NSW University. Australia: Aggression and oppositional behaviour in childhood doesn’t just make
short-term problems for children, their friends and families. It also
places kids at risk of long-term issues with mental and physical health.
And while there are some effective treatments around, not all children
respond to them. Now, neuroscience is helping guide better treatment.
Temper
tantrums, breaking rules, playground fights, or just seeming to delight
in annoying other people – most children will show one or more of these
behaviours at least occasionally while growing up. And some level of
contrariness might even be a sign of healthy development.
But, for
some children, such behaviour can escalate into more persistent
patterns of violating other people’s rights and hurting their feelings.
This creates significant problems for both the child and the people
around them.
Being consistently oppositional towards the world, or
more overt actions such as aggression, theft, and destruction of
property, are collectively referred to in the field of child and
adolescent mental health as disruptive behaviours or conduct problems.
Beyond
their immediate consequences, conduct problems in childhood are the
most common precursor to a variety of disorders affecting mental and
physical health, as well as social function, in adulthood. So
intervening early in conduct problems is important both in the short
term and to prevent longer-term issues as children mature.
But
effective interventions depend on understanding what causes aggression
and other conduct problems in the first place. Why do some children seem
angry all the time, or act as if they just don’t care about the
feelings of others?
As frustrating as this kind of behaviour is,
and tempting as it might be to just try to stop it with punishment, many
parents find that just doesn’t work. What appears to work better is
designing interventions based on understanding how a given child’s
emotions or ways of thinking might be contributing to the way they’re
acting. And how family or other communities might be interacting with
the child to elicit such behaviour.
Different conduct problems
Not all children with conduct problems are alike. Developmental psychology and cognitive neuroscience studies suggest such aggressive behaviour may be of at least two distinct types.
The
more common type is associated with the fight-or-flight response, which
is the set of emotional and physiological reactions people (as well as
animals) have in response to feeling threatened. It may include the
release of hormones such as adrenaline and cortisol, faster heart rate,
and blood flow being directed to the muscles to prepare for action.
Since
it’s important to respond to danger quickly, these reactions often
start before the person has a chance to determine whether something is
actually a threat. And once the response is underway, you have to exert
self-control to stop and think. If you find this difficult for some
reason, then there’s greater risk of inappropriate behaviour.
This
is the child with an explosive temper who impulsively does something
harmful often because he or she feels threatened, but who feels quite
remorseful afterwards. Beneath the bravado, many of these children
suffer from significant anxiety, which contributes to their tendency to
interpret other people as being hostile, and reacting accordingly.
Most
existing treatments for conduct problems work well for this group,
especially if intervention takes place early. But the second type of
conduct problems is more challenging.
These children use
aggression to get something they want in a more callous way. Instead of
high levels of anxiety, they may show less emotional reaction to
experiences most people would find distressing. Other people’s feelings
seem to just not matter to these kids and now neuroscience is helping
explain why.
Brain imaging studies show
their amygdala (the brain region that normally increases activity in
response to a potential threat) doesn’t display the expected
reactivity. Studies in twins have
suggested that while the hyper-aroused type of aggression is often
associated with external risks, such as growing up in an unsafe
environment, this second type appears more strongly genetic.
Seeing other people’s feelings
So what might cause this kind of behaviour? One clue comes from research suggesting part of the answer may lie in the neural systems underpinning attention.
Children
in the second group have been found to often have difficulty
recognising when other people look fearful. This failure has been linked
to them paying less attention to other people’s eyes, the part of the
face that reveals the most about what someone is feeling.
When the
children were directed by researchers to look at other people’s eyes,
their ability to recognise fear improved. This suggests improving
attention to emotional cues may play a helpful in their treatment.
What
isn’t known, though, is whether redirecting their attention will result
in a more normal response in the relevant brain regions. Whether the
amygdala is able to respond when the right cues are being seen.
My
colleagues and I are using functional neuroimaging to study the effects
on brain activity of changing what children with conduct problems pay
attention to. Working with kids displaying callous types of aggression,
we’re trying to find out if refocussing their attention normalises
response in areas of their brain related to emotional activity.
We
also want to know whether the same intervention in the children with
more reactive aggression might have the negative effect of
over-stimulating an already aroused fight-or-flight system.
Better
understanding the differences between children with conduct problems is
an essential step in making sure they receive the right treatment. It
will help kids and their families decrease problem behaviours, and
hopefully prevent some of the long-term issues that arise in the absence
of timely intervention.
Rhoshel K. Lenroot, is a Professor of Infant, Child and Adolescent Psychiatry at UNSW.
This opinion piece was first published in The Conversation.