Recent high profile cases involving violence in our schools and communities have heightened awareness and interest in the literature that deals with juvenile violence. This article is intended to provide an introduction and overview on the subject that is increasingly arousing public and governmental concern and attention.
The level of violent crime committed by juveniles increased from 1985 to 1994 and then declined from 1994 to 1996.1 The rate of adolescent homicides has more than doubled since 1988 with the major increase attributable to the use of handguns by our youth. While the overall frequency of juvenile violence has not substantially changed, the lethality has increased. The proportion of juveniles committing acts of violence has risen only five to ten percent. Currently, there are six to seven juvenile homicides a day. The recently highly publicized school shootings represent a minor percentage of that total. Compared to twenty years ago, adults are at a lower risk for serious violence. The rate of violence against youth aged twelve to fifteen, however, has increased substantially since 1988.2
The theorized etiology of juvenile violence involves exposure to and reinforcement of violence in the home, ineffective parental supervision, weak family bonding and the acquisition of values which support the use of violence.3 Risk factors found to be specific for juvenile violence have been organized into four areas: (1) Community risk factors include: availability of firearms; community laws and norms favorable toward drug use; firearms and crime; media portrayals of violence; low neighborhood attachment and community organization; and extreme economic deprivation. (2) Family risk factors include: family management problems; family conflict and parental attitudes favorable to violence; and parental involvement in the problem behavior. (3) School risk factors include: early and persistent antisocial behavior; and academic failure beginning in elementary school. (4) Individual and peer factors include: friends who engage in the problem behavior; early initiation of the problem behavior; and one’s innate or constitutional predisposition to violence.4
There are three predictors of the onset of serious violent acts by juveniles: attitudes toward deviance, "peer normlessness" (alienation from peers) and delinquent peers. The peak age of onset for males is seventeen years of age and for females fifteen to sixteen years of age. In general, the peak age for committing violent acts is earlier for females; the rate of ongoing violence declines more rapidly for females than for males with the gap widening increasingly with advancing age.5 Females now account for commission of 25% of all juvenile criminal acts.6 The first sexual offense by a juvenile usually occurs at thirteen or fourteen years of age.7 Minor acts of delinquency precede drug and alcohol use. The usual sequence of violence progresses from aggravated assault (the most frequent form), to robbery and then to rape.5 The adolescent who becomes involved in a violent lifestyle is denied many opportunities that facilitate a healthy maturation into an adult role which would serve to reduce violent offending. The violent juvenile is essentially trapped in a state of perpetual adolescence.3
The juvenile’s exposure to media violence is another area of concern . It is estimated that today’s children will be exposed to approximately twenty to twenty five violent acts per hour during a Saturday morning and approximately five violent acts per hour during regular adult programming. Viewing television violence may lead to a change in the child’s values and an increase in violent behavior. Television desensitizes the child to violence in general and to the pain of others. If children are "glued" to the television for a substantial portion of their days, they may view the world as more dangerous than it really is.10
Elliott states that the effects of media violence are negligible if there is protection via adequate monitoring of the youth’s behavior, and strong family bonding in concert with the effective teaching of moral values and norms. "Without these protections, its effect can be quite strong."2 In an immediate exposure to violence, when the adult care provider is calm and "effective", the children have increased "adaptive success". A stable home also predicts favorably for successful adaptation. Protective factors include: an internal locus of control, personal competency, good problem-solving skills, good social skills, high self-esteem, high IQ, family cohesion, a good relationship with at least one parent or other adult in the family, and a good relationship with at least one person outside the home or an institution.10
Parental neglect may have a stronger negative effect on youth than physical violence because it affects three times as many juveniles and may be more damaging to their development. The effects of poor family monitoring, aggressive behavior beginning in childhood, early exposure to violence and weak self-control may adversely affect the characteristics of the friends chosen by the adolescent. The type of friends "largely determines’ what behavior will be modeled, established and reinforced during adolescence. A strong parental bond can be protective as long as the majority of the adolescents’ friends are not delinquent. A dysfunctional family combined with a problematic neighborhood environment decreases the likelihood of a successful transition from adolescence to adulthood.2
Interventions and the role for psychiatry
