Aggression and Related Behavior Problems: The Disruptive Behavior Disorders
Educational and psychological research conducted from the 1960s to the 1990s has established that academic underachievement in the elementary school years is associated with the failure to make adequate educational progress in adolescence and young adulthood. This research also demonstrates that in itself early problems with underachievement may not be the main cause of later-occurring educational problems. Rather, severely disruptive social behavior in early childhood, particularly aggression, has been implicated as a primary cause of both early and later-occurring academic underachievement, the need for special education, and problems with truancy and school dropout. With aggressive and disruptive be haviors showing sharp increases during the last three decades of the twentieth century and prevalence rates of elementary schoolchildren suffering from these behavior disorders estimated at about 20 percent in the 1990s, the negative impact of aggressive/disruptive behavior on children's educational progress has become a serious concern for American society. Accordingly, the purpose here is to review recent findings on the nature and causes of these behavior problems and their relation to children's failure to make educational progress, and to examine promising information regarding preventive measures and treatments.
Aggression and Related Behavior Problems: The Disruptive Behavior Disorders
Narrowly defined, the aggressive child is one who purposely harms others either physically (e.g., fighting) or socially (e.g., spreading malicious rumors). Though this seems a straightforward definition, it does not adequately describe the great majority of aggressive children who are sometimes aggressive but who are more often oppositional (refusing to comply with adult requests), hyperactive, or inattentive. It is now known that this broader range of behavior problems provides a more reliable description of children who experience educational problems throughout their school careers. In fact very few children show severe forms of aggression, oppositionality, hyperactivity, or inattention alone. The great majority show some combination. An important outgrowth of this is that these children are diagnosed by psychologists, psychiatrists, and pediatricians as suffering from one or more of the disruptive behavior disorders, that is, attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), or, when older, conduct disorder (CD). Thus, these children are best described as suffering from some form of a disruptive behavior disorder (also called externalizing, acting out, or emotionally disturbed disorder) rather than focusing more narrowly on aggression alone.
Impact of Disruptive Behavior on Educational Progress
There are three types of studies used to assess whether or not a particular aspect of children's lives–in this case disruptive behavior–has a negative impact on children's educational progress: (1) concurrent, correlational studies (also called observational studies) that document the co-occurrence of both disruptive behavior and various forms of academic failure; (2) longitudinal, correlational studies that document academic problems at a later time (poor achievement, placement in special education, truancy, etc.) based on disruptive behaviors occurring at an earlier time; and (3) experiments (also called clinical trials) in which disruptive behavior is allowed to develop in a control group but is decreased in a treatment group (usually by replacement with positive behaviors), and it is later observed that the treatment group experiences educational success but the control group does not.
Experiments can be evaluated after a short or long follow-up period after treatment. Given that the study of children's social and academic development requires a long-term perspective, only long-term outcomes (follow-ups of at least three months) are considered here. There are two types of experiments: prevention trials begun in early childhood for children at risk of developing disruptive behavior but before symptoms have appeared and intervention trials begun after children have become symptomatic (i.e., have received a diagnosis of ADHD, ODD, CD, or are classified as severely behaviorally or emotionally disturbed). There are two types of preventions, those focusing exclusively on children and those focusing on children and their parents. There are also two types of interventions, those using medications such as methylphenidate (Ritalin) and those using educational and behavioral means to decrease disruptive behaviors. Because it most clearly establishes that the disruptive behavior targeted for prevention is an actual cause of academic problems and not just a co-occurring problem, by far the most important of these study types is the prevention experiment.
Concurrent and longitudinal correlational studies have clearly established a relation between early occurring disruptive behavior and both early and later-occurring school problems. However, child-focused intervention experiments using both behavioral/educational and medication treatments aimed at replacing disruptive behaviors with cooperative and attentive behaviors have not demonstrated positive educational gains for children. Nor have child-focused prevention experiments had good results. Realizing that the exclusion of parents in these experiments could explain their failure to demonstrate a causal role for disruptive behaviors in children's educational problems, family-based experiments have also been conducted. These studies, both intervention and prevention trials, have been successful, providing evidence that children's disruptive behavior does interfere with children's academic progress. They also provide a useful basis for planning large-scale preventive and interventive efforts.
Successful Prevention and Intervention
In a 1998 paper, Steven McFadyen-Ketchum and Kenneth Dodge reviewed eight long-term, family-based experimental studies (four preventions and four interventions), which successfully decreased children's disruptive behavior and produced improved educational outcomes. In all of these studies disruptive behavior was reduced, and cooperative attentive behavior was increased for periods ranging from one to fourteen years. Educational gains included higher grades, higher achievement scores, higher IQ scores, improved use of expressive language, decreased participation in special education, and decreased truancy and dropout rates. It is important to emphasize that these gains occurred only when parents as well as children were participants in the prevention and intervention programs. This means that in addition to replacing disruptive behavior with more cooperative/attentive behavior in children, it was also necessary to replace negative (e.g., nagging) and ineffective (e.g., failing to set clear limits) behaviors in parents with behaviors that were firm and friendly as well as with a parental will-ingness to consistently attend to children's cooperative efforts instead of taking them for granted.
Contribution to Theory
It has long been known that children's cognitive and intellectual deficits interfere with early academic achievement and long-term educational success. The studies discussed here clearly identify an additional source of dysfunction that also seriously interferes with educational progress: aggression and other forms of disruptive social behavior. These studies also clearly demonstrate that preventive/interventive efforts can be successfully applied to these behavior problems with positive educational results. In addition, they achieve a third, though less obvious, goal, that is the clarification of theory regarding the causes of children's disruptive behavior disorders.
As mentioned above, prevention and intervention experiments whose goal was to decrease disruptive behavior in children, but without also addressing the contribution of parents, consistently failed to show positive gains in treatment when compared with control groups of children. In contrast, those experiments that included parents consistently succeeded. Children in these successful treatment groups showed both behavioral and educational gains compared to control-group children. The clear implication is that in addition to whatever genetic or other environmental factors may be at work (e.g., lead poisoning), the parents' support of their children's positive behavioral efforts is necessary if children are to experience educational success. Because some of these experiments were preventions conducted before disruptive behavior problems had developed, these findings demonstrate that positive parental behavior toward young children plays a causal role in children's behavioral and educational success.
These findings may appear to be in sharp contrast to the often-reported finding that genetics play a primary causal role in the kinds of behavioral and educational problems being discussed here, especially for children diagnosed with ADHD. What these findings demonstrate, and what has also been argued by geneticists who study childhood behavior problems, is that genes are not destiny. Children can be helped to perform well in school if it is recognized that their parents play a causal role in producing cooperative, attentive behavior, and are included in the educational process.
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STEVEN A. MCFADYEN-KETCHUM
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