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Research Helps Target Behavioral Interventions for Aggressive Youth

Across the county, many adolescents struggle with disruptive behavior ranging from aggression or rage toward others to outbursts in the classroom. These behaviors appear similar, but a recent brain-imaging study at Boys Town National Research Hospital suggests a youth's prior exposure to abuse or neglect may impact the way that youth emotionally responds to the pain of others.

"If you could not empathize with another's pain or distress, you would be less concerned by hurting another individual," said James Blair, Ph.D., Susan and George Haddix Endowed Chair in Neurobehavioral Research at Boys Town National Research Hospital. "Empathy can act as a barrier against aggressive behavior."

The study, published in Psychological Medicine, is titled "Moderation of prior exposure to trauma on the inverse relationship between callous-unemotional traits and amygdala responses to fearful expressions: an exploratory study."

behavior-graph.jpgPrevious research by Blair showed many adolescents with disruptive behavior have problems expressing empathy and guilt, which means they have difficulty emotionally responding to the distress of others. This background led researchers at Boys Town Hospital to explore the relationship of past traumatic experiences, such as abuse and neglect, with emotional responses, such as empathy and guilt.

Harma Meffert, Ph.D., scientist at the Boys Town Center for Neurobehavioral Research, led a study that investigated how the amygdala (brain region central to empathy) responds to distress in others in youth with varying levels of prior trauma. The study used an MRI machine to measure youths’ brain responses to fearful expressions in others.  The youth also filled out a questionnaire and received a psychological interview on prior traumatic events (abuse and neglect).

The study indicated that not everyone showing the behavioral signs of reduced empathy/guilt also shows the brain signs of reduced empathy/guilt.  In particular, youth that are exposed to significant prior trauma do not show the brain signs of reduced empathy/guilt, despite similar behavioral signs of reduced empathy/guilt.

The findings revealed results that may help map new behavioral interventions. 

  1. The data suggests that not all youth with disruptive disorder face the same difficulty – and therefore need different interventions.  
  2. The data reinforced the importance of considering an individual's trauma history. As other work by this Boys Town research team is beginning to show, trauma has a very negative impact on brain development.
  3. The data indicates that behavioral symptoms alone may not be sufficient to accurately guide treatment decisions.

Currently, all youth with problems in expressing empathy and guilt receive the same interventions. Mental health assessments mostly rely on observed behaviors and information the patient and their family share with the clinician. This makes it difficult to tell apart an individual who is aggressive because they are prone to rage and another individual who uses aggression, including anger outbursts, to achieve their goals. 

The work by Boys Town Center for Neurobehavioral Research in Children is a first step in our goal to improve the care of children with emotional and behavioral problems by developing better assessments in order to find the best interventions for each child individually.