Monday, April 30, 2012

Aggression in children - need for parental intervention

aggression-prevalence
Aggression is uncommon in school children and should be addressed

A Pune teenager was kidnapped and murdered by his school friends a few weeks ago. The victim was deliberately selected and his parents were manipulated for a ransom. Violence, theft and destructiveness are end stage behaviours of conduct problems in children and adolescents.


Trajectories of aggression in children

The commonest path of violence in children is 'adolescence-limited'. The antisocial behaviours usually occur when the adolescents are 'hanging out' in a group.  This type of aggression reflects an anti-authoritarianism. Anti-authoritarianism results from frustration over being denied the benefits of full adult independence despite reaching physical maturity. Adolescent limited aggression is less violent, relies on peer encouragement, and generally diminishes by adulthood  These adolescents are usually able to integrate into society as young adults.

A less common path of violence is 'life-course-persistent'. In this group of antisocial children, problem behaviors unfold in a sequence at home and school
  1. Early noncompliance - with excessive arguing and disobedience
  2. Poor rule adherence - staying out late, playing in prohibited locations
  3. Low frustration tolerance - temper tantrums, abusiveness, aggression
Aggression is common among preschoolers. The prevalence rate of aggression in children reduces dramatically once they enter school. Children whose fighting does not  reduce in the early school years are at high risk for persistent violent behavior. This important subgroup of proactively aggressive youth is profoundly indifferent to the consequences that their misbehavior has upon others. They rarely display genuine remorse. Their personality of 'callous-unemotional traits' is characterised by a lack of empathy, self-centeredness, and shallowness. As youths they are responsible for a large number of violent offenses. Their aggressive behavior is often persistent as features of psychopathic or sociopathic personality.

Parenting can prevent violence

  1. Make aggression irrelevant by modifying the setting
  2. Aggression is significantly affected by the parent-child relationship. Children with conduct problems tend to have acrimonious and negative interactions with their parents. The parent is perceived as just an agent of coercion. It is important to change this environment. Positive interactions between the parent and child serves to reinforce the perception of the parent as a source of positive attention, affection, support and encouragement. This makes the child responsive to parents' authority and to the rewards and punsihment that  the parent dispenses.
  3. Make aggression ineffective by modifying its consequences
  4. The reactions of others to the aggressive behavior sustains and reinforces it. They may give in to what the child wants, give up trying to get compliance, or even bar the child from school -  which may be exactly what the child wants. To render the aggression ineffective parents/ teachers have to respond by ignoring milder misbehaviour and handing out consequences. These include time outs, loss of privileges (TV, cell phone, Facebook) that the child will want to avoid, and limit setting (curfew times, restricting location).
    Parents need to establish  their authority and implement some of these measures in aggressive children. This teaches children that aggression is an ineffective means of fulfilling a particular wish. These lessons are better learned early under caring parents rather than later in a centre for juvenile delinquents.
References
Brennan LM. Toddler-age externalizing behaviors and school-age academic achievement: independent associations and the impact of parental involvement University of Pittsburgh. Thesis presented 27-Aug-2010.

Thursday, September 8, 2011

Parental supervision of children and adolescents

parental supervision and injuries in children with high intensity behaviour
Parental supervision protects boisterous children from injury:
More time unsupervised corresponds to more injury 
“To my parents we were just two girls in the bedroom”. What exactly was going on? Without adequate supervision the parents of this teenager never found out; the memories returned to haunt her in adulthood. Studies comparing children with and without parental supervision show that lax parental supervision is associated with injury in toddlers and preschoolers; conduct problems in school going children; and road accidents, addictions, gambling and sexual risk taking in teenagers.

Parental supervision has three dimensions (Gitanjali 2004)
  1. Attention - watching or listening 
  2. Proximity - within or beyond reach 
  3. Continuity - constant, intermittent, or not at all 

Two factors determine the degree to which a child would be left unsupervised (Morrongiello 2008)
  1. Parent’s conscientiousness - the more conscientious the parent more the supervision
  2. Child’s propensity for risky behaviour - the more impulsive and sensation seeking the child the more likely the child will be kept in direct view. 

Distinguishing adequate from neglectful supervision is not straight forward. The consequences of lower levels of supervision are not uniform for all children. The consequences depend to a great extent on child attributes. For children with high sensation seeking, even close supervision is not adequate to prevent injury. For children who are high in behavioural control, even not supervising does not elevate risk of injury.

Whether or not children comply with their parents’ requests to behave in safe ways is a complex interaction of parenting style, attachment style,  and child temperament. The level of supervision necessary to ensure a child’s safety should finally be based on the child’s characteristics. The only reliable maxim is that the time children could be safely left unsupervised generally increases with child age.

Parental supervision of an adolescent differs from supervising a younger child (DeVore 2005). Direct parental observation gradually gives way to indirect parental ‘‘monitoring’. This indirect supervision involves ongoing communication between parents and adolescents about the adolescents’
  • Whereabouts
  • Friends they are with
  • Schedule to return home
  • Contact information enabling parents to directly communicate with adolescents. 
Effective supervision entails active participation of the adolescent, and honest communication between adolescent and parents.

Parental monitoring buffers negative peer influence. Strong peer attachments and increasing independence from the family is a normal part of adolescent development. Unfortunately, youth whose peers engage in high-risk behaviour are at high risk for the development of similar behaviours. Not only are high levels of monitoring protective, low levels of parental monitoring have been associated with numerous risk behaviours.

More unsupervised time is associated with more sexual activity in youth (Cohen 2002). In one urban study more than half of sexually active youth had sex at home after school. For boys, sex and drug-related risks increase with amount of unsupervised time. Trust and communication did not predict decreases in problem behaviour as strongly as did monitoring. Parental monitoring may be particularly protective for high-risk young urban adolescents; those who spend a significant amount of non-school time unsupervised. 

References 
  1. Cohen DA, Farley TA, Taylor SN, et al. When and where do youths have sex? The potential role of adult supervision. Pediatrics 2002; 110:e66 
  2. DeVore ER, Ginsburg KR. The protective effects of good parenting on adolescents. Curr Opin Pediatr. 2005 Aug;17(4):460-5. 
  3. Gitanjali S, Brenner R, Morrongiello BA, Haynie D, Rivera M, Cheng T. The role of supervision in child injury risk: Definition, conceptual, and measurement issues. Journal of Injury Control & Safety Promotion 2004;11(1):17-22. 
  4. Morrongiello BA, Klemencic N, Corbett M. Interactions between child behavior patterns and parent supervision: Implications for children’s risk of unintentional injury. Child Development 2008;79(3):627-638.