The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) of the American Psychiatric Association (2000) describes the essential feature of a conduct disorder diagnosis is a persistent pattern of behavior, which violates the basic rights of others or disregards major societal norms or rules as demonstrated by a child. Oppositional defiant disorder is characterized by negative, disobedient, or defiant behavior that exceeds the normal "testing" behavior that most children display and may later lead to a diagnosis of conduct disorder in some youth. Many of the children diagnosed with conduct disorder end up committing criminal offenses because they lack empathy which overwhelms them to the extent that they act out in the face of social stigma or criminal laws. The present review has four purposes: (a) to identify the clinical and theoretical framework of violent youths, (b) to focus on specific risk factors that contribute to youth violence, (c) to outline protective factors that buffer youth violence, and (d) to explore preventive system-ecological therapeutic methods to address youth violence. For these purposes several articles and the data collected will be discussed.
In recent years attention has been focused on the apparent rise in youth violence. Most of this attention has been fueled by several high profile cases in the media. Events like the Columbine shootings and the Virginia Tech massacre provide good case examples. Violence as defined legally refers to the use of physical force, specifically physical force with malice that attempts to or harms someone (Webster, 2010). Youth violence refers to violence that has started at the time of life between childhood and maturity. A number of behaviors such as the use of weapons, physical/sexual assault, bullying, etc., may be a part of violent behavior in young adults as illustrated in the cases denoted above.
Studies have analyzed the prevalence of mental disorders and or behavioral issues such as schizophrenia, post-traumatic stress disorder, conduct disorder (CD) and as of late bipolar disorder in the development of violent youth (Juvenile Delinquency, 2010). For the purpose of this literary review I will focus on conduct disorder as the precursor to antisocial personality disorder which statistics show has been diagnosed in 80-85% of incarcerated criminals (Long, 2009). Conduct disorder accounts for approximately 50% of incarcerated youth males and females (Fazel et al., 2008).
Conduct disorder develops during childhood and manifests itself during adolescence. The DSM-IV-TR Codes 312.xx (where xx varies upon the specific subtype exhibited) delineates that adolescents diagnosed with conduct disorder disregard social norms and show lack of empathy. Violent youth who have gone through the criminal justice system on several occasions are likely to have been diagnosed with conduct disorder. This is particularly true of those violent youth who time and time again show a disregard for their own and others safety and property (Juvenile Delinquency, 2010).
A documented history of conduct disorder before the age of fifteen represents one of the criteria used in diagnosing a young adult with antisocial personality disorder. An antisocial personality disorder diagnosis indicates a greater risk on the part of a young adult of exhibiting persistent and serious criminal behavior. Both conduct disorder and antisocial personality disorder are characterized by unpredictable violent behavior and lack of empathy.
Consequently, adolescents who have persistently been involved with the criminal system and have been diagnosed with conduct disorder are at a higher risk showing signs of antisocial personality disorder as they develop into adults (Conduct Disorder, 2010). Antisocial personality disorder is a common diagnosis for serial killers who often fantasize about killing several victims and then fulfill their impulsivity when they are no longer capable of suppressing it.
Youth violence develops in different ways. Children/ adolescents who are diagnosed with oppositional defiant disorder and conduct disorder exhibit problem behavior early in childhood. This problem behavior can persist and increase as the child develops into a young adult. Studies suggest that aggression in childhood is a good predictor for the same in adolescence and young adulthood (CDC, 2002).
The research indicates that there are several risk factors that contribute to youth violence. There are individual factors that are comprised of biological, psychological, and behavioral issues which may be exhibited in childhood or adolescence. A child's family, friends, culture and social setting may influence the individual factors. Of particular interest in most studies is the impact that family has and which is greatest in childhood and the peer impact which is of greater influence in adolescence (CDC, 2008).
Some of the individual factors observed are; low IQ (substandard academic performance), attention deficit hyperactivity disorder, drug and/or alcohol abuse, tobacco use, early history of problem behavior and or violent victimization. The latter is strongly associated with youth violence. A link between low IQ and violence is strongest among boys who have the following traits; dysfunctional family, exposure to violence, antisocial beliefs/attitudes, history of treatment for emotional issues, strong stressors, poor social cognitive abilities, poor impulse control and lower socioeconomic status (CDC, 2002).
Parental behavior and family environment are central factors when it comes to youth violence. Parents who do not monitor and supervise their children and who discipline with harsh corporal punishment have been shown to be strong predictors of youth violence (CDC, 2008).