A brief review of disorders comorbid with juvenile violence delineates the psychiatrist’s role in dealing with violent juvenile offenders. Grisso reported that a "mental illness" factor (bizarre behavior and explicit self-destructiveness) appeared to increase restrictiveness in both detention and disposition judicial decisions.8 "Approximately one million youth are processed through the juvenile justice system and over 100,000 are incarcerated. Of these million youths, one third have learning disabilities, as many as 45% have attention deficit hyperactivity disorder, at least 50% have a conduct disorder, 41% have post traumatic stress disorder, up to 50% have depression, 20% have a thought disorder and 50% have a substance abuse problem." In summary, up to 60% of these million youth have some type of mental illness.9
In general, treatment programs must integrate cognitive, affective and social interventions. They must also be community-based with a strong case advocacy component. Programs should also provide opportunities for the child’s involvement and should demonstrate respect for the youth.8 In view of the fact that "most violent behavior is learned behavior",5 there is a great potential for successful intervention. The Center for the Study and Prevention of Violence has reviewed over 450 delinquency, drug and violence prevention programs and has identified ten programs that meet a high standard (see references for the list).12 The duration of treatment was typically two to five years. The average cost for a stay in the Department of Corrections is $40,000.00 per year,9 while residential treatment programs cost between $20,000 and $40,000 per youth per year, and mentoring and visitation programs cost $1,000 and $7,000 per year respectively. Four of the ten model programs saved more money than they cost in a three-year period. "Our most effective prevention programs achieve a thirty to forty percent reduction in onset or offending rates compared to control groups or average rates."12
The waiver of juveniles to adult court is an active area of legislation. "In 1982, the year that mandatory transfers came into place (in Illinois), there were 261 discretionary transfers requested, with 143 declined. Ten years later, [there were] 52 discretionary transfers and 280 mandatory. In 1993, the discretionary transfers stayed the same, the mandatory transfers went up almost three-fold. In 1994, discretionary transfers stayed the same, the mandatory transfers went up almost three fold…With mandatory transfers, psychiatric evaluations are eliminated."9 The increase in waivers of juveniles to adult court has produced higher conviction rates and longer sentences, a substantially lower probability of treatment while in custody, disproportionate use of waivers for minority youth, longer processing time and longer pre-trial detention.5
Prothrow-Smith recently stated a widely held perception that since people "Don’t believe the problem is preventable, the best they can do is respond with aggression The biggest gap is between what we have learned and know and what is being done is at the level of public policy."6
The Child and Adolescent Forensic Psychiatry committee will meet to address the above issues at the annual meeting, and all are encouraged to attend. Note to interested members: The committee would appreciate it if members with child and adolescent psychiatry training who currently practice forensic psychiatry would call Dr. Dawn Dawson at 719-527-8861 or e-mail at email@example.com to identify yourself.
1. OJJDP Juvenile Offenders and Victims: 1997 Update on Violence. National Center for Juvenile Justice, 1997.
2. Elliott, Delbert S. Guns set off Volatile mix of Problems. Denver Post, June 21, 1998.
3. Elliott, Delbert S. Youth Violence: an Overview. The Center for the Study and Prevention of Violence, March 1994
4. Combating Violence and Delinquency: The National Juvenile Justice Action Plan. U.S. Department of Justice, 1996.
5. Elliott, Delbert S. Serious Violent Offenders: Onset, Developmental Course and Termination, The American Society of Criminology 1993 Presidential Address. Crim, 32:1, 1994.
6. Prothrow-Smith, Debra. Violence Prevention: a Public Health Mandate to Save our Children. The American Psychiatric Association Annual Meeting, 1998.
7. Juvenile Sexual Aggression. Center for the Study and Prevention of Violence.
8. Cocozza, Joseph J. Responding to the Mental Health Needs of Youth in the Juvenile Justice System. The National Coalition for the Mentally ill in the Criminal Justice System, 1992.
9. Juvenile Justice. The American Psychiatric Association Annual Meeting, 1998.
10. Osofsky, Joy D. Children in a Violent Society. New York: Guilford Press, 1997.
11. Effective Psychiatric Work in Juvenile Justice. Juvenile Justice Committee workshop at The American Psychiatric Association, 1998.
12. Elliott, Delbert S. Prevention Programs that Work for Youth: Violence Prevention. Center for the Study and Prevention of Violence, 1998. (The Nurse Home Visitation Program-Dr. David Olds, The Bullying Prevention Program-Dr. Dan Olweus, Promoting Alternative Thinking Strategies (PATHS)-Dr. Mark Greenburg, Big Brothers Big sisters Mentoring Program-Ms. Dagmar McGill, Life Skills Training-Dr. Gil Botvin, Midwestern Prevention Project-Dr. Mary Ann Pentz, Quantum Opportunities-Mr. Ben Lattimore, Multisystemic Therapy (MST)-Dr. Scott Henggeler, Functional Family Therapy (FFT)-Dr. James Alexander, Multidimensional Treatment Foster Care-Dr. Patricia Chamberlai