Conduct Disorder, Aggression, and Violence

April 20, 1999….

… and Every Day... Trauma room specialists stand helplessly as the mother and brother of a teenager killed in a drive- by shooting collapse in grief on the hospital floor. The family was allowed to see the boy's body, which lies in a nearby room, just moments after the emergency room team failed to revive him.

Washington, DC. Thursday, February 10, 2000 'JUST TOTALLY SENSELESS'; TWO WILSON HIGH SENIORS SHOT DOWN AFTER LEAVING GAME Two Students Shot Outside D.C. School The Associated Press Wednesday, April 5, 2006 Public Schools spokeswoman Roxanne Evans said that a 19- year-old male student was shot in the back around 9:15 a.m. E DT, and that he was being treated for serious injuries. SANTEE, Calif., March 6 -- San Diego County sheriff's investigators said today that 15-year-old Charles "Andy" Williams took a.22-caliber long-barrel revolver from his father's locked collection of weapons, brought as many as 40 rounds of ammunition to his high school in his backpack and fired 30 of them during the shooting rampage in which the boy allegedly killed two schoolmates and injured 13 others.

Washington Post, March 7, 2001 In the nearly two years since the massacre at Columbine High School, officials at Santana High School developed elaborate security plans for the campus. There were phones in every classroom. Security guards patrolled the hallways with two-way radios. And a sheriff's deputy was assigned to visit the campus each day. But even with that elaborate security net, school officials could not avert Monday's shooting rampage at the suburban San Diego school because friends of accused gunman Charles "Andy" Williams -- and the one adult who heard Williams's plans -- did not turn him in. For Schools, a Calculus of Rights and Safety

Violence Every Day  Between 1985 and 1991, annual homicide rates among males years old almost tripled (from 13 to 33 per 100,000).  In 2002, 5,219 young people years old were victims of homicide. 4,317 were by firearm (=83% of homicides). 4,317 were by firearm (=83% of homicides). That translates to 14 youth homicide victims per day in the U.S. (12 by firearm). That translates to 14 youth homicide victims per day in the U.S. (12 by firearm). In Iraq since the invasion, we have averaged ~2 U.S. servicemen killed per day. In Iraq since the invasion, we have averaged ~2 U.S. servicemen killed per day.

Homicide in Black Male Youths  Homicide is the second leading cause of death for persons years of age, and is the leading cause of death for African-American youths in this age group.  Rates of homicide/100,000 (2002) age 15-24: White males: 11 White males: 11 Latino males: 30 Latino males: 30 Black males: 83 (1 of every 1,200 murdered/year) Black males: 83 (1 of every 1,200 murdered/year)  By contrast, motor vehicle accident deaths: White males: 41/100,000 White males: 41/100,000 Black males: 30/100,000 Black males: 30/100,000

Carrying a weapon or gun, past 30 days (h.s. students)

H.S. students carrying a gun, past 30 days

Threatened or Injured With a Weapon on School Property, Past Year, 2003

Property Stolen or Intentionally Damaged at School, Past Year, 2003

Homicides in U.S. Schools 1992/ /3 (per 100,000)

A Few Definitions  Antisocial Behavior  Conduct Disorder  Juvenile Delinquency

Conduct Disorder (DSM-IV)  Aggression to people and animals Bullies, intimidates Bullies, intimidates Often initiates physical fights Often initiates physical fights Used a weapon than could physically harm Used a weapon than could physically harm Physically cruel to people, or animals Physically cruel to people, or animals Stolen while confronting victim Stolen while confronting victim Forced someone into sexual activity Forced someone into sexual activitycontinued...

Conduct Disorder Continued  Destruction of Property Fire setting with intent to cause damage Fire setting with intent to cause damage Deliberately destroy others’ property Deliberately destroy others’ property  Deceitfulness or theft Broken into house, building, car Broken into house, building, car Often lies to obtain desired goal Often lies to obtain desired goal Stealing without confrontation Stealing without confrontation  Serious rule violations Often stays out past curfew Often stays out past curfew Run away from home overnight >= 2x Run away from home overnight >= 2x Often truant at school Often truant at school

Course of Antisocial Symptoms  31% of antisocial teens later qualify as adults for diagnosis (Antisocial Personality)  94% later have employment problems  Multiple moving traffic violations (72%)  Severe marital difficulties (67%)  Fewer than 20% show good social functioning as adults

Why Do Youth Become Antisocial?

Characteristics Beginning in Childhood  Impulsivity (and ADHD diagnosis)  Irritability  Inattention  Peer rejection in middle childhood  Poor relationships with teachers  Academic deficiencies  Affiliation with deviant peer group in childhood

Neuropsychological Deficits  Deficiencies in: Attention modulation Attention modulation Self control and impulsivity Self control and impulsivity Verbal skills Verbal skills Memory Memory IQ IQ Visual-motor integration Visual-motor integration  Deficits worse among those with chronic antisocial problems, beginning in childhood

Biological Deficits  Low levels of serotonin metabolite 5- hydroxyinadolacetic acid acid (5-HIAA) in spinal fluid  Under-responsive to electrodermal stimulation, an index of processes involving anxiety and inhibition

Social Cognitive Deficits  Inaccurate interpretations of peers’ intentions--biased towards assuming hostile intent in others  Misjudging aggression as means to positive outcomes  Deficient problem-solving skills

Family Coercion Process  Gerald R. Patterson, John B. Reid  Involves maternal irritability, child provocation  Negative reciprocity ends with parent backing down  Negative reinforcement of aggressive behavior results

Other Social Factors  Experiencing or witnessing violence within the family  Viewing violence on TV and films  Access to firearms  Poverty, economic inequality, discrimination

TreatmentTreatment  Not reimbursable by both insurance plans  Parent management training (Patterson and Forgatch)  FAST Track program

PreventionPrevention  Parent training at early age (when children are preschoolers)  Teaching emotion regulation, conflict resolution in schools  Reducing availability of weapons  Addressing discrimination, economic disparity  Reduction of violence in media--not glorifying it