Review article
Recent research findings on aggressive and violent behavior in youth: Implications for clinical assessment and intervention

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Abstract

Assessing children and adolescents for potential violent behavior requires an organized approach that draws on clinical knowledge, a thorough diagnostic interview, and familiarity with relevant risk and protective factors. This article reviews empirical evidence on risk factors, the impact of peers, developmental pathways, physiological markers, subtyping of aggression, and differences in patterns of risk behaviors between sexes. We explore these determinants of violence in children and adolescents with attention to the underlying motivations and etiology of violence to delineate the complexity, unanswered questions, and clinical relevance of the current research. Interventions, including cognitive behavioral therapy, psychopharmacological treatment, and psychosocial treatment, are reviewed with acute recognition of the need to use multiple modalities with, and to expand research to define optimal treatment for, potentially violent children and adolescents. The information considered for this review focuses on violence as defined as physical aggression toward other individuals. Other studies are included with wider definitions of violence because of their relevance to assessing the potential for violent behavior.

Section snippets

Methodology of search

Research literature on youth aggressive and violent behavior was reviewed after a systematic search of PsycInfo and Medline. Also, manual review of articles' reference lists identified additional pertinent studies. The review focuses on important findings in youth violence and topics that have not been covered in previous general reviews, including gender differences, conduct disorder, subtypes of aggression and risk factors, with emphasis on areas of current research.

Gender

Most of the research on youth violence focuses on men and boys with relatively little attention given to aggressive females, primarily because a much larger percentage of males, as compared with females, commit violent acts [20]. Typically, gender differences were difficult to discern, as many studies (particularly those examining conduct disorder) included only male participants [21]. In the past, to understand the characteristics, history, and symptoms of girls with illegal or aggressive

Family factors

The family environment is the intimate system wherein development is shaped. There is ample empirical evidence (longitudinal designs, randomized controlled clinical trials, and cross-sectional studies) demonstrating the pivotal role of consistent parental discipline in preventing early patterns of aggressive behavior 6, 7, 71, 72.

Dishion et al and Patterson et al developed a model of coercion that starts with family practices beginning in early childhood 73, 74. In this typical scenario, when

Cumulative risk factors

Numerous factors contribute to the relative risk for the development of violence and no single factor is associated with all aggression or provides absolute prediction. Studies utilizing multiple factors provide stronger prediction of violence and demonstrate the interaction and increased cumulative risk of these influences [108]. Evidence indicates that the impact of risk factors depends upon their presence during specific stages of development [96].

Specific models describing distinct pathways

Considerations in risk assessment

Assessing children and adolescents for potential violence requires an organized approach that draws on clinical knowledge, a thorough diagnostic interview, and familiarity with relevant risk and protective factors. Even with guidelines and checklists for identifying risk factors, there is the possibility of errors: false positives, false negatives, or both. False positives are children and adolescents who may have risk factors but do not act violently, whereas false negatives are youth who are

Cognitive-behavioral therapy

Cognitive-behavioral therapy (CBT) seeks to change social cognitive deficits and distortions in aggressive children and adolescents. It focuses on defining the problem, generating alternative solutions, anticipating consequences and introducing behavioral monitoring, and prioritizing responses. Interventions usually involve role-playing, practicing, homework assignments, and specific skill-building to change cognitive distortions and responses. Cognitive-behavioral problem-solving skills

Discussion and summary

Aggression and violence in youth have grave implications for the progression of psychiatric impairment, school difficulties, and legal involvement. As clinicians, it is useful to develop insight about how to conceptualize and organize biopsychosocial information to better guide patients and incorporate new information about treatment. Clinicians are well positioned to identify those individuals that are exposed to multiple risk factors, such as poor social attachments, comorbid psychiatric

Acknowledgements

We thank Tony Earls, Mike Jellinek, and Eliot Pittel for their insightful comments, and Alexa Geovanos for her research assistance.

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