Students’ and teachers’ perceptions of aggressive behaviour in adolescents with intellectual disability and typically developing adolescents

This study investigated aggressive behaviour in Serbian adolescents with intellectual disability (ID) compared to typically developing peers. The sample consisted of both male and female adolescents aged 12–18 years. One hundred of the adolescents had ID, and 348 adolescents did not have ID. The adolescents were asked to complete the Reactive-Proactive Aggression Questionnaire (RPQ), and their teachers provided ratings of aggression for the adolescents using the Children's Scale of Hostility and Aggression: Reactive-Proactive (C-SHARP). Results indicated that adolescents reported a higher prevalence of aggressive behaviour than their teachers. Reactive aggression was more prevalent than proactive aggression in both subsamples. In the subsample of adolescents with ID, there were no sex or age differences for aggression. However, in the normative subsample, boys and older adolescents scored significantly higher on aggression. According to adolescent self-reports the prevalence of aggression was higher in adolescents without ID, while teachers perceived aggressive behaviour to be more prevalent in adolescents with ID. Scientific and practical implications are discussed.     

Prevalence and risk factors of inpatient aggression by adults with intellectual disabilities and severe challenging behaviour: A long-term prospective study in two Dutch treatment facilities

Over five years, various types of aggressive incidents by 421 intellectually disabled inpatients were recorded on a daily basis, using an adapted version of the Modified Overt Aggression Scale. Stable patient characteristics (e.g., gender, intelligence, DSM IV classification at the start of treatment) and pre-treatment scores of two treatment outcome measures (e.g., Adult Behavior Checklist and Dynamic Risk Outcome Scale) were used to predict aggression during the treatment. At an overall average of one incident per patient per week, about ten times more aggression occurred on admission compared to resocialisation wards, and the 20% most aggressive individuals caused 50% of the verbal and 80% of the physical incidents. The best predictor of aggressive behaviour was aggression early in treatment, followed by coping skills deficits and impulsiveness. The relevance of the results for the treatment of aggressive behaviour and methodological issues in the recording of inpatient aggression are discussed.     

Development of the Children's Scale of Hostility and Aggression: Reactive/Proactive (C-SHARP)

Whereas some scales exist for assessing aggression in typically developing children, they do not give a detailed analysis, and none is available for populations with developmental disabilities (DD). Parents of 365 children with DD completed the Children's Scale of Hostility and Aggression: Reactive/Proactive (C-SHARP), which surveys the severity of aggressive and hostile behaviors (Problem Scale) in addition to their proactive or reactive qualities (the Provocation Scale). Factor analysis yielded a 5-factor solution: I. Verbal Aggression (12 items), II. Bullying (12 items), III. Covert Aggression (11 items), IV. Hostility (9 items), and V. Physical Aggression (8 items). Coefficient alpha ranged from moderate (0.74, Physical Aggression) to high (0.92, Verbal Aggression). General validity was supported by expected differences between age and gender groups. Preliminary normative data were presented. The C-SHARP appears to be a promising tool for assessing aggression and hostility in children with DD.     

Measurement by observations of aggressive behaviour and activities in clinical situations

Clinical aggression (towards self or other persons or things) is often thought of as having a certain degree of disease specificity. Thus, suicidal ideation is often associated with major depression, self-mutilation with borderline personality disorder, hostility with mania, negativism with schizophrenia or dementia and violence with explosive—impulsive disorder. Attempts to measure suicidal behaviour have pointed at the dimension of depression. Attempts to measure self-mutilation have shown that this is a behaviour without association to depression or suicidal behaviour. It seems to be associated with borderline disorders as well as mental handicaps. Attempts to measure outward aggression in the clinical situation have identified an aggression factor very similar to that found in the general population by Buss (1971) . This includes passive versus active aggression, direct versus indirect aggression, and verbal versus physical aggression. Among the clinical rating scales the nine-items Social Dysfunction and Aggression Scale (SDAS-9) covers this construct. Furthermore, the SDAS-9 measures both the generalised (day-to-day) aggression and aggressive acts. The scale is administered by the psychiatrist in collaboration with the nursing staff. Among scales specifically designed to be administered by the nursing staff are the Overt Aggression Scale (OAS), the Staff Observation Aggression Scale (SOAS), and the Scale for Assessment of Agitated and Aggressive Behaviour (SAAB). These three scales differ in the aspects of aggression to be measured and in the extent to which risk factors are considered. Among psychopathological risk symptoms are delusions, hallucinations, and lack of insight. Among other risk factors are medication and activities of daily living in the ward (ADL). It is important to differentiate in the measurement between aggressive behaviour and risk factors. Thus, the SDAS-9 measures aggressive behaviour (generalised and attacks), the Brief Psychiatric Rating Scale (BPRS) or the Maudsley Assessment of Delusion Schedule (MADS) measure psychopathological risk factors (e.g. delusions and hallucinations), and the SOAS measures other risk factors (e.g. medication and ADL) .     

