The ANGRY child. Do you see what I see?

By Amanda Downsborough - Holistic Child Health.

BSc, PGDip, GCert, MSc, ACAAM

Parents are suffering under the scrutiny of family, friends, and strangers as their child throws flailing limbs and verbals insults, launching war on them yet again. Inside these fragile, developing brains, the delicate balance of chemicals brews like a Molotov cocktail just waiting for a trigger. We walk on eggshells to prevent another fit of rage (was it over the wrong pair of socks?), hoping they will grow up and grow out of it.

But will they?

After every parenting book has been read and every calming, soothing, resilience-building strategy has been implemented, and there is still no controlling the outbursts, you have to question what is really happening in that little body. After all, little angry bodies become big angry bodies, and a whole lot harder to manage.

"Inside these fragile, developing brains, the delicate balance of chemicals brews like a Molotov cocktail just waiting for a trigger."

Aspects of impulsive aggression in children have been covered extensively by psychologists, yet few specialists are talking about the contributing biochemistry, genetics, nutrition, environment, and gut bacteria. This is by no means an exhaustive list, but provides some insight to the complexity of underlying causes, and what a Functional Medicine and Nutrigenomics approach entails.

Impulsive Aggression

Impulsive aggression is the sudden and unpredictable aggressive reaction to a situation, difficulty controlling their response, followed by remorse for their actions. It is more common in children with ADHD or autism spectrum disorder (ASD). While aggressive responses (eg. pushing, hitting, biting, and kicking) in order to obtain or protect an object can be considered a normal part of early childhood development, it should begin to decrease by 5-6 years of age as the brain develops and verbal and interpersonal skills improve (Connor et al., 2019).

It is the unprovoked, unexpected aggression that can be very problematic and a sign that a child desperately needs help.

Otherwise, as adults, it leaves them at high risk for depression, violent or suicidal behaviour, and substance abuse (Seo, Patrick and Kennealy, 2008).

Brain Chemicals (Neurotransmitters)

Although there are many brain chemicals involved in mood and behaviour, the two main ones that drive impulsive aggression are serotonin and dopamine.

Serotonin is involved in the regulation of many areas of the body, including emotion and behaviours, gut motility, breathing, and constriction of blood vessels. With 90-95% being produced in the gut under the influence of various bacteria (Strandwitz, 2018), low levels of serotonin contribute greatly to aggressive behaviours, especially impulsive forms (Moore, Scarpa and Raine, 2002).

Dopamine is involved in motivation, reward, and helps modulate aggressive behaviours. It is this chemical that controls our feelings of satisfaction and wellbeing. The rush of dopamine that makes us feel good with certain activities, such as shopping, gambling, or taking drugs, wires our brain for addiction. When the body repeatedly makes too much dopamine, the receptors become less sensitive, which means even more dopamine is required to get the same good feeling and a vicious cycle develops.

Too much dopamine increases aggression and reduces impulse control.

Dopamine and serotonin both play a role in appetite and digestion, sleep-wake cycle, and balancing mood and behaviour. Imbalance in these brain chemicals can occur due to one, or many, contributing factors.

Gut Health

The bacteria in our gut help us digest our food and plays a critical role in immune function and mood. Bacteria produce chemicals that impact the brain via the gut-brain axis, and depending on the balance of bacteria, will determine the type and quantity of chemicals released. Anxiety, depression, and autism have all been linked to bacterial imbalances and the gut-brain axis. Analysis of bacteria can be done through stool testing.

The gut-brain axis refers to the physical and chemical connection between the gut and the brain.

Clostridia is one example of a type of bacteria that is commonly seen in children with behavioural problems. Clostridia overgrowth can result in thick sludge coating the walls of the intestine, restricting nutrient absorption, and producing chemicals that prevent dopamine from being broken down. Some of the chemicals produced by certain strains of clostridia are toxic to the brain, resulting in the death of brain cells. These chemicals can be measured with an Organic Acids Test and treated accordingly.

Nutrition

Vitamins and minerals are essential for health and wellbeing. When we have deficiencies or imbalances, symptoms start to emerge. Zinc and copper are two trace minerals that need to be obtained through diet or supplementation. One of the roles of copper is to make dopamine. Copper also blocks serotonin production. Insufficient zinc in the diet allows more copper to be absorbed, resulting in mood and behavioural disturbance. Zinc is involved in hundreds of processes, including immune function, removal of heavy metals, growth, and brain development.

