Identifying the Aggression Impulsive/Reactive (AIR) Profile in Youth With Behavioral Challenges

Although aggression in children and adolescents remains a leading cause of seeking mental health services, the nosology of aggression remains underdeveloped. Prior work characterized youth with aggression by using secondary analyses of large research protocol-based data sets, which revealed a profile characterized by high levels of aggression impulsive/reactive (AIR) and symptoms of hyperactivity/impulsivity. The goal of this study was to evaluate whether the AIR profile was present in a clinical sample using similar methodology with novel dimensional measures of AIR.

Medical records of patients 4 to 17 years of age who presented with behavior concerns to outpatient, inpatient, and emergency department settings were reviewed. Caregivers completed dimensional measures evaluating symptoms of aggression, mania, depression, and hyperactivity/impulsivity. Latent profile analysis was performed with indicators representing the same 6 content domains as in prior work: AIR, depression, mania, rule-breaking, self-harm, and hyperactivity-impulsivity.

A total of 430 patients completed the questionnaires and were included in the analyses. Patients' mean age was 12.52 years, and 53% were female. Four profiles were identified: predominantly AIR with hyperactivity-impulsivity (n = 83) and low mood symptoms; high AIR and high mood symptoms (n = 54); high AIR, mood, and self-harm (n = 56); and moderate overall symptom profile (n = 237). Children with high AIR and hyperactivity-impulsivity symptoms were more likely to be younger and male (mean age, 9.8 years), to have younger ages of onset of aggressive behaviors (mean age, 5.1 years), and to be less likely to have an abuse history.

This work further validated the previously described AIR profile in a new cohort of youth presenting for clinical care. Future studies should focus on developing diagnostic criteria for children with AIR.