Characterizing aggressive behavior with the Impulsive/Premeditated Aggression Scale among adolescents with conduct disorder

This study extends the use of the Impulsive/Premeditated Aggression Scale for subtyping aggressive behavior among adolescents with Conduct Disorder. Of the Conduct Disorder symptoms, aggression has the strongest prognostic and treatment implications. While aggression is a complex construct, convergent evidence supports a dichotomy of impulsive and premeditated aggressive subtypes that are qualitatively different from one another in terms of phenomenology and neurobiology. Previous attempts at measuring subtypes of aggression in children and adults are not clearly generalizable to adolescents. Sixty-six adolescents completed a questionnaire for characterizing aggression (Impulsive/Premeditated Aggression Scale), along with standard measures of personality and general functioning. Principal components analysis demonstrated two stable factors of aggression with good internal consistency and construct validity. Compared to the premeditated aggression factor, the impulsive aggression factor was associated with a broader range of personality, thought, emotional, and social problems. As in the adult and child literature, characterization of aggressive behavior into two subtypes appears to be relevant to understanding individual differences among adolescents with Conduct Disorder.     

The Overt Aggression Scale for the objective rating of verbal and physical aggression

The authors describe the design and reliability of a rating scale that measures aggressive behaviors in adults and children. On the Overt Aggression Scale (OAS), aggression is divided into four categories: verbal aggression, physical aggression against objects, physical aggression against self, and physical aggression against others. In addition, specific interventions related to each aggressive event can be recorded on the OAS. The clinical and research applications of this scale are discussed.     

Ethnic minorities and aggressive behaviour in psychiatric in-patients: an investigation using a "Matched-Pair" design

In a group of 105 mentally ill immigrants we investigated the intensity and the frequency of aggressive behaviour at the time of admission with the help of two standardized instruments: the "Social Dysfunction and Aggression Scale" (SDAS) and the "Modified Overt Aggression Scale" (MOAS). As many as possible collateral informants were contacted to gather all information available for the aggressiveness rating. The immigrant group was compared to a matched group of German patients. 416 German patients had to be investigated until 105 of them fulfilled the matching criteria. The matching variables were: age, gender, diagnosis (ICD-10), severity of mental illness (CGI) and social status. The physicians who carried out the matching process and who carried out the aggression-rating were "blind" to the aim of the investigation. We found out that there was no significant difference between immigrants and German patients when the sum-scores of the SDAS and the MOAS are compared (N = 210). When SDAS single variables were compared German patients had a higher severity and frequency of "physical violence towards other persons". We interpreted this finding as an increased level of disinhibition which may be correlated to a higher acceptance of aggressive behaviour in German culture compared to normative beliefs of Mediterranean immigrants.     

The influence of alcohol use and violent behaviour on the beliefs related to alcohol use and aggression

The authors examined the effect of personal involvement (drinking, violent behaviour) on beliefs concerning the causal connections between drinking alcohol and aggressive behavior. The sample of the study comprised 1200 persons representative of the population over 18 years of age and was selected by a two-step, group stratified sampling method. The measuring instruments used for the study were the questionnaire on alcohol-aggression beliefs applied by Paglia and Room, the Buss and Perry Aggression Questionnaire, and the sociodemographic characteristics of gender, age and education. Analyses using multivariate regression models showed that aggressive behaviour, particularly verbal and physical aggression, and heavy drinking significantly influence the belief of a causal connection between alcohol and aggression. The more a person drinks and the more aggressive he becomes, the more likely he is not to believe the opinion that drinking leads to aggression. Women and older people have a stronger belief in the causal role played by alcohol in aggressive behaviour. These results draw attention to the importance of the cognitive effect of personal involvement. Heavy drinking and aggressivity can prevent a person from recognizing the danger that drinking can have aggressive, criminal consequences. This relationship can be used well in clinical and criminological practice of crime prevention strategy for patients treated with drinking problems and facing proceedings or condemned for criminal actions. The findings of the study also raise a theoretical consideration that the theory of social learning is not a sufficient explanatory model for the connections between drinking and aggression.     

