Maladaptive aggression is a commonly observed trait in psychiatric disorders, especially in the paediatric conduct disorders of interest to this project, ADHD and CD. These two disorders are also the most frequent psychiatric disorders in childhood and adolescence, with over 5% and up to 10% of the population below the age of 18 years affected [14] [31]. This means that there are more than 5.4 million affected children and adolescents in the European Union [41], which is why costs of treatment and direct non-medical health care amount to over €6.2 billion per year for this group.

Importantly however, the disorders are linked to lifelong serious impairment in social and occupational functioning, as ADHD persists into adulthood in 65% of cases and both disorders are strong predictors of the development of antisocial and substance use disorders, which underscores their huge impact on society. Costs associated with the adult outcome of the ADHD and CD are at least 10 times higher than those for childhood disorders [41].

ADHD and CD thus place large personal and economic burdens on individuals and society including the family and schools. The numbers above, computed from studies of youth, do not account for the impact of aggression and criminality in adulthood that accompanies the disorders. Additional impact on our society is thus caused on the victims of this aggression and also on the executive and judiciary legal systems. Crime statistics from Eurostat indicate that in 2009 (the most recent assessment date available), 127 in every 100,000 individuals from the adult and juvenile European population had been imprisoned for a crime (eurostat crime statistics). More detailed statistics available from the US show that approximately 30% of imprisonments are due to violent crimes, such as homicide, robbery, kidnapping, rape and other sexual assaults (Bureau of Justice Statistics).

Strikingly, when systematically meta-analysing the frequency of psychiatric disorders in adolescent detainees, CD (46-53%) and ADHD (12-18%) are the most frequently observed diagnoses [26] [27]. In adult detainees, ADHD-frequencies might even be higher, with a German study reporting a 45% prevalence of ADHD in male prison inmates [28]. It can thus be assumed that persistence of CD and ADHD, under certain negative environmental conditions, opens up a detrimental developmental trajectory leading towards aggression, violence and crime. Appropriate counteractive measures should ideally be prophylactic in nature, i.e. provided early on after definite diagnoses of the disorders, in order to prevent the very first violent-aggressive act.

Current behavioural and pharmacological treatment options for ADHD and CD are however insufficiently effective in treating aggression and have no proven curative potential in this respect. Designing new, improved treatments requires a deeper understanding of the molecular, cellular and brain-circuit-based underpinnings of aggression than is currently available. Strategies to prevent (escalation of) aggression in those susceptible to it require better markers of susceptibility at the genetic, epigenetic and brain-level, which have not yet been forthcoming.

Hence, it rapidly becomes clear that aggression is not a uniform construct and cannot be expected to be prevented or treated in a one-size-fits-all manner. Highly interdisciplinary approaches are needed to make progress in reducing the burden of aggression on society.

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It will …

  • … improve aggression subtype characterization for the benefit of more effective research into underlying mechanisms and enable development of more individualized treatment strategies
  • … develop flexible predictive algorithms based on combinations of molecular, environmental, neural and/or cognitive/behavioural information allowing a stratification of risk groups for more effective, individualized treatment approaches and prediction of adult outcome
  • … develop clinically feasible Risk Assessment Charts to be used in routine clinical practice to provide clinicians with a tool to prioritize and stratify child patients for early prevention and intervention programmes
  • … develop a novel non-pharmacological treatment programme based on neurofeedback, placed strategically at an early time point of disorder manifestation in order to lastingly prevent escalation of aggression
  • … develop best-practice guidelines for aggression treatment in prison inmates
  • … provide a model system for the efficient and cost-effective development of more effective pharmacological treatments for paediatric conduct disorder patients at high risk of aggressive behavior
  • … identify new leads for more effective pharmacological treatment of aggression and further development of such leads in collaboration with the pharmaceutical industry

In the longer term, these measures will reduce aggression impact on society and will reduce the economic burden caused by paediatric conduct disorders. To achieve these impacts, the most important steps to be taken by the Aggressotype consortium are the following

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  • Dissemination of protocols, procedures and results of the Aggressotype studies
  • Establish open communication with youth care and offender health care professionals and their regulatory bodies to familiarize them with the Aggressotype programme and assess clinical implementation possibilities and needs for our approaches
  • Contact relevant professional organizations and get their support for the establishment of a European Guidelines group for the treatment of maladaptive aggression in youth, which will provide a platform for most efficient further development and implementation of our proposed preventive and treatment approaches
  • Contact industrial enterprises to provide possibilities for the further development of our biological and pharmacological treatment approaches
  • Establish open communication with self-help groups and patient organizations at national and EU levels, as well as the US
  • Establish open communication with the public

In addition to the primary areas of impact, we also expect additional spin-offs from our project.

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  • Our neurofeedback approach will more generally inform us about the possibility to treat maladaptive arousal using nonpharmacological brain circuit modulation
  • Our approach to identify pharmacological chaperones for the treatment of aggression will provide data on the feasibility of such approaches more generally in psychiatric research
  • The analysis of the frequency and effect sizes of rare genetic variants related to aggression will inform us about the feasibility and utility of offering genetic counselling to families with such rare, highly penetrant genetic aberrations
  • Our communication with the general public will increase awareness and insight into the causes and mechanisms underlying aggression
  • The data generated by this project will be available for the training of post-docs and will form the basis for submission of follow-up grant proposals to EU and US agencies