Externalizing Conditions

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CHAPTER 17 Externalizing Conditions

JOHN E. LOCHMAN, TAMMY D. BARRY, NICOLE R. POWELL, CAROLINE L. BOXMEYER, KHIELA J. HOLMES

Externalizing problems in children represent the most common reasons for referral for behavioral intervention.¹ However, these behaviors undergo many changes in form and frequency during childhood and adolescence, and without an understanding of normal developmental trends, it may be difficult to determine whether a given child’s behavior is typical or problematic. Therefore, clinicians must have background knowledge in the normal development of externalizing behaviors. We begin this chapter by describing how compliant/noncompliant behaviors, anger, and aggression change in expression and frequency through childhood and adolescence. In subsequent sections, we explore how externalizing behavior manifests in problematic forms, how various biopsychosocial factors contribute to the development of children’s problems with aggression and conduct, and how aggression and conduct problems can be assessed. We conclude by discussing how these problems can be effectively treated with psychosocial methods.

NORMAL VARIATIONS IN EXTERNALIZING BEHAVIORS AND RELATED EMOTIONAL CHARACTERISTICS

Compliance Behaviors

All children at every age exhibit both compliant and noncompliant behaviors. Therefore, noncompliant behaviors, by themselves, are not cause for concern; however, the frequency, intensity, form, and effects of such behaviors distinguish normal and abnormal expressions of noncompliance. Clinical manifestations of noncompliance are categorized as externalizing disorders and are described in a later section. In this section, we outline patterns and contributing factors in normal compliant and noncompliant behaviors.

Although most people involved in the care of children have an idea of what is meant by compliance and noncompliance, these behaviors often prove difficult to define operationally. In their treatment manual for noncompliant children, McMahon and Forehand ² used the definition “appropriate following of an instruction within a reasonable and/or designated time” to operationalize compliance, noting that it is important to distinguish between the initiation of compliance and the completion of the specified task.³ Five to 15 seconds was suggested as a reasonable period for the initiation of compliance. McMahon and Forehand² defined noncompliance as “the refusal to initiate or complete a request” and/or “failure to follow a previously stated rule that is currently in effect” (p 2). In defining compliance and noncompliance, clinicians must also recognize that these are not stand-alone behaviors but are interactional processes between adult and child. Parenting behaviors can affect a child’s likelihood of compliance, and child characteristics and responses can, in turn, affect parenting behaviors.

Children first begin to understand the consequences of their own behavior between 6 and 9 months of age and may also learn to recognize the word “no” during this time. Increasing physical development, cognitive abilities, social skills, and receptive language skills lead to improved abilities to respond to verbal directions, and children are generally able to follow simple instructions by age 2 years. Nonetheless, noncompliance with commands is very common for 2- and 3-year-old children, possibly because of parental expectations of resistance (i.e., “the terrible twos”) and parents’ resulting failure to train their young children to comply.⁴

Compliance levels are expected to increase with age in typically developing children.⁵ However, the collection of normative data has proved to be complex and elusive because of sample characteristics and measurement issues.^2,⁴ A number of investigators have found the expected progression of compliant behaviors in young children as they age. Vaughn and colleagues ⁶ reported increases in compliance with maternal requests between 18 and 30 months of age, and Kochanska and associates⁷ reported an upward trend in one form of compliance from 14 to 33 months of age. Brumfield and Roberts⁴ reported that whereas 2- and 3-year-old children complied with only 32.2% of maternal commands, the compliance rate for 4- and 5-year-olds reached 77.7%. However, Kuczynski and Kochanska⁸ reported no change in compliance to maternal requests between toddler age (1½ to 3½ years) and age 5 years. Kuczynski and Kochanska⁸ did find that direct defiance and passive noncompliance decreased with age, although simple refusal and negotiation (an indirect form of noncompliance) increased. Another longitudinal study reported stable rates of noncompliance from ages 2 to 4 years.⁹

By the time they reach school age, children are expected to comply with adult requests the majority of the time. In a review of studies, McMahon and Forehand ² suggested that compliance rates are approximately 80% for normally developing children. Patterson and Forgatch,¹⁰ however, reported lower compliance rates in a sample of “non-problem 10- and 11-year-old boys”: 57% in response to maternal requests and 47% in response to paternal requests.