Violence among schizophrenia out‐patients compliant with medication: prevalence and associated factors

Objective: Aggressive behaviour has been related to schizophrenia both in in‐patient and out‐patient samples. In this study, we aimed to assess the prevalence and factors associated with aggressive behaviour in out‐patient compliant with their prescribed medication. Method: Eight hundred and ninety‐five patients were interviewed at Community‐Based Mental Health Services about aggressive–violent behaviour within the week prior to the study visit. Adult patients diagnosed with schizophrenia and receiving stable pharmacological treatment were enrolled. Presence of aggressive episodes, including type of aggression, severity and frequency, was assessed with the Modified Overt Aggression Scale (MOAS). Violence was defined as a score of 3 or more in any of the MOAS subscores. Results: Prevalence of recent aggressive behaviour was 5.07%, (95% CI 5.04–5.10), where 47% (43 behaviours 91) reached the violent threshold. Among the 91 violent episodes rated, most episodes were verbal (44%), followed by physical violence towards objects (29%), violence towards others (19%) and self‐directed violence (8%). Recent episodes of any severity were more likely among patients with a history of violence and also with relapses within the previous year and with low treatment satisfaction. Conclusion: Five per cent of the studied cases showed aggressive behaviour in the week prior to assessment, despite having been compliant with their medication. Most aggressive behaviour was verbal rather than physical.     

Links between self-reported media violence exposure and teacher ratings of aggression and prosocial behavior among German adolescents

The relations between adolescents’ habitual usage of media violence and their tendency to engage in aggressive and prosocial behavior in a school setting were examined in a cross-sectional study with 1688 7th and 8th graders in Germany who completed measures of violent media exposure and normative acceptance of aggression. For each participant, ratings of prosocial and aggressive behavior were obtained from their class teacher. Media violence exposure was a unique predictor of teacher-rated aggression even when relevant covariates were considered, and it predicted prosocial behavior over and above gender. Path analyses confirmed a direct positive link from media violence usage to teacher-rated aggression for girls and boys, but no direct negative link to prosocial behavior was found. Indirect pathways were identified to higher aggressive and lower prosocial behavior via the acceptance of aggression as normative. Although there were significant gender differences in media violence exposure, aggression, and prosocial behavior, similar path models were identified for boys and girls.     

Brief report: The Adolescent Child-to-Parent Aggression Questionnaire: An examination of aggressions against parents in Spanish adolescents

The objective of this study was to develop a questionnaire to assess child-to-parent aggression in adolescents and to document the extent of the problem. The questionnaire developed in this study, the Child-to-Parent Aggression Questionnaire (CPAQ), includes forms of physical and psychological aggression directed at both the mother and the father. It also includes open questions about the reasons for the aggressive acts. The CPAQ was completed by a sample of 2719 adolescents (age range: 13–18 years old, 51.4% girls). Confirmatory factor analysis supported a four-factor correlated structure (physical aggression against mother, physical aggression against father, psychological aggression against mother, and psychological aggression against father). Psychological and physical aggression against the mother was more frequent than against the father. However, there were no differences with regard to severe forms of aggression. Girls scored significantly higher on all indicators of psychological aggression, including severe psychological aggression. Nevertheless, except for the prevalence of physical aggression against mothers, which was higher in females, there were no significant differences in physical aggression against parents. Finally, the reasons provided by the adolescents for the aggression included both instrumental (e.g., to obtain permission to get home late and to access their computers) and reactive reasons (e.g., anger and self-defense). These findings highlight the complexity of child-to-parent aggression in adolescence.     

Stability in aggression and aggression control in a sample of primary school children in China

The aim was to study the stability of aggression and aggression control in Chinese children. Olweus' Aggression Inventory was retested after 18 months in a sample of Chinese primary school children in Beijing (average age 12 years; 267 children; 139 boys and 128 girls; 92% of the initial study sample). Compared with relevant studies in Scandinavian countries, this study shows that a degree of stability in aggression behaviour is also found in Chinese primary school children despite strong societal pressures against aggressive behaviour and towards aggression control. The result supports the earlier evidence that aggression was a somewhat more global or less differentiated phenomenon for Chinese children. Nevertheless, the average aggression response level for the Chinese children is clearly low and quite high for aggression control. Positive self-report, which reflects good adjustment and psychological health, was still clearly related to aggression control, but slightly less for the boys. The average difference between boys and girls in general aggression and aggression control was stable over time. Girls showed a lower level of general aggression and a higher level of aggression control compared with boys.     

