Advertisement

Child Psychiatry & Human Development

, Volume 51, Issue 1, pp 2–12 | Cite as

Reactive Aggression and Suicidal Behaviors in Children Receiving Outpatient Psychological Services: The Moderating Role of Hyperactivity and Inattention

  • Madelaine R. AbelEmail author
  • Jonathan L. Poquiz
  • Paula J. Fite
  • Rachel L. Doyle
Original Article
  • 122 Downloads

Abstract

The current study examines associations between reactive and proactive aggression and suicidal thoughts and behaviors among youth (N = 115, 62% male), ranging from 6 to 12 years, seeking services in an outpatient psychological clinic. Symptoms of hyperactivity/impulsivity and inattention were evaluated as potential moderators of this link. Children and a caregiver completed self- and parent-report questionnaires on aggression, suicidal behaviors, depressive symptoms, and ADHD-related behaviors during intake. Reactive aggression was more strongly linked to suicidal thoughts and behaviors than proactive aggression. Further, hyperactivity/impulsivity, but not inattention, moderated the association between reactive aggression and suicidal thoughts and behaviors, such that reactive aggression was only associated with suicidal behaviors at high levels of hyperactivity/impulsivity. These findings were evident for reactive, not proactive, aggression and when accounting for the variance associated with depressive symptoms, age, and gender. Hyperactivity/impulsivity is discussed as a potentially important target among reactively aggressive youth for prevention of suicidal behaviors.

