In the aftermath of a series of shootings that occurred in schools over the past school year, public attention is once again focused on violent behavior among young people and what can be done to prevent it. We interviewed Professor Edward Taylor of the University of Illinois School of Social Work to get his views about the mental states of children who commit violent acts. Professor Taylor is Chair of the Mental Health Concentration within the School of Social Work. His research interests include the etiology, diagnoses, prevention, and treatment of childhood neurobiological and behavior disorders.

In September, we published Part I of Professor Taylor's comments, which focused on the roles of situations and events when children become violent, the possible role of mental illness, the warning signs, the role of attachment to moral authorities and peers, and what concerned adults can do to intervene before violence occurs. In Part II, we look at mental illness in children. This issue of Parent News also includes an article with information about conflict resolution programs.

AA: Are mentally ill children more violent than other children?

ET: There is no higher rate of violence among children and adults who are mentally ill than among those who are not. However, one of the things that does happen when a mentally ill child becomes violent is that oftentimes the violence is extremely aggressive. Second, it often makes no contextual sense whatsoever. We often see children attacking parents who have been wonderful parents. The mental illness causes the child to be unable to recognize the things the parents have done and gone through for him or her, and causes the child to violently attack the individual who has done the most for them. That is not an unusual scenario.

In cases where there is no mental illness, we can often see that a violent act makes contextual sense. For instance, in order to join a gang a child might think he has to commit a violent act. That's a contextual reason for the child's act of violence. In cases where there is mental illness, the violence usually makes very little sense. Depression and even problems like schizophrenia, bipolar illness during the manic phase, or psychotic types of illnesses, do not in themselves make people violent. In fact, there is a tendency in seriously mentally ill children to be more violent to themselves than to others. Approximately 15-20% of individuals with severe mental illness will make a serious attempt on their own life. The differentiation is that when these children do become violent, it usually makes little contextual sense and often is extremely aggressive, unfortunately.

AA: Is there a particular stage during childhood and youth when children are more susceptible to mental illness than at other times?

ET: We are researching that now. One of the things we have generally believed is that serious mental illness does not occur until middle adolescence and young adulthood. The amount of research that has been done on childhood serious mental illness is extremely small. Serious mental illness is the last pediatric problem where we still use adult standards, with the exception of such things as autism. If you look at the Diagnostic Statistical Manual that is put out by the American Psychiatric Association-the bible for diagnosis-you'll see that there is a very thin children's section that deals mainly with autism, eating and sleeping disorders...but the rest of it, that is anxiety, depression, obsessive compulsive disorder, bipolar illness, schizophrenia-all of the standards that are used are adult standards for judging children.

Many of us feel that the reason we have missed so many children is that we have the wrong diagnostic standards, that we do not have a pediatric standard for serious mental illness. As an example, in manic episodes in bipolar illness, children tend to be hyperactive. One of the adult symptoms of mania is that you do dangerous things to yourself involving taking risks. Children make these kinds of poor judgments in different ways. Where is the line between where a child has started to develop low-grade mania and we can intervene before it becomes major mania, and normal pre-teen experimenting and chance-taking? We do not have good criteria for catching children before their mania causes them to become really destructive, for instance running away, becoming aggressive for no reason at all, breaking into houses, etc.

AA: How can labeling or mislabeling of children's mental states be avoided?

ET: We have to help the community and help teachers understand that mental illness in children is not created from bad homes, from sexual or physical abuse-while these are things that can create problems, we are talking about when children have a biological predisposition for mental illness. In order to make that diagnosis, we have to rule out physical and sexual abuse because they can cause symptoms that look like mental illness. They can cause children to have adjustment disorders, or to have post traumatic stress syndrome, or they can create a depressed or aggressive child. Most seriously mentally ill children are not dangerous, as a group, and they are not mentally ill as a result of something going on in the family. Most childhood aggression stems from an interaction between neurodevelopmental lags and social situations or crises, rather than severe biological disorders.

People should share information when they see children deteriorating. In the case of children who do not have serious mental illnesses, we have to organize the homes and the schools to be able to respond. We need to have systematic programs that catch these children before they escalate into violence. Once a child starts slugging other children at school, we certainly want to intervene, but it is often too late at that point. The big issue is setting up boundaries for the non-mentally ill child and setting up training for the family and the child. For the mentally ill child, it is important to get him into very specialized community mental health programs that deal with medications, psychotherapy, support to the parents, etc.

AA: What about children who are labeled as hyperactive or as having attention deficit disorder. Is this an example of using adult criteria to explain children's behavior?

ET: That is one of the big issues. There is a big debate going on in the mental health community as to whether we are discovering more attention deficit or whether it is something that is socially created. There are new categories. For instance, we have children who may be suffering from prenatal exposure to drugs through substance abuse by parents, especially alcohol abuse. And we have a group of children who have a minimal form of brain damage that makes attention and concentration difficult. We also have children who are living in a more dense, permissive society and who may not know how to handle situations when they are away from home and they try to expand their boundaries. These children may get thrown out of class, which is probably the worst thing that we can do. However, with large class sizes it is difficult to take extra time to experiment with what would work with these children.

