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ORIGINAL ARTICLE
Year : 2018  |  Volume : 46  |  Issue : 1  |  Page : 29-37

Assessment of aggressive behavior among preparatory school children in Tanta City


Department of Neuropsychiatry, Faculty of Medicine, Tanta University, Tanta, El-Gharbia Governorate, Egypt

Date of Submission01-Jan-2018
Date of Acceptance07-Feb-2018
Date of Web Publication26-Jul-2018

Correspondence Address:
Abd El-Rahman A Assaf
Department of Neuropsychiatry, Faculty of Medicine, Tanta University, Saeed Street, Tanta, El-Gharbia Governorate, 31111
Egypt
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DOI: 10.4103/tmj.tmj_1_18

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  Abstract 


Background and aim School violence and aggression have become an increasing concern to public health professionals, clinicians, policy makers, educators, and the general public. It is a multidimensional problem with biological, psychological, social, and environmental roots. The purpose of this study was to assess the prevalence of aggressive behavior and to explore the associated psychosocial risk factors among preparatory school children.
Patients and methods A multistage stratified sample of 380 students of both sexes, 12–15 years old, was collected from the preparatory schools at Tanta City through the academic year 2016–2017. Aggressive behavior was assessed by Modified Overt Aggression Scale. Arabic version of Kiddie Schedule for Affective Disorders and Schizophrenia − Present and Lifetime Version was applied to assess current and past episodes of psychopathology in children and adolescents who had high scores of aggression.
Results Overall, 23.7% of the studied sample had aggression, and it was distributed as follows: 0.8% of the sample scored high on aggression scale, 5.5% moderate, 7.4% mild, and 10% minimal. Risk factors of aggressive behavior included male sex; second child of the family; smoking; drug addiction; watching action movies; history of physical abuse; no hobbies or playing sports; widowed or divorced parent; poor relationships with parents, friends, and teachers; living in extended families; family history of psychiatric illness; low socioeconomic class; a drug-addict family member; physical abuse in the family; unfavorable school atmosphere; and history of dropping class. Overall, 8.9% of aggressive students had attention-deficit hyperactivity disorder, 6.7% had conduct disorder, 6.7% had depression, 3.3% had oppositional defiant disorder, and 1.1% had substance use disorder.
Conclusion School aggression and violence is a frequent and a multifaceted problem among the school adolescents.

Keywords: aggression, behavior, preparatory schools


How to cite this article:
Assaf ARA, Abd El-Hay MA, Eissa MA, Abohammar SD. Assessment of aggressive behavior among preparatory school children in Tanta City. Tanta Med J 2018;46:29-37

How to cite this URL:
Assaf ARA, Abd El-Hay MA, Eissa MA, Abohammar SD. Assessment of aggressive behavior among preparatory school children in Tanta City. Tanta Med J [serial online] 2018 [cited 2018 Dec 16];46:29-37. Available from: http://www.tdj.eg.net/text.asp?2018/46/1/29/237619




  Introduction Top


Aggression is a behavior that is intended to harm or hurt a living being. Behaviors subsumed under this definition include verbal threats or physical violence toward others. Sometimes included under the rubric of aggression are explosive acts of impulsive property destruction and self-injurious behaviors [1].

Childhood aggression is a moderately stable behavioral characteristic associated with a variety of psychosocial problems. These problems include social skill deficits and peer rejection as well as delinquency and adult forms of antisocial behavior [2].

Assessing the wide variety of biological, social, and behavioral risk factors associated with aggression may be helpful. Biological factors of aggression include genetic and difficult temperament. Social factors include poverty and difficult classroom environment. Behavioral factors including physical abuse, unstable household, and domestic violence are all risk factors of aggression [3].

The multiplicity of risk factors that differentially contribute to children’s aggressive acts raises questions regarding early identification of these children and whether or not early intervention is appropriate. There has been a reluctance to gather correlative information, to embrace prevention programming, and to provide intervention despite many studies that strongly conclude serious violent offenders begin acting aggressively before the age of 20 years [4].

Persistent aggressive behavior is a common feature in many neuropsychiatric disorders and is the most common reason for referral to a child and adolescent mental health clinic. The primary neuropsychiatric diagnoses associated with aggression include disruptive behavior disorders like attention-deficit hyperactivity disorder (ADHD), conduct disorder (CD), and oppositional defiant disorder (ODD). Aggression may also be associated with other disorders including substance use disorder (SUD), post-traumatic stress disorder, and personality and mood disorders. When treatment of the primary diagnoses does not reduce aggression, it may be useful to consider aggression as the target symptom of psychopharmacologic and psychosocial treatment [5].

Nowadays, several questionnaires have been developed to assess the aggressive behavior in children. These questionnaires have been used in samples from general populations [6].


