Abstract
IntroductionViolence risk assessment is one of the most frequent reasons for child and adolescent psychiatry consultation with adolescents in the pediatric emergency department (ED). Here we provide a systematic review of risk factors for violence in adolescents using the risk factor categories from the MacArthur Violence Risk Assessment study. Further, we provide clinical guidance for assessing adolescent violence risk in the pediatric ED.MethodsFor this systematic review, we used the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2009 checklist. We searched PubMed and PsycINFO databases (1966–July 1, 2020) for studies that reported risk factors for violence in adolescents.ResultsRisk factors for adolescent violence can be organized by MacArthur risk factor categories. Personal characteristics include male gender, younger age, no religious affiliation, lower IQ, and Black, Hispanic, or multiracial race. Historical characteristics include a younger age at first offense, higher number of previous criminal offenses, criminal history in one parent, physical abuse, experiencing poor child-rearing, and low parental education level. Among contextual characteristics, high peer delinquency or violent peer-group membership, low grade point average and poor academic performance, low connectedness to school, truancy, and school failure, along with victimization, are risk factors. Also, firearm access is a risk factor for violence in children and adolescents. Clinical characteristics include substance use, depressive mood, attention deficit hyperactivity disorder, antisocial traits, callous/unemotional traits, grandiosity, and justification of violence.ConclusionUsing MacArthur risk factor categories as organizing principles, this systematic review recommends the Structured Assessment of Violence Risk in Youth (SAVRY) risk- assessment tool for assessing adolescent violence risk in the pediatric ED.
Highlights
Violence risk assessment is one of the most frequent reasons for child and adolescent psychiatry consultation with adolescents in the pediatric emergency department (ED)
The two scales that have the strongest psychometric support are the Structured Assessment of Violence Risk in Youth (SAVRY) and the Psychopathy Checklist-Youth Version (PCL-YV). 12,13 neither these nor other scales are routinely used in clinical practice. To equip both ED pediatricians and child and adolescent mental health professionals with the best knowledge to confront the assessment and treatment of aggression, we report a systematic review of the literature on risk factors for violence in adolescents in the community and characterize what is currently known using the risk factor categories from the MacArthur Violence Risk Assessment study as organizing principles; identify gaps in knowledge; and discuss recommendations for further research.[14]
The studies considered a constricted range of risk factors, weak criterion measures of violence, narrow study samples, and data gathered at a single site
Summary
Violence risk assessment is one of the most frequent reasons for child and adolescent psychiatry consultation with adolescents in the pediatric emergency department (ED). We provide a systematic review of risk factors for violence in adolescents using the risk factor categories from the MacArthur Violence Risk Assessment study. We provide clinical guidance for assessing adolescent violence risk in the pediatric ED. Violence or aggression among adolescents is a common problem of enormous public health significance. Physical fighting is the most common form of violence in adolescents.[1] In addition to the increased risk for injury and substance abuse, those who fight report less satisfaction with life, poorer relations with family and peers, and a worse perception of school. Children first learn to manage aggression from their parents as toddlers; poor parenting, such as abuse, neglect, coercive parenting styles, antisocial modeling, and Volume 22, no. 3: May 2021
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