Youth Violence Assessment and Prevention

Youth Violence – Prevalence and Trends

Four Types of Violence

• Situational
• Relationship
• Predatory
• Psychopathological

There are two types of violence, instrumental and reactive violence. The goal of instrumental violence is to achieve a goal where reactive violence is in response to a situation.

Violence Prevalence

• Teens and young adults experience the highest rate of violence
• Juvenile homicides ~5%
• Juvenile sexual violence 20%
• 25% of adolescents report dating abuse, 10% report physically hurt last 12 months

Rate of Violence Affected By

• Age
• Gender
• Race
• Ethnicity
• Socioeconomic Status (SES)

Young girls are greater victims though young boys engage in more violence-related behaviour (perpetrators)

Community Predictors of Violence

• Poverty
• Community disorganization (presence of crime, drugs, gangs, poor housing)
• Availability of drugs, guns
• Adults involved in crime
• Exposure to violence, racial prejudice

Violence Classifications

Violence may be classified based on its:

• Purpose
• Mechanism
• Target

Purpose of Violence

• Instrumental – to accomplish a goal (e.g. robbery for money)
• Situational – Emotions getting out of control; rare without other risk factors
• Predatory/psychopathic – No goal but to harm people

Target of Violence

• Self-directed – Suicidal behaviour
• Interpersonal – Against another person; in family or community (instrumental, situational, psychopathic); always occurs within existing relationship
• Collective – Violence within groups

Dating Violence – Need for control in relationship

Types of Violence

Family Violence

• Adult family members use violence to control
• Patricide risk factors, severely abused, dangerously antisocial and severely mentally ill
• Usually abuse, DV or parental substance abuse/mental illness in home

School Violence

• Lack of counsellors, support services
• No sense of community
• Bullying, marginalized groups
• Risk factors, history of childhood trauma, school behaviour problems, trouble interacting with prosocial peers, history of aggression, delinquency, substance abuse, lack of appropriate parental discipline, high conflict and low warmth within the family, other behavior problems, especially those that start before the age of 13 years

Homicidal Youth

• History of family violence, abuse and neglect, mental illness, neurological defects, antisocial behaviour, substance abuse
• Significant population with psychotic symptoms, gang participation, substance abuse
• Skill deficits in anger management, impulse control

Gang Violence

• Median age 17-18
• More structured gang is, more likely to engage in criminal activity
• Protective factors: positive role models, organization, absence of substance use and criminality
• Risk factors: Marginalization, dropped out, rejected by prosocial peers, no opportunities for success
• Affiliation and acceptance

Hate Crimes

• Bias motivated
• 63% of offenders were white, 21% were African American
• Correlation b/w youth bullying and violence related to hate; attachment problems

Theoretical Perspectives on Youth Violence

Social Learning Theory

• Most behaviour learned from modeling
• Ignores DNA, brain development, learning differences that might impact ability to imitate

Intergenerational Transmission of Violence

• Learn from early home environment; witnessing b/w adult caregivers, experiencing it themselves or both
• Children victimized are strong candidates for prevention programs

Routine Activity / Event-Centered Theory

• All crime is a crime of opportunity
• Underestimates violent crime/offenders, does not examine social causes of crime

Social Exchange Theory

• Calculated exchanges b/w costs and benefits
• Assumes people take rational approach to emotional decisions

Psychopathy

• No empathy, remorse
• PCL-R; Psychopathy Checklist-Revised (two factors: personality traits and anti-social behaviours)
• May be developmental disorder
• DSM-IV does not use term; classifies psychopathic behaviours under ASPD
• Risk factors include impulsivity/conduct problems, callous/unemotional traits, narcissism
• 20-30% in children and adults

Neurobiological Theories of Violence

• Early trauma affects neurotransmitter regulation, brain structure and development
• Severe chronic stress in childhood can lower arousal point, making it harder to return to homeostasis = Developmental trauma disorder

Developmental Trauma Disorder

• Behaviourally re-enact trauma as perpetrators or frozen avoidance reactions
• Not the same as PTSD
• Behaviour Objective Sequence

Subculture of Violence Theory

• Within larger societies, subgroups may develop which encourage crime and violence
• Incomplete view of violence; potentially racist

Feminist Theory

• Males way of maintaining control of women
• Do not account for female perpetrators, other individual factors,

Social Structure Theories

• Relationship between different groups in a society
• Grievances violating one’s sense of justice
• Social distance

Strain Theory

• Strain as failure to achieve positively valued goals
• Strain as removal of positively valued stimuli
• Strain as potential of negative stimuli
• Power prevention technique = teaching people to deal more positively with strain, increasing opportunities to succeed

Control Balance Theory

• Amount of control people are subjected to vs the amount of control they can exercise
• Imbalance of control (either not enough power or too much power)

Systems Theory

• Interplay of various systems
• Violence caused by many interacting factors
• Risk factors: high levels of conflict in the family, community and cultural norms that encourage violence, racial and sexual norms that preclude individual from participating in society.

