Assessing violent offending in serious juvenile offenders

Biosocial processes predicting multisystemic therapy treatment response

This study examined biological (testosterone) and social (deviant peer affiliation) factors early in treatment as predictors of treatment outcome among adolescent boys receiving Multisystemic Therapy (MST) in community settings. Outcome variables included changes in youth aggression and delinquency as reported by the primary caregiver. Testosterone and deviant peer affiliation were assessed at treatment onset; and outcome variables (aggression and delinquency) were assessed at treatment onset, mid-treatment and end-of-treatment. Participants were 112 adolescent boys (M age=15.42, SD=1.31) and their caregivers. Growth curve analyses revealed that the combination of high testosterone and high deviant peer affiliation early in treatment were significantly associated with less of a decline in aggression and delinquency over the course of treatment. Results provide novel evidence for the role of testosterone in the prediction of future externalizing behaviors. Clinical and theoretical implications are discussed.

Violence in adolescents: social and behavioural factors

OBJECTIVE

To estimate the prevalence of young people's involvement in violence measured as participation in physical fights or being physically, sexually or emotionally abused. We also aimed to understand the role of social, demographic and other behavioural characteristics in violence.

METHODS

We evaluated 7511 adolescents (4243 girls and 3268 boys) aged 15 to 19 years old, enrolled in public schools. Information was obtained using an anonymous, self-administrated questionnaire.

RESULTS

The most frequently reported type of violence was emotional abuse (15.6%). Boys reported greater involvement in fights (3.6 vs. 13.6%, p<0.001) and physical abuse (7.5 vs. 19.5%, p<0.001). The prevalence of emotional abuse (16.2 vs. 14.8%, p=0.082) and sexual abuse (2.0 vs. 1.8%, p=0.435) was similar in girls and boys. After adjustment, increasing age decreased the odds of being involved in fights in both genders but increased the odds of emotional abuse. Living in a rented home was associated with physical abuse in girls (odds ratio [OR]: 1.4; 95% confidence interval [95%CI]: 1.0-1.9) and boys (OR: 1.6; 95%CI: 1.2-2.0). In girls the odds of being emotionally abused increased with greater parental education. Smoking and cannabis use were associated with all types of violence in both genders.

CONCLUSIONS

The most frequently reported form of violence was emotional abuse. We found differences by gender, with boys reporting more physical abuse and involvement in fights. Adolescents whose parents had a higher educational level reported more physical and emotional abuse, which may be related to differences in the perception of abuse.

Multisystemic therapy: a treatment for violent substance-abusing and substance-dependent juvenile offenders

Adolescent violence and substance abuse result in substantial personal and societal cost. Many treatments fail to produce favorable outcome in terms of both violence and substance abuse with adolescents because they fail to comprehensively address etiological and maintaining factors. This article describes multisystemic therapy (MST), a family- and community-based treatment that has produced favorable outcomes with violent substance-abusing or -dependent adolescents in both realms. The clinical basis for the success of MST and studies supporting its effectiveness with violent and substance-abusing adolescents are presented.

At both ends of the gun: testing the relationship between community violence exposure and youth violent behavior

Much psychological inquiry has focused on understanding the contribution that exposure to urban violence makes to violent behavior among youth. However, other ways in which these variables may be related have been largely overlooked. This study compared four alternative social-ecological models of the link between community violence exposure and violent behavior to determine the degree to which (1) community violence exposure contributes to violent behavior, (2) violent behavior contributes to community violence exposure, (3) both are consequences of common antecedents, and (4) both are manifestations of the same higher order construct. Two hundred and seventy-seven adolescent offenders were interviewed about family, neighborhood, cognitive, and peer characteristics, in addition to violent behavior and community violence exposure. Results suggest that a plausible way to understand the association between community violence exposure and youth violent behavior is to consider both as representations of a general involvement in violence.

Adolescent suicide attempts: risks and protectors

OBJECTIVE

In 1997, suicide was the third leading cause of death among 10- to 19-year-olds in the United States, with the greatest increases in suicide rates in the previous decade experienced by black and other minority youth. The purpose of this study was to identify risk and protective factors for suicide attempts among black, Hispanic, and white male and female adolescents.

METHODS

We used data from the National Longitudinal Study of Adolescent Health, conducted in 1995 and 1996. A nationally representative sample of 13 110 students in grades 7 through 12 completed 2 in-home interviews, an average of 11 months apart. We examined Time 1 factors at the individual, family, and community level that predicted or protected against Time 2 suicide attempts.

