‘These aren’t bad kids’: Uncovering the roots of aggression in children

By Laura Ingles
VCU School of Medicine

James Blair, Ph.D., refuses to believe that any child is inherently bad.

As an expert in cognitive neuroscience, he has been studying the brains and behaviors of kids with impulsive aggression for more than 30 years. Now, with new insights into the neural mechanisms underlying aggressive behavior, he has arrived at the Virginia Commonwealth University School of Medicine to translate his findings into improved psychiatric care.

Blair has teamed up with two prominent VCU clinician-researchers - Robert Findling, M.D., chair of the Department of Psychiatry, and Ekaterina Stepanova, M.D., Ph.D., chair of the Division of Child and Adolescent Psychiatry - with the goal of developing new individualized treatments based on both biological and environmental risk factors.

For Findling and Stepanova, who have spent years working to improve how childhood aggression is understood and treated, Blair's research brings a complementary perspective that strengthens that ongoing effort.

"Dr. Blair's work allows the team to integrate biological insights with clinical observations, behavioral assessments and statistical analyses," Stepanova said. "This dynamic, interdisciplinary team is helping fill critical gaps in knowledge, offering hope for better understanding, support and care for children and families affected by aggressive behaviors."

Seeing beyond the behavior

Impulsive aggression is an uncontrolled behavioral response to a situation, characterized by immediate, explosive and violent behaviors that are often out of proportion to the initial trigger. In children, this can mean verbal outbursts like screaming, yelling or making threats, and physical actions like hitting, biting or destroying property. As impulsive aggressive children get older, these behaviors can intensify and put them at greater risk of harming themselves and others, doing poorly in school and ending up in the justice system.

Findling, a pediatric psychiatrist of more than 30 years, said children with impulsive aggression tend to be acutely aware of how others perceive them. His own patients as young as 6 have shared with him that they know other kids think they're "bad" and that their teachers don't like them.

"That's no way for a child to grow up," Findling said. "The issue has to do with reactivity, not being bad, and our job is to understand the underpinnings of that reactivity so we can give these kids the outcomes they deserve."

Blair echoed that sentiment, adding that aggressive behavior should not be mistaken for a moral failure or a lack of empathy. He said it reflects differences in brain function, often compounded by social-environmental factors like family stress, and should be addressed with the same level of understanding and treatment as other emotional disorders like depression or anxiety.

"These aren't bad kids. There are just brain-level issues that give rise to this behavior," Blair said. "We know how to help a lot of people with different emotional disorders, and it would be good for both the individual and for society if we can help these people, too."

A tailored approach to treatment

Blair has spent his career investigating the neurocognitive risk factors of antisocial and aggressive behavior in children and adolescents. His research findings, combined with Findling and Stepanova's clinical expertise, could be the key to developing new interventions for patients.

"By connecting the dots between brain activity, developmental trajectories and clinical symptoms, Dr. Blair's research provides critical insights that could guide more targeted interventions and improve outcomes for these children," Stepanova said. "Together, this team combines clinical expertise, research rigor and neurobiological innovation, attacking the complex problem of childhood aggression from multiple angles."

The first step in this phase is to determine whether a non-invasive neuroimaging method called functional near-infrared spectroscopy can identify signals of neurocognitive systems not working properly, and whether that signal can be translated into identifying risk factors for aggression.

One of the challenges, Blair said, is that previous research indicates there is no singular biological factor contributing to the increased risk of aggressive behavior. For some, aggression arises from a reduced emotional response, or because they feel too little; for others, it is linked to an exaggerated emotional response, or because they feel too much. This variability makes it complicated to pinpoint and treat.

"If we're not able to be sensitive to these phenomena, we might treat two children with the same diagnoses but different problems the same way," Blair said. "If we can't precisely characterize the biological risk factors, we can't get the precision medicine we need to help all these different types of kids."

The team's ultimate goal is to identify and begin treating aggressive children as early as possible, to help them develop coping mechanisms before the behaviors solidify. This, they hope, will improve their long-term prognoses and set them up for a greater chance of success later in life.

"This is our commitment to these children," Findling said. "Obviously we have a commitment to world-class, methodologically rigorous science, but what makes this come from the heart is watching these children grow up knowing what others think about them. These kids deserve better."

This story was originally published on the School of Medicine's website.