Study: Consumption of soft drinks may be linked to aggression in children

17 Aug

Melissa Pandika wrote in the Los Angeles Times article, Soda linked to behavioral problems in young children, study says:

Soda has already been blamed for making kids obese. New research blames the sugary drinks for behavioral problems in children too.
Analyzing data from 2,929 families, researchers linked soda consumption to aggression, attention problems and social withdrawal in 5-year-olds. They published their findings in the Journal of Pediatrics on Friday.
Although earlier studies have shown an association between soft-drink consumption and aggression in teens, none had investigated whether a similar relationship existed in younger children.
To that end, Columbia University epidemiologist Shakira Suglia and her colleagues examined data from the Fragile Families and Child Wellbeing Study, which followed 2,929 mother-child pairs in 20 large U.S. cities from the time the children were born. The study, run by Columbia and Princeton University, collected information through surveys the mothers completed periodically over several years.
In one survey, mothers answered questions about behavior problems in their children. They also reported how much soda their kids drank on a typical day.
Suglia and her colleagues found that even at the young age of 5, 43% of the kids consumed at least one serving of soda per day, and 4% drank four servings or more.
The more soda kids drank, the more likely their mothers were to report that the kids had problems with aggression, withdrawal and staying focused on a task. For instance, children who downed four or more servings of soda per day were more than twice as likely to destroy others’ belongings, get into fights and physically attack people, compared with kids who didn’t drink soda at all.
Even after adjusting for the potential influence of socioeconomic factors, maternal depression, intimate partner violence and other environmental variables, the researchers still saw a strong association between soda consumption and behavior. “That was pretty striking to us,” Suglia said.,0,3247341.story


Soft Drinks Consumption Is Associated with Behavior Problems in 5-Year-Olds
Shakira F. Suglia, ScD1, Sara Solnick, PhD2, and David Hemenway, PhD3
To examine soda consumption and aggressive behaviors, attention problems, and withdrawal behavior among 5-year-old children.
Study design
The Fragile Families and Child Wellbeing Study is a prospective birth cohort study that follows a sample of mother-child pairs from 20 large US cities. Mothers reported children’s behaviors using the Child Behavior Checklist at age 5 years and were asked to report how many servings of soda the child drinks on a typical day.
Results In the sample of 2929 children, 52% were boys, 51% were African-American, 43% consumed at least one serving of soda per day, and 4% consumed 4 or more servings per day. In analyses adjusted for sociodemographic factors, consuming one (beta, 0.7; 95% CI, 0.1-1.4), 2 (beta, 1.8; 95% CI, 0.8-2.7), 3 (beta, 2.0; 95% CI, 0.6-3.4), or 4 or more (beta, 4.7; 95% CI, 3.2-6.2) servings was associated with a higher aggressive behavior score compared with consuming no soda. Furthermore, those who consumed 4 or more (beta, 1.7; 95% CI, 1.0-2.4) soda servings had higher scores on the attention problems subscale. Higher withdrawn behavior scores were noted among those consuming 2 (beta, 1.0; 95% CI, 0.3-1.8) or 4 or more (beta, 2.0; 95% CI, 0.8-3.1) soda servings compared with those who consumed no soda.
Wenote an association between soda consumption and negative behavioramong very young children; future studies should explore potential mechanisms that could explain this association. (J Pediatr 2013;-:—).
Americans buy more soda per capita than people in any other country worldwide.1 Even very young children consume soft drinks. For example, national surveys of US children aged 4-5 years fromthe mid-1990s found that, on average, they consumed 11 g of added sugar per day from regular (ie, nondiet) soft drinks alone, which corresponds to 25% of a 12-oz can.2 In California, a 2005 survey found that more than 40% of children aged 2-11 years drank at least 1 serving of soda per day.3
Among adolescents, consuming soft drinks is associated with aggression,4,5 as well as with depression and suicidal thoughts, and withdrawal behavior (Hemenway et al, unpublished data, 2013).5-7 Previous studies using data from national high school surveys found a dose-response relationship between the amount of soft drinks consumed and both self-harm and aggression toward others. Despite the fact that young children also are consuming soft drinks, the relationship between soda consumption and behavior has not been evaluated in this age group.
Numerous factors may affect both soda consumption and problem behavior in children. Poor dietary choices, such as high soda consumption, in young children may be associated with other parenting practices, such as excessive television (TV) viewing and high consumption of other sweets. Furthermore, parenting practices may be associated with social factors known to be associated with child behavior. The relationship between a stressful home environment and child behavior is well known; for example, children who are victims of violent acts or who witness violence have been found to have more externalizing and internalizing behavior problems and more aggression problems, and to show signs of posttraumatic stress disorder.8-10 Moreover, caretaker mental health can be a strong contributor to problems in children through its effects on parenting quality and overall home environment.11 Children of depressed mothers have been shown to develop more social and emotional problems during childhood, including internalizing and externalizing problems.12 Thus, it is possible that observed associations between behavior and soda consumption in adolescents can be attributed to unadjusted social risk factors.
In the present study, we investigated the effect of soda consumption on behavior,
specifically aggression, attention, and withdrawal behaviors, in a sample of almost 3000 5-year-old children from urban areas across the US. Considering that other dietary factors may be associated with both soda consumption and behavior, we adjusted our analyses for other dietary components as well as for social risk factors that may be associated with parenting practices as well as child behavior.
From the
1Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY;
2Department of Economics, University of Vermont, Burlington, VT; and 3Department of Health Policy and Management, Harvard School of Public Health, Boston, MA
The Fragile Families and Child Wellbeing study was funded by the National Institute of Child Health and Human

