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Child Neuropsychology

A blog by Dr Jonathan Reed

  • Everyone is a psychologist.  By that I mean that everyone tries to work out why people behave the way they do.  This is an inbuilt social drive that helps us to interact normally.  It is based on theory of mind which is about understanding other people’s mental states and intentions.  Lack of theory of mind is the key disability in Autism.   In my work I find that most people have a strong belief about why someone is behaving the way that they do (although in my work I think that it is often a wrong belief).

    I think we base our understanding on why others behave  the way that they do on what we think about ourselves and our cultural norms.  This is essential to group cohesion.  No one can truly know how another person is thinking but we automatically make an educated guess.  The difficulty comes when normal behaviour breaks down.   We know that in some individuals behaviour and personality changes dramatically with acquired frontal brain injury- see the case of Phineas Gage.   I see similar difficulties in my work with children with head injury, neurodevelopmental disorders and sometimes those with a history of abuse and neglect.  With these children I see very challenging behaviour that doesn’t respond to normal parenting or behaviour modification.  I will write about why this is in more detail at a later date (to with difficulties in development of frontal brain areas). In general though behavioural control is more complicated than it seems.

    I was particularly struck by this difficulty in understanding why some people behave the way they do when reading a research paper looking at the most extreme of behaviours, murder.  Why does someone comit murder?  The paper looks at 77 inmates or defendants charged with murder in the US and referred for neuropsychological assessment.  The sample is self selected because they were referred for clinical assessment rather than randomly chosen for research.  However, the sample characteristics are striking.  Some of the key facts are:

    • 49.4% had a developmental disorder in childhood.  (36.4% had ADHD)
    • 87% had a brain injury (self reported and 10% had documented evidence)
    • 85% had a history of substance abuse.
    • 45% had a psychiatric history
    • 35% had a history of abuse in childhood.

    From the neuropsychological assessment the mean IQ was 84 , which is a standard deviation below the norm.  Mean working memory was 87 which is low average.  The mean logical memory score was 68 which is very low indicating significant memory problems.  The sample also had a high rate of assessed executive function difficulty (executive function is the cognitive ability associated with the front area of the brain).

    You will need to read the paper to find all the details because there are so many interesting factors in the sample.   However, taken together the majority of the sample had some form of brain damage/ disorder or abuse stemming from childhood (which as I have discussed here often leads to developmental brain damage).   Exactly what is going on in their heads can never be know and the neuropsychological factors don’t explain the trigger or situation in which the murder took place.  However, it is clear that there are neurological and neurodevelopmental factors going on here, and given what we know about these in childhood and from case studies, it is unclear how much control such individuals have in a given situation.  I don’t offer this as an excuse to let people off and certainly I think many of these people are extremely dangerous.  But the results may shake our assumptions  (based on our own theory of mind) as to why people behave the way that they do.  Consider this next time you hear about a murder in the News.  Also the results may point to the importance of prevention in terms of early identification and treatment of childhood neurological problems and childhood abuse.  So many of these people’s problems seem to stem from experiences and events in their childhoods.

  • In the past few weeks there have been a number of stories in the UK media about violent behaviour by young people such as Ben Kinsella being stabbed, the robbery, torture and murder of the two French students. In the Times last week there was a story about record numbers of children being excluded from school at a young age for aggressive behaviour. It is difficult to make sense of these stories and they obviously cause concern. I tend to think about the neuropsychological reasons why such behaviour occurs. Obviously there can be a number of explanations for violent behaviour but I thought I would mention three important developmental factors to consider.

    1. Development of Self Regulation. Through development children learn to self regulate their behaviour and emotions. There seems to be a neurological correlate to this. Primitive emotions and behaviours are driven by the brain stem, the hypothalamus and the limbic system, which is present at birth. Over time the cerebral cortex develops to regulate this primitive system. Initially this involves the ventral prefrontal cortex (VPC) and the anterior cingulate cortex (ACC). This process seems to happen in early childhood and is associated with reactive control. This is a more sub conscious control involving inhibiting impulsive emotional responses which would include aggressive outbursts. This normally develops through the experience of being parented, whereby the parent provides external regulation which becomes internalized over time by the child. Later (age 4 to 6) the Dorsal-lateral pre frontal cortex develops allowing self control. This results in more effortful conscious control over emotions and behaviour. Children learn to use internalized strategies to regulate themselves. This development process can go wrong for a variety of reasons including brain injury, developmental ADHD and also lack of adequate parenting. The result is individuals who have poor control over emotional impulses including aggressive impulses. These processes can also be temporarily affected by drugs and alcohol. To read more about this developmental process see chapter 13 self regulation and the developing brain by Rebecca Todd and Marc Lewis in our book Child Neuropsychology: Concepts, Theory, and Practice

    2. Development of Empathy- this is the drive to identify another persons emotions and thoughts and to respond to these with appropriate emotion (Davis 1994 Empathy: A Social Psychological Approach (Social Psychology)
    This seems to develop very early in most children’s lives (at about 14 months). It is different to Theory of Mind which seems to be about understanding other peoples thought’s. The classic disorder of empathy is a person described as a psychopath. They understand other peoples thoughts but feel no emotion in relation to this and as a result have nothing to stop them hurting others. Empathy seems to be related to gender in that males are more likely to show less empathy. A few children in my experience seem to lack empathy as a developmental disorder. Sometimes this seems to occur for children with traumatic childhoods with experience of early violence, but in my experience it is rare. It seems to be associated with the inferior frontal gyrus (IFG), which in turn is associated with a discrete network of brain processes involving face processing (fusiform gyrus, inferior occipital gyrus), emotion (amygdala, insula, ventral stratum and other structures) and with action perception (mirror system). To read more about this see chapter 14 social neuroscience by Simon Baron-Cohen and Bhismadev Chakrabarti in our book Child Neuropsychology: Concepts, Theory, and Practice

    3. The third important factor is social processes. Classic social psychology from H.Tajfel has shown how social identity influences group behaviour. Individual placed in a group would quickly begin to favour and maximise the benefits to their group at the detriment of other groups even when they didn’t know the other members of their group. Group identity is very powerful and may explain some of the gang behaviour in inner cities i.e. why gang members hate members of other gangs. Also there are the studies on social influence by Stanley Milgram. In this study volunteers delivered what they thought where powerful electric shocks to others when told to do so by someone in authority. This authority effect may explain the way that leaders in a group will influence other lower members . This is particularly pertinent in gangs with children- the younger children being influenced by older members. These social influences may also explain state controlled violence where leaders get subordinates to carry out violence on their behalf. It seems to me that social influences can override individual brain processes. This is an important factor in gang related violence – much of which is a problem in London UK at the moment. Children will do what older gang members want through the influence of authority and also start to hate other groups/gangs through social identity processes. There are likely to be wider social influences in society but I will leave that to the sociologists to explain.

    These factors don’t explain all the reasons for violent behaviour but they are important and may be helpful in thinking how to prevent violent behaviour developing. Certainly help with early parenting skills for parents with young children at risk would help with development of self regulation. Early identification and treatment for disorders of regulation such as ADHD and brain injury is important. Early screening for signs of empathy disorder is an option to be explored (treatment options for this are at a very early stage). Finally realizing the negative social influences of groups or gangs is important. The social influences surrounding the gang will be more powerful than the individual within the gang (and perhaps by a certain age their parents) can control. To try and prevent violence in inner cities it is necessary to disrupt the gang itself and find other ways for children to meet their social needs. In the meantime unless these issues are addressed in childhood we will continue to have news headlines about young people being killed and others being jailed for life- not a good option for either or for us.

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