In adolescence, noncompliant behaviors often increase above childhood levels in typically developing youths. Developmental changes in cognition and social skills, combined with adolescents’ growing independence and need to establish their own identity, may lead to increased parent-adolescent conflict. However, developmental research suggests that typical levels of parent-adolescent conflict are manageable and do not constitute the period of severe “storm and stress” described in early models of family relations.^11,¹² Conflict tends to be at its most extreme during early adolescence and to decline from early adolescence to mid-adolescence and from mid-adolescence to late adolescence.¹³

Boys and girls differ in their normative rates of oppositional, noncompliant behaviors; boys demonstrate higher rates than do girls during childhood. However, the gender difference closes with age, and boys and girls demonstrate increasingly similar rates as they progress through adolescence.¹⁴

Anger and Aggression

Like compliance and noncompliance, angry and aggressive behaviors are common to all children, representing clinically significant problems only when frequent and severe enough to disrupt a child’s or family’s daily life. Anger is often, but not always, a precursor to aggression in children. In fact, the presence or absence of anger is often a defining factor in the classification of aggression. Anger is a key feature of hostile aggression, which carries the intent to harm and is accompanied by emotional arousal, but not of instrumental aggression, which is motivated by external reward rather than by emotional arousal. Similarly, reactive aggression is emotionally driven and takes the form of angry outbursts, whereas proactive aggression is instrumentally driven and takes the form of goal-driven behaviors (e.g., domination of others or obtaining a desired object).¹⁵

Another classification of aggression differentiates between physical aggression and relational aggression. Girls may be more likely to engage in acts of relational aggression, which cause harm by damaging relationships or threatening to do so (e.g., spreading rumors, social exclusion).¹⁶

Not surprisingly, children who are identified as angry by parents and teachers are more likely to display externalizing behaviors.¹⁷^–¹⁹ Relations have also been reported between anger in children and internalizing problems²⁰ and between anger in children and being victimized by peers.²¹

Anger and Development

Anger is one of the earliest emotions to appear in infancy. Between ages 2 and 6 months, infants engage in recognizable displays of anger, including a characteristic cry, and by 7 months, facial expressions of anger can be reliably detected.²² Caregivers tend to respond to infants’ anger expressions by ignoring them or reacting negatively, thus beginning the socialization process against anger.^23,²⁴ As children learn what is socially acceptable, their displays of anger may diminish. For example, one study demonstrated that by 24 months of age, toddlers are able to modulate their expression of anger and are more likely to display sadness, which is more likely to elicit a supportive response from a caregiver.²⁵

Anger is likely to be accompanied by physically aggressive behavior in very young children, but with increasing age and developmental level, expressions of anger change in typically developing children. Dunn,²⁶ for example, found that physical aggression and teasing were equally prevalent in 14-month-old children, but by age 24 months, children were much more likely to tease. During early childhood, children are expected to learn appropriate ways to manage and express their anger. Young children demonstrate progressive increases in their vocabulary of emotional terms and increased understanding of the causes and consequences of emotions.^27,²⁸ By the time they reach elementary school age, children have generally developed a sophisticated understanding of the types of emotional displays that are appropriate and functional in a given context.²⁹ Shipman and colleagues²⁹ reported that children in the first through fifth grades identified verbalization of feelings as the most appropriate means of expression of anger, followed by facial displays. The children identified sulking, crying, and aggression as equally inappropriate ways of expressing anger. These findings are consistent with those of other research demonstrating that, with age, children become increasingly less likely to engage in expressive displays of anger as they come to recognize that their ability to maintain emotional control is important to their social functioning.³⁰

The types of circumstances that elicit anger in children also change with developmental level. Very young children are likely to react angrily when someone or something interferes with their attempts to reach a goal, whereas anger in older children is more often precipitated by a threat to self-esteem. This change is accompanied by increases in older children’s self-awareness, understanding of social norms, and the importance they place on others’ perceptions of them.

