Congressional Briefing on Children’s Mental Health--October 10, 2007
Thank you for providing this opportunity to focus on children’s mental health, one of the most under-recognized and under-addressed problems in our society.
I am Patrick Tolan and I work as Director of the Institute for Juvenile Research in Chicago Illinois. The institute happens to be the oldest center in this country focused on advancing children’s mental health through strong research and innovative training and services. When the institute was started there was no recognition of child mental health as the root of problems such as delinquency and violence or of the importance scientific study could play in guiding toward effective solutions. We now know violence has a profound impact on the development of children, that aggression and violent behavior while common, can be part of a mental illness and problems in thinking and managing emotions, and that there is much we can do to help with and prevent much of the bullying, victimization, behavior problems that impede learning and classroom order, and risky delinquency.
In addition, we are increasingly recognizing that what may seem like a great idea is not inherently useful but that there are several approaches that have substantial effects, for example reducing arrest rates as much as 1/3 or through intervention with young mothers preventing the involvement of their children in delinquency 15 years later. We have also learned that some popular or intuitively appealing ideas turn out to actually make such problems more likely. That is why I am here today.
Understanding violence can seem confounding. That is because we are not all talking about a single issue when we refer to violence and youth. Some are talking about the horrifying but fortunately very rare events such as Columbine or Virginia Tech. Others are focused on the developing pattern of behavior problems that start early in childhood and lead to delinquency and adult crime. Others are talking about exposure to violence due to residing in communities where violent acts are likely to be witnessed or take away family members and caregivers. And others mean the most common and perhaps the most impacting violence, the violence between family members including domestic violence and child abuse. Violence is not a single problem. We have violence problems, particularly when you are thinking about children. I will try to quickly make some key points about this complex set of issues with my remaining time. I find that it useful to talk about three types of problems.
There is little debate about the tragic consequences of violence and there is increasingly clear evidence that exposure to violence affects the developing cognitive abilities of children, including how fear and aggression impulses are managed, how social interactions are labeled and responded to, and how rules and conventions are bonded to and heeded. Mental health resides at the center of valuable responses that can make a real difference in our safety, reduce the economic burden of violence and related problems on our society, and restore the lost potential of all those children and families subjected to or wrapped up in violence.
The dramatic and riveting tragedies such as Columbine and Virginia Tech, while engendering a desire to figure out how to predict who will do such a thing may mislead us about actually making schools safer and actually helping with the much more common and affecting basis of violence in schools. It is becoming clearer that such incidents are a consequence of mental illness and its basis in brain dysfunction, but is not characteristic of youth with mental illness. The consistency of early and chronic emotional and social problems among the perpetrators is remarkable. However, although the wish may be to know what singular distinction is possessed by these children, their families, or their schools, focusing on that pursuit is akin to trying to find the needle in a haystack.
Instead, the lesson to be taken form these events is to soberly recognize that within every school there are about 5% of children who are exhibiting problems with following rules, that tend to use aggression when frustrated, have limited social skills for managing peer relations or social demands, and have parents with limited skills or support to meet their behavior needs. They not only fail to learn but they and their parents quickly become unwelcome in school and see school as a hostile place. It is the group of children that, if not identified and provided appropriate and proven programs of aid, are most likely to bully others, experience chronic school failure, engage in serious delinquency, use violence, and as adults commit crimes, abuse substances, be early parents, and face employment and relationship failures.
And, over the past 15 years, through federal support for scientific studies, we have been able to gain understanding of how multiple influences can lead such at risk children toward these problematic outcomes, and more importantly, what can help stem this development. We have identified over a dozen proven programs and several approaches to help such high risk youth. The most consistent and powerful effects are from interventions that permit early intervention when behavior problems are first noticed and provide parenting skills and support. The effects can be impressive and the cost-benefits quite high. For example, our research group and several others across the country have shown that application of such efforts can reduce rates of later substance use and delinquency from 15-30%, while showing immediate prevention effects on academic failure and school bonding. Several programs showed a savings of $7 for each dollar invested in services.
We know what can be done and much of what should be done, but few in need have access to these types of services and few who serve these youth are trained to use methods that can make the difference.
While identifying high risk youth and making access to adequate and effective services is a major mental health need, violence is not limited to high risk youth. Violent behavior is not limited to a small distinct subpopulation. In fact, most persons are violent at some point in their lives and intimidation and fear are unfortunately common in the social experience of many of our youth. Referred to as bullying, it disrupts schools, distracts from learning and positive orientation to education, and drains teacher enthusiasm. We are now identifying key school level interventions that can reduce the incidence of bullying and the fear it induces. Part of that is reminding all that schools are the safest and often the most ordered social settings children inhabit. Part of that is pronounced norm setting for students of not accepting or silently standing by when there is bullying. Part of it is to teach and reinforce skills to manage bullying and to reduce need to use it. And, although less emphasized in many popular but untested programs, is to remind and reinforce that children should and can get help from adults in schools when faced with such problems, including the nonspecific issues my adolescent daughter calls it “teenage dramas”. While perhaps seeming like negligible and trivial minor bumps, they can lead to anxiety disorders, depression, suicide, and other serious impairments of mental health and can make up almost half of the incidents of violence in a given school.
Yet, the most common and perhaps the most important for children’s mental health is violence within families. Across the lifespan the most likely person to commit violence against you is a family member, just as that is who each of us is most likely to be violent toward. It is also the case that violence runs in families, that domestic violence or violence between couples predicts child abuse, which in turn predicts violence by that child toward others and his or spouse, and then toward his or her children. Violence is often rooted in our family and it becomes the root for violent behavior or tolerance of violence towards others, inside our family and out in our community. Indeed, it is rare to see violence against peers or as a delinquent act if there is not violence in family relationships. It highlights that much violence is rooted in family relationships, which is perhaps why the most effective interventions, whether preventive or treatment after the fact for family violence and other forms is family interventions, particularly those that help promote consistent and proportional parenting practices, increasing communication and monitoring of children, and support the challenges of parenting children in our complex society.
I have gathered and brought with me some brief summaries of the patterns of violence affecting children and youth in our society and the best understanding of what approaches and programs can make a difference. As I think one will see there is not a single answer but the most effective responses are not exotic or removed from much of what helps promote mental health generally. It is a matter of early and adequate intervention for high risk children, adequate support for and means to use effective norm setting and adult supervision where children gather in groups, and more access to and application of family focused interventions, including to address family violence. These rest of continuing scientific study and wider access to what can work.