Life Course Theories

• Follows individual through life; positive and negative influence can change trajectory
• Biological, psychological and social trajectories
• Childhood diagnosis of conduct disorder correlated with adult ASPD
• Early starters vs late starters

Reciprocal Theory of Violence

• Properties of violence including negative emotional states, alienation, shame, denial, humiliation and lack of empathy, compassion
• Nine Structural Pathways to violence

Dynamics of Youth Violence

Individual Factors that Affect Youth Violence

• Parental substance abuse
• Insecure attachment w/mother
• Conduct problems
• Lack of empathy
• Cognitive dysregulation
• Dysregulated behaviours
• Belief in legitimacy of aggression
• Childhood trauma
• Parent rating of hyperactivity
• Low academic performance; school problems
• Deliquent peers
• Availability of drugs
• Early initiation of violence, delinquency, moderate-to-severe behaviour problems
• Home or family maladjustment

Domains of Violence

• Physiological
• Cognitive
• Psychological
• Developmental

Physiological

• Genetics
• MAO-L increases aggression

Neurobiological Factors

• Abnormalities in amygdala, hypothalamus

• Alcohol exposure

Cognitive Factors

• Low IQ linked to violent, aggressive behaviour

Psychological Factors

0-2 Years of Age

• Attachment issues predict later violence and aggression
• Secure, Anxious/Avoidant and Disorganized/Dismissive
• Mirror Neurons in infants

Toddlers (3-4)

• Master environment
• Autonomy vs shame and doubt
• Theory of Mind important at stage; take perspective of others

Early School Years (5-6)

• Initiating activities
• Interact with groups of children
• Self-soothing, emotional regulation
• Risk factors: absence of attachment figure, single parent, use of corporal punishment, preference for violent video games, exposure to verbal aggression, aggressive peers, victimization

Middle Childhood (7-10)

• Preadolescence and Adolescence
• Puberty
• Peer group supplants family group as influence
• Family risk factors decrease in importance
• Risk factors, poor affect regulation, early onset of puberty, increased arousal patterns

Behaviour

• Greatest predictor of severe and chronic violent behaviour is early onset of behaviour problems, aggression, disregard for rules, delinquency, substance abuse
• Late onset antisocial behaviour tends to stop in adulthood, early onset tends to continue
• Interventions must include family therapy, reduction of home violence

Temperament

• Behaviour or emotional problems
• Attract victimization

Mental Health

• Mental illness alone not a predictor
• Personality disorder places one at risk
• Skill building, DBT
• Substance use: age of onset, perception of drug use among peers

Traits of Violent Preadolescent Boys

• CARE2 Assessment Tool
• Family history of violence
• Skill deficits in problem solving and anger management
• Twice as many assaulters harming animals, delinquency, fire setting, school behaviour problems, attachment issues
• 3x as many bullying others
• Less resiliency

Chronic Violent Teen Boys

Risk Factors

• Uninvolved parents
• Ineffective/inappropriate discipline
• Psychological or substance abuse families
• Low warmth, high conflict
• Childhood trauma

Protective Factors

• Nurturing, supportive caregiver
• Appropriate discipline
• Achievable future goals

Chronic Violent Teen Girls

Risk Factors

• Moderate to severe behaviour problems
• No remorse
• Bullying
• Poor emotional regulation, impulsivity, psychiatric problems, truancy, attachment problems
• Enuresis
• Anger management, deficient problem solving skills

Environmental Factors That Impact Youth Violence

Special Issues in Youth Violence

Bullying

Four Phases of Bullying

1. Rejecting phase, identifying with the victims
2. Performing phase, moving towards becoming a bully
3. Perpetuating phase, enjoying being a bully
4. Withdrawing phase, moving away

Bullying Interventions

• Emotional skills training, teaching children and adolescents how to recognize and regulate emotional states
• Social skills training
• Reduce prejudice and discrimination
• Problem solving, resiliency, prosocial skills

Suicide

• Most teens would tell their friends first
• 80% gave verbal clues
• Friends and peers more aware of clues
• How a young person responds (perception of stressor, social supports, resources available, skills to cope with stress)
• Having youth identify three protective factors, linked to 70-85% reduction in suicide attempts
• Inability to correlate death to permanent and ireverssible final state
• Yellow Ribbon, ASIST, QPRT

Assessment, Prevention and Intervention

• By clinical judgement only at chance
• Youth change rapidly so assessments only valid <6 months
• Self-report tools less helpful
• Attachment to caregivers important

Areas of Assessment

• Youth
• Caregiver
• School
• Peers
• Community Environment

Risk Assessment Tools

• SAVRY
• CARE2
• Youth Level of Service—Case Management Inventory
• Positive Achievement Change Tool
• Psychopathic Checklist—Youth Version
• Early Assessment Risk for Boys and Girls (EARL20/EARLY21G)

Motivational Interviewing techniques useful

Trauma issues important

Interventions

• Skill building behavior management programs, cognitive-behavioral therapy, social skills training, “challenge” programs (i.e., wilderness therapy), academic training (GED programs, tutoring), and job-related skills
• Botvin Life Skills Training
• Aggression Replacement Training Skillstreaming, anger control, moral education
• Behavioral Objective Sequence Adaptive, Personal, Task, Interpersonal, Self-management, Communication
• Individual therapy
• Family therapy
• Multimodal Therapy
• Multisystemic Therapy
• Multidimensional Treatment Foster Care
• School-based Mental Health Care
• Gang Interventions
• Victim-Offender Mediation