1. بسم الله الرحمن الرحيم يا أيها الناس اتقوا ربكم الذى خلقكم من نفس واحدة و خلق منها زوجها وبث منهما رجالا كثيرا و نساء و اتقوا الله الذى تساءلون به و الارحام ان الله كان عليكم رقيبا النساء 1

2. Aggressive Behaviour In Children Subject : By Mohamed Abdel-Ghani Moustafa Ali M.B., B.CH. Zagazig University

3. Supervisors Prof. Dr. Wael Mohamed Ahmed Professor of Psychiatry Faculty of Medicine, Zagazig University Dr. Haythem Mohamed Abou Hashem Assistant Prof. of Psychiatry Faculty of Medicine, Zagazig University Dr. Mohamed Gamal Sehlo Lecturer of Psychiatry Faculty of Medicine, Zagazig University

4. Prof. Dr. Abdel-Shafy Metwaly Khashaba Professor and Head of Psychiatry Department Faculty of Medicine, Zagazig University Prof. Dr. Abdouh Elsayed El-Dodd Professor of Psychiatry Faculty of Medicine, Tanta University Prof. Dr. Wael Mohamed Ahmed Professor of Psychiatry Faculty of Medicine, Zagazig University Discussion Committee

6. Aggressive Behaviour In Children PSYCHOSOCIAL ASPECT

7. I- FAMILY-RELATED RISK FACTORS A. Sexual and Physical Abuse B. Parental Violence C. Broken Home D. Parental Characteristics E. Mental Disorders of Parents F. Perceived Parenting Styles (Barnow and Freyberger, 2003).

8. The role of family environment in early life for later aggressive behavior (Mattson, 2003). Pre/Perinatal Complications that cause brain damage Maternal rejection Sexual, Physical Abuse Increased Risk For Aggressive Behavior Difficult temperament Psychological risks Low social status , young age Of Mother ,broken home , Mental Disorder of parents Increased risk for Postnatal Complications Negative Parental Style Time

9. II - Community-Related Risk Factors A- Peers: Peer groups appear to be a place for consolidation of aggressive behaviors for youth, later on (Loeber & Hay, 1994). B- School Factors: Disorganized school structures with lax discipline, enforcement of rules and crowded physical space (Flannery, 1997). C- Neighborhood Factors : include poverty, gang involvement, availability of drugs and low neighborhood attachment (Maguin et al., 1995).

11. Aggressive Behaviour In Children GENETIC ASPECT

12. ♦ The influence of genetic factors appears to increase over the course of development and is followed by a concomitant decrease in shared environmental factors (Blonigen & Krueger, 2007). ♦ Furthermore, genetic effects may be moderated by gender differences, as well as interactions with adverse environmental factors (Blonigen & Krueger, 2007).

15. Aggressive Behaviour In Children NEURAL ASPECT

16. I- ACETYLCHOLINE: ♦ ACh generally has facilitatory effects on aggressive behavior (Gay and Leaf, 1986). ♦ In most cases, the primary target is the hypothalamus (Brudzynski, 1994). II- DOPAMINE: ◊ The studies showed that dopamine facilitates aggressive behavior (Siegel, 2005). ◊ Van Erp and Miczek (2003) reported increased dopamine levels in the prefrontal cortex during aggressive encounters.

17. III- SEROTONIN :  Serotonin suppresses several different forms of aggressive behavior (Siegel, 2005).  A strategy using knockout mice genetically engineered to disrupt the neuronal nitric acid sythase gene , which inhibits aggression, by acting through 5-HT 1A and 5- HT 1B receptors leading to a dramatic increase in aggressive behavior (Chiavegatto et al., 2004).

18. IV- PEPTIDES ■ Include opioid peptides, substance P (SP), and cholecystokinin (CCK) ■ Opioid peptides have antiaggressive properties (Siegel, 2005). ■ SP have an excitatory action on neurons (Otsuka and Yoshioka, 1993). ■ CCK potentiates defensive rage behavior elicited from the medial hypothalamus (Siegel, 2005).

19. Aggressive Behaviour In Children Neural Areas & Circuits Mediating Aggressive Behavior

21. Summary of functional anatomical connections relevant for aggressive behavior (Gregg, 2003).

23. Efferent projections from PAG (Gregg, 2003)

25. Aggressive Behaviour In Children HORMONAL ASPECT

28. Aggressive Behaviour In Children AGGRESSIVE BEHAVIOR IN CHILD PSYCHIATRIC DISORDERS

30. I- Disruptive Behavior Disorders 1- Conduct disorder:  The commonest aggression-related psychiatric disorder of childhood ( Rutter et al., 1985).  Characterized by a repetitive, persistent pattern of behavior violating the basic rights of others (Tynan, 2006).  Aggressive acts include persistent bullying, initiating fights, using a weapon, stealing while confronting the victim, forcing someone into sexual activity, and showing physical cruelty (Christophersen and Mortweet, 2001).

40. IX- Intermittent Explosive Disorder Discrete episodes of losing control of aggressive impulses resulting in serious assault or the destruction of property. The symptoms appear within minutes or hours and remit spontaneously. Other disorders of impulse control and substance use and mood, anxiety disorders have also been associated with intermittent explosive disorder (Hollander et al., 2006).

41. Aggressive Behaviour In Children Cognitive-Behavioral Intervention for Childhood Aggressive behavior

43. THE BRAINPOWER PROGRAM According to social cognitive theory, the aggressive children attend selectively to social cues, make biased interpretations of the available cues, and act on beliefs that aggressive response is the appropriate course of action (Hudley, 2003). The BrainPower Program seeks to modify this dysfunctional pattern of attributional bias (Hudley, 2001) .

44. Aggressive Behaviour In Children PHARMACOLOGICAL INTERVENTION

47. II- ADRENERGICS 1- β-Blockers 2- α- 2 Agonists: "Clonidine"

50. VI- BENZODIAZAPINES Use of short-acting benzodiazepines like lorazepam to treat aggression is limited to acute cases (Salzman et al., 1991) . VII- ANTIPSYCHOTICS ☺ Typical Antipsychotics ☺ Atypical Antipsychotics

54. Finally, I would like to express my deepest appreciation and gratitude to MY SUPERVISORS Prof. Dr. Wael Mohamed Ahmed Professor of Psychiatry Faculty of Medicine Zagazig University Dr. Haythem Mohamed Abou Hashem Assistant Professor of Psychiatry Faculty of Medicine Zagazig University Dr. Mohamed Gamal Sehlo Lecturer of Psychiatry Faculty of Medicine Zagazig University DISCUSSION COMMITTEE Prof. Dr. Abdel-Shafy Metwaly Khashaba Professor and Head of Psychiatry Department Faculty of Medicine Zagazig University Prof. Dr. Abdouh Elsayed El-dodd Professor of Psychiatry Faculty of Medicine Tanta University Prof. Dr. Wael Mohamed Ahmed Professor of Psychiatry Faculty of Medicine Zagazig University A ll my professors, staff members and colleagues for their continuous supervision, patience, generous help and fruitful remarks that are inscribed within this work Ramadan Karim