Aggression and Development

An understanding of normal developmental trends in aggressive behavior is an important starting point in identifying clinically significant problems for children of a given age. In typically developing children, aggressive behaviors follow a declining trend with age during childhood and adolescence. Large-scale longitudinal and cross-sectional studies have demonstrated that rates of aggression decline during childhood and adolescence; aggressive behavior occurs at the highest levels in the youngest children and at the lowest levels in late adolescence.^14,³¹^–³³

Declining trajectories of aggression over time hold for children of both genders; however, at any given point in childhood, boys tend to display higher rates of aggressive behavior than do girls. In fact, boys may display twice as much aggression as girls do during childhood. These gender differences appear to be present very early on, before 4 years of age, and therefore are unlikely to be caused by socialization effects associated with school attendance. Aggressive behavior declines more quickly for boys, and by late adolescence, the rates of aggression in boys and girls are indistinguishable.^14,³¹ Aggressive acts are nearly nonexistent in typically developing late adolescent–aged youths of both genders.

Aggressive Behavioral Problems

Because of a number of factors that are further elaborated upon later in this chapter, some children display externalizing behaviors that exceed the normal amounts or typical variations. Within this group of disruptive children, aggression is a frequent and particularly concerning complaint. Aggression is one of the most stable problem behaviors in childhood, with a developmental trajectory toward negative outcomes in adolescence, such as drug and alcohol use, truancy and dropout, delinquency, and violence.³⁴ Additional studies indicate that children’s aggressive behavior patterns may escalate to include a wide range of severe antisocial behaviors in adolescence.³⁵ The negative trajectory may even continue into adulthood, as demonstrated by Olweus’s finding that of adolescents identified as bullies, 60% had their first criminal conviction by age 24.³⁶

These findings highlight the fact that aggressive behavior can have serious and negative implications for a child’s future. The negative effects are not, however, limited to the aggressive individual, inasmuch as aggressive behavior, by definition, has the potential to cause harm or injury to others. In today’s schools, aggressive bullying, which may be verbal, physical, or psychological, is increasingly recognized as a serious problem.³⁷ Bullying is a deliberate act with the intent of harming the victims.³⁸ Examples of direct bullying include hitting and kicking, charging interest on goods and stealing, name calling and intimidation, and sexual harassment. Other forms of bullying that are more indirect in nature (i.e., relational bullying) include spreading rumors about peers and gossiping.³⁹ The victims of bullies usually tend to be shy and likely to seek help.⁴⁰

Children who display high levels of aggressive behavior often exhibit additional externalizing behaviors and may meet criteria for a disruptive behavior disorder diagnosis such as Oppositional Defiant Disorder (ODD) or Conduct Disorder.⁴¹ Although not an explicit part of the diagnosis, aggression may accompany the characteristic pattern of negativistic, hostile, and defiant behavior associated with a diagnosis of ODD. More severe disruptive behaviors, including aggression toward people or animals, destruction of property, theft, and deceit, are associated with conduct disorder. Prevalence rates for these diagnoses are estimated to be from 2% to 16% of the general population for ODD and from 1 to more than 10% for conduct disorder.⁴¹ ODD is mostly closely associated with “aggressive/oppositional behaviors” under the category of “negative/antisocial behaviors” in the Diagnostic and Statistical Manual of Mental Disorders—Primary Care: Child and Adolescent Version.^41a The features of conduct disorder are similar to “secretive antisocial behaviors” under the same category. Some researchers are beginning to identify psychological features that are linked to subsequent psychopathy.⁴² Youths who have psychopathic features display manipulation, impulsivity, and remorseless patterns of interpersonal behavior, are usually referred to as “callous” or “unemotional,” and are considered to be conceptually different from youths with a diagnosis of Conduct Disorder.^43,⁴⁴

