There is a growing number of pre-schoolers presenting to clinics with high levels of aggression. These children are at risk of developing conduct disorder, especially when the symptoms are severe. Treatment for older children with aggressive symptoms has often relied on teaching their parents behavior management techniques and has ignored affective and relationship issues. After presenting observations of the play interactions of aggressive pre-schoolers with their mothers and other relevant research findings, this article explores important aspects of the parent-child interaction and affective relationship. These aspects include the mother's difficulty in tolerating and modulating the child's negative affect, reluctance to enter the play metaphor and failure to gradually move aggressive play to more pro-social themes. The importance of these interactions and affective relationship aspects and their contribution to the child's difficulty are discussed in light of their implications for treatment. Also, suggestions are made for caregivers working with these children to help them self-regulate and acquire appropriate cognitive strategies to contain the negative affects.
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