BRACHA Tool to Help Forecast Violent Behavior in Children and Teens

A new study has led to the revision of the Brief Rating of the Child and Adolescent Aggression (BRACHA) tool, a unique 14-item questionnaire used to determine which children are most likely to develop aggressive and violent behavior in adolescence. The researchers conducted the study on children in the psychiatric unit of the Cincinnati Children’s Hospital Medical Center in an effort to increase prevention of future violent behavior. “Using the BRACHA could help hospitals cut down on violence,” says child and adolescent forensic psychiatrist at Cincinnati Children’s and lead author, Drew Barzman, MD.

The researchers assessed 418 young people who had previous hospitalizations for psychiatric issues. Each of the children was screened by clinicians using the BRACHA tool before being admitted to the psychiatric unit, and nearly 30 percent of the children responded to behaving aggressively. The findings have prompted the researchers to further explore the validity of this tool. They hope to conduct a broader study in order to support their current findings. “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.”

Additionally, the researchers are closely examining three specific hormones that have been associated with violent behavior in children; cortisol, testosterone and DHEAS. “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.”

© Copyright 2011 by By John Smith, therapist in Bellingham, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Flame


    June 16th, 2011 at 5:51 PM

    Good to hear! Too often kids that display any negative traits like aggression are alienated by their peers and to an extent their family rather than investigated further for the root causes. Every child, every single one of them, deserves a chance at having a good life and if you don’t give them that care and concern, there’s little hope.

    We need more researchers like Dr Barzman who have their best interests at heart and can see beyond their actions.

  • Chris E

    Chris E

    June 17th, 2011 at 4:35 AM

    The key to success is going to be to get everyone in this kids life on board.
    We have to have the parents and the teachers and all of the important adults in this kids life to make a committment to making a difference for the better in these kids.
    We do not want them to squander their talents or end up in jail but it would be so easy for this to happen, even if they are diagnosed early.
    If there is no one there with a solution, only the problem, then what is next? There has to be a long term plan for changing the path that so many of them are destined to take without the right guidance and treatment.

  • R.Cole


    June 17th, 2011 at 3:00 PM

    Don’t you think we are only putting our kids under more and more of stress? I mean what would these kind of things tell us? That this kid may have issues later on? Is there any guarantee of the results?

    Behavioral aspects can actually be guaged by parents if they keep their eyes and ears open. And it will also prevent overreaction by the parents and thus a hard time for the kids!

  • Russell O’Dowd

    Russell O’Dowd

    June 17th, 2011 at 9:35 PM

    No good can come of this unless a very gentle approach is taken when confronting the parents with the news. Undoubtedly when you advise a parent that their child will grow up to be violent or even imply it, they will be horrified and shocked.

    There has to be a positive angle you can also convey to them at the same time like how much treatment and therapy options started at an early age would help.

  • Chason S. Knox

    Chason S. Knox

    June 18th, 2011 at 1:07 AM

    @Russell O’Dowd– Those were my thoughts exactly. Also, parents are never psychologists- they will ignore all that and instead blame music, videogames and movies. It’s good to be able to predict problem students in advance. However I feel they should never under any circumstances be treated differently unless they actually commit an act that validates that.

  • Megan Struthers

    Megan Struthers

    June 18th, 2011 at 3:46 AM

    @Chason S. Knox–Let me get this straight. You are saying that if a student who might snap at any moment is in a school, they should not be under any special supervision until they give another student a black eye because they rubbed them the wrong way? Please. It’s about prevention!

  • Reese


    June 18th, 2011 at 5:15 AM

    I have never heard of BRACHA. Something that hospitals use or mainly a research tool?

  • Martin Cassidy

    Martin Cassidy

    June 18th, 2011 at 8:24 PM

    @ Megan : How it should be handled is a very gray area. If you start giving one student too much attention like that it could, ironically, be what sets them off. Or it could foster hatred and disdain for their teachers and peers within them more than it would have had you left them to their own devices.

    I agree with supervision but I would suggest it be carried out surreptitiously.

  • Andrew Anderson

    Andrew Anderson

    June 19th, 2011 at 2:09 PM

    I’ve looked up the questionnaire and I see that most who would exhibit aggressive behavioral signs are children that have been physically or sexually abused. That’s a given, isn’t it? It’s the cycle of violence all over again. Here’s how we can all contribute to preventing violence in children.

    1: Don’t rape them.
    2: Don’t beat them.
    3: Don’t scream at them.
    4: Don’t abuse them at all.
    5: Don’t manipulate them for your own selfish reasons.

  • Levi Mitchell

    Levi Mitchell

    June 19th, 2011 at 11:40 PM

    @Andrew Anderson-Hear hear! Even if it goes in a cycle though, I believe it remains your own fault if you hurt another intentionally. Not society, not your parents– you. You’re the guy that raises your fist, your feet or your weapon. One who intentionally brings harm to another human being that is weaker than them and for no good reason (barring self defense of course) is a criminal imho and needs dealt with by the justice system, regardless of age.

    The poor treatment in childhood may have planted the seed, but ultimately you’re the one that does the deed. Zero tolerance!

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