Symptoms associated with ODD are age inappropriate, usually appearing before 8 years of age and no later than adolescence.⁴¹ These symptoms include angry, defiant, irritable, and oppositional behaviors and are usually first manifested in the home environment. The diagnosis of ODD should be made only if these behaviors occur more frequently than what would be typically expected of same-aged peers with a similar developmental level. Conduct disorder symptoms such as setting fires, breaking and entering, and running away from home are more severe and may become evident as early as the preschool years, but these behaviors usually begin in middle childhood to middle adolescence. Less severe symptoms (e.g., lying, shoplifting, and physical fighting) are observed initially, followed by intermediate behaviors such as burglary; the most severe behaviors (e.g., rape, theft while confronting a victim) usually emerge last.⁴¹ Professionals who provide services to children and adolescents must be aware of the symptoms of ODD and provide intervention, because ODD is a common antecedent to conduct disorder. Furthermore, a significant subset of individuals who receive a diagnosis of Conduct Disorder, particularly those with an early onset, subsequently develop antisocial personality disorder.⁴¹ Table 17-1 lists diagnostic criteria for ODD and Conduct Disorder from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR).⁴¹

TABLE 17-1 DSM-IV-TR Diagnostic Criteria for Oppositional Defiant Disorder and Conduct Disorder

Oppositional Defiant Disorder	Conduct Disorder
A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following occur:	A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:
1. Often loses temper 2. Often argues with adults 3. Often actively defies refuses or to comply with adults’ requests or rules 4. Often deliberately annoys people 5. Often blames others for his or her mistakes or misbehavior 6. Is often touchy or easily annoyed by others 7. Is often angry and resentful 8. Is often spiteful or vindictive

Aggression to people and animals

1. Often bullies, threatens, or intimidates others

2. Often initiates physical fights

3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)

4. Has been physically cruel to people

5. Has been physically cruel to animals

6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)

7. Has forced someone into sexual activity

Destruction of property

8. Has deliberately set fires with the intention of causing serious damage

9. Has deliberately destroyed others’ res)

Deceitfulness or theft

10. Has broken into someone else’s

11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)

12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

Serious violation of rules

13. Often stays out at night despite parental prohibitions, beginning before age 13 years

14. Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)

15. Is often truant from school, beginning before age 13 years

There are no separate codes based on age at onset

Conduct Disorder, Childhood-Onset Type: Onset of at least one criterion characteristic of Conduct Disorder before age 10 years

Conduct Disorder, Adolescent-Onset Type: Absence of any criteria characteristic of Conduct Disorder before age 10 years

Conduct Disorder, Unspecified Onset: Age at onset is not known

There are no specified levels of severity

Mild: Few if any conduct problems in excess of those necessary to make the diagnosis and conduct problems cause only minor harm to others

Moderate: Number of conduct problems and effect on others intermediate between “mild” and “severe”

Severe: Many conduct problems in excess of those necessary to make the diagnosis or conduct problems cause considerable harm to others

DSM-IV-TR, Diagnostic and Statistic Manual of Mental Disorder, 4th edition, text revision.

With regard to gender features, ODD is more prevalent in boys than in girls before puberty, but the rates are fairly equal after puberty. ODD symptoms are typically similar in boys and girls, except that boys exhibit more confrontational behavior and have more persistent symptoms.⁴¹ Diagnoses of Conduct Disorder, particularly the childhood-onset type, are more common in boys than in girls. According to the American Psychiatric Association,⁴¹ boys with conduct disorder usually display symptoms such as “fighting, stealing, vandalism, and school discipline problems,” and girls with conduct disorder usually engage in “lying, truancy, running away, substance use, and prostitution.”