The Center for Sport Policy and Conduct (Sport Center) at Indiana University, Bloomington has excellent capsule definitions of violence, aggression, and deviance According to the Sport Center violence is defined as:

Violence can be seen as a form of physical assault based on an intent to injure another person or destroy the property of others. To continue this definition, “violence in sport violates the norms and rules of the contest, threatens lives and property, and usually cannot be anticipated by the persons affected” (Smith, 1983, p. 6).

Aggression is defined as:

Aggression can be generally defined as all behavior intended to destroy another person’s property or to injure another person, physically or psychologically. It has been reported that action has to violate norms and rules shared by society in order to be defined as aggressive. Several experiments (Tedeschi, Gaes, & Rivera, 1977) found that a protagonist who intends to cause injury is only judged by witnesses to be aggressive when his behavior is also judged to be antinormative; in other words, when they are opposing the social rules that apply to that particular situation. Judgment is the same when the action or “intent to injure” constitutes a response to a previous provocation. If, however, the action exceeds the preceding deed, the revenge is viewed as excessive and judged as inappropriate and aggressive.

Deviance is defined as “Deviant behavior is usually that which departs from the norm; anything that goes against the accepted societal standards could be classified as such.” The subject of this article is aggressive behavior in children.

Leo J. Bastiaens, MD and Ida K. Bastiaens wrote an excellent article about youth aggression in the Psychiatric Times. One part of the article looked at the economic impact.

Before taking into account the costs of juvenile justice programs and institutions, youth violence alone costs the United States more than $158 billion each year….
US cities lose nearly $50 billion a year because of crime and violence….Reallocation of resources, new social spending initiatives, programs with a higher quality of care, and a better public health perspective would change the lives of our youths and cut the social cost of juvenile crime in the United States.

What is Aggressive Behavior?

Dr. Dianne S. O’Connor lists the following causes of aggressive behavior in children

• Genetic and/or temperamental influences.
• Insecure or disorganized attachment patterns.
• Ongoing and unrelieved stress.
• Lack of appropriate problem solving and coping strategies.
• Limited experience with role models (e.g. peers, family members, TV. & computer games) who value and provide examples of non-aggressive behaviors.
• Ineffective parenting style: for example, authoritarian, controlling, harsh or coercive parenting style; permissive, overindulgent parenting style; rejecting parenting style; psychological problems in the parent such as depression or alcoholism.
• Poor fit between parent and child: Ineffective parenting could be an effect rather than a cause of the child’s behavior. Children’s problem behaviors may affect parents’ moods and parenting behaviors.
• Family stress, disruption and conflict.