  Aim Top


The aim was to assess the prevalence of aggression among preparatory school children in Tanta City, El-Gharbia Governorate, Egypt. This was followed by assessment of all possible psychosocial risk factors among those children.


  Patients and methods Top


After taking the needed permissions, the researcher went to the school manager and explained the research and its objectives and asked for his assistance to perform the study. Written consent was obtained from the parents of the children. The screening tool was read by the researcher after explaining its aim and instructions. All patients’ related data were kept confidential. All these ethical procedures were reviewed, approved, and monitored by the faculty of medicine Tanta University Research Ethics Committee.

The estimated sample size was 380 students calculated according to population size, which is nearly 31 000 students in preparatory stage (according to the information obtained from directorate of education and the prevalence of frequent involvement in school bullying and aggressive acts which is nearly 29.9%) [7] with confidence level 95% and confidence interval 5. Students were selected from three preparatory schools which have been chosen representing districts of Tanta in the academic year 2016–2017. They were aged from 12 to 15 years. We selected only the second grade level in the preparatory schools. The study was conducted in three preparatory schools including urban area, rural area, and suburban area. Of the 31 000 students, we selected 380 students to screen for aggressive behavior, and then the students who scored high on aggressive scale were furthermore evaluated for possible underlying psychiatric illness behind this aggressive behavior. Students with intellectual disabilities, traumatic brain injuries, epilepsy, other neurological disorders, and general medical condition were excluded from the study.

Tools and instruments

  1. Assessment of demographic variables:

    This included age of the children, culture (urban/rural/suburban), family structure, socioeconomic state of the family, education and occupation of the parents, and birth order.
  2. Screening of aggression:

    Screening of aggression was done using Modified Overt Aggression Scale (MOAS) [8], which was translated into Arabic by the researcher (Appendix 1). This scale rates the patient’s aggressive behavior over the past week regarding four types of aggression (verbal, against objects, against self, against others) to give a total MOAS score about the patient’s aggressive behavior. Each type of aggression had a rating of 0 when aggression was absent and four levels of severity. Weighted scores are then added together to yield the total score. A scoring summary can be found at the bottom of the measure to aid in interpretation of responses. Total scores on the MOAS range from 0 to 40, with higher scores indicating more aggressive behavior as follows: no aggression=0, minimal aggression=1–10, mild aggression=11–20, moderate aggression=21–30, and severe aggression=31–40.

  3. Assessment of psychosocial risk factors:

    This included parenting style, perceived social atmosphere (good/fair/poor), academic performance, and history of physical abuse. The assessment of both demographic variables and psychosocial risk factors was done using the following tools:
    1. Self-reported questionnaire designed by the researcher team: it consists of 19 items, including age (years), site of school (urban/rural/suburban), marital status of parents, relationship to parents (good/fair/poor), family structure (extended or nuclear family), birth order, perceived school atmosphere (good/fair/poor), perceived relationship with teachers and classmates (good/fair/poor), history of dropping class (yes/no), sports, hobbies, watching movies, smoking, drug addiction of student and his/her family, family history of psychiatric illness, personal history of physical abuse, and physical abuse among family members (yes/no).
    2. The Egyptian classification of socioeconomic status by Fahmy and El-Sherbini [9]: it was designed specifically to assess the socioeconomic state of the family. It consists of five items, including education of the father, education and work of the mother, the income of the family, crowding index, and sanitation.
  4. Psychiatric assessment:

    This was carried out using Arabic version of Kiddie Schedule for Affective Disorders and Schizophrenia − Present and Lifetime Version which is a semistructured diagnostic interview designed to assess current and past episodes of psychopathology in children who had scores of aggression.


Statistical analysis

The following statistical methods were used for analysis of results of the present study. Data were checked, entered, and analyzed using SPSS, version 22 for Windows (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.) for data processing and statistics.

Descriptive statistics

Data were expressed as number and percentage.

The comparison was done using χ2-test to find the association between row and column variables.

For all statistical tests done, the threshold of significance was fixed at 5% level (P).
  1. P value more than 0.05 indicates nonsignificant results.
  2. P value less than 0.05 indicates significant results.


The smaller the P value obtained, the more significant the results.


  Results Top


The sample of this study consisted of 380 students aged from 12 to 15 years. They were distributed as follows: 33.4% of the sample was from urban school, 33.4% was from suburban schools, and 33.2% was from rural schools. Approximately 51.6% of the studied sample comprised male students and 48.4% female students.

Overall, 23.7% of the studied sample had aggression, and it was distributed as follows: 10% of the studied sample had minimal degree of aggression, 7.4% had mild aggression, 5.5% had moderate aggression, and 0.8% had severe aggression ([Figure 1]).
Figure 1 Prevalence & severity of aggression among the studied sample assessed by MOAS.

