New Ideas to Prevent Chronic Violence and Aggression in American Youth
The cost of crime in American Society today has been reported to exceed one trillion dollars. Crime by and against children and teenagers has steadily increased over the last thirty years. In 2006 there were nearly seventy-four million children and teenagers under the age of eighteen in the United States, and by the year 2030 that number will increase to nearly eighty-six million.
Fifteen percent of them live in poverty; thirty percent live in one-parent homes, and over 30% live in homes with one significant problem. In 2007 over half a million children were in foster care with hundreds of thousands awaiting placement. We have seen increases in anti-social behavior including crime, drug use and violence among children and teens. There have been increases in the rates of divorce, illegitimacy and teenage pregnancy, while membership in voluntary associations has decreased. The Children’s Defense Fund reports that three million children a year are abused or neglected with 50% of all victims under seven years old. Homicide is the second leading cause of death among twelve to twenty-four-year-olds. More than three quarters of a million American youth are injured each year by violence and despite vigilant efforts, a significant percentage of teens carry weapons to school. The Committee for Children reports that one out of every seven children reports being bullied in school regularly, with nearly two thirds of that group reporting being bullied at least once in the past month.
These experiences contribute in an additive way to the risk that a particular youth will progress to aggressive and violent behavior. Traditionally, people have framed this problem as a relatively small number of chronically violent individuals, often referred to as career criminals and early starters. Though over half of all crimes by members of a particular cohort (e.g., current teenagers) across their life spans is committed by fewer than 7% of the group, they cause society 1.6 to 2.3 million dollars each in costs to victims, courts, incarceration, and treatment. Given the astronomical costs of violent behavior, preventive intervention costing just a few thousand dollars per high risk youth would not only benefit this group, but also provide favorable economic returns for the investment even if it saved only one out of every two thousand youth from becoming a violent offender. In fact, a number of well-controlled studies have found that several interventions for chronic violence prevention in youth work, including home visits, multi-systemic therapy and multi-dimensional foster-based treatment. Unfortunately, these programs are traditionally under funded.
In a recent article in the American Psychologist (October, 2008), Dr. Kenneth A. Dodge, of Duke University, provides a fascinating and reasoned appraisal to explain the public and political skepticism about the prevention of chronic youth violence and aggression. In his article titled “Framing Public Policy and Prevention of Chronic Violence and Aggression in American Youths,” Dodge focuses upon metaphors as partially responsible for this phenomenon. He writes that metaphors are able to both “inspire and mislead the public.” His article speaks to the power of metaphors in not only shaping ideas and behavior but in framing public policy. In our first joint book, Raising Resilient Children, Dr. Robert Brooks and I wrote of a powerful metaphor that Bob termed “islands of competence.” We proposed that success builds upon success and each new accomplishment for a child reinforces self-esteem and a resilient mindset. We wrote that if a child faces an ocean of problems and adversity we must help them find an “island of competence,” or something they can succeed at, or they will drown. Our readers, workshop participants and patients have given this metaphor overwhelmingly positive responses. So it is with great interest that I read Dr. Dodge’s article, and provide a brief summary of it here. Dodge proposes that several of the current metaphors concerning youth aggression and violence have been strategically successful in capturing the public’s attention but have not been scientifically accurate, inspirational, or helpful in charting a path to effective prevention and intervention. He proposes that the dominant metaphors used to frame the problem of chronic aggression and violence in youth emphasize retribution and punishment, and thus constrain policy makers’ and the public’s visions of the problem.
Dodge offers four metaphors currently used when considering chronic youth violence and aggression. All four appear to be scientifically incorrect and misdirect prevention effectiveness.
The teenage time bomb. In November, 1995, political scientist, John Dilulio, coined a new term referring to morally impoverished juvenile super predators. This is the same John Dilulio who served as an aide to George W. Bush for the first 180 days of his presidency, and eventually resigned after suggesting the President put more effort into politics than policy. In 1995 his comments were endorsed by other scientists such as James Allen Fox. These scientists warned there was a teenage time bomb waiting to explode into a bloodbath of teenage violence. This metaphor became immediately successful in influencing policy. In May of 1996, Florida introduced and passed the Violent Youth Predator Act. Soon after more than forty states also enacted legislation to make it easier to transfer juvenile offenders to adult court. This metaphor spoke to the public’s hidden stereotype of violent youth as those who are dangerous, living in hopeless situations and unworthy of empathy or support. Yet this super predator metaphor has proven false. A generation of super predators has yet to appear and the bloodbath never ensued. In fact, overall the rate of youth violence dropped in the late 1990's, precisely when it was predicted to explode.
