Psychiatrists Focus on Teen Violence

From the WebMD Archives

May 15, 2000 (Chicago) -- Last week, another highly publicized school shooting -- this one in Arkansas -- served as a grisly anniversary card for last year's bloodbath at Colorado's Columbine High School. At Sunday's "Million Mom March," an estimated 750,000 mothers converged on Washington to demand that Congress pass tougher gun control laws to prevent more of these killing sprees.

Even though statistics show youth violence has actually been decreasing in the U.S. for the last several years, intensive media coverage of events like these has focused public attention on the issue, says Paul J. Fink, MD, speaking at the annual meeting of the American Psychiatric Association (APA) here. But because all the attention does little do address the real issues behind youth violence, he says, organizations like the APA are taking notice of the problem.

"Youth violence is a complex issue [we] must attend to until the problem is totally eliminated," says Fink, a professor of psychiatry at Temple University School of Medicine in Philadelphia, a past president of the APA, and the chair of the APA's Psychiatric Aspects of Violence task force.

A big piece of the puzzle will be to find out which children are most likely to be violent, says Marvin S. Swartz, MD, who heads the division of social and community psychiatry at Duke University Medical Center in Durham, N.C.

"We're making progress in identifying which adolescents are at risk of violent behavior," he tells WebMD. It's been slow going, he admits, partly because it is so hard to find enough teens to study; only about one in 50,000 people eventually goes on to become a killer. Still, some progress has been made in "typing" the teen-aged killer.

Adolescents who kill have several characteristics in common, says Kenneth G. Busch, MD, a Chicago-based psychiatrist who has worked with a group of violence specialists to identify those characteristics. Their efforts will make it possible for doctors and counselors to more accurately pinpoint which children are at the most risk of committing murder. These kids, of course, would also be the ones who would benefit the most from social and medical interventions.

Busch has found that a teen-ager's risk of becoming a killer is doubled if he comes from a violent family, grew up being physically abused, is a gang member, or abuses alcohol or illegal drugs.

Even more telling, he has found that a child's risk is four times greater if he also has access to weapons or has had a prior arrest, a neurological problem, and/or severe educational difficulties that led to constant skipping of classes, failing grades, and suspensions/expulsions from school.

Stephen Thomas, PhD, a professor in the Rollins School of Public Health at Atlanta's Emory University, notes that there is also computer software that can do FBI-like profiling of students who might be prone to violence. But he believes that identifying them as troublemakers is the wrong way to deal with these children, since so many of them have witnessed violence and abuse or have been victims of it.

Thomas advocates an approach in which young therapists are sent into schools before violence occurs to try to connect with teens who are having problems. Thomas, who is also director of Emory's Institute of Minority Health Research, did not attend the APA meeting.

Fink tells WebMD that most of the solutions put forth for youth violence focus on punishing the children who commit these crimes -- and this is because such approaches have a strong public appeal. Punishment may feel good to the general public, but unfortunately, he says, it doesn't work well in preventing violence. A better approach is to design methods to help keep kids from becoming violent.

For example, he says, it's been shown that kids who skip school are more likely to be murdered or to murder someone else. So it came as no surprise to him that efforts to enforce school attendance in Philadelphia have had the added benefit of reducing youth violence in that city.

Members of the APA panel point out that the psychiatric community cannot act alone, and stress the need for increased resources in schools and in the wider public arena.

"This is a complex issue," Thomas says. "We need to stay on it longer than a media minute."

Even as the psychiatrists met, the Sheriff's Department in Jefferson County, Colo., released a minute-by-minute account of the Columbine shootings, showing that the 12 students killed by the teen-age gunmen were dead within 16 minutes and that the two gunmen had killed themselves within 57 minutes of starting the attack.

But the 700-page report left the most important question about the shootings open.

"While this report established a record of the events of April 20," said Jefferson County Sheriff John Stone, "it cannot answer the most fundamental question -- why?"