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Moreover, 8.9% of the aggressive students were diagnosed as having ADHD, 6.7% were diagnosed as having CD, 6.7% had depression, 3.3% had ODD, and 1.1% had SUD ([Figure 2]).
Figure 2 Psychiatric diagnosis assessed by K-SADS-PL among aggressive students.

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There is no statistically significant difference (P<0.05) between students with and without aggression regarding culture and age (years).

Aggression was found to be significantly more among male students than female students (P>0.05). Approximately 31.6% of the male students were aggressive, whereas 15.2% of the female students were aggressive.

There was a statistically significant difference (P>0.05) between aggressive students and their nonaggressive peers regarding birth order. Approximately 25% of the first birth order students were aggressive, whereas 28.9% of the second birth order students were aggressive. Approximately 14% of the third birth order students were aggressive, and ∼17.6% of the fourth or more birth order students were aggressive. The prevalence of aggression was the highest among second birth order students.

There was a statistically significant difference (P>0.05) between aggressive students and their nonaggressive peers regarding tobacco smoking, drug addiction, and personal history of physical abuse. Approximately 100% of tobacco smokers and drug-addict students were aggressive. Moreover, ∼100% of students who had personal history of physical abuse were aggressive ([Table 1]).
Table 1 Special habits and history of abuse among studied sample

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There was statistically significant difference (P>0.05) between aggressive students and their nonaggressive peers regarding playing sports, having hobbies, and watching action movies. Approximately 34.8% of students who did not play sports were aggressive. Approximately 39.7% of students who did not have hobbies were aggressive, and ∼28.5% of students who watched action movies were aggressive.

There was a statistically significant difference (P>0.05) between aggressive students and their nonaggressive peers regarding marital status of parents, relationship to parents, and family type. Approximately 60% of students who had a widowed parent were aggressive, whereas ∼43.7% of students who had a divorced parent were aggressive. Approximately 100% of students who had a poor relationship with their parents were aggressive, whereas 70% of students who had a fair relationship with their parents were aggressive. Approximately, 36.9% of students who had extended families were aggressive.

There was a statistically significant difference (P>0.05) between aggressive students and their nonaggressive peers regarding socioeconomic class of the family. Approximately 100% of students who had a low and very low socioeconomic class were aggressive, whereas ∼21.2% of students who had average socioeconomic class and ∼18% of students who had high socioeconomic class were aggressive.

There was a statistically significant difference (P>0.05) between aggressive students and their nonaggressive peers regarding drug addiction of a family member, physical abuse in the family, and family history of psychiatric illness. Approximately 100% of students who had a drug-addict family member or had physical abuse in the family were aggressive. Approximately 54.5% of students who had family history of psychiatric illness were aggressive ([Table 2]).
Table 2 Relationship between aggression and some characteristics of families of studied students

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There was a statistically significant difference (P>0.05) between aggressive students and their nonaggressive peers regarding perceived school atmosphere and history of dropping class. Approximately 79.5% of students who perceived their school atmosphere as poor were aggressive, whereas ∼15.4% of students who perceived their school atmosphere as fair were aggressive. Approximately 66.7% of students who had history of dropping class were aggressive ([Table 3]).
Table 3 Relationship between some school risk factors and aggression

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There was a statistically significant difference (P>0.05) between aggressive students and their nonaggressive peers regarding relationship with teachers and relationship with friends. Approximately 100% of students who had poor relationship with their teachers were aggressive, whereas ∼23% of students who had fair relationship with their teachers were aggressive. Approximately 100% of students who had poor relationship with their friends were aggressive, whereas ∼47.9% of students who had fair relationship with their friends were aggressive ([Table 4]).
Table 4 Relationship between some other school risk factors and aggression

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  Discussion Top


The purpose of this study was to assess the prevalence of aggressive behavior and to explore the associated psychosocial risk factors among preparatory school children and the role of the local culture (Tanta) in shaping of this aggression in this study. Overall, 23.7% of the studied sample showed aggression: 10% of the studied sample had minimal aggression, 7.4% had mild aggression, 5.5% had moderate aggression, and 0.8% had severe aggression. Risk factors of aggressive behavior included male sex; second child of the family; smoking; drug addiction; watching action movies; history of physical abuse; no hobbies or playing sports; widowed or divorced parent; poor relationships with parents, friends, and teachers; living in extended families; family history of psychiatric illness; low socioeconomic class; a drug-addict family member; physical abuse in the family; unfavorable school atmosphere; and history of dropping class. Overall, 8.9% of aggressive students had ADHD, 6.7% had CD, 6.7% had depression, 3.3% had ODD, and 1.1% had SUD.

