A Narrative Review on Aggression in Children and Adolescents: Anthropology, Developmental Phenomenology, Transdiagnostic Trajectories, Contextual Nosology, and Strategic Pathways for Interventions
Mayank Gupta, Nihit GuptaIntroduction/Objective::
The transdiagnostic construct of aggression in children and adolescents is often characterized by distinct mental phenomena, such as irritability, emotional dysregulation (ED), anger, and outbursts. However, these terms are frequently interchanged in clinical settings despite their distinct semantic nuances. Therefore, it is critical to delve into the complex dynamics of aggression, irritability, and emotional dysregulation in the child and adolescent population.
Methods::
An extensive search was conducted across diverse databases using the keywords "Aggression," "Violence," "Irritability," and "Emotional dysregulation." This search encompassed articles on childhood aggression, covering its prevalence, risk factors, clinical manifestations, assessment methods, treatment modalities, and prognostic indicators. Initial screening identified 261 articles, with 40 selected for the initial draft and an additional 15 included later, either manually or via reverse citations.
Results::
The appraisal of aggression is challenging due to its terminology and diagnostic complexities, especially in distinguishing normative behavior from psychopathological impairments. There is a significant lack of empirical evidence, like systematic reviews concerning the heterogenous dimensional understanding of aggression, including its social determinants, comorbidities, and targeted interventions. Likewise, there is a crucial need to assess comorbid conditions like ADHD, DMDD, and ODD to gain deeper insights into their developmental, social, and biological determinants. Emphasizing comorbidity assessment and age of onset during initial diagnostic evaluations is vital, followed by a structured approach to interventions encompassing behavioral and pharmacological strategies.
Conclusion::
There is a need for a stepwise multidimensional assessment towards contextual understanding of aggression and sequencing the treatment of aggression in children and adolescents. It is paramount to incorporate tailored interventions with shared decision-making.