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THE HEALTH | NOVEMBER , 2022
| Column |
MINDTALK
BY DR ROZANIZAM ZAKARIA
ADAM may have a typical youth appearance . He attends classes , participates in afterschool activities , and hangs out with his peers .
But over the past few months , his family has grown concerned about his actions . He has begun being absent from school and hanging out with the wrong crowd .
He developed the habit of using electronic cigarettes and began to spend most of his time playing online video games with a particular gang of teenage dropout lads . His mother said that some money went missing more recently , and he was found to have lied to his parents .
He started using foul language with family members and disregards any counsel . Their concern increased when his family learned that Adam was engaged in bullying .
His family ’ s worries escalated when they were recently informed that Adam was involved in bullying at school , where physical fights have led to serious physical injury to the victims . Adam is at risk of being expelled from school and , worse , could be prosecuted . Sad , furious and puzzling at the same time - this is a common reaction we get every time we encounter news regarding violent behaviour among children and adolescents , just like what happened to Adam . Bully , gang rape , physical aggression and many other unwanted behaviours still tragically occur within schools , homes and community involving minors .
Although children are not commonly associated with this kind of act , the presence of these issues nevertheless should not be ignored . According to the Department of Statistics Malaysia ( DOSM ), the number of children involved in crime in 2020 increased by 10.5 per cent to 5,342 cases compared to the previous year ( 4,833 cases ).
First offence increased by 15.7 per cent to 4,916 cases while repeated offences recorded a decrease of 27.2 per cent to 426 cases compared to the previous year . According to the Malaysia Crime Prevention Foundation , various forms of bullying affect 84 per cent of children under 18 . The bullying took many types including cyberbullying and , in some cases , physical violence which led to severe injuries and even death .
It can be difficult and challenging to assess children ’ s hostility and violence . In contrast to being a diagnosis in and of itself , aggression is a symptom of complicated underlying causes .
In some circumstances , such as a child ’ s response to threats in their daily lives , aggression can be adaptive . However , the problem must be handled
When a child becomes aggressive
In contrast to being a diagnosis in and of itself , aggression is a symptom of complicated underlying causes
holistically when aggression develops into a maladaptive and persistent behaviour that puts the kid and others in danger .
This includes a professional evaluation to ensure there are no undiagnosed psychiatric issues that might have influenced the issue . For instance , a study conducted in 2002 by Teplin and colleagues found that up to 70 per cent of young offenders have at least one psychiatric diagnosis .
Risk factors for aggression among children and adolescents
It is hard to narrow down the cause of aggression in children into a single reason . In many circumstances , the problem occurs as a result of interaction of multiple factors . To clarify our perspectives into this matter , Hilt and French ( 2011 ) divided the causes into three main components . Individual risk factors
• Genetic susceptibility
• Prenatal toxin exposure
• Difficult temperament as a child
• Cognitive deficits
• Affect dysregulation Family risk factors
• Maltreatment and neglect
• Inadequate parenting
• Family dysfunction
• Marital conflict
Community risk factors
• Peer rejection
• Antisocial peer group affiliation
• Neighbourhood violence
• Media violence exposure
Diagnostic consideration
Clinicians must consider the surrounding circumstances when determining the clinical cause of violent behaviour . We must first comprehend the nature of aggression , the progression of such conduct , typical triggers , and the effects of such behaviour , including the responses of family members and educators .
Additionally , we must carefully assess other factors like developmental disorders , cognitive challenges , psychosocial stressors , and additional co-occurring psychiatric illnesses like mood , anxiety , and psychosis . Investigating the child ’ s use of drugs and other illegal activity and any indications of probable medical sickness is crucial . As many pertinent people as possible should be involved
Dr Rozanizam Zakaria is a Psychiatrist and Assistant Professor in Psychiatry , Kulliyyah of Medicine , International Islamic University Malaysia ( IIUM ). in the assessment , which should be conducted in several contexts .
The assessment should be done in a calm , safe , non-judgemental and supportive nature . In any setting where the child is still actively displaying aggressive behaviour , one must ensure the child ’ s safety and all individuals involved in the assessment .
Calmly approach the child , use clear communication and set firm boundaries . Assess the needs of the child and tackle the needs accordingly .
In situations where there are signs of family conflicts , we need to ensure that we assume a neutral stance and try to understand the situation from all angles . It is also detrimental to assess the modelling of aggression in the family and the history of victimisation in the child ’ s life .
In situations where the problems escalate , ensure the child is being managed by the specialised team with experience in dealing with such situations . Involvement of the child and adolescent psychiatry team and the welfare department is important to address the issue safely .
There are three childhood disorders commonly grouped together as potentially contributing to the disruptive behaviours – conduct disorders , oppositional defiant disorder ( ODD ) and attention deficit and hyperactivity disorder ( ADHD ). In some situations , the diagnosis may involve more than a single diagnosis entity .
For example , a child with ADHD may display ODD-related behaviour due to being bullied and consequently develop depression and social anxiety . Hence the diagnosis of merely ADHD or ODD may not have tackled the entirety of the problem .
The management will depend on the situational context of the problem , any primary psychiatry diagnosis and ensuring proper social and educational support . Seeing the problem from a medical perspective is more important rather than simply looking at it from a legal perspective .
The underlying issues need to be addressed from the root of the problem . More importantly , all parties must be ready to take part in preventing cases like Adam ’ s from happening . Parents , school , community , and health professionals need to play their roles seriously to ensure that all potential risk factors can be curbed , and any further damage avoided . – The Health