ADOLESCENT ANGER AND AGGRESSION

The teen years are a challenge for most adolescents and their parents, filled with episodes of anger, rebellion, and extreme moodiness. But for many kids, the teen years are a time of crisis. Their anger is out of control, and for some, minor childhood delinquencies may escalate into criminal behavior, substance abuse, inappropriate sexual activity, self-destructive behaviors and suicide attempts. These hazardous behaviors may be symptoms of disruptive disorders, the largest single group of psychiatric illnesses in adolescents. According to the American Psychiatric Association, approximately 9 percent of all boys and 2 percent of all girls under the age of 18 are affected by one of these disorders.

WHAT ARE DISRUPTIVE DISORDERS?

Psychiatrists generally separate disruptive disorders into two categories, depending on whether the individual is violating the rights of others. Oppositional defiant disorder applies to teenagers whose symptoms include uncontrolled temper, resentfulness and resistance to discipline that do not violate the rights of others. Teens with conduct disorder exhibit many of these same emotional symptoms, but they also consistently violate the rights of others or the laws of society by stealing or vandalizing property, or by harming people or animals.

HOW DO YOU KNOW IF A TEEN HAS A DISRUPTIVE DISORDER?

Anger, guilt, and denial can interfere with parents' ability to recognize a disruptive disorder in their child. If a teenager you know has exhibited these behaviors, especially those that are illegal, professional help should be considered.

• Consistently breaks rules, stays out late, or has run away from home
• Loses temper frequently, often breaking or throwing things when angry
• Gets in trouble at school, has been suspended or expelled, or is frequently truant
• Steals, lies
• Has broken into a home and stolen or damaged property
• Gets into fights, or has threatened another person with a weapon
• Has injured or killed an animal
• Has been in jail or gotten into trouble with the police
• Sets fires
• Appears to lack a conscience or not feel guilt
• Has forced someone into sexual activity, participates in self-destructive or indiscriminate sexual behavior
• Abuses drugs or alcohol
• Has mentioned or attempted suicide

WHAT CAUSES ADOLESCENT DISRUPTIVE DISORDERS?

Angry and aggressive behaviors are often the result of underlying conditions that, undetected and untreated through the years, have increasingly interfered with the teen's ability to function and relate to others normally. Researchers have identified the following as potential contributing or causal factors in disruptive disorders:

• Environment. A traumatic event, such as the illness or death of a loved one, divorce, molestation, or a particularly stressful move, can contribute to the development of a disruptive disorder. Ongoing stress, such as family discord, peer or sibling harassment, physical or sexual abuse, or living with a parent who has a psychiatric or addictive illness can make a teenager more vulnerable to disruptive disorders.
   
• Psychiatric disorders. Some psychiatric disorders can play a role in disruptive disorders. Illnesses such as depression, bipolar disorder, post-traumatic stress disorder, panic disorder, phobias and schizophrenia have all been connected to the aggressive behaviors that are characteristic of disruptive disorders. A coexisting psychiatric disorder can also contribute to the onset or intensity of behavioral problems, or even be mistaken for a disruptive disorder.
   
• Medical or biological factors. Epilepsy, Tourette's Syndrome, mental retardation, and brain damage may also cause or contribute to angry and aggressive behaviors. A complete medical examination by a licensed physician is helpful in assessing biological factors when diagnosing a disruptive disorder.
     
• Learning disabilities and ADHD. Learning disabilities and attention-deficit hyperactivity disorder (ADHD), a condition distinguished by problems with inattentiveness, hyperactivity and impulsivity, ale frequently associated with disruptive disorders. Many children with learning disabilities or ADHD face a variety of emotional, learning and social difficulties that may manifest themselves as angry or aggressive behavior.
   
• Drug or alcohol abuse. In many teens, substance abuse is a result or symptom of a disruptive disorder, functioning as an expression of the teen's rebellion or an attempt to cope with feelings of emotional pain. In other teens, substance abuse actually can contribute to the onset of a disruptive disorder by creating emotional states that stimulate aggressive behavior.
   

THERE IS HELP...

Because of the wide range of influences that may contribute to the development, or complicate the existence of disruptive disorders, a complete medical and psychiatric evaluation is necessary A licensed physician or psychologist should diagnose and treat an individual with a psychiatric disorder. It is important for people to seek a diagnostic evaluation with one of these qualified professionals. Depending on the findings of the evaluation, treatment may include:

• Individual counseling. Through talk therapy, professionals help teens understand the impact of their behaviors, take responsibility for their conduct, and work through relationship problems.
   
• Family counseling. Professional therapists help family members improve communication with each other, unlock relationship problems that are perpetuating conflicts, and change problematic behaviors.
   
• Group therapy. Guided by professional therapists, teens share their feelings and experiences with teens who have similar problems. This kind of therapy serves as a valuable vehicle for teens to develop new communication and problem solving skills and to provide understanding, support and empathy for each other.
   
• Medication. A number of the underlying psychiatric or neurological conditions, such as depression or epilepsy, that can contribute to the symptoms of disruptive disorders can be treated with medication.
   

HOW PARENTS CAN COPE WITH TEENAGE ANGER AND AGGRESSION

Parents can help their children control their anger and learn to express it in ways that are healthy. By utilizing some of the following suggestions, parents can teach their teens new ways to deal with anger, stress or conflict.

• Prevention. Try to stop the teenager from escalating out of control. If he or she is obviously angry or upset, avoid confrontation while emotions are running hot. Wait until he or she has "cooled off" before discussing why the incident or conflict occurred. When you do finally sit down to talk, calmly explore why the situation occurred, ask about who was involved, where and when the problem arose. Then together develop an appropriate form of punishment or restitution, and discuss strategies to avoid a recurrence of the incident.
   
• Crisis Management. In some instances, tempers may flair up again, even after an adequate cooling off period. For this reason make sure you speak to your son or daughter alone; an audience will only aggravate the situation. Keep to the subject at hand, avoid veering off the specifics of the incident. Stay in the present; don't dredge up the past. Do not attack or blame each other. Talk about what you feel or think, speak from your perspective only, start your sentences with "I" instead of "you" or "we." Recognize when you are not making any progress and call for another cooling off period.
   
• Time-outs. The ability to maintain or regain control and composure is a critical skill for parents and teenagers to learn. Time-outs are mutually respected five to ten minute periods for parents and/or children to calm down. Formalize these therapeutic breaks by having a hand signal or special sign that automatically puts a stop on the action. Either person may retreat to a private room, sit outside or go for a walk in order to regain control. Time-outs should be used whenever outbursts occur to prevent pointless arguing that may escalate into physical assaults.
   

More than any other technique, parents can learn to be positive role models for their children by avoiding insulting or abusing each other, or other members of the family and by practicing constructive communication and anger management skills.

GROWTH AND CHANGE CAN OCCUR

By better understanding the causes, the effects, and the treatments of adolescent disruptive disorders, you can help a teen headed for trouble change his or her future. By recognizing the signs and symptoms of behavioral problems and developing new coping skills, teenagers and their families can turn confrontation and conflict into dialogue, mutual respect and understanding.

Reprinted with permission from NAMI (National Alliance for the Mentally Ill) of Wishigan. The information in this publication is meant to compliment the advice and guidance of your health care professional, not replace it. Please consult with a licensed health care provider for help with these issues. For information, for help, for options, call 1-888-PATHWAY (728-4929).

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