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COLUMN ONE : Nipping Violence in the Bud : With studies linking genetics and criminal behavior, one pioneering program tries to identify and help children at risk. The Chicago study is testing the theories in real-life settings.

TIMES MEDICAL WRITER

Five wide-eyed 11-year-olds are gathered around a Formica table in the cafeteria of the James G. Blaine Elementary School, a 100-year-old brick building with pockmarked wooden balustrades and stairs worn down from too much use. This aging public school hardly seems a place where cutting-edge science is conducted.

Yet here, in a working-class neighborhood not far from Wrigley Field, a grand experiment is under way, with these and other young students as its subjects. Although they do not know it, the youngsters have been selected because a battery of tests have shown that they are at risk for one of America’s worst public health threats.

The threat is not cancer, or tuberculosis, or even AIDS: It is that these children will grow up to be violent.

Margot Mosley is trying to stop that from occurring. The behavioral researcher from the University of Illinois has come to the Blaine cafeteria on this blustery December day to deliver an alarmingly simple lesson: Think before you act.

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“Shauna,” Mosley says brightly in her best teacher’s voice, “give me an example of a time in your life when you found it important to stop and think.”

Shauna, a tall skinny girl in maroon stretch pants and a striped shirt, pipes up with the story of a fight she had with her brother: “He was whoopin’ the dog and I had hit him so he got on top of me and I tried to pick him off and he hit my mama’s glass and she got real mad.”

“Did you regret breaking the glass?” Mosley asks.

“No,” the girl flatly replies.

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“Did your mama get upset?”

“Uh huh.”

This exchange--aimed at changing the way one child handles her anger--is one tiny part of a massive violence prevention project, unprecedented in size and scope. More than 8,600 children in 16 Chicago area schools have participated in the program, which is paid for by the National Institutes of Health and run by a team of University of Illinois psychologists.

They take children as young as 8 and attempt to identify who is likely to become violent later in life; then, they “treat” them with lessons such as the one Mosley conducted. Shauna, whose name was changed to protect her privacy, and the others will be tracked for at least five more years and, researchers hope, until they turn 22. Only then will psychologists know whether their plan has had a lasting effect.

This is uncharted territory. Children’s lives are at stake. Although the program is generating praise from teachers and parents who see it as a steadying influence on young people, the team is treading lightly, knowing that some might find its methods unsettling.

For instance, although parents sign consent forms, they are kept in the dark about the project’s goals. To preserve confidentiality and to avoid stigmatizing the children, researchers say only that they are trying to help the youngsters do well in school. Moreover, some children--the “control subjects"--get no treatment at all, even though they might benefit from it.

This is all in the name of science. And science is what sets the Chicago project apart from nearly every other violence prevention program in the nation, making it more difficult to conduct yet also more promising.

The research builds upon 30 years of medical evidence that shows that aggressive behavior in children can be measured, and used to forecast aggression. Yet with all the furor over America’s mean streets, this project--along with one conducted by Vanderbilt and Duke universities--marks the first time anyone has attempted to use evidence on predicting violence to develop a solid plan for preventing it.

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“This is exactly what we need to do, and do more of, in this field,” said Jim Mercy of the U.S. Centers for Disease Control and Prevention. “We are so focused on reacting to the problem through a criminal justice approach that very little research has been devoted to preventing violence in the first place.”

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There are hundreds, if not thousands, of violence prevention programs in America--everything from late-night inner-city basketball leagues to “scared straight” programs for juvenile delinquents. Rarely are they conducted as true experiments, with control groups and rigorous analysis. So nobody can be sure if they are doing any good.

The Chicago study will be different. It is being conducted with all the rigor of a pharmaceutical firm testing a new drug.

“We would never put drugs on the market without trials to see if they work, and yet we do this all the time for kids,” said Nancy Guerra, the psychologist who heads the study. “There are so many violence prevention programs out there. Everybody and their brother is funding this and that, and one of the real unfortunate things is we have very little data about what works.”

The data that does exist focuses mostly on the fallout from violence, rather than the cure. The statistics are oft-cited:

The United States has the dubious distinction of leading the industrialized world in murder. Race is a troubling factor. Murder is the No. 1 cause of death for black men between ages 15 and 24, and Latino men are three times as likely to be killed as whites.

The costs are enormous, both in human and economic terms. The nation may spend up to $18 billion a year in direct medical costs to care for victims of violence. That does not include billions more in lost wages and productivity, and a lifetime of social services for the injured.

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Against the backdrop of these figures, Mercy and his CDC colleagues for more than a decade have argued that violence is a public health problem, one that can be studied scientifically and prevented, just like heart disease. This year, for the first time, their philosophy found a receptive ear in the White House.

