What is it with kids these days?
Authors: David Misselbrook
Journal: Journal of the Royal Society of Medicine (2011)

Only two months ago our TV screens were filled with images of youths rioting, looting and burning our city streets. Children as young as 11 have subsequently been brought before the courts. David Cameron has cited ‘the slow-motion moral collapse that has taken place in parts of our country these past few generations’.1 Predictably, societal responses tend to polarize towards hang ‘em or hug ‘em.

One focus of the current debate has been the influence of a so-called street gang culture on children themselves. There are many vulnerable children and young people who are exposed to relentless violence and chronic abuse both in the home and on the street, and this may be complicated by substance misuse.2 For some a dysfunctional peer group may be the best family they have got.

Clearly any measured analysis of the August riots will recognize that their causes are likely to be complex and multifactorial. Not all rioting youths were from underprivileged or abusive backgrounds, but a hard core may well be. But why does one traumatised child turn to violence and another turn to education and social campaigning? In examining the causes of antisocial and violent behaviour in the young the classic heredity versus environment controversy has been going on for two and a half millennia. Plato believed that the acquisition of knowledge, behaviour and attitudes was a matter of retrieving something innate, whereas Aristotle saw the child's mind as a tabula rasa to be moulded at will by adults. The ancient Greeks lacked the scientific evidence to resolve the issue, but so it appears do we. Modern battles between genetic and environmental hypotheses perpetuate this ancient argument.

So has medicine, psychiatry or neuroscience got anything new to say? Camila Batmanghelidjh, a psychotherapist and founder of the charity Kids Company has developed a hypothesis that there is an ‘adaptive violence disorder’ observable in some children who have been persistently physically or psychologically abused.3 At first glance one could be excused for not welcoming yet another medical ‘disorder’ that seeks to explain dysfunctional behaviour, perhaps just medicalizing plain bad conduct.

So is there persuasive evidence for this hypothesis? Therapists observe that many young people who have persisting levels of arousal experience a paradoxical calming effect when perpetrating or engaging in recurrent violence. This has been compared to the similar cathartic effect of self-harm in some adults with mental health disorders, but may also be understood as a dissociative effect. Such a paradoxical calming effect may be a learnt pattern of dealing with the experience of receiving and delivering violence, and hence might be seen as an adaptive for the individual concerned, as more and more violence can be tolerated with minimal internal psychological disturbance, and indeed emotional calming.4 Given the plastic nature of the brain in childhood and adolescence the hypothesis can be seen as encompassing responses that are not only psychologically conditioned but may become ‘hard wired’.

If we are to take this hypothesis seriously we should be able to locate neurophysiological and psychological mechanisms that might be displayed in differing patterns of neural functioning in brain areas and networks that are implicated in self-regulation and emotion processing. Such an effect may potentially be the result of neurophysiological adaptations to environmental factors such as early life and childhood exposure to chronic stressors concomitant with maltreatment, neglect and abuse.5 If an adaptive violence disorder exists then any debate about society's response to violent juvenile crime and the ‘gang culture’ must take this into account.

My own interest is not as a neuroscientist but as an ethicist. One of the most positive recent developments in both neuroscience and ethics is that they can begin the long process of talking to one another. This will not be easy for they speak different languages, and to define one's language is to define one's world.6 Neuroscience, with its new high-tech investigations can give perhaps us a better insight into the mechanisms of behaviour. Genetics can tell us more about inherent susceptibilities. But both are telling us about mechanisms that influence choice, not about the possibility or nature of moral choice itself.

We therefore need to come to a richer understanding of the human condition. One which does not see damaged children as ‘nothing but’ the consequence of trauma.7 But a view that at the same time is grimly realistic about just how deep that trauma may be embedded in childrens' cognitions. If we better understand the complexity of this mix of neuroscience, genetics and common humanity then we will be better placed to find a way forward for our ‘broken society’. Wherever our moral values come from, most of us would agree with the view of Hobbs that life in any society without norms of moral conduct is likely to be ‘poor, nasty, brutish and short’.8

The JRSM will publish a forthcoming series of linked papers stemming from an RSM Expert Forum that has examined the prima fascia evidence for the credibility of the adaptive violence disorder hypothesis. The purpose of these papers is to initiate a much needed dialogue to discuss the current evidence base of such a hypothesis and suggest possible ways forward. Look out for these papers. We hope you can become part of this debate.