Aggression and Anxiety: A New Look at an Old Notion JAVAD H. KASHANI, M.D., WILLIAM DEUSER, B.A.,
AND
JOHN C. REID, PHD.
Abstract. The present study examined the relationship between anxiety and aggression. A total of 210 subjects, 8, 12, and 17 years of age, were studied. The Conflict Tactics Scale was used to measure the subjects’ verbal and physical aggression. The Revised Children’s Manifest Anxiety Scale was used to measure anxiety; the Child Assessment Schedule and its parental version were used to identify the DSM-1II diagnoses. Results indicated significantly more anxiety in both the high-verbal and high-physical aggression subjects. Findings are discussed, and clinical implications of the study are considered. J . Am. Acad. Child Adolesc. Psychiatry, 1991, 30, 2:218223. Key Words: aggression, conduct disorder, anxiety Aggression has been defined in many ways over the years. One definition of aggression includes the following: a forceful action or procedure; the practice of making attacks; and hostile, injurious or destructive behavior or outlook (Webster’s 9th New Collegiate Dictionary, 1985). Moyer (1976) developed a psychobiological classification system of aggression based on the object of attack and the behaviors of the attacking organism. Moyer’s outline of aggression classes included fear-induced, irritable, and instrumental. Zillman (1979) in his classification scheme defined nonphysical harm as hostile behavior. In this scheme, hostile behavior includes threats and verbal abuse that is often termed “verbal aggression.” The definition of aggression in this paper will be the one offered by Steinmetz (1977): “the intentional use of physical or verbal force to obtain one’s goal during a conflict.” This definition recognizes that there afe two distinct forms of aggression, verbal and physical, and that the definition captures the essence of what the other definitions of aggression imply. In this paper, verbal aggression will mean the intentional use of yelling, .screaming, threatening, or other similar tactics to achieve a goal in a conflict. Physical aggression may include hitting, kicking, throwing objects, or using a weapon. This paper will discuss two ways to measure aggression. The first method is measuring aggression through DSM-Ill diagnosis, and the second way is through the self-report scale. One such scale is the Conflict Tactics Scale (CTS) developed by Strauss (1979). Previous research, using the CTS, has assessed factors that may increase the risk for spouse abuse (Hornung et al., 1981): interpersonal interaction of persons with violent histories (Gully and Dengerink, 1983) and methods of conflict ~~
Accepted August 21, 1990. Dr. Kashani is Professor of Psychiatry, Psychology, Pediatrics, and Medicine; Director of Training in Child Psychiatry; and Director of Child and Adolescent Services at Mid-Missouri Mental Health Center. William Deuser is a graduate student in Social Psychology and a research assistant. D r . Reid is Professor of Educational Research and Statistics. All are affiliated with the University of Missouri-Columbia. Reprint requests to Dr. Kashani, University of Missouri-Columbia, Department of Psychiatry, 3 Hospital Drive, Columbia, MO 65201. 0890-8567/91/3002-0218$03.OO/OO 1991by the American Academy of Child and Adolescent Psychiatry.
218
resolution transmitted from parents to children (Jorgenson, 1985). A few studies have used the CTS as a measure of aggression. One such study by Jaffe et al. (1986) examined family violence and child adjustment while comparing the behavioral symptoms of boys and girls. Another study by Kashani and Shepperd (1990) investigated the degree to which social support and personality moderated the use of aggression in 150 adolescents (ages 14-16), using the Diagnostic Interview for Children and Adolescents. To date, no studies have used the CTS as a measure of aggression across several developmentally different age groups while simultaneously assessing behavioral and diagnostic criteria according to DSM-IIZ. The present study also will assess whether or not children resort to a particular type of aggression as a function of age differences, something past studies have not focused on. Anxiety seems to be an important factor in many different behavior problems (Werkman, 1985). Hence, the present study focused on anxiety as one of the potentially important factors in aggression. A person may be anxious when under stress or feeling that danger is impending and, in such instances, becomes ready to either confront or flee from the cause of such a threat. This state of readiness was first described by Cannon (1929) as a mental and physiological state in which the person is prepared to react in some waybe it adaptive or maladaptive. Hence, the term, “fight-orflight syndrome,” meaning the person is ready to either combat danger or take flight. Although Cannon’s (1929) fight-or-flight concept was originally applied to situations involving serious danger, it may be that anxious children perceive many situations as more threatening than nonanxious children. With this fightor-flight syndrome in mind, it was hypothesized that some children will exhibit more aggressive behavior as a result of anxiety that they are experiencing. In other words, some children who are apprehensive or uncertain and scared of their environment may be more aggressive as a result of their fears about people they must interact with or situations/ environments in which they might be harmed.
