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How to Take a Weapons History: Interviewing Children at Risk for Violence at School
CLINICAL
Associate Editor: Michael S. [ellinek, M.D.
PERSPECTIVES
How to Take a Weapons History: Interviewing Children at Risk for Violence at School ELLIOT M. PITTEL, M.D.
Violence is prevalent and has been escalating in U.S. schools. One in 10 public schools reported at least one serious violent incident (defined as murder, sexual assault. suicide, physical attack or fight with a weapon, or robbery) during 1996-1997 (U.S. Department of Education, 1998). A nationwide survey reported 15% of students had been in a physical fight. 8% were threatened or injured with a weapon at school during the preceding 12 months, and 4% had missed at least 1 day of school because they felt unsafe at or en route to school during the preceding 30 days; in the same period. 9.8% reported carrying weapons on school property (Centers for Disease Control and Prevention, 1996). There were 11,000 incidents of attacks or fights in which weapons were used during 19961997 (U.S. Department of Education, 1998). Between 1992 and 1994 there were 76 student deaths from violence; most involved firearms and knives and started with interpersonal disputes (Kachur et al., 1996). School-related violence often stems from factors originating outside of school. Youths who are victims of gun-related violence at school often have male family members who routinely carry guns or use or sell drugs (Sheley et al., 1992). Carrying a weapon at school has been associated with alcohol use and being offered. given, or sold illicit drugs (Durant et al., 1997). In rural areas, high school students who carry guns at school may be prone to physical fighting. victimization, entering dangerous situations. and cocaine use (Kingery et al., 1996). Youths often justify carrying weapons because they erroneously believe weapons will prevent fights and make them safer. Of more than 400 adolescents surveyed in Boston, only 55% acknowledged that carrying a gun increases the risk of death or injury (Hausman et aI.• 1994); half agreed that "people
Accepted May 8. 1998. Dr. Pinel is a consultant to the Barron Assessment and Counseling Centerof the Boston PublicSchools, a staffpsychiatrist affiliatedwith the LemuelShattuck Hospital, Boston, and Assistant Clinical Professor, Department of Psychiatry, Division ofChild and Adolescent Psychiatry, New EnglandMedicalCenterand Tufts University SchoolofMedicine, Boston. The author thanks Sher Quaday ofthe HarvardSchoolofPublicHealthand Sharon Hogan[ar editorialassistance. Reprint requests to Dr. Pinel, Youth Services Program, Lemuel Shattuck Hospital. 170 Morton Street, Jamaica Plain, MA 02130. 0890-8567/98/371O-1100/$03.00/0© 1998 by the American Academy of Child and Adolescent Psychiatry.
llOO
will not bother you if you have a gun" (Price et al., 1991). In the Boston public schools. the most common weapon chosen was a knife, with 259 knives discovered. compared to 5 guns, during 1996-1997. Other weapons frequently discovered in this urban school system included 62 razors and 28 mock guns. while mace, shod feet. lead pipes, rocks, hammers, clubs, scissors, bullets, lighters. firecrackers, smoke bombs, wrenches. screwdrivers. machetes. and slingshots were found at lower frequencies. School officials may ask psychiatrists to evaluate children who carry weapons at school. They may be concerned that these students are psychologically troubled, and they may want to know whether these students are endangering themselves or others. To maintain acceptable safety risks to the school, psychiatrists may be asked to assesswhether it is safe to allow students to return to school, or whether they would benefit from an alternative placement. The psychiatrist also may determine whether weapon-carrying behavior is the presenting symptom of or associated with a psychiatric condition, advise the school on how to address students' mental health and social needs, and advocate for services or interventions that reduce the risk of violence. Such a comprehensive psychiatric evaluation in school settings includes a violence history that focuses on weapon carrying (Pinel, 1998). First, inquire about the incident at school and determine the extent and frequency of the child's weaponcarrying behavior. Find out whether anyone was hurt in the incident and whether the youth regrets what happened. Ask what kind of weapon was involved and how it was discovered (e.g.• because the student was searched, because he or she showed it to others and was turned in. or because the weapon was seen by a teacher). Has the student brought a weapon to school before. but evaded discovery. even in the presence of security devices such as metal detectors (Noguera. 1995)? How the weapon was discovered by school staff may relate to the purposes the student had in carrying the weapon. For example, students whose weapons "accidentally" fall out of a coat pocket may claim innocence or the need for protection. whereas students who show weapons to others may do so to impress peers or to intimidate individuals with whom they intend to fight. Identify the owner of the weapon and how it was obtained. Students typically acknowledge that the weapon belonged to
