Sometimes, it may be necessary to go outside the immediately family for help, to grandparents or spouse equivalents, she said.
Psychoeducation, enhancing attachment, marital therapy, and parent support groups are all helpful adjuncts for parents of aggressive children.
“These families are often held hostage to their child's behavior,” Dr. Lomax said.
The treatment of a child with impulsive or affective aggression may be successful in one-on-one sessions or in group therapy. Principles include anxiety management, correction of cognitive distortions, assertiveness training, impulse control strategies, stress reduction, and, if applicable, therapy to address trauma.
In extreme cases, medications may be both necessary and helpful.
Treat any primary psychiatric disorder first, then consider risperidone in very low doses (0.5–2 mg/day), a mood stabilizer if the child is irritable and volatile, or a β-blocker in the context of hyperarousal, Dr. Lomax said.
She cautioned that antidepressants can sometimes have activating effects that exacerbate aggression in some children.
Lorazepam should be avoided for this reason in aggressive children, and children prescribed other antidepressants should be monitored very closely early in therapy for signs of akathisia, sleep problems, and “rage reactions” out of character for the child.
Questions That Should Be Asked
▸ When did the behavior start? What was the context? What is the child's age?
▸ Is the child capable of empathy and/or real regret? Does he or she laugh when confronted with the consequences of the aggressive behavior?
▸ Is the aggressive behavior situation specific?
▸ How is the child's general tolerance for frustration? (Is this a rigid child?)
▸ Has the child had a traumatic experience? Was he/she nurtured early in life?
▸ Do other children in the family have problems with aggression?
▸ How readily does the child adjust to changes in routine?
Source: Dr. Lomax