As indicated, the onset of violent behavior in youth is strongly linked to parental conflict in early childhood as well as poor attachment between children and parents. In addition traits such as a large number of children in the family, a mother who had her first child at an early age, possibly as a teenager, and a low level of family cohesion have been shown to contribute to youth violence. These factors can have a detrimental effect on a child's social and emotional functioning and behavior barring the lack of social supports (CDC, 2002). Consequently, violent youths who have witnessed violence in the home, and or have been physically or sexually abused may see violent behavior as an acceptable way to resolving conflict (CDC, 2002).
Social influences, in particular, peer pressure during adolescence may normally be seen as positive and important in shaping interpersonal relationships. Nevertheless, these influences may also have a negative effect if the peer pressure stems from aggressive and violent youth. That is, delinquency can cause peer bonding which, inversely causes delinquency (Harding, 2009).
In fact, young adults with depression who socialize with youth offenders they are more likely to act out violently towards others. Harding (2009), indicated that the most significant contributing factors to youth violence were depression and having youth offenders as peers in addition to parent's psychological abuse of a partner, antisocial personality, negative relationships with adults and family conflict. The composition of a family has also been shown to be a significant factor in the development of violent behavior in youth. Findings from studies conducted in New Zealand, the United Kingdom and the United States suggest that there is a higher risk for violence in youth from single-parent households (CDC, 2002).
The risk factors attributed to family include; dysfunctional family functioning, lack of child supervision, parental substance abuse or criminal history, parental lack of formal education, harsh and/or authoritarian parenting styles or inconsistent disciplinary practices. In terms of peer risk factors these are socializing with peers that are in gangs, who are themselves juvenile delinquents, being socially rejected by others, no involvement in extracurricular activities a little interest in school or school performance (CDC, 2009).
Likewise the social groups in which children and adolescents live have a significant role in how they relate to their parents, friends and the circumstance in which they may be exposed to situations that lead to violence. Consequently, males in urban areas will most likely be involved in violent behavior than those living in rural areas. Similarly in urban settings children and adolescents who live in neighborhoods with high levels of crime are more likely to be involved in violent behavior than those living in other neighborhoods. In addition, a correlation has been found between children and adolescents who come from a low socio-economic status and youth violence (CDC, 2008). A national survey of young people in the United States indicated that the prevalence of self-reported assault and robbery among youths from low socio-economic classes was about twice than among middle-class youths (CDC, 2002). The effects that youth violence has on a community or community risk factors include; neighborhoods that are in social disarray, little community cohesiveness, increase in family disruption, increase in transiency, greater numbers of poor residents and less economic opportunities (CDC, 2009).
It is of equal importance to note the influence of culture on youth violence. There are cultures which endorse violence as an accepted manner to resolve conflicts. In these cultures the young adopt the norms and values that support violence. These cultures lack the ability to provide their youth with non-violent alternatives to resolve conflicts and consequently have been shown to have higher rates of youth violence. A study by Bedoya Marin and Jarramillo Martinez on gangs in Medellin, Colombia, analyzed how low-income youths are influenced by the culture of violence, in society in general and in their particular community. The authors indicated that the community enables a culture of violence through the growing acceptance of "easy money" and of whatever means are necessary to obtain it, as well as through corruption in the police, judiciary, military and local government (CDC, 2002).
When considering the possible biological factors which contribute to youth violence, studies have focused on areas such as injuries and complications associated with pregnancy and delivery. The interest in these areas is fueled by the belief that they may contribute to neurological damage and in turn lead to violent behavior. The CDC noted that complications during delivery have been shown to contribute significantly to future violence when a parent had a history of psychiatric illness. It should be noted that complications during delivery when in conjunction with other familial factors is the stronger predictor of youth violence (CDC, 2002).
Other studies of interest have indicated that low heart rates-studied in males have a correlation with behaviors such as sensation seeking and risk taking. These behaviors may act as a catalyst to violence in that they provide the necessary stimulation and arousal levels (CDC, 2002). Deficiencies of executive functions of the brain which are housed in the frontal lobe may be connected to impulsiveness, attention problems, low intelligence and low educational attainment. Additional deficiencies include the inability to sustain attention and concentration, abstract reasoning and concept formation, goal formation, anticipation and planning, effective self-monitoring and self-awareness of behavior, and inhibitions regarding inappropriate or impulsive behavior (CDC, 2002).
