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Maladaptive Aggression: With a Focus on Impulsive Aggression in Children and Adolescents.

  • Connor, Daniel F1
  • Newcorn, Jeffrey H2
  • Saylor, Keith E3
  • Amann, Birgit H4
  • Scahill, Lawrence5
  • Robb, Adelaide S6, 7
  • Jensen, Peter S8
  • Vitiello, Benedetto9
  • Findling, Robert L10, 11
  • Buitelaar, Jan K12
  • 1 Department of Psychiatry, Division of Child & Adolescent Psychiatry, University of Connecticut Medical School, Farmington, Connecticut.
  • 2 Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
  • 3 NeuroScience, Inc., Herndon, Virginia.
  • 4 Behavioral Medical Center-Troy, Troy, Michigan.
  • 5 Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. , (Georgia)
  • 6 Department of Psychiatry and Behavioral Sciences, Children's National Medical Center, Washington, District of Columbia.
  • 7 Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, District of Columbia.
  • 8 Department of Psychiatry, University of Arkansas for Medical Science, Little Rock, Arkansas.
  • 9 Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy. , (Italy)
  • 10 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland.
  • 11 Department of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute, Baltimore, Maryland.
  • 12 Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands. , (Netherlands)
Published Article
Journal of Child and Adolescent Psychopharmacology
Mary Ann Liebert
Publication Date
Oct 01, 2019
DOI: 10.1089/cap.2019.0039
PMID: 31453715


Objective: Aggressive behavior is among the most common reasons for referral to psychiatric clinics and confers significant burden on individuals. Aggression remains poorly defined; there is currently no consensus on the best ways to recognize, diagnose, and treat aggression in clinical settings. In this review, we synthesize the available literature on aggression in children and adolescents and propose the concept of impulsive aggression (IA) as an important construct associated with diverse and enduring psychopathology. Methods: Articles were identified and screened from online repositories, including PubMed, PsychInfo, the Cochrane Database, EMBase, and relevant book chapters, using combinations of search terms such as "aggression," "aggressive behavio(u)r," "maladaptive aggression," "juvenile," and "developmental trajectory." These were evaluated for quality of research before being incorporated into the article. The final report references 142 sources, published from 1987 to 2019. Results: Aggression can be either adaptive or maladaptive in nature, and the latter may require psychosocial and biomedical interventions when it occurs in the context of central nervous system psychopathology. Aggression can be categorized into various subtypes, including reactive/proactive, overt/covert, relational, and IA. IA in psychiatric or neurological disorders is reviewed along with current treatments, and an algorithm for systematic evaluation of aggression in the clinical setting is proposed. Conclusions: IA is a treatable form of maladaptive aggression that is distinct from other aggression subtypes. It occurs across diverse psychiatric and neurological diagnoses and affects a substantial subpopulation. IA can serve as an important construct in clinical practice and has considerable potential to advance research.

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