Method Subjects The total sample consisted of 210 youngsters. It was decided before sampling that an equal number (70) of 8-, J . A m . Acad. Child Adolesc. Psychiatry,30:2, March1991
AGGRESSION AND ANXIETY
12-, and 17-year-oldswould serve as subjects and that there would be equal gender representation in each of these groups (for a total of 105 males and 105 females). Eight-year-olds were chosen to represent the early stage of preadolescence; 12-year-oldswere chosen to represent the transitional period just before the teen years and perhaps puberty; and 17-yearolds were chosen to represent late adolescence. The names of subjects in this study were obtained by systematically sampling the public school listings of 4,8 10 children in a midwest college town. The socioeconomic status (Hollingshead and Redlich, 1958) of these subjects was as follows: Class I, 20%; Class 11, 34.8%, Class 111, 27.1%; Class IV, 16.7%; Class V, 1.4%. Racial representation included 89% Caucasian, 9% black, and 2%Oriental and other. Procedure The children’s families were contacted by telephone, at which time the experimenter explained the procedure and mentioned the incentive for participation ($50.00per child). The interview took place in the subject’s home and consisted of a structured interview and some other instruments. A total of 378 families were called with 289 (77%) agreeing to participate. The interview procedure was halted when the predetermined sample size of age and gender had been obtained. The interviews were conducted by doctoral students in psychology or child and family development. The interviewers were trained in the administration of the Child Assessment Schedule until the following criteria were met: (1) an item-by-item mean criterion of Kappa = 0.80 during practice role playing of the interview; and (2) an interrater reliability criterion of k = 0.85. To insure that this quality was consistently maintained, meetings were held weekly to rereview scoring procedures, further probe appropriate DSMI11 criteria, discuss concerns, and to check each completed interview to ensure that it had indeed been scored in its entirety. Measures Conflict Tactics Scale group composition. The CTS (Strauss, 1979)measures the use of verbal aggression, physical aggression, and reasoning as conflict tactics used within a family. Items on the CTS are responded to by circling a number (from 1 = never to 6 = more than once a month), which represents how frequently that item was used as a conflict tactic during the preceding year. On the version of the CTS used in this study, six items comprised the verbal aggression subscale and eight items made up the physical aggression subscale. The item “cried” was omitted as it was not seen as being relevant. The reliability of the scale appears to be adequate as the coefficients of internal consistency ranged from 0.79 to 0.94 (Strauss, 1979). Limited evidence shows that the scale possesses adequate concurrent, content, and construct validity (Strauss, 1979). To investigate the factorial validity of the CTS for the sample used in this study, a principal axes factor analysis was conducted, followed by a varimax rotation. A three factor solution emerged with reasoning, verbal aggression, and physical aggression (violence) all loading on the appropriate J.Am.Acad. ChildAdolesc.Psychiatry, 30:2, March1991
TABLE1 . Subdivisions of the Verbal and Physical Aggression Subscales (Frequencies and Percentaees Shown) Subdivisions
Ranee
N
%
10-24 25-36
34 146 30
16 70 14
8-9 10-16 17-42
104 69 37
50 33 17
~
Verbal aggression Low Moderate High Physical aggression Low Moderate High
a9
items. However, the items “threatened with a knife or gun” and “used a knife or gun” did not seem to contribute heavily to the violence subscale-in fact only three out of the 210 subjects marked the item “used a knife or gun.” Thus, the CTS appeared to measure what it was designed to in this sample except for the two extreme items mentioned above. For both the verbal and physical aggression subscales, persons were assigned to one of three groups, based on their scores on the CTS. In determining the divisions of the verbal aggression subscale of the CTS, it was decided that the group to be labeled low in verbal aggression would not have scores above nine; hence, on the average only three of the six items would be used once a year. A score of nine represents one standard deviation below the mean of the distribution of the verbal aggression subscale. The group labeled moderate in verbal aggression includes persons who scored at least a 10 on the subscale but did not exceed a