With President Clinton endorsing the CDC line, the agency is funding 14 prevention programs in large and small cities across the nation. Although each will be evaluated for years to come, Mercy said, “we feel very strongly that we can’t tell communities: ‘Don’t do anything until we find the perfect scientific answer.’ ”

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There will, of course, never be the perfect scientific answer. But in Room 3033 of the Behavioral Sciences building at the University of Illinois, there may one day be enough information to come close.

There, 25 file cabinets are stuffed with behavioral evaluations of every youngster participating in the Metropolitan Area Child Study. Across the hall, graduate students tap away on computers, building a massive data base that includes aggression ratings for each child.

The pioneer in this field--and the guiding force behind the Chicago research--is Leonard Eron, a straight-talking 73-year-old psychologist at the University of Michigan.

In 1960, Eron set out to measure aggression among 875 third-graders in New York state’s Columbia County, a semirural region on the Hudson River. He interviewed parents, teachers and, most important, the children, asking a series of simple questions: Who starts a fight over nothing? Who pushes and shoves? Who always gets into trouble? The idea was to let the subjects rate one another.

Eron followed the children until they turned 30. What he found was startling. Those who were highly aggressive at age 8 were about three times as likely as their peers to commit crimes by age 30. And the crimes committed by the “high aggressors” were violent more often than not.

Clearly, this is not a perfect predictor. But Kenneth Dodge, a clinical psychologist at Vanderbilt, said: “It is impressively better than chance--better enough that we have judged that it is worth trying to intervene with those children who are at risk.”

The Chicago team is trying to do just that. Using Eron’s methods of picking out children at risk, it is offering a variety of interventions--or “treatments"--to youngsters who score in the top half on the aggression scale.

Some get a year’s worth of classroom lessons, conducted by their regular teachers (the cheapest intervention). Others, such as Shauna, the 11-year-old at Blaine, attend small group sessions, lasting 22 weeks, where behavior experts teach them to resolve conflicts peacefully. Others get special family counseling (the most expensive treatment), also for 22 weeks.

One of the biggest dangers is stigmatizing the children. Mindful of this, the Chicago researchers have taken great care to keep the aggression ratings strictly confidential--and to put a positive spin on their work.

Shauna and the others in the small group sessions are given a hearty round of congratulations and sent home with a letter that says they have been selected for “leadership training.” Parents are told the family counseling will help their children excel in school.

It is a deception, the researchers admit, but one that they say is justified--and necessary--to avoid harming the children and skewing the results. Medical ethicists agree. They liken it to a clinical trial for a new drug, in which some people get a placebo and some get the real thing.

“Is it totally on the up and up? No,” said psychologist Pat Tolan, a principal investigator on the study, “in the sense that we don’t say to people the real reason we’re being funded is because we believe these kids are at high risk for antisocial behavior. But anybody who knows prevention research will say that it’s two sides of the same coin. The same things that promote good development and academic achievement and pro-social behavior also prevent antisocial behavior.”

But can antisocial behavior be prevented in today’s violent climate? It is a long way, Tolan and his colleagues are learning, from semirural Columbia County, N.Y., in the ‘60s to the rough city life of Chicago in the ‘90s.

Guns are everywhere; a recent nationwide survey found that 270,000 weapons are carried to school each day by U.S. students. Drugs add danger to the mix. Last year, a crack house operated next door to one school in the Chicago study, and two teachers were raped in the parking lot. In one survey the team conducted, 45% of the second-graders said they had seen someone shot.

This is not lost on the academics. The harsh reality of the streets has intruded on the ivory tower.

“Sometimes I think: What the hell are we doing with our cockamamie procedures when this is such a tremendous problem that it is going to take macro-forces to make changes?” Eron said with a sigh. “This is very, very difficult. You can’t reach the parents. They don’t have telephones or they’re not at home. A lot of them are on drugs. We have some of our children living in crack houses. Those problems are so awful, so horrendous, I don’t know what we can expect to achieve.”

Yet there are bright spots, glimmers of hope, places such as Fuller Elementary School.

Fuller may be the poorest school in the Chicago study. There is no integration there; all the students are black. More than nine of 10 live below the poverty line. Many began life as crack babies, said Principal Judith Riggins. Most don’t have fathers who live at home.

The school sits between a patch of weed-covered lots and a block of burned-out, boarded-up buildings on Chicago’s South Side. To get to school, youngsters must tread across the turf of two of the city’s toughest gangs, the Disciples and the Vice Lords.

In Riggins’ office, a spent shotgun shell sits on a secretary’s desk; a young student brought it in for show. Although few guns have made their way into Fuller, knives, scissors and screwdrivers are confiscated more often than the teachers care to discuss. Some complain that the kids are running the school, that even the little ones resort to violence to settle their disputes.