There are certain family and social risk factors which should alert educators and social workers that an early intervention may be needed.

Physorg.Com reports about an University of North Carolina at Chapel Hill study which cites early neglect as a predictor of aggressive behavior in children.

Early child neglect may be as important as child abuse for predicting aggressive behavior, researchers say. Neglect accounts for nearly two-thirds of all child maltreatment cases reported in the United States each year, according to the Administration for Children and Families.
According to Joan Arehart-Treichel’s article in Psychiatric News, aggression comes in four types. She writes about a study project conducted by He was Henri Parens, M.D., a professor of psychiatry at Jefferson Medical College and a training and supervising analyst at the Psychoanalytic Center of Philadelphia. “Parens and his colleagues not only met with 10 socioeconomically disadvantaged mothers and their 16 infants twice a week over seven years, but have been following up with the mothers and their offspring ever since.” According to Arehart –Treichel, the four types of aggression are
One was a nondestructive aggression, the kind the 5-month-oldgirl had demonstrated. It is children’s attempt to master themselvesand their environment. “This is a magnificent kind of aggression,”Parens said. It represents the kind that drives youngsters toexcel academically, win at sports, climb mountains, and do fantasticthings with their lives. It is inborn and essential for survivaland adaptation. It is the kind of aggression that parents shouldcultivate.
A second kind of aggression is the urge to obtain food. It toois inborn and essential for survival and adaptation.
A third kind of aggression is displeasure-related aggression(say, a temper tantrum or a rage reaction), and a fourth kindof aggression is pleasure-related aggression (for example, teasingand taunting). Neither is inborn; both are hostile aggression,and both are activated by emotional pain. In other words, hurtinga person’s feelings can generate hostile aggression. That istrue for all people. In contrast, people whose feelings arenot hurt will probably not engage in hostile aggression.

According to Parens’ observations a good deal of the aggression behavior observed in the children in the study was related to how their parents treated them.

Aggressive Behavior in Boys

PBS has a good description of aggression in boys and what characteristics are normal and not necessarily cause for concern.
Why do boys become aggressive? Sometimes boys are aggressive because they are frustrated or because they want to win. Sometimes they are just angry and can’t find another way to express that feeling. And some may behave aggressively, but they’re not aggressive all the time.

An active boy is not necessarily an aggressive one. “We often see young boys playing out aggressive themes. It’s only a problem when it gets out of control,” comments Thompson.

Competition, power and success are the true stuff of boys’ play. Many young boys see things in competitive terms and play games like “I can make my marble roll faster than yours,” “my tower is taller than yours” and “I can run faster than you.” But these games of power and dominance are not necessarily aggressive unless they are intended to hurt.

Fantasy play is not aggressive. A common boy fantasy about killing bad guys and saving the world is just as normal as a common girl fantasy about tucking in animals and putting them to bed. “Most boys will pick up a pretzel and pretend to shoot with it,” comments teacher Jane Katch. “If a boy is playing a game about super heroes, you might see it as violent. But the way he sees it, he’s making the world safe from the bad guys. This is normal and doesn’t indicate that anything is wrong unless he repeatedly hurts or tries to dominate the friends he plays with. And sometimes an act that feels aggressive to one child was actually intended to be a playful action by the child who did it. When this happens in my class, we talk about it, so one child can understand that another child’s experience may be different than his own. This is the way empathy develops.”

Only a small percentage of boys’ behavior is truly aggressive. While “all boys have normal aggressive impulses which they learn to control, only a small percentage are overly aggressive and have chronic difficulty controlling those impulses,” says Michael Thompson, Ph.D. These are the boys who truly confuse fantasy with reality, and frequently hit, punch, and bully other kids. They have a lack of impulse control and cannot stop themselves from acting out. “They cannot contain their anger and have little control over their physical behavior and this is when intervention by parent or teacher is needed,” says Thompson.

The key point is a lot of behavior, which is normal activity for most boys is not unacceptable aggression and should not trigger the use of medication for behavior which is within the normal range.

A University of Chicago examined boys who exhibited abnormal aggression and found that there might be a physical cause.

