Scoping Review: Evidence-Based Assessment of Reactive Aggression in Children

Severe reactive aggression poses a major mental health challenge for many families. A lack of validated instrumentation for assessing young children may present a barrier to more effective clinical assessment and treatment. This scoping review evaluates tools currently used in clinical research to assess aggressive behavior, and identifies gaps in the evidence base for their use in children under the age of 12 years. Measures were evaluated through an evidence-based assessment framework to support clinical decision making.

A comprehensive review of registered clinical trials targeting childhood aggression in the US identified relevant instruments; tools cited in 3 recent reviews of related constructs were also coded. Measures included were available in English, contained at least 3 items measuring aggressive behavior, and had at least 1 validation study in children under 12 years of age. Validation studies were identified through structured queries, and information was extracted from full text review of these studies as well as published manuals.

Of 173 candidate measures, 17 met inclusion criteria: 3 broadband and 14 narrow-band. Compared to commercially distributed measures, free instruments that were more targeted to assess aggression nevertheless had poorer norms and fewer validation studies in children under 12 years of age.

Improving instrumentation for assessing reactive aggression would address an urgent clinical need and a gap in current research. More work is needed to validate measures of reactive aggression in children under 12 years of age, especially studies that include non-clinical comparison samples. Here we recommend broad and narrow measures for providers to use in clinical care, emphasizing tools with good psychometric properties and no cost barrier.