J. AM. ACAD. CHILD ADOLESC:. PSYCHIATRY, .>7:10. OCTOBER 1998
C LI N IC AL PERSPECTIVES
themselves, friends , siblings, or an unknown source . Was the weapon purchased from a peer, brought from home, or found on the street? Ask whether the weapon was borrowed, because 30% of adolescent gun owners lend guns to others (Ash et al., 1996) . The clinical implications of obtaining weapons by active means (e.g., borrowing, buying) versus passive mean s (e.g., finding) may differ, with active methods raising more concern for safety risks. When weapons are passed or loaned among students, implicated lenders also should receive similar attention. Assess the child's reasons for taking a weapon to school. Everett and Price (1995) found that students carried weapons to impress friends, to feel important, for protection, because friends carried weapons, and to hurt someone. In my experience, several broad clinically derived descriptive categories of students have emerged: deniers, innocents, fearfuls, and defenders. "Deniers" claim ignorance of how the weapon came into their possession. They insist that they did not knowingly carry the weapon into school and claim it was planted in their book bag or locker by an unknown culprit. "Innocents" admit to possessing a weapon but claim they were holding it for someone else or found it. Psychiatrists should ask what the student intended to do with the weapon had it not been discovered. Fear has been associated with an increased risk of weapon carrying among youths of middle school age (Arria er al., 1997). "Fearfuls" are afraid of being threatened or harassed, and because they believe that adults cannot ensure their safety and they cannot protect themselves from harm any other way, they may resort to carrying a weapon if harassed or intimidated. If the student was worried about being attacked at school or hurt in a fight, ask whether he or she carried the weapon to feel safer. Ask the student to consider how the weapon keeps him or her safe, and whether carrying a weapon ensures protection. Develop a "safety plan" with the child who feels afraid en route to or from school. Having been threatened or injured with a weapon and the frequency of fighting at school also are associated with carrying weapons (Durant et al., 1997). "Defenders" encounter ongoing conflicts, and they may show, threaten with, or use their weapons in fights. Some students may carry a weapon to elevate self-esteem , so inquire about a history of being teased or bullied. Psychiatrists should pay attention to how a youth resolves conflict because students might carry weapons to settle disputes. In my sample, most denied intending to commit violence, but if the student reports that he or she intended to injure someone, assess his or her skills and abilities to control arousal, anger, and aggression; resolve conflicts nonviolently; and avoid fighting. In situations of conflict, find out what the "beef" was about, and whether it was "squashed." Ask how the youth handles being "dissed" by peers and whether carrying a weapon enhances status respect. Some
adoles cents, particularly minority youths who feel marginalized by society, may take justice into their own hands and seek revenge when they feel victimized or perceive disrespect (Ward, 1995). Snyder and Sickmund (1995) reported that 28% of inner-city high school students believe it is "okay to shoot someone who hurts or insult s you." Does the youth feel there are situations in which it is acceptable to get revenge? Is a person ever justified in shooting or stabbing someone? Other issues may motivate a child to carry a weapon at school besides the child's stated reasons. Weapon carrying may represent the child's way of coping with traumatic exposure to family or peer violence or lack of adult involvement or support. The youth's adaptations to such an environment may include identification with the violent behavior of stronger peers, fighting to avoid being labeled a "sucker" (Rich and Stone, 1996), or fatalistic "not caring" about living or dying. Other students may be influenced by the "contagion effect." If students perceive that those who carry weapons are safer or that they are in