Violent Behavior in Children and Youth: Preventive Intervention From a Psychiatric Perspective GROUP FOR THE ADVANCEMENT OF PSYCHIATRY, COMMITTEE ON PREVENTIVE PSYCHIATRY

OBJECTIVE: 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. METHOD: The committee used literature searches to identify biological, psychological, and sociocultural factors associated with violent behavior. RESULTS: 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. CONCLUSIONS: Violent behavior can be prevented, and child and adolescent psychiatrists must be more active in community preventive interventions.