Artificial colours, flavours, and preservatives. Many children react negatively to these, with major behavioural implications often found in those with ADD or ADHD. Monosodium glutamate (MSG) is a common flavour enhancer and when consumed causes a massive release of dopamine in the brain. Some artificial colours increase dopamine release and cause changes to brain cell structure.

Dairy and gluten contain casomorphins and gliadorphins respectively, which are proteins that bind to opiate receptors in the brain. These are the same receptors that drugs such as morphine and heroin would bind to. These proteins not only cause behavioural problems via brain inflammation, they increase the risk of autoimmunity. Children who crave dairy or gluten products and become irritable or angry without regular consumption, may well be addicted.

Sugar is incredibly inflammatory in the brain, and highly addictive. Eating foods containing sugar results in the brain releasing dopamine and bringing about the feeling of pleasure and reward, wiring the brain to engage in seeking these foods again. The same pathways that are activate by eating sugar are those used when a person uses cocaine.

Amines are chemicals present in some foods, but also produced during some cooking or storing methods. Amines are found in brain chemicals, including dopamine and serotonin. These chemicals are normally broken down by monoamine oxidase (MAO) enzymes, but when this enzyme doesn't work properly due to genes we may inherit, reducing dietary amines and supporting gene function can help enormously.

Genetics

Two of the most significant genes involved in the regulation of aggressive behaviour are monamine oxidase A (MAOA) and catechol-O-methyltransferase (COMT). These genes both provide instructions for the body to produce enzymes to break down catecholamines, including dopamine. When variations of this gene are inherited, called single nucleotide polymorphisms (SNPs), enzyme activity slows, and dopamine breakdown is significantly reduced. These genes are both associated with increased aggression, with MAOA being more commonly found in males. These can be identified by Nutrigenomics testing so that dietary and lifestyle modifications, and supplement support, can be provided.

Environment

Uncontrolled outbursts of rage can be caused by chronic infection that results in brain inflammation. One example is Bartonella, a tick-borne infection that has been found in many areas of the world, including Australia. Some symptoms of Bartonella infection include irritability, agitation, severe mood swings, outbursts, antisocial behaviour, and severe anxiety, amongst others. Being able to identify and treat this requires a knowledgable practitioner who understands Lyme disease, as they are frequently found together. This should be a serious consideration if mood disturbance develops after a tick bite.

Gaming. There is no easy way to address the elephant in almost every home. Most children have access to devices and the games they have to offer, with some parents handing them a device before they are 2 years old, oblivious to the damage that may lie ahead. Devices and gaming are well and truly part of our society and may be a very big part of children's lives, yet it doesn't appear to be doing our youngest generation any favours with brain development.

In fact, gaming activates the dopamine reward system, with the urge to play being the same pathway that is used in substance addiction.

There is a strong association between ADHD and gaming, with ADHD being the most significant predictor for developing an internet addiction (Weinstein and Weizmann, 2012. Excessive gaming causes long term changes in the brain reward system.

Going Forwards

For some children, the cause of anger can be easily identified and strategies put in place to correct the underlying imbalances. For others, it may be much more complex with multiple contributing factors that has absolutely nothing to do with parenting styles or the child's personality. A Functional Medicine approach is very well positioned to identify these factors and correct them. Perhaps next time you experience an explosive child, you might pause -

Do you see what I see?

References

Connor, D.F., Newcorn, J.H., Saylor, K.E., Amann, B.H., Scahill, L., Robb, A.S., Jensen, P.S., Vitiello, B., Findling, R.L. and Buitelaar, J.K. (2019). Maladaptive aggression: With a focus on impulsive aggression in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 29(8), pp.576–591. doi:10.1089/cap.2019.0039.

Moore, T.M., Scarpa, A. and Raine, A. (2002). A meta-analysis of serotonin metabolite 5-HIAA and antisocial behavior. Aggressive Behavior, 28(4), pp.299–316. doi:10.1002/ab.90027.

Seo, D., Patrick, C.J. and Kennealy, P.J. (2008). Role of serotonin and dopamine system interactions in the neurobiology of impulsive aggression and its comorbidity with other clinical disorders. Aggression and Violent Behavior, [online] 13(5), pp.383–395. doi:10.1016/j.avb.2008.06.003.

Strandwitz, P. (2018). Neurotransmitter modulation by the gut microbiota. Brain research, [online] 1693(Pt B), pp. 128-133. doi: 10.1016/j.brainres.2018.03.015.

Weinstein, A. and Weizman, A. (2012). Emerging association between addictive gaming and Attention-Deficit/Hyperactivity Disorder. Current Psychiatry Reports, 14(5), pp.590–597. doi:10.1007/s11920-012-0311-x.