more danger when others carry weapons, they may see no other option (Hemenway er al., 1996). Adolescents who perceive that classmates possess guns at school are more likely to take a weapon to school themselves for protection. They are also more likely to avoid school (Martin et aI., 1996). In addition to enhancing feelings of safety and power, weapon carrying may stimulate other emotions such as anxiery (e.g., if stopped by police), energy, or excitement (Ash, 1996). Youths are more likely to own a gun if they believe that wounded pride is best repaired by fighting, if they feel comfortable with aggression, and if they derive excitement and stimulation and feel more powerful and safe with a gun (Shapiro et al., 1997). Ask the student about these feelings, as well as about cou nreraggressive fantasies . like shooting or stabbing someone who was disrespectful. In the face of attitude s and feelings that indicate attraction to weapons , consider whether restraint from aggression is possible. What threat or conflict would convince a youth who carries a weapon to then use it to injure someone, and what factors (e.g., moral beliefs, empathic capacities) might prevent this action? Ask whether the youth is aware of the consequences of violence . By understanding the range of attitudes, feelings, and beliefs that weapons evoke, the psychiatrist can perform a risk assessment by comparing the youth's attraction to violence with his or her level of restraint. Address family responses to aggression, weapons, fighting, and the youth's weapon-carrying behavior. What overt or covert messages about violence has the family given the youth? Is self-defense condoned, even if it means using a weapon? Other members of the family may own or carry weapons. Ask about firearm safery issues, includ ing where guns and bullets are stored and whether they are kept locked. Inquire whether the youth ever played with a family member's gun (e.g., shot tin cans or
J. AM . AC AD . C H IL O ADO LESC. P SYCHI ATRY , 3 7 : 10 . OC T O BER 199 8
1101
PITTEL
TABLE 1
Ash P, Kellermann A. Fuqua-Wh irley D. Johnson A (1996), Gun acquisition and use by juvenile offenders.]AMA 275:1754-1 758 Centers for Disease Control and Prevention (1996). CDC Surveillance Summaries : Youth risk behavior surveillance- United States. 1995. MMWR MorbidMortal Wkry R~p 45:No. SS-4. September 27 Durant R. Kahn J. Beckford P, Woods E (1997). The association of weapon carrying and fight ing on schoo l property and oth er health risk and problem behaviors among high school students. Arch PediatrAdoles« M~d 151:360-366 Everett S. Price JH (1995). Students' perceptions of violence in the public schools: the Merl.ife survey.] Adolesc Health 17:345-352 Hausman A. Spivak H, Prothrow-Stirh D (1994). Adolescents' knowledge and ani tudes about and experience with violence . ] Adale« Health 15:400-406 Hemenway D. Prorhrow-Srirh D. BergsteinJM. Ander R. Kennedy B (1996). Gun carrying among adolescents. Law Contemp Prob/ 59:101-115 Kachur S. Stennies G. Powell K er a!. (1996). School-associated violent deaths in the United States. 1992 10 1994.]AMA 275:1729-1733 Kingery P, Pruitt B. Heuberger G (1996). A profile of rural Texasadolescents who carry handguns to school. ] Sch Health 66:18-22 Martin S. SadowskiL. Collen N. McCarraher D (1996). Response of AfricanAmerican adolescents in North Carolina to gun carrying by school mates.] Sch H~alth 66:23-26 Noguera P (1995), Preventing and producing violence: a critical analysis of responses to school violence. Harv Educ Re» 65:189-212 Pittel E (1998), Observation, interview.and mental status assessment: violent. In: Handbook of Child and Adolescent Psychiatry. Harrison S. Eth S. eds, New York: Wiley. pp 483-495 Price J, Desmond S, Smith D (1991). A preliminary investigation of inner city adolescents' perceptions of guns.] Sch Health 61:255- 259 Rich J. Stone D (l996). The experience of violent injury for young AfricanAmer ican men : the mean ing of being a "sucker." ] Gen Inurn M~d 11:7 7-82 Shapiro J. Dorman R. Burkey W. Welker C. Clough J (l997). Development and factor analysis of a measure of youth an itudes toward guns and violence.] Clin Child Psycho!26:311-320 Sheley J, McGee Z. Wright J (l 992), Gun -related violence in and around inner-city schools. Am] Dis Child 146:677-682 Snyder H. Sickmund M (1995), [uuenile Offintkrs and Victims: A National Report. Washington , DC : Office of Juvenile Justice and Delinquency Prevention US Department of Education , National Center for Education Statistics (1998), Violence and Discipline Problems in US PublicSchools: 1996-91 (FRSS 63. NCES 98-030). Washington. DC: US Government Printing Office Ward J (1995), Cultivating a morality of care in African American adolescents: a culture-based model of violence prevention. Harv Educ Rev 65:175-188