Keywords

Reactive/proactive aggression Suicidal behavior Hyperactivity Inattention 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Centers for Disease Control and Prevention (2018) Preventing suicide fact sheet. http://www.cdc.gov/violenceprevention/pdf/suicide-factsheet.pdf
  2. 2.
    Balázs J, Miklósi M, Keresztény Á, Hoven CW, Carli V, Wasserman C et al (2013) Adolescent subthreshold-depression and anxiety: psychopathology, functional impairment and increased suicide risk. J Child Psychol Psychiatry 54:670–677PubMedGoogle Scholar
  3. 3.
    Kerr DC, Reinke WM, Eddy JM (2013) Trajectories of depressive symptoms and externalizing behaviors across adolescence: associations with histories of suicide attempt and ideation in early adulthood. Suicide Life Threat Behav 43:50–66PubMedGoogle Scholar
  4. 4.
    Dervic K, Brent DA, Oquendo MA (2008) Completed suicide in childhood. Psychiatr Clin N Am 31:271–291Google Scholar
  5. 5.
    Greening L, Stoppelbein L, Luebbe A, Fite PJ (2010) Aggression and the risk for suicidal behaviors among children. Suicide Life Threat Behav 40:337–345PubMedGoogle Scholar
  6. 6.
    Fite PJ, Stoppelbein L, Greening L (2009) Proactive and reactive aggression in a child psychiatric inpatient population. J Clin Child Adolesc Psychol 38:199–205PubMedPubMedCentralGoogle Scholar
  7. 7.
    Fite PJ, Poquiz J, Frazer AL, Reiter N (2017) Further evaluation of associations between reactive and proactive aggression and suicidal behavior in a treatment seeking sample of youth. Child Psychiatry Hum Dev 48:903–910PubMedGoogle Scholar
  8. 8.
    Hartley CM, Pettit JW, Castellanos D (2018) Reactive aggression and suicide-related behaviors in children and adolescents: a review and preliminary meta-analysis. Suicide Life Threat Behav 48:38–51PubMedGoogle Scholar
  9. 9.
    Chronis-Tuscano A, Molina BS, Pelham WE, Applegate B, Dahlke A, Overmyer M, Lahey BB (2010) Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Arch Gen Psychiatr 67:1044–1051PubMedGoogle Scholar
  10. 10.
    Fite PJ, Craig J, Colder CR, Lochman JE, Wells KC (2016) Proactive and reactive aggression. In: Levesque RJR (ed) Encyclopedia of adolescence. Springer, GenevaGoogle Scholar
  11. 11.
    Card NA, Little TD (2007) Differential relations of instrumental and reactive aggression with maladjustment: Does adaptivity depend on function. In: Hawley PH, Rodkin PC (eds) Aggression and adaptation: the bright side to bad behavior. Lawrence Erlbaum Associates, Mahwah, pp 107–134Google Scholar
  12. 12.
    Berkowitz L (1978) Whatever happened to the frustration-aggression hypothesis? Am Behav Sci 21:691–708Google Scholar
  13. 13.
    Vitaro FB (2012) Subtypes of aggressive behaviors: Etiologies, development, and consequences. In: Bliesenner ABT, Stemmler M (eds) Antisocial behavior and crime: contributions of developmental and evaluation research to prevention and intervention. Hogrefe, Cambridge, pp 17–38Google Scholar
  14. 14.
    Rathert J, Fite PJ, Gaertner AE, Vitulano M (2011) Associations between effortful control, psychological control and proactive and reactive aggression. Child Psychiatry Hum Dev 42:609–621PubMedGoogle Scholar
  15. 15.
    Vitaro F, Brendgen M, Barker ED (2006) Subtypes of aggressive behaviors: a developmental perspective. Int J Behav Dev 30:12–19Google Scholar
  16. 16.
    White BA, Turner KA (2014) Anger rumination and effortful control: mediation effects on reactive but not proactive aggression. Pers Individ Differ 56:186–189Google Scholar
  17. 17.
    Fite PJ, Rathert JL, Stoppelbein L, Greening L (2012) Social problems as a mediator of the link between reactive aggression and withdrawn/depressed symptoms. J Child Fam Stud 21:184–189Google Scholar
  18. 18.
    Day DM, Bream LA, Pal A (1992) Proactive and reactive aggression: an analysis of subtypes based on teacher perceptions. J Clin Child Adolesc Psychol 21:210–217Google Scholar
  19. 19.
    Dodge KA, Lochman JE, Harnish JD, Bates JE, Pettit GS (1997) Reactive and proactive aggression in school children and psychiatrically impaired chronically assaultive youth. J Abnorm Psychol 106:37–51PubMedGoogle Scholar
  20. 20.
    Vitaro F, Brendgen M, Tremblay RE (2002) Reactively and proactively aggressive children: antecedent and subsequent characteristics. J Child Psychol Psychiatry 43:495–505PubMedGoogle Scholar
  21. 21.
    Dodge KA (1991) The structure and function of reactive and reactive aggression. In: Rubin DJ (ed) The development and treatment of childhood aggression. Lawrence Erlbaum, Hillsdale, pp 201–218Google Scholar