score of 24 (designating usage of a subscale item on average less than once per month). The high-verbal aggression group comprised persons who scored 25 to 36 (meaning on average, each of the six items was used more than once a month) on this subscale. A score of 25 is slightly more than one standard deviation above the mean (Table 1). The divisions for the physical aggression subscale were determined as follows: persons were labeled low in physical aggression if they never resorted to violence or if they had used only one physically violent tactic in the past year (scores of 8-9). Persons who used violence in excess of this (scores of 10-16) but reported use of each tactic nor more than an average of once a year were labeled moderate physical aggressors. Those who used on average each of the tactics more than once a year (and as much as once per month or more) were labeled as being high in physical aggression (scores of 17-42). Table 1 presents the score distributions for both verbal and physical aggression. Child Assessment Schedule (CAS) and Parent-Child Assessment Schedule (P-CAS). These semistructured diagnostic interviews determine whether DSM-I11 criteria are met for various childhood diagnoses. These scales provide information about content areas including family, friends, fears, and mood (Hodges, 1987). Information on the reliability of these instruments has been reported by Hodges et al. (1982a) and both test-retest and interrater reliabilities have typical Kappa values of 0.85 or greater. The validity of the CAS scales has been reported, among others, by Hodges et al. (1982a,b, 1987) and Verhulst et al. (1987). 219
KASHANI ET AL.
TABLE2. Frequency Distribution of Sex for High-, Moderate-, and Low-Physical Aggression Cells Cateeorv LOW
Moderate High Total
Males
Females
45 35 25 105
59 34 12 105
Note: ~ ~ ( =2 6.47, ) p < 0.05.
Diagnostic categories from the CAS and P-CAS were examined for attentional deficit disorder (ADD), conduct disorder (CD), oppositional disorder (OD), anxiety, enuresis, encopresis, and substance abuse. These scales were choosen with regard to their relevance to the hypotheses of the study. In addition, eight different symptom complex scales from the CAS and P-CAS were used in the analyses: the ADD score, the CD score, the OD score, the anxiety score, the family content score, the fears content score, the friends content score, and the mood content score. Revised Children’s Manifest Anxiety Scale (RCMAS). This anxiety scale was developed by Reynolds and Richmond (1978). Reynolds and Paget (1981) conducted a factor analysis on the scale using a national normative sample and found two lie scales and three manifest anxiety scales: physiological, worry/oversensitivity, and concentration. The construct validity of this scale has been supported by Reynolds (1980, 1982), and Reynolds and Paget (1981, 1983). A high score (more “yes” answers) indicates greater anxiety. Statistical Analyses For the verbal aggression analyses, an analysis of variance (ANOVA) was performed for each of the scales of interest from the above instruments. All tests were two sided. For post-hoc comparisons of means among verbal aggression groups the Tukey procedure was used. Because the physical aggression scale was skewed, Kruskal-Wallis analyses were used. To control for inflated alphas on analyses (due to the examination of multiple scales from an instrument), the alpha level was divided by four for the RCMAS analyses and by eight for the CAS and P-CAS analyses. For the comparison of means among the physical aggression group, a nonparametric post-hoc comparison was used (Conover, 1980).
Results Chi-square tests were conducted to determine if the high, moderate, or low aggression subjects differed in age, sex, race, socioeconomic status, or parental marital status for both verbal and physical aggression. No significant differences were found among the three groups in verbal aggression. For physical aggression, however, significant differences were seen for sex (x2 = 6.47, p < 0.05, df = 2 ) . Adjusted residuals for high-physical aggression males were significantly greater than for high-physical aggression females (p < 0.05). For parental marital status, fewer than the expected number of subjects with single parents appeared in the moderate group and more appeared in the high 220
TABLE3. Frequency Distribution of Parental Marital Status for High-, Moderate-, and Low-Physical Aggression Cells Category Married Single 79 59 24 162
Low Moderate High Total
25 10 13 48
Note: ~ ~ ( =2 5.98, ) p < 0.05.
group (both p < 0.05) (Tables 2 and 3) 0.05, df = 2 ) .
