Researchers at Cincinnati Children’s Hospital Medical Center have developed a tool to rapidly assess the risk of aggressive and violent behavior by children and adolescents hospitalized on psychiatric units. Ultimately, they hope to use the questionnaire to improve treatment and prevention of aggressive behavior in schools and in the community.

A study providing preliminary validation of the Brief Rating of the Child and Adolescent Aggression (BRACHA) tool is published online in the Journal of the American Academy of Psychiatry and the Law.

“Using the BRACHA could help hospitals cut down on violence,” says Drew Barzman, MD, a child and adolescent forensic psychiatrist at Cincinnati Children’s and lead author of the study.

The study involved 418 children and teens who had been hospitalized on psychiatric units at Cincinnati Children’s. Prior to hospitalization, they were evaluated in the emergency department by psychiatric social workers who administered the BRACHA questionnaire. A total of 292 aggressive acts were committed by 120 of the hospitalized patients (or 29 percent). Fourteen of the 16 items on the survey were significantly associated with aggression by children and teens.

The researchers expect to further validate the updated 14-item BRACHA questionnaire in a larger study of about 1,000 to 1,500 patients in their database.

“The BRACHA may ultimately help doctors improve safety in hospitals, reduce the use of seclusion and restraint in the inpatient setting and focus interventions on reducing aggression-related risk,” says Dr. Barzman. “The long-term goal is to prevent kids from going down a criminal path. If we can find high risk children before they become involved with the juvenile justice system, which is why we are studying 7 to 9 year olds, we can hopefully provide more effective treatment and prevention.”

The BRACHA study was funded by grants from the National Institutes of Health and Cincinnati Children’s.

Combining Questionnaire with New Research

Dr. Barzman and fellow researchers also are now examining two dozen 7- to 9-year-old psychiatric inpatients to determine whether levels of three hormones in their saliva (biomarkers of pediatric aggression) – testosterone, cortisol and DHEAS – can be combined with the BRACHA questionnaire to even better predict aggressive behavior in the hospital and also improve treatment and prevention outside hospital walls.

“In previously published studies, investigators linked levels of these hormones with levels and types of aggression and violence,” says Dr. Barzman. “We’re hoping our current salivary study, in conjunction with the BRACHA questionnaire findings, will provide even more meaningful results.”