Unusually aggressive youth may actually enjoy inflicting pain on others, research using brain scans at the University of Chicago shows.
Scans of the aggressive youth’s brains showed that an area that is associated with rewards was highlighted when the youth watched a video clip of someone inflicting pain on another person. Youth without the unusually aggressive behavior did not have that response, the study showed.
The results are reported in the paper “Atypical Empathetic Responses in Adolescents with Aggressive Conduct Disorder: A functional MRI Investigation” in the current issue of the journal Biological Psychology. Benjamin Lahey, the Irving B. Harris Professor of Epidemiology and Psychiatry at the University, co-authored the paper, along with University students Kalina Michalska and Yuko Akitsuki. The National Science Foundation supported the work.
In the study, researchers compared eight 16- to 18-year-old boys with aggressive conduct disorder to a control group of adolescent boys with no unusual signs of aggression. The boys with the conduct disorder had exhibited disruptive behavior such as starting a fight, using a weapon and stealing after confronting a victim.

Clearly, the youth in this study were not the typical boy and required intervention.

Generally, boys are thought to be more physically aggressive and girls are thought to be more socially or indirectly aggressive. Carolyn Willbert reports on a study at WebMD, which finds boys use indirect methods of aggression as well.
Girls often get a bad rap for gossiping, forming cliques, and other aggressive social behavior, as characterized in the popular movie Mean Girls. Boys, meanwhile, are known for physically aggressive behavior, such as hitting.

A new study, however, says these attitudes may be at least partly unfounded. While boys are indeed more physically aggressive, girls and boys are equally guilty of aggressive social behavior, according to the report published in Child Development.

Researchers did an analysis of 148 studies that included nearly 74,000 children and teenagers. The studies were mostly done in schools and looked both at direct aggression, which is physical or verbal, and indirect aggression, which includes covert behaviors designed to damage another person’s social relations with others, without direct confrontation.

“These conclusions challenge the popular misconception that indirect aggression is a female form of aggression,” says Noel A. Card, PhD, assistant professor of family studies and human development at the University of Arizona and the study’s lead author, in a news release.

Based on the analysis, researchers concluded that often the same kids who are directly aggressive are also indirectly aggressive. Although boys tend to exhibit more direct aggression than girls, there is little difference between girls and boys for indirect aggression. This continues over different ages and ethnicities….

Kids who are indirectly aggressive often have depression and lower self-esteem. However, they tend to have high pro-social behavior, necessary to get support of others such as convincing peers to gossip and exclude others
Behavior is unacceptable when it is “intended to destroy another person’s property or to injure another person, physically or psychologically.” Purposeful harm to another person is never acceptable.
Aggressive Behavior in Girls
Dr. Nicki Crick, of the University of Minnesota has studied aggression in girls. Her work in the field of relationalship aggression is summarized:
Most studies about aggressive behavior in children have focused on boys and on physical expressions of aggression. “It gave the appearance that girls really were sugar and spice and everything nice,” says Nicki Crick, professor of child development. “But I didn’t believe that was really the case.”

For more than six years, Crick has been conducting longitudinal studies of relational aggression, witnessed mainly in girls. Rather than physically harming others, relationally aggressive children will threaten such retaliations as: “Do this or I won’t be your friend.” Or: “If you don’t help me, I’ll tell Amy you said she was ugly….”
What the research shows

Some of Crick’s early research findings show relational aggression is related to factors such as particular types of family relationships and relationships with friends and other peers. She is especially interested in children whose aggression is gender-atypical—that is, girls who are physically aggressive and boys who are relationally aggressive.

“These kids seem to be the most at-risk for more serious social problems later in life,” she says. “The most apparent reason is that not only does their aggressive behavior make them less popular, but the fact that they’re perceived by their peers as acting inappropriately for their gender further isolates them.”