(x2 = 5.98, p
=
Instrument Analyses Analyses were conducted comparing the high, moderate, and low aggression subjects on each of the instruments and their subscales. Significant differences were seen on all of the RCMAS scales and on some of the CAS and P-CAS scales. All RCMAS scales and the RCMAS total scores showed significant differences for the verbal aggression analyses using ANOVAs (Table 4). For the physical aggression analyses, the physiological anxiety and RCMAS total were significant using Kruskal-Wallis analyses (Table 5). The high-verbal aggression subjects showed significantly higher mean scores on the CD scale, the OD scale, and the mood content area from the CS. The high-physical aggression subjects scored significantly higher on the CD scale, OD scale, ADD scale, and the content area of friends. For P-CAS, differences were seen on the total score for physical aggression only. No other P-CAS content areas or symptom complexes were significant for either the physical or verbal aggression analyses. Conduct Disorder Diagnoses One diagnosis from the CAS , conduct disorder, was highly significant, both for verbal aggression (x2 = 22.78, p < 0.001, df = 2 ) and for physical aggression (x2 = 33.11, p < 0.001, df = 2 ) (Table 6 ) .
Discussion The present study examined both physical and verbal aggression in children and adolescents concerning anxiety as a possible factor in determining such behavior. Additionally, the present study sought to determine whether different levels of anxiety and aggression were related to a number of DSM-ZZI diagnoses. The major findings of this study may be summarized as follows: (1) a factor analysis of the items on the CTS demonstrated its factorial validity with the sample used in this study; (2) no demographic differences were found for verbal aggression, but for physical aggression, both sex and parental marital status were significant as demographic factors; (3) both high-verbal aggression and high-physical aggression subjects reported significantly higher levels of anxiety; (4) the diagnosis of CD was significantly higher for both high-verbal and highphysical aggression subjects; and (5) the CAS total scores for both high-verbal and high-physical aggression subjects were significantly higher than for the other groups. Before further discussion of the results, some of the study’s J . Am.Acad. Child Adolesc. Psychiatry, 30:2, March I991
AGGRESSION AND ANXIETY
TABLE4. Comparison of Means between High-, Moderate-, and Low-Verbal Aggression and F-Values Moderate
LOW
Instrument RCMAS (physiological anxiety) RCMAS (worry) RCMAS (concentrate) RCMAS (total) CAS (mood) CAS (conduct disorder) CAS (oppositional disorder) CAS (total)
High
x
SD
if
SD
x
SD
F-Value
p
AND
JOHN C. REID, PHD.
Abstract. The present study examined the relationship between anxiety and aggression. A total of 210 subjects, 8, 12, and 17 years of age, were studied. The Conflict Tactics Scale was used to measure the subjects’ verbal and physical aggression. The Revised Children’s Manifest Anxiety Scale was used to measure anxiety; the Child Assessment Schedule and its parental version were used to identify the DSM-1II diagnoses. Results indicated significantly more anxiety in both the high-verbal and high-physical aggression subjects. Findings are discussed, and clinical implications of the study are considered. J . Am. Acad. Child Adolesc. Psychiatry, 1991, 30, 2:218223. Key Words: aggression, conduct disorder, anxiety Aggression has been defined in many ways over the years. One definition of aggression includes the following: a forceful action or procedure; the practice of making attacks; and hostile, injurious or destructive behavior or outlook (Webster’s 9th New Collegiate Dictionary, 1985). Moyer (1976) developed a psychobiological classification system of aggression based on the object of attack and the behaviors of the attacking organism. Moyer’s outline of aggression classes included fear-induced, irritable, and instrumental. Zillman (1979) in his classification scheme defined nonphysical harm as hostile behavior. In this scheme, hostile behavior includes threats and verbal abuse that is often termed “verbal aggression.” The definition of aggression in this paper will be the one offered by Steinmetz (1977): “the intentional use of physical or verbal force to obtain one’s goal during a conflict.” This definition recognizes that there afe two distinct forms of aggression, verbal and physical, and that the definition captures the essence of what the other definitions of aggression imply. In this paper, verbal aggression will mean the intentional use of yelling, .screaming, threatening, or other similar tactics to achieve a goal in a conflict. Physical aggression may include hitting, kicking, throwing objects, or using a weapon. This paper will discuss two ways to measure aggression. The first method is measuring aggression through DSM-Ill diagnosis, and the second way is through the self-report scale. One such scale is the Conflict Tactics Scale (CTS) developed by Strauss (1979). Previous research, using the CTS, has assessed factors that may increase the risk for spouse abuse (Hornung et al., 1981): interpersonal interaction of persons with violent histories (Gully and Dengerink, 1983) and methods of conflict ~~
Accepted August 21, 1990. Dr. Kashani is Professor of Psychiatry, Psychology, Pediatrics, and Medicine; Director of Training in Child Psychiatry; and Director of Child and Adolescent Services at Mid-Missouri Mental Health Center. William Deuser is a graduate student in Social Psychology and a research assistant. D r . Reid is Professor of Educational Research and Statistics. All are affiliated with the University of Missouri-Columbia. Reprint requests to Dr. Kashani, University of Missouri-Columbia, Department of Psychiatry, 3 Hospital Drive, Columbia, MO 65201. 0890-8567/91/3002-0218$03.OO/OO 1991by the American Academy of Child and Adolescent Psychiatry.
