Sunday, March 19, 2017

Aggression and the Brain Stem

A recent study published last month in the journal Research in Autism Spectrum Disorders reports that children with autism who have smaller brain stems are more likely to be aggressive. [To read an article about this research, please click here.] Under the direction of Brigham Young University assistant professor of psychology Rebecca Lundwall, the research team studied MRI images of two groups of children with autism: those who were highly aggressive and those who were not.

The research team is investigating the connection between autism and aggression in hopes of finding better intervention. Study co-author and BYU assistant professor of school psychology Terisa Gabrielsen notes that aggression in autism “impacts families’ quality of life so significantly.” Moreover, she states, “If we look long-term at things that affect the family the most, aggression is one of the most disruptive.”

The brain stem controls the flow of messages between the brain and the rest of the body, namely basic body functions, including breathing, heart rate, blood pressure, swallowing, and digestion. As BYU clinical psychology Ph.D. student Kevin Stephenson notes of the connection between the brain stem and aggression in autism, “ this is evidence that there’s something core and basic, this connection between aggression and autism.”

Study coauthor and BYU professor of psychology Mikle South notes the need to discover triggers that overwhelm children with autism before they display physical reactions, such as sweating or rapid pulse. He states, “Some of these kids, if the brain isn’t working as efficiently, they may pass that point of no return sooner.” He, therefore, emphasizes the need to use behavioral interventions “early before that arousal becomes too much.”

Recognizing that the areas of the brain work together, the research team plans to study how the brain stem works with other areas of the brain. As team member Kevin Stephenson notes, “So if one area is disrupted, it’s likely that other areas are disrupted, as well.” Moreover, they plan to seek possible mechanisms linked to arousal and aggression.

This research on aggression and autism and the possible link to the brain stem holds particular interest for me because exactly five years ago yesterday we had to hospitalize Alex for extreme anxiety and aggressive behavior. After desperately trying to find help for him for several months, an especially aggressive outburst necessitated calling the police to help us restrain him, and we knew that we had to have him placed in a psychiatric ward for his safety and ours so that he could get the intensive help he needed to get better.

The months leading up to the hospitalization were heartbreaking and terrifying. Our son, who had been docile and sweet natured most of his life, had become an angry young man, whose unpredictable behavior meant that he could fly into a rage at any moment, physically attacking us and hurling anything he could get his hands on. We had taken him to various professionals, yet no one had answers. In the middle of the night, after Alex was subdued by Ativan, I made a phone call to a hospital in the next county and found that they would take him if we brought him to their emergency room. We headed out in the darkness, and in the morning light, he was finally admitted to behavioral medicine.

Without a doubt, hospitalizing Alex was the hardest decision Ed and I ever had to make. However, we can look back on that decision and say without a doubt it was the best decision we ever made for Alex. God had led us precisely to the place and the people who knew how to help Alex get better. After weeks of developing a medication plan, they were able to get under control the anxiety that plagued Alex and made him aggressive. Their social worker guided us to resources that allowed Alex to receive support services he needed to continue coping with anxiety, such as behavioral therapy and music therapy.

Five years later, we are thankful that we regained our sweet, docile son who can manage anxiety with proper medication and the calming techniques he has learned in therapy. Perhaps his brain stem is smaller, making him react differently to stresses in life. Perhaps had we known this, we would have pursued behavioral therapy as a preventative method instead of a reactive one. Certainly, investigating how brains of children with autism and aggression differ is a worthwhile pursuit. However, I still believe that we had to go through the trials we did to get to the place of peace and contentment we have now found. God led us through the fires and brought us safely to the other side, better and stronger than we ever thought possible.

“The Lord says, ‘I will rescue those who love me. I will protect those who trust in my name.’” Psalm 91:14

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