CHICAGO (FRONTLINE MEDICAL NEWS)Younger children and those in foster care have a higher likelihood of aggressive behavior, reported Kacey Appel at the annual meeting of the American Academy of Psychiatry and the Law.

Ms. Appel,who is affiliated with Cincinnati Children’s Hospital Medical Center (CCHMC), and her coinvestigators evaluated 4,148 children aged 4-18 years who were admitted through the medical center’s emergency department to the College Hill Campus, a pediatric residential treatment facility. The admissions, made between May 1, 2010 and April 31, 2014, lasted 30 days or less. The children were administered the Brief Rating of Aggression by Children and Adolescents ( BRACHA ) in the emergency department and later were scored twice a day using the Overt Aggression Scale (OAS), which records instances of aggression.

Investigators assessed the OAS scores, focusing on four demographic elements: age, gender, living arrangement, and history of previous hospitalizations. An OAS score of above 0 is generally considered aggressive, but Ms. Appel and her associates compared severity levels of aggression and their interplay with the four demographics.

Findings showed “no matter how you define aggression, the demographic variables remain significant,” said Ms. Appel, an epidemiology PhD candidate at the University of Cincinnati.

Results showed also that children living in foster care had a 10%-20% higher probability of being aggressive than another child with the same demographics but a different living arrangement. Only 5% of patients in the study sample were considered to live in a foster arrangement, Ms. Appel noted in an interview.

Additionally, the probability of aggression in children spiked when they were younger and decreased as they grew older, findings showed. For example, a nonfoster, female child with no previous hospitalizations had about a 60% probability of being aggressive at age 4. That probability of aggression for the same child at age 16 was about 15%. Investigators did not look at variables individually, but instead studied the four demographics together. Boys had a higher probability of being aggressive than girls.

The foster care finding is consistent with other data showing that children within such living arrangements often have a history of abuse and/or neglect, said Dr. Drew H. Barzman, director of the child and adolescent forensic psychiatry service at CCHMC and a coauthor of the study.

“Foster care kids may develop reactive attachment disorder or posttraumatic stress disorder, and these diagnoses can be associated with aggression on the inpatient unit, Dr. Barzman said in an interview.

The findings about age likely relate to younger children’s cognitive development, hormones, and mental processing, Ms. Appel added. “When kids are young, they often act out because they don’t know how to communicate what they’re frustrated about, and they can’t process what they’re frustrated about,” she said in an interview. “As they grow older, cognitively, they can more aptly process why they’re upset.”

The original intent of the research was to identify which BRACHA factors are most significant in predicting aggression. They will next study the significance of BRACHA factors based on frequency of aggression and time to aggressive incident. A primary goal of the research is to develop a web application tool for clinicians aimed at predicting more accurately which children within an inpatient population will be aggressive. The application will allow health providers to enter demographic data and BRACHA responses to determine predicted probability of aggression.

“If we can accurately predict the probability of a child being aggressive in the unit, we hope to improve safety on these inpatient units,” Ms. Appel said.

No conflicts of interest were reported.

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