218
resolution transmitted from parents to children (Jorgenson, 1985). A few studies have used the CTS as a measure of aggression. One such study by Jaffe et al. (1986) examined family violence and child adjustment while comparing the behavioral symptoms of boys and girls. Another study by Kashani and Shepperd (1990) investigated the degree to which social support and personality moderated the use of aggression in 150 adolescents (ages 14-16), using the Diagnostic Interview for Children and Adolescents. To date, no studies have used the CTS as a measure of aggression across several developmentally different age groups while simultaneously assessing behavioral and diagnostic criteria according to DSM-IIZ. The present study also will assess whether or not children resort to a particular type of aggression as a function of age differences, something past studies have not focused on. Anxiety seems to be an important factor in many different behavior problems (Werkman, 1985). Hence, the present study focused on anxiety as one of the potentially important factors in aggression. A person may be anxious when under stress or feeling that danger is impending and, in such instances, becomes ready to either confront or flee from the cause of such a threat. This state of readiness was first described by Cannon (1929) as a mental and physiological state in which the person is prepared to react in some waybe it adaptive or maladaptive. Hence, the term, “fight-orflight syndrome,” meaning the person is ready to either combat danger or take flight. Although Cannon’s (1929) fight-or-flight concept was originally applied to situations involving serious danger, it may be that anxious children perceive many situations as more threatening than nonanxious children. With this fightor-flight syndrome in mind, it was hypothesized that some children will exhibit more aggressive behavior as a result of anxiety that they are experiencing. In other words, some children who are apprehensive or uncertain and scared of their environment may be more aggressive as a result of their fears about people they must interact with or situations/ environments in which they might be harmed.
Method Subjects The total sample consisted of 210 youngsters. It was decided before sampling that an equal number (70) of 8-, J . A m . Acad. Child Adolesc. Psychiatry,30:2, March1991
AGGRESSION AND ANXIETY
12-, and 17-year-oldswould serve as subjects and that there would be equal gender representation in each of these groups (for a total of 105 males and 105 females). Eight-year-olds were chosen to represent the early stage of preadolescence; 12-year-oldswere chosen to represent the transitional period just before the teen years and perhaps puberty; and 17-yearolds were chosen to represent late adolescence. The names of subjects in this study were obtained by systematically sampling the public school listings of 4,8 10 children in a midwest college town. The socioeconomic status (Hollingshead and Redlich, 1958) of these subjects was as follows: Class I, 20%; Class 11, 34.8%, Class 111, 27.1%; Class IV, 16.7%; Class V, 1.4%. Racial representation included 89% Caucasian, 9% black, and 2%Oriental and other. Procedure The children’s families were contacted by telephone, at which time the experimenter explained the procedure and mentioned the incentive for participation ($50.00per child). The interview took place in the subject’s home and consisted of a structured interview and some other instruments. A total of 378 families were called with 289 (77%) agreeing to participate. The interview procedure was halted when the predetermined sample size of age and gender had been obtained. The interviews were conducted by doctoral students in psychology or child and family development. The interviewers were trained in the administration of the Child Assessment Schedule until the following criteria were met: (1) an item-by-item mean criterion of Kappa = 0.80 during practice role playing of the interview; and (2) an interrater reliability criterion of k = 0.85. To insure that this quality was consistently maintained, meetings were held weekly to rereview scoring procedures, further probe appropriate DSMI11 criteria, discuss concerns, and to check each completed interview to ensure that it had indeed been scored in its entirety. Measures