The literature indicates that hyperactivity, impulsiveness, poor behavioral control and attention problems are behavioral/ personality factors that may precede violent acts by youths. Hyperactivity, high levels of daring or risk taking behavior, poor concentration and attention difficulties in youth younger than thirteen years have been shown to be good predictors of youth violence (CDC, 2008).
The CDC also found that among some juvenile offenders, situational factors may act as a catalyst to youth violence. In order to conduct a situational analysis of the events it is necessary to determine the motives for the violent behavior, where the behavior occurred, whether alcohol or weapons were present, all parties involved to include the victim and aggressor, and if other actions were involved such as a robbery that would lend itself to violence (CDC, 2002).
In terms of gender, the literature indicates that most of the perpetrators of youth violence are males. Feminist theorists who have analyzed this phenomenon have indicated that the concept of masculinity may put males more at risk to be violent. Behaviors such as appearing to be tough, powerful, aggressive, daring and competitive are ways in which males express their masculinity. Nevertheless, expressing these behaviors may be conducive to male's participation in antisocial and criminal behavior. It should be noted that males may act in this manner due to societal pressure to conform to masculine cultural standards like in Colombia as mentioned earlier. However, one must keep in mind that males may be biologically more aggressive and greater risk takers than females (Juvenile Delinquency, 2010).
This review of the literature shows that youth violence is a growing problem that affects and is affected by family, community and society at large. More and more children are not attending school out of fear of what can happen on their way to school or at school. A nationwide survey indicated that about 6% of high school students reported not going to school on one or more days in the 30 days preceding the survey (CDC, 2009).
Additional ways in which Youth violence impacts the community at large are disrupts social services, decreases property value, decreases productivity, and it raises the cost of health care (Mercy et al., 2002). Health care is a topic that is on the nation's political forefront. It is impacted by youth violence which contributes to the costs of health care and welfare services. The CDC reports that violent youth are also involved in a range of crimes and other problems which include truancy, dropping out of school, substance abuse, compulsive lying, reckless driving and high rates of sexually transmitted diseases. According to the CDC more than 780,000 young adults age ten to twenty sustain injuries due to violence and are treated in emergency rooms yearly (CDC, 2009).
Factors that have been shown to buffer the risk of youth violence include individual/family protective factors listed as; high involvement with parents, high parental academic expectations, healthy family communication, good familial and/or adult support, healthy social orientation, high IQ and/or grade point average and no tolerance for antisocial behavior. The consistent presence, during at least one, of parents when their children wake up, arrive home from school, during dinner, at bed time and involvement in their social activities are also seen as protective factors . Peer/social protective factors are noted as involvement in extracurricular activities and an interest and commitment to school (Resnick et al., 2004).
Based on the literature review, youth violence is embedded and linked to traits of the youth, youth's family, peer group, school environment and community. A socio-ecological model would aim to ease the risk factors (individual/family, peer/social, etc.) by focusing on the youth and youth's family strengths and doing so on a highly individualized and comprehensive basis. Of particular interest and focus would be the protective factors outlined earlier. This could be provided via home-based family services in order to assists those violent youth and their families who have limited access to therapeutic services. This would help the therapist to focus on parental empowerment in order to change the natural social network of the youth in order to maximize the treatment outcomes.
The therapist would focus risk factors in the youth's social network that are contributing to their problem behavior. The goals may include but would not be limited to; improving social support and network system, getting the youth involved in positive extracurricular activities, minimizing the youths association with juvenile delinquents, improving family functioning and communication, and improving the parenting skills of caregivers. The techniques used can be drawn from cognitive behavioral, behavioral and family therapies.
The therapy sessions could take place at home, school or a community environment (a comfortable setting for the youth and the youth's family). The treatment plan would be agreed upon with the help of family members and should then be driven by the family and not the therapist. In doing so the therapist would empower the family to promote healthy changes through the mobilization of the child, family and community resources.
Given the information provided on youth violence, the therapist should focus specifically on the risk factors in the child/adolescent, and family's social networks that are linked to the violent behavior. Therefore, special attention would be given to improving a youth's outlook on academics and academic performance, improving social and familial support systems, and decreasing the influence of violent peers by removing the youth from the negative environment.
These therapeutic gains would in turn have a positive effect on the youth, the youth's family and the community at large. This may begin to address and prevent the health care issues outlined earlier and other subsets of youth violence such as school shootings and cyber bullying to name but two.