RESULTS

Perceived parent and family connectedness was protective against suicide attempts for black, Hispanic, and white girls and boys, with odds ratios ranging from 0.06 to 0.32. For girls, emotional well-being was also protective for all of the racial/ethnic groups studied, while a high grade point average was an additional protective factor for all of the boys. Cross-cutting risk factors included previous suicide attempt, violence victimization, violence perpetration, alcohol use, marijuana use, and school problems. Additionally, somatic symptoms, friend suicide attempt or completion, other illicit drug use, and a history of mental health treatment predicted suicide attempts among black, Hispanic, and white females. Weapon-carrying at school and same-sex romantic attraction were predictive for all groups of boys. Calculating the estimated probabilities of attempting suicide for adolescents with increasing numbers of risk and protective factors revealed that the presence of 3 protective factors reduced the risk of a suicide attempt by 70% to 85% for each of the gender and racial/ethnic groups, including those with and without identified risk factors.

CONCLUSIONS

In these national samples of black, Hispanic, and white youth, unique and cross-cutting factors derived from a resiliency framework predicted or protected against attempting suicide. In addition to risk reduction, promotion of protective factors may offer an effective approach to primary as well as secondary prevention of adolescent suicidal behavior.

Youth violence. Developmental pathways and prevention challenges

Youth violence is an important public health problem. During the latter half of the 1980s and early 1990s, the United States witnessed unprecedented levels of violence among the nation's youths. Homicide remains one of the leading causes of death for young people aged 10 to 24 years. This paper reviews the major trends in homicide victimization and perpetration among youths during the past decade, the developmental pathways of delinquent and violent behavior and the context in which these behaviors occur, and some of the challenges associated with disrupting these pathways and preventing violence. Previous research reveals that multiple pathways lead toward violence and delinquency. Predicting which pathway a youth will follow, or if one will be followed at all, depends to some extent on a host of other biological, psychosocial, and environmental factors present as young people transition from early childhood to adolescence to early adulthood. Preventing violence requires a comprehensive approach that takes into account developmental needs, tasks, and supports.

The 18-month impact of an emergency room intervention for adolescent female suicide attempters

Following a suicide attempt by female adolescents, the impact of a specialized emergency room (ER) care intervention was evaluated over the subsequent 18 months. Using a quasi-experimental design, this study assigned 140 female adolescent suicide attempters (SA), ages 12-18 years, and their mothers (88% Hispanic) to receive during their ER visit either: (a) specialized ER care aimed at enhancing adherence to outpatient therapy by providing a soap opera video regarding suicidality, a family therapy session, and staff training; or (b) standard ER care. The adjustment of the SA and their mothers was evaluated over 18 months (follow-up, 92%) using linear mixed model regression analyses. SA's adjustment improved over time on most mental health indices. Rates of suicide reattempts (12.4%) and suicidal reideation (29.8%) were lower than anticipated and similar across ER conditions. The specialized ER care condition was associated with significantly lower depression scores by the SA and lower maternal ratings on family cohesion. Significant interactions of intervention condition with the SA's initial level of psychiatric symptomatology indicated that the intervention's impact was greatest on maternal emotional distress and family cohesion among SA who were highly symptomatic. SA's attendance at therapy sessions following the ER visit was significantly associated with only one outcome--family adaptability. Specialized ER interventions may have substantial and sustained impact over time, particularly for the parents of youth with high psychiatric symptomatology.

Psychiatric diagnoses in the child and adolescent members of extended families identified through adult bipolar affective disorder probands

OBJECTIVE

To investigate the type and distribution of psychiatric disorders in the child and adolescent members of extended pedigrees identified through bipolar probands.

METHOD

The child and adolescent offspring (24 male, 26 female, aged 6 to 17 years) and the adult parents (60) of 14 bipolar pedigrees ascertained for the National Institutes of Mental Health Genetics Initiative Study of Bipolar Affective Disorder were personally assessed using structured psychiatric interviews. A parent was also interviewed about each child or adolescent offspring.

RESULTS

Twelve of the 50 interviewed offspring received a lifetime DSM-III-R diagnosis of an affective disorder. This included six cases of bipolar disorder, five cases of major depressive disorder, and one case of dysthymia. Eight of the offspring who received an affective disorder diagnosis also qualified for an anxiety disorder (four), a disruptive behavior disorder (two), or both (two). Offspring who had a parent with an affective disorder had a 5.1-fold higher risk for receiving an affective disorder diagnosis than did offspring with healthy parents.

CONCLUSIONS

In a consecutive series of families identified through a proband with bipolar disorder, there were significant increases in the prevalence of affective disorder diagnoses in the child and adolescent offspring. The distribution of illness in offspring was compatible with the presence of important genetic factors which contribute to early-onset affective illness.