Unlike sadness, worries, or fear, aggression goes outside the individual and impacts others. Thus the bad boy can frequently seem amazingly undisturbed by his aggressive behavior while others in the environment, such as parents, teachers, friends, etc., are extremely upset. Several different psychiatric syndromes of childhood are characterized by such externalizing symptoms and many of them are extremely common. Among them are attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, substance abuse, bipolar disorder, or other psychoses. Taken together, these disorders are extremely common and create extreme hardship for the individual, their families, and society as a whole.
Proper diagnosis is essential if treatment is to be successful.
Generally, as a society, we think of boys as being intrinsically more aggressive than girls. Boys as a group do tend to engage in more rough and tumble play from toddlerhood than their female counterparts, and thus may be more predisposed toward the development of these behavioral problems. We are also increasingly aware of genetic influences that, together with societal and familial factors, can interact to cause the disorders. Other environmental factors such as poverty, exposure to violent crimes, and domestic violence also can have a profound impact. When environmental stressors interact with the genetic factors, bad behavior becomes increasingly prominent.