Physical aggression during early childhood:: Trajectories and predictors
Physical aggression during early childhood:: Trajectories and predictors
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DOI：
10.1542/peds.114.1.e43
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发表时间：
2004-07-01
期刊：
影响因子：
8
通讯作者：
Japel, C
中科院分区：
文献类型：
--
作者：
Tremblay, RE;Nagin, DS;Japel, C
目标。儿童的身体攻击是一个重大的公共卫生问题。儿童时期的身体攻击不仅是受害者身体和精神健康问题的先兆，而且好斗的儿童本身也更容易酗酒和滥用药物、发生事故、暴力犯罪、抑郁、自杀未遂、虐待配偶以及父母的忽视和虐待。此外，暴力行为通常导致施暴者自己受到严重伤害。尽管幼儿严重伤害他们身体攻击的目标是不寻常的，但对婴儿期身体攻击的研究表明，到17个月大的时候，绝大多数儿童对兄弟姐妹、同伴和成年人都有身体攻击行为。本研究的目的是，首先，确定幼儿时期身体攻击的轨迹，其次，确定生命早期高水平身体攻击的前因。这样的先例可以帮助更好地理解生命后期暴力的发展起源，并确定预防干预的目标。随机抽取572个有5个月大新生儿的家庭作为样本。在母亲出生后17个月、30个月和42个月对身体攻击频率进行评估。采用半参数混合模型，识别出不同类型的肢体攻击轨迹。然后采用多元logit回归分析来确定5个月前的家庭和儿童特征对出生后17至42个月的高水平身体攻击轨迹的预测。结果。确定了三种身体攻击轨迹。第一组是由很少或没有身体攻击行为的孩子组成的。据估计，这些人约占样本的28%。最大的一组，估计约占样本的58%，遵循适度攻击的上升轨迹。最后，估计约占样本总数14%的一组人，其身体攻击倾向呈上升趋势。最佳预测之前或出生时身体攻击轨迹组高,控制其他危险因素的水平,在年轻的兄弟姐妹(优势比[或]:4.00;可信区间[CI]: 2.2 - -7.4),母亲与高水平的反社会行为在年底前高中(or: 3.1; CI: 1.1 - 8.6),母亲开始生孩子早期(or: 3.1; CI: 1.4 - 6.8),家庭收入较低(or: 2.6; CI: 1.3 - 5.2),和母亲在怀孕期间吸烟(or: 2.2;Ci: 1.1 - 4.1)。5个月大时的最佳预测因子是母亲的强制性养育行为（OR: 2.3; CI: 1.1 - 4.7）和家庭功能障碍（OR: 2.2; CI: 1.2 - 4.1）。如果母亲同时报告了高水平的反社会行为和早育，那么孩子的高攻击性轨迹的OR是10.9。大多数孩子在婴儿期就开始使用身体攻击，大多数孩子在进入小学之前的几年里会学会使用替代方法。人类似乎在学龄前就学会了控制身体攻击的使用。那些不这样做的人，似乎在青春期和成年期发生严重暴力行为的风险最高。目前的研究结果表明，在儿童早期不学会控制身体攻击的儿童，其母亲在上学期间有反社会行为史，母亲早育且在怀孕期间吸烟，父母收入低且在共同生活中存在严重问题。所有这些变量在怀孕期间都相对容易测量。预防性干预措施应针对在这些变量上具有高风险概况的家庭。这些项目的实验已经显示出对儿童虐待和儿童反社会行为的长期影响。然而，在有身体暴力的家庭中没有观察到这些影响。问题可能是，提供的预防方案并没有专门针对父母对他们的身体攻击的控制和他们教婴儿不要身体攻击的技能。大多数预防青少年身体攻击的干预项目都是针对学龄儿童的。如果儿童通常在学前阶段学会不进行身体攻击，那么人们就会期望针对具有慢性身体攻击高风险的婴儿的干预措施会比5到10年后的干预措施产生更大的影响，那时身体攻击已经成为一种生活方式。
Objectives. Physical aggression in children is a major public health problem. Not only is childhood physical aggression a precursor of the physical and mental health problems that will be visited on victims, but also aggressive children themselves are at higher risk of alcohol and drug abuse, accidents, violent crimes, depression, suicide attempts, spouse abuse, and neglectful and abusive parenting. Furthermore, violence commonly results in serious injuries to the perpetrators themselves. Although it is unusual for young children to harm seriously the targets of their physical aggression, studies of physical aggression during infancy indicate that by 17 months of age, the large majority of children are physically aggressive toward siblings, peers, and adults. This study aimed, first, to identify the trajectories of physical aggression during early childhood and, second, to identify antecedents of high levels of physical aggression early in life. Such antecedents could help to understand better the developmental origins of violence later in life and to identify targets for preventive interventions.Methods. A random population sample of 572 families with a 5-month-old newborn was recruited. Assessments of physical aggression frequency were obtained from mothers at 17, 30, and 42 months after birth. Using a semiparametric, mixture model, distinct clusters of physical aggression trajectories were identified. Multivariate logit regression analysis was then used to identify which family and child characteristics, before 5 months of age, predict individuals on a high-level physical aggression trajectory from 17 to 42 months after birth. Results. Three trajectories of physical aggression were identified. The first was composed of children who displayed little or no physical aggression. These individuals were estimated to account for similar to 28% of the sample. The largest group, estimated at similar to 58% of the sample, followed a rising trajectory of modest aggression. Finally, a group, estimated to comprise similar to 14% of the sample, followed a rising trajectory of high physical aggression. Best predictors before or at birth of the high physical aggression trajectory group, controlling for the levels of the other risk factors, were having young siblings (odds ratio [OR]: 4.00; confidence interval [CI]: 2.2-7.4), mothers with high levels of antisocial behavior before the end of high school (OR: 3.1; CI: 1.1 - 8.6), mothers who started having children early (OR: 3.1; CI: 1.4 - 6.8), families with low income (OR: 2.6; CI: 1.3 - 5.2), and mothers who smoked during pregnancy (OR: 2.2; CI: 1.1 - 4.1). Best predictors at 5 months of age were mothers' coercive parenting behavior (OR: 2.3; CI: 1.1 - 4.7) and family dysfunction (OR: 2.2; CI: 1.2 - 4.1). The OR for a high-aggression trajectory was 10.9 for children whose mother reported both high levels of antisocial behavior and early childbearing.Conclusions. Most children have initiated the use of physical aggression during infancy, and most will learn to use alternatives in the following years before they enter primary school. Humans seem to learn to regulate the use of physical aggression during the preschool years. Those who do not, seem to be at highest risk of serious violent behavior during adolescence and adulthood. Results from the present study indicate that children who are at highest risk of not learning to regulate physical aggression in early childhood have mothers with a history of antisocial behavior during their school years, mothers who start childbearing early and who smoke during pregnancy, and parents who have low income and have serious problems living together. All of these variables are relatively easy to measure during pregnancy. Preventive interventions should target families with high-risk profiles on these variables. Experiments with such programs have shown long-term impacts on child abuse and child antisocial behavior. However, these impacts were not observed in families with physical violence. The problem may be that the prevention programs that were provided did not specifically target the parents' control over their physical aggression and their skills in teaching their infant not to be physically aggressive. Most intervention programs to prevent youth physical aggression have targeted school-age children. If children normally learn not to be physically aggressive during the preschool years, then one would expect that interventions that target infants who are at high risk of chronic physical aggression would have more of an impact than interventions 5 to 10 years later, when physical aggression has become a way of life.