Conflict Tactics Scale group composition. The CTS (Strauss, 1979)measures the use of verbal aggression, physical aggression, and reasoning as conflict tactics used within a family. Items on the CTS are responded to by circling a number (from 1 = never to 6 = more than once a month), which represents how frequently that item was used as a conflict tactic during the preceding year. On the version of the CTS used in this study, six items comprised the verbal aggression subscale and eight items made up the physical aggression subscale. The item “cried” was omitted as it was not seen as being relevant. The reliability of the scale appears to be adequate as the coefficients of internal consistency ranged from 0.79 to 0.94 (Strauss, 1979). Limited evidence shows that the scale possesses adequate concurrent, content, and construct validity (Strauss, 1979). To investigate the factorial validity of the CTS for the sample used in this study, a principal axes factor analysis was conducted, followed by a varimax rotation. A three factor solution emerged with reasoning, verbal aggression, and physical aggression (violence) all loading on the appropriate J.Am.Acad. ChildAdolesc.Psychiatry, 30:2, March1991
TABLE1 . Subdivisions of the Verbal and Physical Aggression Subscales (Frequencies and Percentaees Shown) Subdivisions
Ranee
N
%
10-24 25-36
34 146 30
16 70 14
8-9 10-16 17-42
104 69 37
50 33 17
~
Verbal aggression Low Moderate High Physical aggression Low Moderate High
a9
items. However, the items “threatened with a knife or gun” and “used a knife or gun” did not seem to contribute heavily to the violence subscale-in fact only three out of the 210 subjects marked the item “used a knife or gun.” Thus, the CTS appeared to measure what it was designed to in this sample except for the two extreme items mentioned above. For both the verbal and physical aggression subscales, persons were assigned to one of three groups, based on their scores on the CTS. In determining the divisions of the verbal aggression subscale of the CTS, it was decided that the group to be labeled low in verbal aggression would not have scores above nine; hence, on the average only three of the six items would be used once a year. A score of nine represents one standard deviation below the mean of the distribution of the verbal aggression subscale. The group labeled moderate in verbal aggression includes persons who scored at least a 10 on the subscale but did not exceed a score of 24 (designating usage of a subscale item on average less than once per month). The high-verbal aggression group comprised persons who scored 25 to 36 (meaning on average, each of the six items was used more than once a month) on this subscale. A score of 25 is slightly more than one standard deviation above the mean (Table 1). The divisions for the physical aggression subscale were determined as follows: persons were labeled low in physical aggression if they never resorted to violence or if they had used only one physically violent tactic in the past year (scores of 8-9). Persons who used violence in excess of this (scores of 10-16) but reported use of each tactic nor more than an average of once a year were labeled moderate physical aggressors. Those who used on average each of the tactics more than once a year (and as much as once per month or more) were labeled as being high in physical aggression (scores of 17-42). Table 1 presents the score distributions for both verbal and physical aggression. Child Assessment Schedule (CAS) and Parent-Child Assessment Schedule (P-CAS). These semistructured diagnostic interviews determine whether DSM-I11 criteria are met for various childhood diagnoses. These scales provide information about content areas including family, friends, fears, and mood (Hodges, 1987). Information on the reliability of these instruments has been reported by Hodges et al. (1982a) and both test-retest and interrater reliabilities have typical Kappa values of 0.85 or greater. The validity of the CAS scales has been reported, among others, by Hodges et al. (1982a,b, 1987) and Verhulst et al. (1987). 219
KASHANI ET AL.
TABLE2. Frequency Distribution of Sex for High-, Moderate-, and Low-Physical Aggression Cells Cateeorv LOW
Moderate High Total
Males
Females
45 35 25 105
59 34 12 105
Note: ~ ~ ( =2 6.47, ) p < 0.05.
