J Am Acad Child Adolesc Psychiatry. 1999 Mar;38(3):235-41. doi: 10.1097/00004583-199903000-00008.
To outline causative factors for the epidemic of violence among children and youth in North America and suggest roles for child and adolescent psychiatry in preventive intervention.
The committee used literature searches to identify biological, psychological, and sociocultural factors associated with violent behavior.
Children and youth are both victims and perpetrators of violence. Risk factors include socioeconomic status, difficult temperament, chronic illness, psychiatric comorbidity, and parental psychopathology. Access to firearms in a culture of violence presents a particularly serious risk. Protective factors include intact family structures, prosocial peer groups, and supportive communities. Preventive interventions include the following: universal, addressed to total population groups; selective, for at-risk populations; and indicated, for children and youth developing violent behavior. Universal interventions including gun control and improved perinatal care are helpful, and selective interventions such as gun-free zones around schools may be successful. Indicated programs such as gun confiscation and conflict resolution for youth at serious risk may be useful, but only when embedded within well-funded, clinically based, and community-focused programs. Single-emphasis programs such as "Boot Camps" have intuitive appeal, but their utility is doubtful.
Violent behavior can be prevented, and child and adolescent psychiatrists must be more active in community preventive interventions.