Additional Questions to Ask When Taking a Weapons H istory • Does anyone yo u know own or carry a weapon? • Do an y of your classmates carr y a weapon to school? • Where do you feel safest- ho me. school. yo uth cent er, church . neighborhood . playground, etc .? • Do you worry about being shot o r stabbed? • Have you ever held a gun. po inted a gun at someone. or fired a gun ? What were the circumstances? • If you have ever carried a gun. what made you decide the first time to do it? • Do you carry a weapon outside of school? Where do you take it ? • What do other kids in school think of your carrying a weapon? • Do you think owning a weapon is fun? • Do you ever wonder how it would feel to shoot or stab someone? • If you used a weapon to injure someone. would you think about his or her feelings? Would you regret it? • Have you ever used a weapon to hurt someone badly? • When someone you know is killed . do you think about his or her fami ly's feelings? • Are there any young ch ildren at home who might play with a weapon? • If your parents knew yo u had a weapon . what would they say?
birds) . Has there ever been an accidental injury at home due to a weapon? As part of a full psychiatric evaluation. psychiatrists should attempt to understand the complex psychosocial issues that may lead a child to obtain, carry, and use a weapon . In addition to the questions provided in this article, the psychiatrist may wish to pursue other questions when taking a violence history (Table 1). By listening openly to the child's description of seemingly "senseless" acts of violence, the psychiatrist can make "sense" of weapon carrying as a complex symptom with psychiatric implications.
REFERENCES Arria A. Borges G. Anthon y J (1997). Fears and other suspected risk factors for carrying lethal weapons among urban youths of middle-school age. Arch Pediatr AdolescMed 151 :555- 560
1102
J.
AM . ACAD. CHILD AD OLE SC . PS YC H IAT RY. 37:10. O CT OB ER 19 98
Associate Editor: Michael S. [ellinek, M.D.
PERSPECTIVES
How to Take a Weapons History: Interviewing Children at Risk for Violence at School ELLIOT M. PITTEL, M.D.
Violence is prevalent and has been escalating in U.S. schools. One in 10 public schools reported at least one serious violent incident (defined as murder, sexual assault. suicide, physical attack or fight with a weapon, or robbery) during 1996-1997 (U.S. Department of Education, 1998). A nationwide survey reported 15% of students had been in a physical fight. 8% were threatened or injured with a weapon at school during the preceding 12 months, and 4% had missed at least 1 day of school because they felt unsafe at or en route to school during the preceding 30 days; in the same period. 9.8% reported carrying weapons on school property (Centers for Disease Control and Prevention, 1996). There were 11,000 incidents of attacks or fights in which weapons were used during 19961997 (U.S. Department of Education, 1998). Between 1992 and 1994 there were 76 student deaths from violence; most involved firearms and knives and started with interpersonal disputes (Kachur et al., 1996). School-related violence often stems from factors originating outside of school. Youths who are victims of gun-related violence at school often have male family members who routinely carry guns or use or sell drugs (Sheley et al., 1992). Carrying a weapon at school has been associated with alcohol use and being offered. given, or sold illicit drugs (Durant et al., 1997). In rural areas, high school students who carry guns at school may be prone to physical fighting. victimization, entering dangerous situations. and cocaine use (Kingery et al., 1996). Youths often justify carrying weapons because they erroneously believe weapons will prevent fights and make them safer. Of more than 400 adolescents surveyed in Boston, only 55% acknowledged that carrying a gun increases the risk of death or injury (Hausman et aI.• 1994); half agreed that "people
Accepted May 8. 1998. Dr. Pinel is a consultant to the Barron Assessment and Counseling Centerof the Boston PublicSchools, a staffpsychiatrist affiliatedwith the LemuelShattuck Hospital, Boston, and Assistant Clinical Professor, Department of Psychiatry, Division ofChild and Adolescent Psychiatry, New EnglandMedicalCenterand Tufts University SchoolofMedicine, Boston. The author thanks Sher Quaday ofthe HarvardSchoolofPublicHealthand Sharon Hogan[ar editorialassistance. Reprint requests to Dr. Pinel, Youth Services Program, Lemuel Shattuck Hospital. 170 Morton Street, Jamaica Plain, MA 02130. 0890-8567/98/371O-1100/$03.00/0© 1998 by the American Academy of Child and Adolescent Psychiatry.