Internet Resources

National Alliance for the Mentally Ill
http://www.nami.org/

American Academy of Child and Adolescent Psychiatry, Facts for Families
http://www.aacap.org/factsfam/index.htm [Editor's Note (5-9-2000): this url has changed: http://www.aacap.org/info_families/index.htm]

Justice Information Center, Juvenile Justice Page Documents, Violence and Victimization
http://www.ncjrs.org/jjvict.htm [NPIN Editor's note (9-9-02): this URL is no longer active, see: http://www.ncjrs.org]

Early Warning, Timely Response: A Guide to Safe Schools http://www.ed.gov/offices/OSERS/OSEP/earlywrn.html

Following are several citations chosen from a search of the ERIC database using the following search strategy:

Young Children or Preschool Children or Adolescents or Elementary School Students or Middle School Students
and
Behavior Disorders or Emotional Disturbances

EJ555176 CG551326
Differences in Depression and Self-Esteem Reported by Learning Disabled and
Behavior Disordered Middle School Students.
Stanley, Patricia D.; Dai, Yong; Nolan, Rebecca F.
Journal of Adolescence, v20 n2 p219-22 Apr 1997
ISSN: 0140-1971
Language: English
Document Type: JOURNAL ARTICLE (080); RESEARCH REPORT (143)
Journal Announcement: CIJMAY98
Examined differences in level of self-reported self-esteem and depression between
learning-disabled (LD) and behavior-disordered (BD) middle school students (N=61).
Results indicate that BD students reported unrealistically high self-esteem, whereas
LD students reported significantly lower self-esteem than did the BD students. Both
groups reported mild depression. (RJM)
Descriptors: Adolescents; *Behavior Disorders; Comparative Analysis; *Depression
(Psychology); Intermediate Grades; Junior High Schools; *Learning Disabilities;
Middle Schools; Peer Relationship; *Self Esteem; Student Attitudes
Identifiers: *Middle School Students

EJ553882 EC617461
Challenges in Conducting Family-Centered Mental Health Services Research.
Koroloff, Nancy M.; Friesen, Barbara J.
Journal of Emotional and Behavioral Disorders, v5 n3 p130-37 Fall 1997
ISSN: 1063-4266
Language: English
Document Type: REVIEW LITERATURE (070); JOURNAL ARTICLE (080)
Journal Announcement: CIJAPR98
This introductory article analyzes the challenges facing researchers as they
respond to the ideas that guide family-centered services and incorporate these themes
into research focused on improving services for children with emotional, behavioral,
or mental disorders. The fit between traditional mental health research and family
centered services is examined. (Author/CR)
Descriptors: *Behavior Disorders; Children; *Emotional Disturbances; Exceptional
Child Research; *Family Involvement; *Family Programs; *Mental Health Programs;
Psychological Studies; *Research Design; Theory Practice Relationship

EJ553880 EC617459
Psychopathology in Children and Adolescents with Developmental Disorders.
Hardan, Antonio; Sahl, Robert
Research in Developmental Disabilities, v18 n5 p369-82 Sep-Oct 1997
ISSN: 0891-4222
Language: English
Document Type: JOURNAL ARTICLE (080); RESEARCH REPORT (143)
Journal Announcement: CIJAPR98
A study of 233 children with developmental disorders and mental illness found that
the most common psychiatric diagnoses were oppositional defiant disorder and
attention deficit hyperactivity disorder. Pica, organic mental disorder, and autism
were more often encountered in low functioning individuals, while depressive and
speech/language disorders were found more in high functioning subjects. (Author/CR)
Descriptors: Adolescents; *Attention Deficit Disorders; Autism; *Behavior Disorders;
Children; *Clinical Diagnosis; Correlation; Depression (Psychology); Language
Impairments; *Mental Disorders; *Mental Retardation; Predictor Variables; *Severity
(of Disability)

EJ552727 PS526856
Treating Anger: The Misunderstood Emotion in Children.
Akande, Adebowale
Early Child Development and Care, v132 p75-91 May 1997
Language: English
Document Type: JOURNAL ARTICLE (080); POSITION PAPER (120)
Journal Announcement: CIJMAR98
Reviews behavioral and cognitive interventions that are potential models for the
treatment of anger and impulsivity in brain injured patients, including a
multicomponent treatment approach coupled with cognitive interventions. Proposes
strategies to establish a therapeutic relationship with angry, impulsive patients.
Examines models for treating anger, including implosive therapy, overcorrection,
cognitive behavior modification, and rational emotive behavior therapy. (Author/KB)
Descriptors: *Anger; Behavior Disorders; Behavior Modification; *Children; Clinical
Psychology; Cognitive Restructuring; Counselor Client Relationship; Desensitization;
Extinction (Psychology); Mental Disorders; *Neurological Impairments; Positive
Reinforcement; Psychological Services; *Psychotherapy; Punishment; Rational Emotive
Therapy; Self Control; Timeout
Identifiers: Differential Reinforcement of Other Behaviors; Impulsiveness;
Overcorrection; Response Cost
--------------------------------
Accessing the Full-Text of ERIC Journal Articles

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