Violent behavior in children and youth: Preventive intervention from a psychiatric perspective

Objective: To outline causative factors for the epidemic of Violence among children and youth in North America and suggest roles for child and adolesc ent psychiatry in preventive intervention. Method: The committee used liter ature searches to identify biological, psychological, and sociocultural fac tors associated with violent behavior. Results: Children and youth are both victims and perpetrators of violence. Risk factors include socioeconomic s tatus, difficult temperament, chronic illness, psychiatric comorbidity, and parental psychopathology. Access to firearms in a culture of Violence pres ents a particularly serious risk. Protective factors include intact family structures, prosocial peer groups, and supportive communities. Preventive i nterventions include the following: universal, addressed to total populatio n groups; selective, for at-risk populations; and indicated, for children a nd youth developing violent behavior. Universal interventions including gun control and improved perinatal care are helpful, and selective interventio ns such as gun-free zones around schools may be successful. Indicated progr ams such as gun confiscation and conflict resolution for youth at serious r isk may be useful, but only when embedded within well-funded, clinically ba sed, and community-focused programs. Single-emphasis programs such as "Boot Camps" have intuitive appeal, but their utility is doubtful. Conclusions: Violent behavior can be prevented, and child and adolescent psychiatrists m ust be more active in community preventive interventions.