Childhood Aggression Predicts Health Care Use Later in Life

Young children can be physically aggressive, owing to a combination of instinct, temperament, cultural and social influences, and (sometimes) not getting what they want. But, by the time most kids reach preschool age, they have learned to control their aggression with coping skills and relational techniques. However, children who do not learn to regulate aggressive behavior are at risk for physical and mental health issues, as well as serious patterns of aggression and violence, as adults. A new study, published in the Canadian Medical Association Journal, shows that the more aggressive a young child is the more likely he or she is to use health care services as an adult.

The 15-year longitudinal cohort study examined nearly 4000 children who were in grades 1, 4, and 7 in the mid-1980s. Children were ranked by their peers on three attributes: aggression, withdrawal, and likeability. Researchers used Canadian databases to assess health care use when the subjects were, on average, 39 years old. They adjusted their results for socioeconomic status of the children in 1986 and educational level.

Overall, results indicate that each standard deviation in peer-rated childhood aggression accounted for an 8% increase in overall medical visits during the follow-up period. Additionally, aggressive children showed an 11% increase in medical visits for injuries, a 44% increase for lifestyle-related illnesses, which included obesity, type 2 diabetes, ulcers, alcohol dependence, and drug use, a 6% increase in visits to specialists, a 24% increase in visits to dentists, a 12% increase in visits to emergency rooms, and an 11% increase in hospital admissions. Childhood aggression was not associated with an increase in infections.

Children who were judged to be more socially withdrawn than their peers had a 15% increase in visits to dentists. Alternatively, likeable children had a 4% decrease in overall health care use, a 9% decrease in medical visits due to injuries, and an 11% decrease in visits to dentists.

It is difficult to clarify precisely what causes aggression, but associations have been identified between childhood aggression and poor peer relationships, having young siblings, mothers with antisocial behavior, young mothers, families with low income, mothers who smoked during pregnancy, mothers who exhibit coercive parenting behavior, and family dysfunction. Still, no matter the cause, aggressive children can grow into aggressive adults. And, aggressive adults can impose a burden on public health services owing to increased physical, mental, and emotional violence toward victims, increased violent crimes, and increased spouse and child abuse. And, perpetrators themselves are at increased risk for depression, suicide, alcohol and drug use, and injuries.

The authors do not go so far as to calculate the total monetary costs associated with health care use within this cohort, but the implication is that the increased use of health care imposes a significant economic burden on public health services. They claim that decreasing the aggression will lead to decreased expenditures and overall health care cost savings. Identifying problematic and aggressive childhood behavior, and teaching corrective or preventive strategies, might mitigate long-term health risks and economic burdens to the children themselves and the public at large.


Temcheff CE, Serbin LA, Martin-Storey A, Stack DM, Hastings P, Ledingham J, & Schwartzman AE (2011). Childhood aggression, withdrawal and likeability, and the use of health care later: a longitudinal study. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 183 (18), 2095-101 PMID: 22083681

Temcheff CE, Serbin LA, Martin-Storey A, Stack DM, Ledingham J, & Schwartzman AE (2011). Predicting adult physical health outcomes from childhood aggression, social withdrawal and likeability: a 30-year prospective, longitudinal study. International journal of behavioral medicine, 18 (1), 5-12 PMID: 20383621

Tremblay RE, Nagin DS, Séguin JR, Zoccolillo M, Zelazo PD, Boivin M, Pérusse D, & Japel C (2004). Physical aggression during early childhood: trajectories and predictors. Pediatrics, 114 (1) PMID: 15231972

Yamasaki K, & Nishida N (2009). The relationship between three types of aggression and peer relations in elementary school children. International journal of psychology : Journal international de psychologie, 44 (3), 179-86 PMID: 22029493

Image via Cresta Johnson / Shutterstock.

Jennifer Gibson, PharmD

Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.
See All Posts By The Author