Diagnostic categories from the CAS and P-CAS were examined for attentional deficit disorder (ADD), conduct disorder (CD), oppositional disorder (OD), anxiety, enuresis, encopresis, and substance abuse. These scales were choosen with regard to their relevance to the hypotheses of the study. In addition, eight different symptom complex scales from the CAS and P-CAS were used in the analyses: the ADD score, the CD score, the OD score, the anxiety score, the family content score, the fears content score, the friends content score, and the mood content score. Revised Children’s Manifest Anxiety Scale (RCMAS). This anxiety scale was developed by Reynolds and Richmond (1978). Reynolds and Paget (1981) conducted a factor analysis on the scale using a national normative sample and found two lie scales and three manifest anxiety scales: physiological, worry/oversensitivity, and concentration. The construct validity of this scale has been supported by Reynolds (1980, 1982), and Reynolds and Paget (1981, 1983). A high score (more “yes” answers) indicates greater anxiety. Statistical Analyses For the verbal aggression analyses, an analysis of variance (ANOVA) was performed for each of the scales of interest from the above instruments. All tests were two sided. For post-hoc comparisons of means among verbal aggression groups the Tukey procedure was used. Because the physical aggression scale was skewed, Kruskal-Wallis analyses were used. To control for inflated alphas on analyses (due to the examination of multiple scales from an instrument), the alpha level was divided by four for the RCMAS analyses and by eight for the CAS and P-CAS analyses. For the comparison of means among the physical aggression group, a nonparametric post-hoc comparison was used (Conover, 1980).
Results Chi-square tests were conducted to determine if the high, moderate, or low aggression subjects differed in age, sex, race, socioeconomic status, or parental marital status for both verbal and physical aggression. No significant differences were found among the three groups in verbal aggression. For physical aggression, however, significant differences were seen for sex (x2 = 6.47, p < 0.05, df = 2 ) . Adjusted residuals for high-physical aggression males were significantly greater than for high-physical aggression females (p < 0.05). For parental marital status, fewer than the expected number of subjects with single parents appeared in the moderate group and more appeared in the high 220
TABLE3. Frequency Distribution of Parental Marital Status for High-, Moderate-, and Low-Physical Aggression Cells Category Married Single 79 59 24 162
Low Moderate High Total
25 10 13 48
Note: ~ ~ ( =2 5.98, ) p < 0.05.
group (both p < 0.05) (Tables 2 and 3) 0.05, df = 2 ) .
(x2 = 5.98, p
=
Instrument Analyses Analyses were conducted comparing the high, moderate, and low aggression subjects on each of the instruments and their subscales. Significant differences were seen on all of the RCMAS scales and on some of the CAS and P-CAS scales. All RCMAS scales and the RCMAS total scores showed significant differences for the verbal aggression analyses using ANOVAs (Table 4). For the physical aggression analyses, the physiological anxiety and RCMAS total were significant using Kruskal-Wallis analyses (Table 5). The high-verbal aggression subjects showed significantly higher mean scores on the CD scale, the OD scale, and the mood content area from the CS. The high-physical aggression subjects scored significantly higher on the CD scale, OD scale, ADD scale, and the content area of friends. For P-CAS, differences were seen on the total score for physical aggression only. No other P-CAS content areas or symptom complexes were significant for either the physical or verbal aggression analyses. Conduct Disorder Diagnoses One diagnosis from the CAS , conduct disorder, was highly significant, both for verbal aggression (x2 = 22.78, p < 0.001, df = 2 ) and for physical aggression (x2 = 33.11, p < 0.001, df = 2 ) (Table 6 ) .
Discussion The present study examined both physical and verbal aggression in children and adolescents concerning anxiety as a possible factor in determining such behavior. Additionally, the present study sought to determine whether different levels of anxiety and aggression were related to a number of DSM-ZZI diagnoses. The major findings of this study may be summarized as follows: (1) a factor analysis of the items on the CTS demonstrated its factorial validity with the sample used in this study; (2) no demographic differences were found for verbal aggression, but for physical aggression, both sex and parental marital status were significant as demographic factors; (3) both high-verbal aggression and high-physical aggression subjects reported significantly higher levels of anxiety; (4) the diagnosis of CD was significantly higher for both high-verbal and highphysical aggression subjects; and (5) the CAS total scores for both high-verbal and high-physical aggression subjects were significantly higher than for the other groups. Before further discussion of the results, some of the study’s J . Am.Acad. Child Adolesc. Psychiatry, 30:2, March I991
AGGRESSION AND ANXIETY
TABLE4. Comparison of Means between High-, Moderate-, and Low-Verbal Aggression and F-Values Moderate
LOW
Instrument RCMAS (physiological anxiety) RCMAS (worry) RCMAS (concentrate) RCMAS (total) CAS (mood) CAS (conduct disorder) CAS (oppositional disorder) CAS (total)
High
x
SD
if
SD
x
SD
F-Value
p