A STUDY OF AGGRESSION AMONG REFERRALS TO A COMMUNITY-BASED PSYCHIATRY OF OLD AGE SERVICE

Objective. The aims of the study were to examine the prevalence of aggressive behaviour in a non-selected community-based population, to identify clinical and sociodemographic variables associated with aggression and to examine the relationship between aggression and outcome at 2-year follow-up. Design. Case series, using the Ryden Aggression Scale as a retrospective measure of aggression. Setting. A community-based specialist psychiatry of old age service. Participants. All referrals to the service over a 3-month period. Results. Of the 42 subjects included in the study, 25 patients had a diagnosis of dementia. Aggressive behaviour was reported in 18 patients, this being verbal only in nine cases and both verbal and physical in nine cases. Sexual aggression and self-injurious behaviour were each reported in one case only. Aggression was found to be positively associated with a diagnosis of dementia and high physical dependency but was not found to be associated with age, sex, physical illness or the use of psychotropic medication. At 2-year follow-up, aggressive patients were found to have a higher rate of admission to psychiatric inpatient or residential care and tended to have a higher use of neuroleptic drugs. Conclusions. These findings suggest that aggression is a significant problem for community-based elderly people and their carers, may increase the likelihood of admission into long-term care and that a reliable instrument to measure aggression would be useful in the clinical assessment of this population. © 1997 by John Wiley & Sons, Ltd.     

Social determinants of aggression in a sample of Chinese primary school children

The aim of the present study was to relate children's aggression levels to social determinants of interest (i.e., child-rearing measures, day-care attendance, peer group influence, and TV-watching) in a sample of Chinese children in the People's Republic of China. A sample of 290 primary school students (155 boys and 135 girls, mean age 10.3) in grade four in Beijing were investigated using the Multi-Faceted Aggression Inventory. The children's parents were asked about child-rearing measures and day-care experience for the child. Teachers rated the children's aggression, school achievement level, and membership in the Young Pioneers. Despite acknowledged limitations, the findings in this study gave evidence that according to a person-environment interaction perspective, the Chinese children's individual differences in aggression were influenced by the restricted environment. As aggressive behaviour is undesired and suppressed in the Chinese culture in and outside the home, the Chinese children seemed to show lower levels and less variation of aggression behaviour than children in permissive environments (e.g., Sweden). However, when analysing sex differences in aggression environmental influences alone might not explain the differences.     

Profiles of aggression among psychiatric patients. I. Nature and prevalence

Based on the Yudofsky scale, a Modified Overt Aggression Scale (MOAS) with upgraded psychometric properties was developed to assess the nature and prevalence of aggression in a psychiatric population. The present report describes the standardization of this scale and the pattern of findings on two cohorts of 114 and 150 inpatients. The results support the discriminative validity of the MOAS and its internal, interrater, and retest reliabilities. Within 1 week some form of aggression was noted in about one fourth of the patient samples, with verbal aggression the most prevalent and autoaggression the least. Chronic patients showed the lowest incidence of physical assault and general aggression, whereas gender differences and daily variations were not significant. Greater stability of aggression was demonstrated for patient groups and for forms of aggression with higher base rates and for the short term (within 1 week) rather than the long course (3 months). The high prevalence of aggression and the consistency of profiles across patient samples suggested that sensitive, multivariable scaling can improve the accuracy of measurement and the depiction of the construct.     

The Influence of Aggressiveness on Rape-Myth Acceptance among University Students

The detrimental effects of rape are well established. In order to support victims of rape in reporting sexual assault, the factors which predict rape myths need to be investigated. Aggression has been linked to sexual violence, but little is known about the role of aggressive behaviour in rape-myth acceptance. The present study aimed to investigate whether rape myths could be predicted by verbal aggression, physical aggression, hostility, anger or sex in a sample of 121 participants. A regression analysis found that an individual's sex and self-reported physical aggression significantly predicted rape-myth acceptance.     

Adolescents' outcome expectancies about relational aggression within acquaintanceships, friendships, and dating relationships

Adolescents' (N = 292) relational aggression and outcome expectancies for relational aggression in three different relationship contexts (acquaintanceship, friendship, and dating) were assessed. With respect to each type of relationship, adolescents were questioned about the emotional and dyadic consequences of relational aggression, and about whether the victim of relational aggression would retaliate. It was also of interest to assess whether adolescents' personal involvement in relational aggression was associated with these judgments. The results suggest that adolescents' involvement in relational aggression and outcome expectancies for relational aggression often varies by gender, age, relationship context, and type of relational aggression. Additionally, in several instances, adolescents' personal involvement in relational aggression was associated with outcome expectancies for relational aggression. For example, after gender and age had been accounted for, participants' own relational aggression predicted beliefs about whether the victim of relational aggression would want to continue a friendship and a dating relationship. Implications of the results and future directions for research are discussed.     