  22. 22.
    Crick NR, Dodge KA (1996) Social information-processing mechanisms in reactive and proactive aggression. Child Dev 67:993–1002PubMedGoogle Scholar
  23. 23.
    Bandura A (1973) Aggression: a social learning analysis. Prentice-Hall, Englewood CliffsGoogle Scholar
  24. 24.
    Dodge KA, Coie JD (1987) Social-information-processing factors in reactive and proactive aggression in children’s peer groups. J Pers Soc Psychol 53:1146–1158PubMedGoogle Scholar
  25. 25.
    Poulin F, Boivin M (2000) The role of proactive and reactive aggression in the formation and development of boys’ friendships. Dev Psychol 36:233–240PubMedGoogle Scholar
  26. 26.
    Prinstein MJ, Cillessen AH (2003) Forms and functions of adolescent peer aggression associated with high levels of peer status. Merrill Palmer Q 49:310–342Google Scholar
  27. 27.
    Fite PJ, Colder CR, Lochman JE, Wells KC (2008) The relation between childhood proactive and reactive aggression and substance use initiation. J Abnorm Child Psychol 36:261–271PubMedGoogle Scholar
  28. 28.
    Kovacs MD, Goldston D, Gatsonis C (1993) Suicidal behaviors and childhood-onset depressive disorders: a longitudinal investigation. J Am Acad Child Adolesc Pscyhiatry 32:8–20Google Scholar
  29. 29.
    Prinstein MJ, Boergers J, Spirito A, Little TD, Grapentine WL (2000) Peer functioning, family dysfunction, and psychological symptoms in a risk factor model for adolescent inpatients’ suicidal ideation severity. J Clin Child Adolesc Psychol 29:392–405Google Scholar
  30. 30.
    Mayes SD, Calhoun SL, Baweja R, Feldman L, Syed E, Gorman AA et al (2015) Suicide ideation and attempts are associated with co-occurring oppositional defiant disorder and sadness in children and adolescents with ADHD. J Psychopathol Behav Assess 37:274–282Google Scholar
  31. 31.
    James AF, Lai F, Dahl C (2004) Attention deficit hyperactivity disorder and suicide: a review of possible associations. Acta Psychiatr Scand 110:408–415PubMedGoogle Scholar
  32. 32.
    Lam LT (2005) Attention deficit disorder and hospitalization owing to intra- and interpersonal violence among children and young adolescents. J Adolesc Health 36:19–24PubMedGoogle Scholar
  33. 33.
    Galéra C, Bouvard MP, Encrenaz G, Fombonne E (2008) Hyperactivity-inattention symptoms in childhood and suicidal behaviors in adolescence: the Youth Gazel Cohort. Acta Psychiatr Scand 118:480–489PubMedGoogle Scholar
  34. 34.
    Hinshaw SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E et al (2012) Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol 80:1041–1051PubMedPubMedCentralGoogle Scholar
  35. 35.
    Diamond A (2016) Executive functions. Annu Rev Psychol 64:135–168Google Scholar
  36. 36.
    Kochanska G, Murray KT, Harlan ET (2000) Effortful control in early childhood: continuity and change, antecedents, and implications for social development. Dev Psychol 36:220–232PubMedPubMedCentralGoogle Scholar
  37. 37.
    McGirr A, Renaud J, Bureau A, Seguin M, Lesage A, Turecki G (2008) Impulsive-aggressive behaviors and completed suicide across the life cycle: a predisposition for younger age of suicide. Psychol Med 38:407–417PubMedGoogle Scholar
  38. 38.
    McKeown RE, Garrison CZ, Cuffe SP, Waller JK, Jackson KL et al (1998) Incidence and predictors of suicidal behaviors in a longitudinal sample of young adolescents. J Am Acad Child Adolesc Psychiatry 37:612–619PubMedGoogle Scholar
  39. 39.
    Jarret MA, Ollendick TH (2008) A conceptual review of the comorbidity of attention-deficit/hyperactivity disorder and anxiety: implications for future research and practice. Clin Psychol Rev 28:1266–1280Google Scholar
  40. 40.
    Meinzer MC, Pettit JW, Viswesvaran C (2014) The co-occurrence of attention-deficit/hyperactivity disorder and unipolar depression in children and adolescents: a meta-analytic review. Clin Psychol Rev 34:595–607PubMedGoogle Scholar
  41. 41.
    Manor I, Gutnik I, Ben-Dor DH, Apter A, Sever J, Tyano S et al (2010) Possible association between attention-deficit hyperactivity disorder and attempted suicide in adolescents—a pilot study. Eur Psychiatry 25:146–150PubMedGoogle Scholar
  42. 42.
    Harpin V, Mazzone L, Raynaud JP, Kahle J, Hodkins P (2016) Long-term outcomes of ADHD: a systematic review of self-esteem and social functions. J Atten Disord 20:295–305Google Scholar
  43. 43.
    Ambrosini PJ, Bennett DS, Elia J (2013) Attention deficit hyperactivity disorder characteristics: II. Clinical correlates of irritable mood. J Affect Disord 145:70–76PubMedGoogle Scholar
