- The Washington Times - Thursday, July 1, 2004

On April 20, 1999, teen-agers Eric Harris and Dylan Klebold horrified the world when they killed 13 persons at Columbine High School in Littleton, Colo.

And now, our own region continues to watch with equal dread as details unfold about a 12-year-old boy who brought 100 rounds of ammunition, guns, a knife and a flammable liquid to his middle school in Prince William County. According to press accounts, the youth had researched the Columbine shootings for a class report.

Each time one of these devastating incidents happens, society searches for answers to perplexing questions: Why do kids become violent? Is violence in entertainment to blame? How about gun control? Where are the parents? Could something have been done to intervene?

During my career as a neurologist — which has often brought me out of the hospital and into contact with death-row inmates and juvenile offenders — I have searched for answers to aggressive behavior.

Consider a 26-year-old death-row inmate I once met. He was a seemingly nice guy who suffered immensely from attention-deficit hyperactivity disorder (ADHD) and dyslexia, which are two disorders common among the aggressive population. He could hardly sit still and was unable to read the headlines in the local newspaper.

Throughout his education, his parents could not accept he had learning disabilities. He switched schools constantly and never received treatment. He dropped out of school in 11th grade and, due in large part to his inability to hold a job because of his learning disabilities, he got involved in drug dealing. During a robbery, he impulsively killed someone. To me, this is tragic: a man whose boyhood medical problems — both of which are treatable — were ignored, resulting in destructive consequences.

These stories of shattered lives — for inmates, victims and society-at-large — present the pressing need to forge ahead with neurological research that may shed light on root biological causes of violence and may lead to new remedies for the behavior.

The study of aggression through a neurological lens is a fairly new one. Yet recent research has shown that people with a penchant for aggression have lesions in the pre-frontal cortex of their brain. This vital area is associated with a number of complex cognitive functions, including controlling impulses, planning goals, moderating behavior and focusing on tasks.

One recent major study, led by Jordan Grafman, Ph.D., chief of the Cognitive Neuroscience Section of the National Institute of Neurological Disorders and Stroke, looked at Vietnam veterans who sustained brain injuries. The study showed there were increased amounts of aggression in the veterans after their injury compared with before. It also revealed through advanced brain imaging technology that the pre-frontal cortex is essential in controlling aggressive impulses.

The next crucial step in this medical research involves solving another mystery: Why do certain people with these brain lesions not exhibit violent behavior, and others do? Animal data suggest that exposure to chronic stress can cause impairment to the way the prefrontal cortex develops and functions. Lesions in this area also have been shown to induce rage reactions and rage responses in animals.

While much work still needs to be done to understand if and how physical and social conditions lead to aggressive behavior, I have learned some early important lessons:

• Screening: Simple tests can and should be done on school-age children to test for common neurological impairments, such as ADHD, that increase the risk of a child being aggressive. Physicians can then assist with these conditions and help avoid major problems in the future.

• Treatment, not detention: The District, for example, has been good about sending adolescents with neurological impairments to treatment facilities, rather than detention centers. It is essential that these youth get into a stable environment with trained physicians and nurses who can address their problems and intervene before it’s too late.

• Better training: It is important that all who come in contact with aggressive youth know about the potential for neurological and psychiatric conditions that may be contributing to aggression, and the presence of treatment options. Health care providers — and, more importantly, attorneys and probation officers — need to know what to look for or, at the very least, to know when to refer a questionable patient to a specialist.

Out of this experience, I have learned one thing for sure. I prefer working with adolescents rather than the adults facing a death sentence. The deal is not done with them. Intervention is possible. The sooner we learn that as a society, the better.

Pamela Blake is an assistant professor of neurology at Georgetown University Medical Center and director of the university’s Center for the Neurobiology of Aggression.

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