llOO
will not bother you if you have a gun" (Price et al., 1991). In the Boston public schools. the most common weapon chosen was a knife, with 259 knives discovered. compared to 5 guns, during 1996-1997. Other weapons frequently discovered in this urban school system included 62 razors and 28 mock guns. while mace, shod feet. lead pipes, rocks, hammers, clubs, scissors, bullets, lighters. firecrackers, smoke bombs, wrenches. screwdrivers. machetes. and slingshots were found at lower frequencies. School officials may ask psychiatrists to evaluate children who carry weapons at school. They may be concerned that these students are psychologically troubled, and they may want to know whether these students are endangering themselves or others. To maintain acceptable safety risks to the school, psychiatrists may be asked to assesswhether it is safe to allow students to return to school, or whether they would benefit from an alternative placement. The psychiatrist also may determine whether weapon-carrying behavior is the presenting symptom of or associated with a psychiatric condition, advise the school on how to address students' mental health and social needs, and advocate for services or interventions that reduce the risk of violence. Such a comprehensive psychiatric evaluation in school settings includes a violence history that focuses on weapon carrying (Pinel, 1998). First, inquire about the incident at school and determine the extent and frequency of the child's weaponcarrying behavior. Find out whether anyone was hurt in the incident and whether the youth regrets what happened. Ask what kind of weapon was involved and how it was discovered (e.g.• because the student was searched, because he or she showed it to others and was turned in. or because the weapon was seen by a teacher). Has the student brought a weapon to school before. but evaded discovery. even in the presence of security devices such as metal detectors (Noguera. 1995)? How the weapon was discovered by school staff may relate to the purposes the student had in carrying the weapon. For example, students whose weapons "accidentally" fall out of a coat pocket may claim innocence or the need for protection. whereas students who show weapons to others may do so to impress peers or to intimidate individuals with whom they intend to fight. Identify the owner of the weapon and how it was obtained. Students typically acknowledge that the weapon belonged to
J. AM. ACAD. CHILD ADOLESC:. PSYCHIATRY, .>7:10. OCTOBER 1998
C LI N IC AL PERSPECTIVES
themselves, friends , siblings, or an unknown source . Was the weapon purchased from a peer, brought from home, or found on the street? Ask whether the weapon was borrowed, because 30% of adolescent gun owners lend guns to others (Ash et al., 1996) . The clinical implications of obtaining weapons by active means (e.g., borrowing, buying) versus passive mean s (e.g., finding) may differ, with active methods raising more concern for safety risks. When weapons are passed or loaned among students, implicated lenders also should receive similar attention. Assess the child's reasons for taking a weapon to school. Everett and Price (1995) found that students carried weapons to impress friends, to feel important, for protection, because friends carried weapons, and to hurt someone. In my experience, several broad clinically derived descriptive categories of students have emerged: deniers, innocents, fearfuls, and defenders. "Deniers" claim ignorance of how the weapon came into their possession. They insist that they did not knowingly carry the weapon into school and claim it was planted in their book bag or locker by an unknown culprit. "Innocents" admit to possessing a weapon but claim they were holding it for someone else or found it. Psychiatrists should ask what the student intended to do with the weapon had it not been discovered. Fear has been associated with an increased risk of weapon carrying among youths of middle school age (Arria er al., 1997). "Fearfuls" are afraid of being threatened or harassed, and because they believe that adults cannot ensure their safety and they cannot protect themselves from harm any other way, they may resort to carrying a weapon if harassed or intimidated. If the student was worried about being attacked at school or hurt in a fight, ask whether he or she carried the weapon to feel safer. Ask the student to consider how the weapon keeps him or her safe, and whether carrying a weapon