  44. 44.
    Seymour KE, Chronis-Tuscano A, Halldorsdottir T, Stupica B, Owens K, Sacks T (2012) Emotion regulation mediates the relationship between ADHD and depressive symptoms in youth. J Abnorm Child Psychol 40:595–606PubMedGoogle Scholar
  45. 45.
    Hubbard JA, Smithmyer CM, Ramsden SR, Parker E, Flanagan KD, Dearing KF et al (2002) Observational, physiological, and self-report measures of children’s anger: relations to reactive versus proactive aggression. Child Dev 73:1101–1118PubMedGoogle Scholar
  46. 46.
    Card NA, Little TD (2006) Proactive and reactive aggression in childhood and adolescence: a meta-analysis of differential relations with psychosocial adjustment. Int J Behav Dev 30:466–480Google Scholar
  47. 47.
    Fite PJ, Raine A, Stouthamer-Loeber M, Loeber R, Pardini DA (2010) Reactive and proactive aggression in adolescent males: examining differential outcomes 10 years later in early adulthood. Crim Justice Behav 37:141–157Google Scholar
  48. 48.
    Cotton CR, Range LM (1993) Suicidality, hopelessness, and attitudes toward life and death in children. Death Stud 17:185–191Google Scholar
  49. 49.
    Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA et al (2001) The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples. Assessment 8(4):443–454PubMedGoogle Scholar
  50. 50.
    Kovacs M (2011) Children’s depression inventory (CDI 2), 2nd edn. Multi-Health Systems Inc, Noth TonawandaGoogle Scholar
  51. 51.
    Kovacs M (2001) Children’s depression inventory (CDI) technical manual. Multi-Health Systems Inc, Noth TonawandaGoogle Scholar
  52. 52.
    Conners CK (1994) The Conners Rating Scales: use in clinical assessment, treatment planning and research. In: Maruish M (ed) Use of psychological testing for treatment planning and outcome assessment. Lawrence Erlbaum, HillsdaleGoogle Scholar
  53. 53.
    Conners CK, Sitarenios G, Parker JDA, Epstein JN (1998) Revision and restandardization of the Conners Teacher Rating Scale: factor structure, reliability, and criterion validity. J Abnorm Child Psychol 26:279–291PubMedGoogle Scholar
  54. 54.
    Hayes AF, Matthes J (2009) Computational procedures for probing interactions in OLS and logistic regression: SPSS and SAS implementations. Behav Res Methods 41:924–936PubMedGoogle Scholar
  55. 55.
    Hayes AF (2017) Introduction to medication, moderation, and conditional process analysis: a regression-based approach, 2nd edn. The Guildford Press, New YorkGoogle Scholar
  56. 56.
    Goodman G, Gerstadt C, Pfeffer CR, Stroth M, Valdez A (2008) ADHD and aggression as correlates of suicidal behaviors in assaultive prepubertal psychiatric inpatients. Suicide Life Threat Behav 38:46–59PubMedGoogle Scholar
  57. 57.
    Barker ED, Tremblay RE, Gain DS, Vitaro F, Lacourse E (2006) Development of male proactive and reactive aggression during adolescence. J Child Psychol Psychiatry 47:783–790PubMedGoogle Scholar
  58. 58.
    Fite PJ, Rubens SL, Preddy TM, Raine A, Pardini DA (2014) Reactive/proactive aggression and the development of internalizing problems in males: the moderating effect of parent and peer relationships. Aggress Behav 40:69–78PubMedGoogle Scholar
  59. 59.
    Centers for Disease Control and Prevention (2014) Depression in the U.S. household population, 2009–2012. https://www.cdc.gov/nchs/data/databriefs/db172.htm
  60. 60.
    De Los Reyes A, Kazdin AE (2005) Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework, and recommendations for further study. Psychol Bull 131:483–509Google Scholar
  61. 61.
    Lochman JE, Wells KC (2004) The coping power program for preadolescent aggressive boys and their parents: outcome effects at the 1-year follow-up. J Consult Clin Psychol 72:571–578PubMedGoogle Scholar
  62. 62.
    Raaijmakers MA, Smidts DP, Sergeant JA, Maassen GH, Posthumus JA, Van Engeland H, Matthys W (2008) Executive functions in preschool children with aggressive behavior: impairments in inhibitory control. J Abnorm Child Psychol 36:1097–1108PubMedGoogle Scholar
  63. 63.
    Becker SP, Withrow AR, Stoppelbein L, Luebbe AM, Fite PJ, Greening L (2016) Sluggish cognitive tempo is associated with suicide risk in psychiatrically hospitalized children. J Child Psychol Psychiatry 57:1390–1399PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Madelaine R. Abel
    • 1
    Email author
  • Jonathan L. Poquiz
    • 1
  • Paula J. Fite
    • 1
  • Rachel L. Doyle
    • 1
  1. 1.Clinical Child Psychology ProgramUniversity of KansasLawrenceUSA

Personalised recommendations