Assessing and treating aggression in children and adolescents

: Aggression is common in children and adolescents and has serious consequences. This manuscript reviews the following aspects of aggression: (I) types and causes, (II) components of a comprehensive assessment, (III) a comprehensive approach to treatment, (IV) recent evidence based psychotherapeutic treatments, (V) the recent evidence based psychopharmacological treatments and (VI) aggression outcomes. We conducted a selective review from the last two decades using terms, “aggression”, “children”, “adolescents” using PubMed and also PsychINFO for the psychotherapy literature, and PubMed alone for the psychopharmacology review. We also included additional relevant references. We provide evidence-based recommendations for the assessment and treatment of aggression for children and adolescents. Aggression treatment requires a comprehensive assessment, treatment for the underlying conditions and behavioral interventions/psychotherapy and may also include careful pharmacological treatment and eventual recovery and/or short/long-term monitoring. A comprehensive assessment includes gathering a thorough history, considering symptoms in a developmental context, interviewing the guardian and child separately and together, ruling in and out psychopathology and potential stressors, conducting a risk assessment and using rating scales at baseline to assist in diagnosis and to track symptoms. A comprehensive approach to treatment includes providing or assisting the family in obtaining evidence-based psychotherapy appropriate for the child’s age and developmental level, engaging the child, family and school in taking an active role in implementing psychosocial strategies and implementing the appropriate supports, following evidence-based guidelines to treat the primary (underlying) disorder with evidence-based psychotherapies and medications. The manuscript provides a review of the psychotherapeutic approaches that have been shown to be effective in treating aggression as well as the evidence for efficacy of the different classes of medication including psychostimulants, alpha agonists, antidepressants, atypical antipsychotics and mood stabilizers. Evidence supports that first line medication begins with optimization of pharmacological treatment for the primary diagnosis, for example the use of stimulants for children with attention deficit hyperactivity disorder (ADHD) and co-occurring aggression, followed by risperidone, and aripiprazole with substantial evidence supporting their effectiveness in treating aggression. Finally, we review the outcomes of aggression.