Aggressive behavior in a sample of children with autism spectrum disorders

Little is known about the manifestation of aggressive behavior in children with autism, although it is commonly cited as a significant problem. Existing reports in autism do not emphasize subtypes of aggression, whereas distinguishing forms of aggression is commonplace in the typically developing literature. This study compared a sample of 121 children aged 3–20 years with autism spectrum disorders (ASD) to 244 children with other intellectual and developmental disabilities (IDD; age 4–21 years). Item- and subscale-level data from the Children's Scale for Hostility and Aggression: Reactive/Proactive (C-SHARP) were reported. Children with ASDs received higher ratings than those with IDD on several subscales tapping physical and reactive aggression. Within the ASD group, children with Asperger's disorder were rated significantly higher than children with autism on subscales tapping covert and verbal behaviors. Results indicate that at least some types of aggression were more common in children with ASDs than those with IDDs.     

Aggressive symptoms in children with tic disorders

Episodes of explosive anger and aggression are reported in patients with tic disorders and probably contribute to psychosocial stress and low quality of life. The source of these symptoms is controversial. The objective of the study was to study the relationship between tic disorders, their associated comorbidities, and aggressive behavior. The cohort included 47 children and adolescents (age 7–17 years) with Tourette syndrome or other chronic tic disorders attending a tertiary pediatric Tourette clinic. Associated psychopathology was assessed with the Yale Global Tic Severity Scale, Yale Brown Obsessive Compulsive Scale, Conners ADHD Rating Scale, Screen for Child Anxiety-Related Emotional Disorders, and Child Depression Inventory. Aggression was assessed with the Overt Aggression Scale and scores were compared with a group of 32 healthy age- and sex-matched children. There were no significant differences in aggression scores between the children with tic disorders and controls. Verbal aggression was the most prevalent type of aggression, found in 70% of the patients with tic disorders. The level of aggression was not correlated to tic severity. Comorbid attention-deficit hyperactivity disorder and obsessive–compulsive disorder increased the probability of aggressive behavior in patients with tic disorders. On regression analysis, the only significant predictor of aggression was the severity of attention-deficit hyperactivity disorder. This study suggests that there is no difference in aggressive behavior between children with tics without comorbidities and healthy children. It is possible that aggressive behavior in children with tic disorders is predominantly associated with comorbid attention-deficit hyperactivity disorder.

     

Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder

CONTEXT: Violent behavior of patients with schizophrenia prolongs hospital stay and interferes with their integration into the community. Finding appropriate treatment of violent behaviors is of primary importance. OBJECTIVE: To compare the efficacy of 2 atypical antipsychotic agents, clozapine and olanzapine, with one another and with haloperidol in the treatment of physical assaults and other aggressive behaviors in physically assaultive patients with schizophrenia and schizoaffective disorder. DESIGN AND SETTING: Randomized, double-blind, parallel-group, 12-week trial. Physically assaultive subjects with schizophrenia or schizoaffective disorder who were inpatients in state psychiatric facilities were randomly assigned to treatment with clozapine (n = 37), olanzapine (n = 37), or haloperidol (n = 36). MAIN OUTCOME MEASURES: Number and severity of physical assaults as measured by the Modified Overt Aggression Scale (MOAS) physical aggression score and the number and severity of all aggressive events as measured by the MOAS overall score. Psychiatric symptoms were assessed through the Positive and Negative Syndrome Scale (PANSS). RESULTS: Clozapine was superior to both olanzapine and haloperidol in reducing the number and severity of physical assaults as assessed by the MOAS physical aggression score and in reducing overall aggression as measured by the MOAS total score. Olanzapine was superior to haloperidol in reducing the number and severity of aggressive incidents on these 2 MOAS measures. There were no significant differences among the 3 medication groups in improvement of psychiatric symptoms as measured by the PANSS total score and the 3 PANSS subscales. CONCLUSIONS: Clozapine shows greater efficacy than olanzapine and olanzapine greater efficacy than haloperidol in reducing aggressive behavior. This antiaggressive effect appears to be separate from the antipsychotic and sedative action of these medications.