Dr. Katya Stepanova, chair of child and adolescent psychiatry, answers 9 questions about overcoming aggressive behaviors
Aggressive behavior in children is one of the most common—and most stressful—challenges parents face. Whether it’s a preschooler who hits during playtime or a teen who explodes with verbal outbursts, aggression can be confusing, upsetting and sometimes even scary. It could also be a way for a child to communicate that something isn’t going well. Here’s what we want families to know.
What types of behaviors would you classify as aggressive in children?
Aggression in children and adolescents can take many forms. It may be verbal, such as screaming, yelling or threatening; or physical, like hitting, biting or destroying property. Aggression can also be impulsive or reactive, such as when a child lashes out in the heat of the moment in response to a trigger. In other cases, it may be proactive or planned, such as when a child deliberately waits for the right moment to retaliate against a peer who previously hurt or upset them.
How common are aggressive behaviors and outbursts in kids?
Short answer: very common. Most young children display some aggressive behaviors during early development—especially toddlers and preschoolers, who are still learning how to express big emotions and use language effectively. Among older children in community settings, studies suggest that 10–20% may exhibit some form of aggressive behavior. These rates are significantly higher in children referred for mental health care.
While occasional outbursts are a normal part of development, frequent, intense or escalating aggression may signal a need for closer attention and professional support.
Why do some kids exhibit aggressive behaviors?
There’s no one-size-fits-all answer. Aggressive behavior is usually a symptom of an underlying problem. Some common problems associated with aggressive behaviors include:
- Emotional dysregulation – difficulty managing feelings like anger, frustration or anxiety
- Neurodevelopmental conditions – including ADHD, autism spectrum disorder, learning disorders or intellectual disability
- Mood or anxiety symptoms
- Exposure to stress or traumatic experiences – such as experiencing violence, neglect, bullying or family conflict
- Environmental factors – including inconsistent discipline, high parental stress, or chaotic home or school environments
In other words, aggression is often a signal that something else is going on under the surface.
What strategies do you recommend for helping families manage aggressive behaviors?
Strategies vary by age, but the core principle stays the same: understanding what’s driving the behavior is key to addressing it. And above all, safety comes first—for the child, the family and others.
- For younger children, focus on creating predictable routines, clear structure and consistent consequences. Praise positive behaviors and model calm, appropriate responses. Visual schedules, simple emotion-labeling and redirection can be especially helpful at this age.
- For older children and teens, it’s important to help them recognize and name their emotions and to practice problem-solving strategies. Work with them to identify triggers and build a personalized “coping toolbox”—deep breathing, walking away or using words instead of actions, for example.
No matter the age, try to avoid escalating the situation through yelling, power struggles or harsh discipline. It rarely helps and often makes things worse.
The good news? There are several evidence-based parenting programs that work. These include Parent-Child Interaction Therapy (PCIT), Chicago Parenting Program and several others.
At what point do you recommend families seek help for aggressive behaviors?
Consider seeking professional support if aggression is frequent, intense or worsening over time, interfering with school, friendships or family life, or if it is causing significant distress for your child or others. Most importantly, please ask for help if you’re feeling unsafe, overwhelmed or unsure how to manage it.
Early intervention is key. It’s much easier to work on these behaviors before they become deeply ingrained patterns.
How do you help kids address these behaviors in the professional setting?
Treatment depends on the child’s age and developmental level, as well as the underlying cause. Some common approaches include behavioral therapy for both child and parents, parent training programs to strengthen skills and routines at home. Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) can help children learn emotional regulation and social problem-solving. In some cases—particularly when aggression is severe and behavioral interventions alone aren't making enough of a difference—medication may be considered. When used, it’s typically part of a broader treatment plan that includes both behavior interventions and medications.
Collaboration is most important. We often work as a team with pediatricians, schools and therapists to ensure consistent support.
What information is helpful for families to share with you when they come for an appointment?
It is important for clinicians to have the full picture. Helpful information includes specific examples of aggressive behavior—what happened, what led up to it and how it was handled, how often aggressive behaviors are occurring, what strategies help and which ones did not. Please tell your provider if there are any recent changes or family stressors. School reports and teacher feedback are particularly important.
The more detailed and concrete the information, the better we can understand the patterns and tailor the support.
What resources do CHoR and Virginia Treatment Center for Children offer for families working to overcome aggressive behaviors?
We have a whole team of pediatric mental health professionals who work with kids in the inpatient and outpatient settings. Our providers can offer a comprehensive evaluation and treatment plan that will help patients with a variety of diagnoses, including specialized care. We’re engaged in active research as well to better understand aggressive behaviors and other conditions so we can ensure we’re offering the best treatments today and moving forward.
We also recently launched an outpatient consult clinic for families of children ages 17 and younger who need to be seen in a timely manner. This isn’t intended to replace a new patient or follow-up visit with your child’s regular provider, but rather to provide a timely, one-time psychiatric assessment, along with resources and recommendations if you are concerned about a change or worsening symptoms in your child.
Is there anything else important to note about aggressive behaviors in children?
Aggressive behavior does not make your child “bad” and does not mean you’ve failed as a parent. Children communicate with behavior when they don’t yet have the tools to express themselves another way or when they’re having trouble coping with emotions. With the right support, children can—and do—learn healthier ways to cope.
We also want to normalize help-seeking. Just like you’d see a doctor for a recurring cough, it’s okay (and wise) to seek help for emotional and behavioral challenges. You’re not alone.