I was invited to give a lecture on aggressive behaviours in children and adolescents. This is of course a topic we are constantly thinking about in our adolescent forensic unit, and I also focus a lot on it in my research work. I have a lot of material to share, so I set out to update my slides a bit and select materials best suitable for the current audience.

Updating lectures is a moment of reflecting how our understanding of the topic changes in time. When we opened out adolescent forensic unit, we were very concerned about justice. We then felt that justice is a key to successful work with adolescent with severe developmental challenges and aggression problems. Justice would include that the unit has explicit and clear rules, and breaking the rules systematically results in clearly predefined consequences.

However, rules and consequences are nowadays largely seen as wielding of power. And anyway, think about a homely situation: Your 14-, 9- and 5-year-old kids decide to bake together. They manage to create a cake and eat it happily, but they leave the kitchen a horrible mess and also break a cake plate you have cherished. Coming home from work, exhausted, you discover the situation. I assume it is unlikely you hold the five year old most responsible? So perhaps justice has to do with meeting each young person individually, setting individual goals and demands according to each kid’s capacity?

Most of the aggression we deal with in adolescent psychiatry is of reactive type, happens as a reaction to perceived threat or provocation. The perception may be much influenced by hostile attribution bias, but it is nevertheless what the young person finds actual and reacts upon. The aggression takes place under the stress of unbearable emotion, and its goal is to reveal the emotional turmoil. The young person has no skills to solve the situation with anything else than aggressive behaviour.

If a young person has no other skills to deal with situations challenging to her/him than to behave aggressively and use violence, will the skills increase if we only are systematic with consequences? Will the skills increase if we ignore the aggressive behavior? Will the skills increase if we use more coercion?

A key to success in business world is being able to notice weak signals pointing to future developments yet unrevealed. I have noticed a weak signal that the idea of letting kids release aggression by behaving aggressively in (relatively) safe way is coming back to aggression management scene. But will it improve self-regulation and social skills if the minor is directed to a special room where s/he can undisturbed hit and kick objects until the emotion dies down?

Acute situations that have already escalated have to be managed somehow. Ideas of best approach vary in time and across treatment cultures. But destructive aggression should best be prevented. But in a long run, kids prone to hostile attribution bias and unbearable emotions, with no better skills that to hit likely need new skills such as keeping negative emotions from escalating, tolerating anxiety and redirecting attention, calming oneself down in non-aggressive way, and better social skills. I doubt that a boxing bag will teach these.

My life’s ambition is serenity of mind. On my way to give the lecture I focused my attention intensively to a Swedish podcast, because my current ambition is to improve my Swedish. As a bi-product I realized that during the whole day, I did not let my emotions escalate a single time due to remembering 37 things I had forgotten, or a problem in our clinic, or a recent disagreement, or being late, or if they like my lecture or not. Redirecting attention succeeded and worked better than expected.