“What I see are outbursts of anger, kicking, hitting other students, cursing,” said John C. Greene, who has taught there for more than a decade. “Some of the little kids can out-curse the adults.”

Unlike the students at Blaine, who receive intensive small-group training, the Fuller students have received only classroom instruction, offered by their teachers and based on a curriculum the university psychologists have devised. But as a bonus for Fuller, the researchers recently began “peer mediation” training to teach students to arbitrate disputes that turn violent.

Even with this less intensive treatment, the program is having noticeable success, at least by principal Riggins’ estimation. She said the rate of violence--as measured by disciplinary actions her office has taken--has dropped 40% since the project began three years ago.

Whether that drop will translate into a long-term behavior changes will not be known for years. But for Riggins, the thought that it might is one of the few sources of hope in a job that is increasingly grim.

“Our little children grow up and they don’t know how to handle their violence. They see their parents using violence to solve their problems. We have one little boy who’s been told (by his parents) that no matter what he does wrong his father will come over here and (rough) up the people. . . . This program is badly needed. Without it, I see more kids being shot, stabbed, dying young. The answer will lie in people learning how to handle their anger.”

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It is a delicate business, however, to pick out kids and declare them “at risk” for anything, let alone violence. Experts acknowledge that there is a danger the predictions of violence could turn into self-fulfilling prophecies, or that the “treatments” could hurt more than they help.

What if the kids in the control group--those who got no treatment--grow up to be violent? What if the researchers pick the wrong kids for treatment? Will a lot of time and money have been expended for nothing?

Albert Reiss, a Yale sociologist and expert on violence, is wary of the whole affair. He says that because the predictions are never 100% accurate, the Chicago team will inevitably be treating kids who do not need the help, and missing kids who do.

“The prediction thing is very, very tricky,” Reiss said. “There are more false positives than you or I would want to live with. You are predicting someone will turn out to be a delinquent, except they don’t turn out to be that way. And so you’ve done all these things to them because you thought they were going to be somebody they are not.”

One famous--if relatively unsophisticated--attempt at preventing violence backfired. From 1939 to 1945, the Cambridge-Somerville Youth Program provided counseling to 500 delinquent boys in Massachusetts. When sociologist Joan McCord of Temple University did a follow-up study 30 years later, she says, she found that the boys who got the counseling died an average of five years younger than those in a control group and were more likely to be career criminals and alcoholics.

“From every point of view you care to name, the kids in the treatment program were not turning out better,” McCord said.

The Chicago researchers insist that their plan will not do its young subjects any harm. But they know that, like any experiment, this one could flop.

“I know that’s a possibility,” Tolan said. “Do I think our project is harmful? No. If I did, I’d stop it immediately. . . . But my feeling is that the choice is to do it this way, or just continue to spend money and submit kids to things that we don’t know work, and I don’t think that’s an option.”

Even if Tolan and the others do prove violence can be prevented--and that their program is a way to do it--there remains the question of the bottom line: Will Americans be willing to foot the bill for this nationwide?

The taxpayers, through the NIH, are giving the Illinois researchers $650,000 a year. Tolan estimates that the most expensive treatment--the family counseling--costs $1,200 per child each year. By comparison, it costs anywhere from $15,000 to $20,000 a year to keep a person in prison. The numbers, he said, speak for themselves:

“If you could target the right kids and keep 30% of them from spending a year in jail, look at all the money you have saved. And that’s not counting whether you care about keeping people from hurting one another.”

Pattern of Violence

Pioneering research by psychologist Leonard Eron has demonstrated that children who are considered highly aggressive at age 8 are three times as likely as other children to commit crimes by age 30. On average, those placed in the low or medium levels at age 8 had fewer criminal convictions by age 30.

Source: Leonard Eron, University of Michigan

Predicting Aggression

Psychologists employ a variety of means to forecast aggression in children. One way is to simply ask youngsters questions about their classmates and themselves.

Here are some of the questions that researchers in a massive violence prevention project in Chicago ask; the answers help determine who is at risk for becoming violent later in life.

* Who likes to share with others?

* Who does not obey the teacher?

* Who often says, “Give me that!”?

* Who pushes and shoves other children?

* Who gives dirty looks or sticks out their tongue at other children?

* Who helps other kids?

* Who starts a fight over nothing?

* Who is always getting into trouble?

* Who says mean things?

* Who takes other children’s things without asking?

* Who are the children who get picked on by other kids?

* Who are the children you would like to have as your best friends?

* Who wiggles or moves around in their seat a lot?

SOURCE: University of Illinois


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