See, Gender Differences in Aggressive Behavior As with boys, Purposeful harm to another person is never acceptable.
Behavior Modification

The American Academy of Pediatricians has the following suggestions for dealing with aggressive behavior for most children
The best way to prevent aggressive behavior is to give your child a stable, secure home life with firm, loving discipline and full-time supervision during the toddler and preschool years. …

Self control

Your youngster has little natural self-control. He needs you to teach him not to kick, hit, or bite when he is angry, but instead to express his feelings through words. It’s important for him to learn the difference between real and imagined insults and between appropriately standing up for his rights and attacking out of anger.


The best way to teach these lessons is to supervise your child carefully when he’s involved in disputes with his playmates. …

Your example
To avoid or minimize “high-risk” situations, teach your child ways to deal with his anger without resorting to aggressive behavior. Teach him to say “no” in a firm tone of voice, to turn his back, or to find compromises instead of fighting with his body. …


If you must discipline him, do not feel guilty about it and certainly don’t apologize. If he senses your mixed feelings, he may convince himself that he was in the right all along and you are the “bad” one…

When to call the pediatrician

If your child seems to be unusually aggressive for longer than a few weeks, and you cannot cope with his behavior on your own, consult your pediatrician. Other warning signs include:
• Physical injury to himself or others (teeth marks, bruises, head injuries)
• Attacks on you or other adults
• Being sent home or barred from play by neighbors or school
• Your own fear for the safety of those around him….
The pediatrician or other mental health specialist will interview both you and your child and may observe your youngster in different situations (home, preschool, with adults and other children). A behavior management program will be outlined. Not all methods work on all children, so there will be a certain amount of trial and reassessment

Dr Joan Simeo Munson has some good suggestions about how to deal with aggressive behavior in young children
Medication for Aggressive Behavior

ccording to Leo J. Bastiaens, MD and Ida K. Bastiaens in their article about youth aggression in the Psychiatric Times, one of the treatment options is medication. For some children medication works and helps them to control their aggressive tendencies. Probably, more children are medicated than need to be, but the decision to use medication is highly individual and should be made in conjunction with health care providers. A second or even a third opinion may be necessary. NYU’s Child Study Center has an excellent Guide to Psychiatric Medicine for Children and Adolescents Mary E. Muscari, PhD, CPNP, APRN-BC,CFNS Professor, Director of Forensic Health/Nursing, University of Scranton, Scranton, Pennsylvania; Pediatric Nurse Practitioner, Psychological Clinical Specialist, Forensic Clinical Specialist, Lake Ariel, Pennsylvania writes at Medscape.Com about pharmacotherapy for adolescents
Before prescribing medication therapy for aggression, the clinician should ensure that the patient has a medical evaluation to rule out contraindications to treatment and to determine whether the patient’s aggressive symptoms might improve with appropriate medical care. Psychiatric evaluation is also necessary to determine whether psychosis, depression, anxiety, substance abuse, or other problems are present. Treatment of these conditions may also result in reduced symptoms of aggression. Nonpharmacologic measures should be instituted; however, when pharmacologic treatment is warranted, institute treatment with an antiaggression medication that best fits the patient’s symptom cluster.
Medication should not be a first resort, but is an acceptable option after a thorough evaluation of all treatment options has been made.

Aggressive behavior can be costly for the child and society if the child’s behavior is not modified. At least one study has found preventative intervention is effective
E. Michael Foster, Ph.D., University of North Carolina at Chapel Hill, and Damon Jones, Ph.D., Pennsylvania State University, in conjunction with the Conduct Problems Prevention Research Group, examined the cost effectiveness of the NIMH-funded Fast Track program, a 10-year intervention designed to reduce aggression among at-risk children….
Previous results showed that among children moderately at risk for conduct disorder, there were no significant differences in outcomes between the intervention group and the control group. However, among the high-risk group, fewer than half as many cases of conduct disorder were diagnosed in the intervention group as in the control group. These results were extended in the current paper to consider also the cost effectiveness of providing the early intervention. By weighing the costs of the intervention relative to the costs of crime and delinquency found among the study participants, the researchers concluded that this early prevention program was cost-effective in reducing conduct disorder and delinquency, but only for those who were very high-risk as young children.

As with many problems, the key is early diagnosis and intervention with appropriate treatment. Purposeful harm to another person is never acceptable.
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