Our results coincide with those of Huang et al. [10] who investigated the prevalence of aggression and the associated stressful life events in a large sample of school students living in Chinese rural areas and indicated that ∼24.3% of participants reported to have been engaged in aggression.

Other studies that reported similar findings include Obikeze and Obi [11] who found that according to the data from Anambra State Ministry of Education, Nigeria (2011–2013), the prevalence of aggressive behavior and bullying was 21.3% among the school students.

Results of this study were slightly different from those of national survey done by Youssef et al. [12] in Alexandria in Egypt, which stated that initiating violent assaults was reported by 51% of boys and 20.9% of girls.

The percentage of aggressive students in our sample was lower than that of Potirniche and Enache [13] when asked they students if there is aggression in their school.

The percentage of aggressive students in our sample was also lower than reported by the study conducted of Elmasry et al. [14]. The sample of that study consisted of 574 students between 13 and 18 years of age, selected from the preparatory and secondary schools chosen from Zagazig Center in Egypt through the academic year 2014–2015. Their results revealed that nearly 98.7% of the students were aggressive regarding both physical and verbal domains of aggression. This difference can be attributed to different tools (which estimated minimal levels of aggression) and different age groups (as we included only preparatory schools in our study, whereas they included both preparatory and secondary schools).

In this study, males were significantly more aggressive than females. Our results coincide with the study of Price [15] who found that boys engage in more bullying behavior than girls. Research suggests that boys are twice as likely to use physical and verbal bullying and that girls are more likely to use social isolation and exclusion as a form of bullying.

Childhood physical and sexual abuse, infant spanking, and other forms of corporal punishment have been related to physical fighting, dating violence, and other delinquent behaviors. Many surveys have documented the association between childhood physical abuse and psychiatric disorders [16],[17]. Both minor assault (corporal punishment) and more serious physical abuse, when compared with no punishment or abuse, are related to major depression, SUDs, CD, and antisocial disorders. This coincides with our results.

We also agree with the findings of Huesmann et al. [18]. They found that childhood exposure to media violence predicted aggressive behavior in later life for both males and females and remained persistent when the effects of socioeconomic status, intellectual ability, and parenting factors were controlled.

In this study, aggressive students who did not play sport or had hobbies were significantly high. This agreed with the study of Rahimizadeh et al. [19] which held in Iran to determine the difference of aggression in male and female, athlete and nonathlete students. They found that the highest aggression rate is reported for nonathlete male students, the lowest violence rate is reported for athlete female students.

There were many family risk factors contributing to aggressive behavior in school children such as marital status of parents, family type, relationship to parents, drug addiction, and psychiatric illness in families. Family as being the primary environment in which the children grow, household characteristics such as family relationships, family coherence, parenting style, and socioeconomic conditions are linked with rates of aggression and violence. Children who either witness or experience domestic violence are more likely to behave aggressively toward others in schools and in other settings [20].

Our findings are consistent with those found in the study by Elmasry et al. [14] regarding the strong association between aggression and academic failure. It can be explained as school failure causes suppression to the student, and aggression is considered as a way to express this suppression. This causes more academic failure that causes more suppression and aggression and so on; the student enters a vicious circle.

We found that the percentage of aggressive students with poor relationships to their teachers and their friends was more than the percentage of those who perceived it as fair or good, with statistically significant difference between both. This finding is consistent with that of Thornberry et al. [21]. This finding differs from that of Larsen et al. [22] who state that the aggressive youth is less likely to be susceptible to teachers’ and friends’ influence, because the children has already established a habit of aggression.

We found that smoking and drug addiction percentages increased in all levels of aggression, and this indicates that there is an association between smoking and substance abuse from one side and aggression from the other side. Our results coincide with the study by Moore et al. [23] regarding the strong association between aggression in adolescence and variety of mental health and substance use problems during adolescence period and later in adult life. It was a prospective cohort study designed to examine the association between peer aggression at 14 years and mental health and substance use during the same age period and later in life.

Our results were also in concordance with those of Killu and Byrd [24] who found that ODD was strongly associated with aggression. They also found that students with ODD can be among the most challenging to teach and handle in the classroom because of their disruptive behavior.


  Limitations Top


This study is a cross-sectional study which eliminates the causal relationship of all data. Sample bias of students who did not participate in the study, especially those who were absent from school, suspended, expelled or dropped out.


  Conclusion Top


The problem of aggressive behavior among adolescents of preparatory school students in Tanta City and related villages is frequent among the school adolescents.

Acknowledgements

The authors thank all the attending students who participated in the study.

All authors had equal role in design, work, statistical analysis, and manuscript writing.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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