Cognitive therapy tends not to work, especially in the long-term for impulse disorders, not because all therapy is bogus but because it is treating the wrong area of the brain. The failing, by most standards of cognitive therapy and especially, cognitive behavioral therapy is that it tends to assume that actions are driven by thought, even when such thoughts are not really there, or at the very least are to fleeting to actually be considered cognitions but are more akin to fleeting words, rather than core beliefs. (Neenan & Dryden, 2004, p. 77) The biology that is outlined by Karr-Morse and Wiley and the many experts they cite to demonstrate the necessity for feeding the infant brain certain things at certain times is foundational to a better understanding of why the brain and the body tend to disconnect with, out of context response in so many people. A greater social understanding of the latent effects of deprivation and/or extreme harm to a very young child is crucial, and it gives light to the common latent expression of rage in situations where individuals might not even remember the circumstances that occurred during this time. One case in point is the common occurrence of rage expression, associated with sexual abuse of very young children. As these children grow into adults, some tend to react impulsively to their environment, often in a destructive manner and with no logical thought explanation for it. (Painter & Howell, 1999, p. 5) This disconnect between cognition and limbic function could also explain the tendency of some impulsive individuals to blackout, or fail to remember of conceive the reasons for their actions. It can take some people days or even weeks to put back together the events of an outburst, as in general they are feeling victimized during the event, where in reality they may be the aggressor or the victimizer, responding to the situation in a manner that is outside the context or understanding of the person or situation they are actually in.

Some survivors of childhood sexual abuse are unable to recognize and accept their anger. Others act out...

According to Briere (1989), a woman's anger that is repressed or denied may emerge in disguised or global forms, or the survivor may experience a tendency toward self-harm. (Painter & Howell, 1999, p. 5)
It is presumed that such people are not seeking to self-harm cognitively but are simply unwittingly acting out anger. In the context of juvenile delinquency and impulsive or even premeditated acts of violence, the individual may be acting with or without thought based on an event or more likely a group of events that occurred even before they were able to verbalize or "remember" them. Stepping away from brain development as an explanation for impulsive and violent behavior in children and adults would then seem illogical and irresponsible and seeking an education system that better responds to the stages of development, beginning long before the age of 5 would seem logical.