Childhood disorders rarely occur in isolation, and comorbidity issues are important to consider in treating children within clinical populations.⁴⁵ ODD and conduct disorder are often observed in conjunction with attention-deficit/hyperactivity disorder (ADHD), academic underachievement and learning disabilities, and internalizing disorders (e.g., depression and anxiety disorders). Among youth with conduct disorder and ODD, 50% also have a diagnosis of ADHD.⁴⁵ Furthermore, the hyperactive-impulsive subtype of ADHD is more closely associated with aggression than is the inattentive subtype. ODD in conjunction with ADHD increases the likelihood for the development of early-onset conduct disorder symptoms.^46,⁴⁷ Children with disruptive behaviors are at a greater risk for dropping out of school and thus becoming part of a deviant peer group in their neighborhood. Moreover, children with both conduct problems and depressive symptoms are more likely to engage in substance abuse as adolescents than are children with conduct problems alone.

With regard to differential diagnoses, ODD should not be diagnosed if the symptoms occur exclusively during a mood or psychotic disorder. As previously noted, ADHD often co-occurs with ODD, warranting two separate diagnoses. Furthermore, the oppositional behavior associated with ODD and the impulsive and disruptive behaviors associated with ADHD should be distinguished when a diagnosis is made.⁴¹ The diagnosis of ODD should not be made if the individual meets criteria for diagnosis of an adjustment disorder, conduct disorder, or, if the individual is aged 18 years or older, antisocial personality disorder. Last, the behaviors associated with ODD must be more frequent and severe than what is typically expected and lead to significant impairment in social, academic, or occupational functioning.⁴¹ As with ODD, a diagnosis of Conduct Disorder should not be made if the behaviors occur exclusively during the course of a psychotic disorder, mood disorder, or ADHD. Furthermore, Conduct Disorder should not be diagnosed when the individual meets criteria for an adjustment disorder or, if the individual is 18 years of age or older, antisocial personality disorder. According to the DSM-IV-TR, when an individual meets criteria for both ODD and Conduct Disorder, a diagnosis of Conduct Disorder should be made.

ETIOLOGY: RISK AND CAUSAL FACTORS WITHIN A CONTEXTUAL SOCIAL-COGNITIVE MODEL

The contextual social-cognitive model,⁴⁸ which is derived from etiological research on childhood aggression, indicates that certain family and community background factors (neighborhood problems, maternal depression, poor social support, marital conflict, low socioeconomic status) have both a direct effect on children’s externalizing behavior problems and an indirect effect through their influence on key mediational processes (parenting practices, children’s social cognition and emotional regulation, children’s peer relations). A child’s developmental course is set within the child’s social ecology, and an ecological framework is required.⁴⁹ Risk factors that are biologically related are noted first, followed by contextual factors in the model, and, finally, by their effect on children’s developing social-cognitive and emotional regulation processes.

Biological and Temperament Factors

With regard to biological and temperamental child factors, some prenatal factors such as maternal exposure to alcohol, methadone, cocaine, and cigarette smoke and severe nutritional deficiencies ⁵⁰^–⁵³ have been found to have direct effects on childhood aggression. However, aggression is more commonly the result of interactions between the child’s risk factors and environmental factors, in diathesis-stress models.⁵⁴ Thus, risk factors such as birth complications, genes, cortisol reactivity, testosterone, abnormal serotonin levels, and temperament all contribute to children’s conduct problems but only when environmental factors such as harsh parenting or low socioeconomic status are present.⁵⁵^–⁵⁹

Examples of these diathesis-stress models abound in the literature on children’s risk factors. Birth complications such as preeclampsia, umbilical cord prolapse, forceps delivery, and fetal hypoxia increase the risk of later violence among children but only when the infants subsequently experience adverse family environments or maternal rejection.^55,⁵⁸ Higher levels of testosterone among adolescents and higher cortisol reactivity to provocations are associated with more violent behavior but only when the children or adolescents live in families in which they experience high levels of abuse by parents or low socioeconomic status.^57,⁶⁰ Children who have a gene that expresses only low levels of monoamine oxidase A have a higher rate of adolescent violent behavior but only when they have experienced high levels of maltreatment by parents.⁶¹ Similar patterns of findings are found when children’s temperament characteristics are examined as child-level risk factors. Highly active children,⁶² children with high levels of emotional reactivity,⁶³ and infants with difficult temperament⁵⁶ are at risk for later aggressive and conduct problem behavior but only when they have parents who provide poor monitoring or harsh discipline. The children’s family context can serve as a key moderator of children’s underlying propensity for an antisocial outcome.