ensures protection. Develop a "safety plan" with the child who feels afraid en route to or from school. Having been threatened or injured with a weapon and the frequency of fighting at school also are associated with carrying weapons (Durant et al., 1997). "Defenders" encounter ongoing conflicts, and they may show, threaten with, or use their weapons in fights. Some students may carry a weapon to elevate self-esteem , so inquire about a history of being teased or bullied. Psychiatrists should pay attention to how a youth resolves conflict because students might carry weapons to settle disputes. In my sample, most denied intending to commit violence, but if the student reports that he or she intended to injure someone, assess his or her skills and abilities to control arousal, anger, and aggression; resolve conflicts nonviolently; and avoid fighting. In situations of conflict, find out what the "beef" was about, and whether it was "squashed." Ask how the youth handles being "dissed" by peers and whether carrying a weapon enhances status respect. Some
adoles cents, particularly minority youths who feel marginalized by society, may take justice into their own hands and seek revenge when they feel victimized or perceive disrespect (Ward, 1995). Snyder and Sickmund (1995) reported that 28% of inner-city high school students believe it is "okay to shoot someone who hurts or insult s you." Does the youth feel there are situations in which it is acceptable to get revenge? Is a person ever justified in shooting or stabbing someone? Other issues may motivate a child to carry a weapon at school besides the child's stated reasons. Weapon carrying may represent the child's way of coping with traumatic exposure to family or peer violence or lack of adult involvement or support. The youth's adaptations to such an environment may include identification with the violent behavior of stronger peers, fighting to avoid being labeled a "sucker" (Rich and Stone, 1996), or fatalistic "not caring" about living or dying. Other students may be influenced by the "contagion effect." If students perceive that those who carry weapons are safer or that they are in more danger when others carry weapons, they may see no other option (Hemenway er al., 1996). Adolescents who perceive that classmates possess guns at school are more likely to take a weapon to school themselves for protection. They are also more likely to avoid school (Martin et aI., 1996). In addition to enhancing feelings of safety and power, weapon carrying may stimulate other emotions such as anxiery (e.g., if stopped by police), energy, or excitement (Ash, 1996). Youths are more likely to own a gun if they believe that wounded pride is best repaired by fighting, if they feel comfortable with aggression, and if they derive excitement and stimulation and feel more powerful and safe with a gun (Shapiro et al., 1997). Ask the student about these feelings, as well as about cou nreraggressive fantasies . like shooting or stabbing someone who was disrespectful. In the face of attitude s and feelings that indicate attraction to weapons , consider whether restraint from aggression is possible. What threat or conflict would convince a youth who carries a weapon to then use it to injure someone, and what factors (e.g., moral beliefs, empathic capacities) might prevent this action? Ask whether the youth is aware of the consequences of violence . By understanding the range of attitudes, feelings, and beliefs that weapons evoke, the psychiatrist can perform a risk assessment by comparing the youth's attraction to violence with his or her level of restraint. Address family responses to aggression, weapons, fighting, and the youth's weapon-carrying behavior. What overt or covert messages about violence has the family given the youth? Is self-defense condoned, even if it means using a weapon? Other members of the family may own or carry weapons. Ask about firearm safery issues, includ ing where guns and bullets are stored and whether they are kept locked. Inquire whether the youth ever played with a family member's gun (e.g., shot tin cans or
J. AM . AC AD . C H IL O ADO LESC. P SYCHI ATRY , 3 7 : 10 . OC T O BER 199 8
1101
PITTEL
TABLE 1
