, yet parents need to be reminded that their brains have not yet matured enough for them to make adult decisions with sound judgment in every situation.

Adult guidance is still important despite their protests.

Unresolved Conflicts Leftover from Family of Origin When facing an angry teen, parents may need help with unresolved issues from their family of origin. History tends to repeat itself. Coaching them to identify some of these issues may help them find their own “blind spots” with their children. As old conflicts are redressed, the parents may listen with “new ears” and become less reactive with their own adolescent.

Defiance

1. Failure to comply with an adult’s request within a reasonable time.

2. Failure to keep doing what has been requested until the task is finished.

3. Failure to follow previously taught rules of conduct.

It is noncompliance coupled with verbal or physical resistance.

It is an interaction, and parents need help to see that they play a part in sustaining it.

(Barkley, R.A. and Robin, A.L., 2014) (Barkley, A., 2013) Parent Training: Leaders in the Field Barkley, 1987, 1997, 2014 Forehand and McMahon, 1981, 2003 Kazdin, 1996, 2005, 2008 Patterson, Reid, Jones, and Conger, 1975 Webster-Stratton, 1983, 1996 Greene, Ablon, 2006 (Barkley, R.A., 2013) Parent Training Principles for Addressing Defiant Teens

1. Focus on the positive.

2. Strive for good communication.

3. Use positive and negative consequences wisely.

4. Establish bottom-line rules for living at home and enforce these rules consistently.

5. Involve teen in negotiating solutions to all issues that are not bottom-line nonnegotiables.

6. Maintain adequate structure and supervision.

7. Facilitate appropriate independence seeking.

8. Make sure parental beliefs and expectations are reasonable.

9. Respect family structure.

(Barkley, R.A. & Robin, A.L., 2014) Most parents are not familiar with the basics of adolescent development and it is helpful to discuss this with them..

Developmental Tasks for Adolescents

1. Establish their own set of values

2. Establish and maintain peer relationships

3. Learn to express themselves in complex verbal ways

4. Start to develop a personal identity

5. Begin to establish independence from parents

6. Learn to manage increasingly complex emotions

7. Develop ability to plan for the future and control impulses

8. Learn to manage sexual identity

9. Deal with changing bodies

10. Learn to experience the real-world consequences of their behavior

11. Learn about romantic relationships (Branstetter,Masse, Greene, 2007)

• Punishment will reduce noncompliance for a while, but is likely to reappear shortly after punishment occurs.

(McMahon and Forehand, Helping the Noncompliant Child, 2003)

• Punishment may cause guilt or upset if done out of frustration or anger.

(McMahon and Forehand, Helping the Noncompliant Child, 2003) Parental Effectiveness Diminishes

• The value of the parent as a positive influence decreases, since the caretaker is always associated with punishment.

• The caretaker will be avoided.

(McMahon and Forehand, Helping the Noncompliant Child, 2003) Teach Parents Skills for Positive Attending

•Paying positive attention

•Spending enjoyable time together

•Ignoring minor misbehavior

•Praising spontaneous compliance

–  –  –

Scheduling family weekend leisure time activities is an addition &/or alternative.

Parents may need help in understanding the rationale

for this focused positive time:

•It conveys caring and understanding to the adolescent and breaks the cycle of frequent criticism, which lowers self esteem.

•It shows positive involvement, as disengaged parenting increases insecurity for the adolescent.

Reinforce positive behaviors:

Behaviors of their teen that parents attend to are reinforced and likely to recur.



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