Contextual Family Factors

A wide array of factors in the family, ranging from poverty to more general stress and discord, can affect childhood aggression and conduct problems. Children’s aggression has been linked to family background factors such as parent criminality, substance use, and depression ⁶⁴^–⁶⁶; low socioeconomic status and poverty⁶⁷; stressful life events^64,⁶⁸; single and teenage parenthood⁶⁹; marital conflict⁷⁰; and insecure, disorganized attachment.⁷¹ All of these family factors are intercorrelated, especially with socioeconomic status,⁷² and low socioeconomic status assessed as early as the preschool years has been predictive of teacher- and peer-rated behavior problems at school.⁷³ These broad family risk factors can influence child behavior through their effect on parenting processes.

Starting as early as the preschool years, marital conflict probably causes disruptions in parenting that contribute to children’s high levels of stress and consequent aggression.⁷⁴ Both boys and girls from homes in which marital conflict is high are especially vulnerable to externalizing problems such as aggression and conduct disorder; this is found even after age and family socioeconomic status are controlled.⁷⁴

Parenting Practices

Parenting processes linked to children’s aggression ^75,⁷⁶ include (1) nonresponsive parenting at age 1, in which pacing and consistency of parent responses do not meet children’s needs; (2) coercive, escalating cycles of harsh parental interactions and child’s noncompliance, starting in the toddler years, especially for children with difficult temperaments; (3) harsh, inconsistent discipline; (4) unclear directions and commands; (5) lack of warmth and involvement; and (6) lack of parental supervision and monitoring as children approach adolescence.

Parental physical aggression, such as spanking and more punitive discipline styles, has been associated with oppositional and aggressive behavior in both boys and girls. Poor parental warmth and involvement contribute to parents’ use of physically aggressive punishment practices. Weiss and colleagues ⁷⁷ found that parent ratings of the severity of parental discipline were positively correlated with teachers’ ratings of aggression and behavior problems. In addition to higher aggression ratings, children experiencing harsh discipline practices exhibited poorer social information processing; this was found even when the possible effects of socioeconomic status, marital discord, and child temperament were controlled. Of importance is that although such parenting factors are associated with childhood aggression, child temperament and behavior also affect parenting behavior.⁷⁸

Poor parental supervision has also been associated with childhood aggression. Haapasalo and Tremblay ⁷⁹ found that boys who fought more often with their peers reported having less supervision and more punishment than did boys who did not fight. Interestingly, the boys who fought reported having more rules than the boys who did not fight, which suggests the possibility that parents of aggressive boys may have numerous strict rules that are difficult to follow.

Contextual Peer Factors

Children with disruptive behaviors are at risk for being rejected by their peers.⁸⁰ Childhood aggressive behavior and peer rejection are independently predictive of delinquency and conduct problems in adolescence.^81,⁸² Aggressive children who are also socially rejected tend to exhibit more severe behavior problems than do children who are either only aggressive or only rejected. As with bidirectional relations evident between the degree of parental positive involvement with their children and children’s aggressive behavior over time,⁸³ children’s aggressive behavior and their rejection by their peers affect each other reciprocally.⁸⁴ Children who have overestimated perceptions of their actual social acceptance can be at particular risk for aggressive behavior problems in some settings.⁸⁵

Despite the compelling nature of these findings, race and gender may moderate the relation between peer rejection and negative adolescent outcomes. For example, Lochman and Wayland ⁸¹ found that peer rejection ratings of African American children in a mixed-race classroom were not predictive of subsequent externalizing problems in adolescence, whereas peer rejection ratings of white children were associated with future disruptive behaviors. Similarly, whereas peer rejection can be predictive of serious delinquency in boys, it can fail to be so with girls.⁸⁶