Ash P, Kellermann A. Fuqua-Wh irley D. Johnson A (1996), Gun acquisition and use by juvenile offenders.]AMA 275:1754-1 758 Centers for Disease Control and Prevention (1996). CDC Surveillance Summaries : Youth risk behavior surveillance- United States. 1995. MMWR MorbidMortal Wkry R~p 45:No. SS-4. September 27 Durant R. Kahn J. Beckford P, Woods E (1997). The association of weapon carrying and fight ing on schoo l property and oth er health risk and problem behaviors among high school students. Arch PediatrAdoles« M~d 151:360-366 Everett S. Price JH (1995). Students' perceptions of violence in the public schools: the Merl.ife survey.] Adolesc Health 17:345-352 Hausman A. Spivak H, Prothrow-Stirh D (1994). Adolescents' knowledge and ani tudes about and experience with violence . ] Adale« Health 15:400-406 Hemenway D. Prorhrow-Srirh D. BergsteinJM. Ander R. Kennedy B (1996). Gun carrying among adolescents. Law Contemp Prob/ 59:101-115 Kachur S. Stennies G. Powell K er a!. (1996). School-associated violent deaths in the United States. 1992 10 1994.]AMA 275:1729-1733 Kingery P, Pruitt B. Heuberger G (1996). A profile of rural Texasadolescents who carry handguns to school. ] Sch Health 66:18-22 Martin S. SadowskiL. Collen N. McCarraher D (1996). Response of AfricanAmerican adolescents in North Carolina to gun carrying by school mates.] Sch H~alth 66:23-26 Noguera P (1995), Preventing and producing violence: a critical analysis of responses to school violence. Harv Educ Re» 65:189-212 Pittel E (1998), Observation, interview.and mental status assessment: violent. In: Handbook of Child and Adolescent Psychiatry. Harrison S. Eth S. eds, New York: Wiley. pp 483-495 Price J, Desmond S, Smith D (1991). A preliminary investigation of inner city adolescents' perceptions of guns.] Sch Health 61:255- 259 Rich J. Stone D (l996). The experience of violent injury for young AfricanAmer ican men : the mean ing of being a "sucker." ] Gen Inurn M~d 11:7 7-82 Shapiro J. Dorman R. Burkey W. Welker C. Clough J (l997). Development and factor analysis of a measure of youth an itudes toward guns and violence.] Clin Child Psycho!26:311-320 Sheley J, McGee Z. Wright J (l 992), Gun -related violence in and around inner-city schools. Am] Dis Child 146:677-682 Snyder H. Sickmund M (1995), [uuenile Offintkrs and Victims: A National Report. Washington , DC : Office of Juvenile Justice and Delinquency Prevention US Department of Education , National Center for Education Statistics (1998), Violence and Discipline Problems in US PublicSchools: 1996-91 (FRSS 63. NCES 98-030). Washington. DC: US Government Printing Office Ward J (1995), Cultivating a morality of care in African American adolescents: a culture-based model of violence prevention. Harv Educ Rev 65:175-188
Additional Questions to Ask When Taking a Weapons H istory • Does anyone yo u know own or carry a weapon? • Do an y of your classmates carr y a weapon to school? • Where do you feel safest- ho me. school. yo uth cent er, church . neighborhood . playground, etc .? • Do you worry about being shot o r stabbed? • Have you ever held a gun. po inted a gun at someone. or fired a gun ? What were the circumstances? • If you have ever carried a gun. what made you decide the first time to do it? • Do you carry a weapon outside of school? Where do you take it ? • What do other kids in school think of your carrying a weapon? • Do you think owning a weapon is fun? • Do you ever wonder how it would feel to shoot or stab someone? • If you used a weapon to injure someone. would you think about his or her feelings? Would you regret it? • Have you ever used a weapon to hurt someone badly? • When someone you know is killed . do you think about his or her fami ly's feelings? • Are there any young ch ildren at home who might play with a weapon? • If your parents knew yo u had a weapon . what would they say?
birds) . Has there ever been an accidental injury at home due to a weapon? As part of a full psychiatric evaluation. psychiatrists should attempt to understand the complex psychosocial issues that may lead a child to obtain, carry, and use a weapon . In addition to the questions provided in this article, the psychiatrist may wish to pursue other questions when taking a violence history (Table 1). By listening openly to the child's description of seemingly "senseless" acts of violence, the psychiatrist can make "sense" of weapon carrying as a complex symptom with psychiatric implications.
REFERENCES Arria A. Borges G. Anthon y J (1997). Fears and other suspected risk factors for carrying lethal weapons among urban youths of middle-school age. Arch Pediatr AdolescMed 151 :555- 560
1102
J.
AM . ACAD. CHILD AD OLE SC . PS YC H IAT RY. 37:10. O CT OB ER 19 98