Introduction Aggressive behavior develops already in childhood, frequently occurs, and may have far-reaching consequences for the mental and physical health of the aggressor, individuals involved, and the safety in society at large. To mitigate these detrimental effects, it is crucial to identify risk factors, that can be targeted by preventive measures already in childhood. Poor facial recognition of emotions, in particular sadness, has been found to be such a risk factor. Moreover, music was found to positively affect both emotion recognition and aggressive behavior, and to be easily implementable. Here, the association was explored between poor recognition of sad faces and aggressive behavior, and the moderating effect of exposure to shared music activities at home on this relationship in children.

Methods Participants were 69 participants from the “Future of music” study, a Dutch cohort of middle childhood-aged primary school children (mean age=8.84 years, SD=0.81). To assess the ability to recognize sadness, the Emotional Recognition Task accuracy scores were used for sadness (ERT-sadness) at different intensity levels. To assess aggressive behavior the parent- report Child Behavior Check List scores of items about aggressive behavior (CBCL-aggression) was used. A multivariate linear regression analysis was performed to examine the association of ERT-sadness with CBCL-aggression. Analyses were adjusted for the confounders age and previous exposure to Shared Music Activities at home (SMA). Furthermore, the SMA-ERT- sadness-interaction effects were explored.

Results Low ERT-sadness accuracy scores at 50% intensity were not associated with high CBCL- aggression scores in all children (B=-0.148, 95% CI -0.662;0.366) nor in boys (B=0.568 95% CI - 1.005;0.401) nor in girls (B=-0.107, 95% CI -0.938;0.724) only. Controlling for the confounders age and SMA (B=-0.195, 95% CI -0.714;0.324) or adding a SMA-ERT-sadness interaction term (B=- 0.539, 95% CI -2.564;1.486) did not change the results. Repeating these analyses using ERT- sadness faces with a low (10%) or high (100%) - instead of medium (50%) - intensity level also did not change these results.

Conclusion In this study, poor recognition of sad faces in middle childhood-aged primary school children was not associated with and aggressive behavior, and no moderating effect of exposure to shared music activities at home on this relationship was found.