As children with conduct problems enter adolescence, they tend to associate with deviant peers. We believe that many of these teenagers are continually rejected from more prosocial peer groups because they lack appropriate social skills and, as a result, they turn to antisocial cliques as their only sources of social support.⁸⁶ The tendency for aggressive children to associate with one another increases the probability that their aggressive behaviors will be maintained or will escalate, because of modeling effects and reinforcement of deviant behaviors.⁸⁷ The relation between childhood conduct problems and adolescent delinquency is at least partially mediated by deviant peer group affiliation.⁸⁸

Contextual Community and School Factors

Neighborhood and school environments have also been found to be risk factors for aggression and delinquency beyond the variance accounted for by family characteristics.⁸⁹ Exposure to neighborhood violence increases children’s aggressive behaviors,^90,⁹¹ reinforces their acceptance of aggression,⁹¹ and begins to have heightened effects on the development of antisocial behavior during the middle childhood, preadolescent years.⁹² Neighborhood problems disrupt parents’ ability to supervise their children adequately⁹³ and have a direct effect on children’s aggressive, antisocial behaviors^94,⁹⁵ beyond the effects of poor parenting practices. Early onset of aggression and violence has been associated with neighborhood disorganization and poverty, partly because children who live in lower socioeconomic status and disorganized neighborhoods are not well supervised, engage in more risk-taking behaviors, and experience the deviant social influences that are apparent in problematic crime-ridden neighborhoods.

Schools can further exacerbate children’s conduct problems through frustration with academic demands caused, in part, by their children’s learning problems and by peer influences. The density of aggressive children in classroom settings can increase the amount of aggressive behavior exhibited by individual students.^96,⁹⁷

Social Information Processing

Children begin to form stable patterns of processing social information and of regulating their emotions on the basis of (1) their temperament and biological dispositions and (2) their contextual experiences with family, peers, and community.⁹⁸ Children’s emotional reactions, such as anger, can contribute to later substance use and other antisocial behavior, especially when children have not developed good inhibitory control.⁹⁹ The contextual social-cognitive model⁴⁸ stresses the reciprocal, interactive relationships among children’s initial cognitive appraisal of problem situations, their efforts to think about solutions to the perceived problems, their physiological arousal, and their behavioral response. The level of physiological arousal depends on the individual’s biological predisposition to become aroused and varies according to the interpretation of the event.¹⁰⁰ The level of arousal further influences the social problem solving, operating either to intensify the fight-or-flight response or to interfere with the generation of solutions. Because of the ongoing and reciprocal nature of interactions, children may have difficulty extricating themselves from aggressive behavior patterns.

Aggressive children have cognitive distortions at the appraisal phases of social-cognitive processing because of difficulties in encoding incoming social information and in accurately interpreting social events and others’ intentions. They also have cognitive deficiencies at the problem solution phases of social-cognitive processing, as evidenced by their generating maladaptive solutions for perceived problems and having nonnormative expectations for the usefulness of aggressive and nonaggressive solutions to their social problems. In the appraisal phases of information processing, aggressive children recall fewer relevant cues about events,¹⁰¹ base interpretations of events on fewer cues,¹⁰² selectively attend to hostile rather than neutral cues,¹⁰³ and recall the most recent cues in a sequence, with selective inattention to earlier presented cues.¹⁰⁴ At the interpretation stage of appraisal processing, aggressive children have a hostile attributional bias: They tend to infer excessively that others are acting toward them in a provocative and hostile manner.^101,¹⁰² These attributional biases tend to be more prominent in reactively aggressive children than in proactively aggressive children.¹⁰⁵

The problem solving stages of information processing begin with the child accessing the goal that the individual chooses to pursue, thereby affecting the responses generated for resolving the conflict in the next processing stage. Aggressive children have social goals that are more dominance and revenge oriented, and less affiliation oriented, than those of nonaggressive children.¹⁰⁶

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