A moral defect. In this metaphor, chronically violent and aggressive youth are framed as morally defective, implying their problem lies within them and cannot be attributed to environmental factors such as poverty, family dysfunction or unemployment. However, developmental researchers have demonstrated that chronically violent and aggressive behavior develops out of a complex interaction of both biological factors and early life experiences, including poverty, exposure to violent models and victimization. These same researchers have demonstrated that later environmental experiences including treatment can deflect criminal trajectories. In one of my previous web articles titled Water Fleas, Caterpillars and People with ADHD, I reviewed fascinating research demonstrating that experience over time can and does dramatically alter the expression of biological propensities such as aggressive and violent behavior.
Youth violence is contagious. A number of researchers in the late 1990's invoked the term epidemic to describe secular trends in youth violence over the past decade. The contagion metaphor implied deviant peer influence is strong and that peer influence is uni-directional. That is, deviant youth influence pro-social peers but not vice versa. This metaphor also implies that the deviant influence applies in all circumstances and to all peers. Thus, there is a net benefit to society to simply isolate and quarantine these youth. Although research has demonstrated the strength of influence that deviant peers can have on deviant behavior among high-risk adolescents, this phenomena is not equally true among all youth. Non-deviant youth are not adversely affected by contact with deviant peers. Further, there is little evidence to support that quarantine is an effective intervention. Just look at our prisons.
The bad seeds. I borrowed this term “the bad seeds” to explain Dr. Dodge’s fourth metaphor, that violent and aggressive youth are rational and make a choice to behave in certain manners. This implies a fixed, stable, internal pattern of anti-social personality. This metaphor is attractive because it too implies that the problem lies within these youth and little can be done to help them. On the positive side, this metaphor focuses attention on genetically driven differences in human behavior. On the negative side, however, it offers what is referred to in genetics as a “homunculus model”. That is, children simply grow up and develop with a pre-ordained destiny. Additionally, this metaphor fails to incorporate human beings often-irrational behavior.
The majority of these metaphors have lead to the perception that some type of behavioral vaccine or surgical-like intervention is necessary to cut out or cure the “cancerous” aspects driving these youth’s behavior. The majority of current treatment programs are built on these metaphors. However these short term, quick fix, programs focused on preventing violence, substance use, inappropriate behavior, have at best demonstrated short-term success with only a limited lasting impact on anti-social behavior.
Dodge concludes his article by offering four new metaphors that he believes are more scientifically accurate and more likely to drive effective long-term prevention and intervention.
A preventive system of care. Dodge suggests that a health care model similar to preventive dentistry offers a novel metaphor for understanding chronic violence and aggression. Such a model can succeed only when interventions are applied simultaneously at multiple levels. Multiple research studies have suggested that programs beginning when youth are at risk, applied consistently over a long term, can prevent and are effective in preventing violent outcomes.
2.A disease prevention model. Dodge proposes that chronic violence can be viewed in a way similar to cardiovascular disease. That is, multiple factors contribute to risk each of which should be addressed within the environment and life experiences, not just for at risk youth, but for all youth.
3. An injury prevention model. Dodge proposes framing treatment of violent and aggressive youth similar to a public health model, suggesting epidemiological surveillance of the health of the population at large, health promotion, disease prevention and access to evaluation and a wide range of services. Such a model disseminates information widely and implements evidence based prevention strategies.
4.A public education model. Dodge proposes a final metaphor examining chronic violence and aggression similar to illiteracy. Literacy depends not only on public expenditures, education and government policy, but also on societal commitment through its investment of social capital. Such a program would build upon community support for violence prevention. Initial research suggests this type of intervention can be very effective.
Dodge offers a powerful argument that new metaphors can be used to promote new approaches to understand how chronic violence and aggression develops in youth and how it might be prevented. He proposes that the language of metaphors can help the public and policy makers develop new ways of helping at-risk youth. In my day-to-day interactions with patients and their families, I repeatedly use metaphors to promote understanding, shape ideas and motivate change. Words are in fact our most powerful ally. As Dodge points out, even when metaphors are proven to be inaccurate their influence endures. They can, as he writes, be “catalytic and inspiring.” Mankind’s future lies not in science and technology but in our children. Children instilled by their parents, teachers and other adults with the resilient qualities necessary to help them shape a future with satisfaction and confidence. As my colleague, Dr. Brooks, and I have written, we can all metaphorically serve as the charismatic adults in children’s lives, believing in them and providing them with opportunities that reinforce their islands of competence and feelings of self-worth.
