A Combination of Vitamins and Mineral Supplementation May Improve Hetero-aggression in Children and Youth

by | Jun 1, 2023 | Infant and Children's Health, Minerals, Vitamins

Written by Taylor Woosley, Staff Writer. Results of the systematic review of 22 studies shows that supplementation with a board range of vitamins and minerals was significantly more effective at reducing hetero-aggressive behavior in adolescents compared to single micronutrient or macronutrient supplementation. 

infant and children's healthAggressive behavior is one of the most common behavioral issues in children and adolescents and is associated with significant individual and familial that increase with the age of the aggressive child1. Aggressive behaviors take many forms, including overt (physical and verbal actions) and relational (gossiping), both of which contribute to a host of negative psychosocial and academic outcomes2. More recently, considerable attention has focused on exploring the boundaries and connections between mood disorders and aggression3.

The current treatment modalities for disruptive behavior and mood symptoms related to the diagnoses of attention-deficit/hyperactivity disorder (ADHD), and other mood disorders in children, include both behavioral interventions and psychopharmacological treatments4. While the determining factors of mental health are complex, increasing evidence indicates a strong association between a poor diet and the exacerbation of mood disorders5. Nutritional intervention, via dietary modification as well as macro- or micronutrient supplementation, is an emerging field of interest in treatment research for behavioral and mood disorders6.

Qamar et al. conducted a systematic review to analyze accumulated evidence on nutritional supplement interventions for the management of hetero-aggressive behavior in children and youth to better understand potential treatment options. Study inclusion consisted of investigating the effectiveness of nutritional supplementation in reducing violent or hetero-aggressive behavior in individuals younger than 18 years. Studies were excluded if they investigated aggressive/hostile emotions without observable behavior, aggressive tendencies presented in simulated environments, and self-harm only. The current systematic review considered controlled trials, observational cohort studies, and case series.

22 studies were included in the final analysis. Of the studies, 16 were randomized controlled trials and 6 were single group, pre-post studies. 13 studies investigated children with neurodevelopmental or disruptive, impulse control and conduct disorders. The 22 studies consisted of a total sample size of 2931 participants, ranging from 9 to 940 subjects per study. 13 studies analyzed the effect of macronutrients, 6 studies investigated the effect of micronutrients, and 3 studies analyzed a combination of macro and micronutrients. The length of study supplementation was 14.8 weeks on average. 17 studies used a single aggression indicator such as the Aggression Subscale of the Child Behavior Checklist and the Buss-Perry Aggression Questionnaire and 4 studies created aggregate indexes out of multiple assessment tools using factor analytic techniques. Significant findings of the systematic review are as follows:

  • A total of 6 studies reported beneficial effects of nutritional supplementation regarding non-aggression-related indicators, including reduced depression and improved health-related quality of life. For example, a study of adolescent males diagnosed with neurodevelopmental disorders supplementing with micronutrient capsules (zinc, vitamin C, vitamin B6, chromium, selenium) resulted in a significant decrease in aggression and violent behaviors in 8 weeks, for Modified Overt Aggression Scale (p < 0.001) and parent-rated Children’s Aggression Scale (p < 0.001 to p = 0.002) scores.
  • 13 studies reported mixed effects of treatment in relation to non-aggression-related outcomes. For example, adolescent patients diagnosed with epilepsy reported no significant differences when supplementing with vitamin B6 in combination with phenobarbital for 13 weeks. However, aggression values in the treatment and control group were lower at the end of the supplementation phase compared to the end of the placebo phase, but the within-group different was significant only in one of the two study groups (p = 0.01).

Results of the study suggest that supplementation with a broad range of vitamins and minerals was significantly more effective in reducing pathological hetero-aggressive behaviors in children compared to a single micro- or macronutrient. Additional studies are warranted to provide further support for the supplemental recommendation due to the low number of randomized controlled trials on the topic. Study limitations include the systematic review focusing solely on nutritional supplements and not considering the role diet may play in the regulation of aggressive behaviors and the large diversity in the original studies in terms of sample characteristics, study design, and supplement type.

Source: Qamar, Rameen, Sabrina M. Wang, Fahad Manzar Qureshi, Laura Lachance, Nathan J. Kolla, and Barna Konkolÿ Thege. “Nutritional supplementation in the management of childhood/youth aggression: A systematic review.” Aggression and Violent Behavior (2023): 101841.

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Posted June 1, 2023.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

  1. Connor DF, Newcorn JH, Saylor KE, et al. Maladaptive Aggression: With a Focus on Impulsive Aggression in Children and Adolescents. J Child Adolesc Psychopharmacol. Oct 2019;29(8):576-591. doi:10.1089/cap.2019.0039
  2. Waasdorp TE, Paskewich BS, Waanders C, Fu R, Leff SS. The Preventing Relational Aggression in Schools Everyday (PRAISE) Program: Adaptations to Overcome Subgroup Differences in Program Benefits. Prev Sci. May 2022;23(4):552-562. doi:10.1007/s11121-022-01348-6
  3. Young AS, Youngstrom EA, Findling RL, et al. Developing and Validating a Definition of Impulsive/Reactive Aggression in Youth. J Clin Child Adolesc Psychol. Nov-Dec 2020;49(6):787-803. doi:10.1080/15374416.2019.1622121
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  5. Adan RAH, van der Beek EM, Buitelaar JK, et al. Nutritional psychiatry: Towards improving mental health by what you eat. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology. Dec 2019;29(12):1321-1332. doi:10.1016/j.euroneuro.2019.10.011
  6. Perez L. The Role of Dietary Patterns in Mood Disorders: Prospective Research in Youth Populations. Am J Lifestyle Med. Jul-Aug 2018;12(4):286-290. doi:10.1177/1559827618765937