Violent Juvenile Delinquents
Treatment Effectiveness and Implications for Future Action
David C. Tate
N. Dickon Reppucci
Edward P. Mulvey
Traditionally, the juvenile justice system has emphasized
the goals of treatment and rehabilitation of young offenders, while protecting them from punishment, retribution,
and stigmatization. Violent juvenile offenders have posed
a challenge to this rehabilitative ideal because of mounting
public pressure to ensure societal protection. Juveniles who
are perceived as dangerous or persistent in their criminal
activity are increasingly transferred to the adult criminal
justice system, where they may receive much harsher consequences. Whether violent delinquents can be successfully
treated is a key point in the debate regarding the wisdom
of this trend in juvenile justice. This article considers the
available research to address the policy question of how
society should reasonably invest in the treatment of violent
juvenile offenders.
H
istorically, the philosophy of the juvenile court
has emphasized the goals of treatment and rehabilitation and downplayed the role of punishment and retribution (Reppucci & Crosby, 1993). In recent years, community protection, punishment, and retribution appear to have gained ascendancy and been
openly accepted as the legitimate primary objectives for
the juvenile court, especially in cases of violent youth
(Grisso, 1993). For example, many states (e.g., New York
and Virginia) have changed laws, allowing younger juveniles who commit a broader range of offenses to be
transferred to adult criminal court, where they usually
receive harsher punitive measures (Poulos & Orchowsky,
1994). In addition, many juvenile court judges favor
tough-minded changes that would make the juvenile court
more like the adult system. For example, 40% of the juvenile court judges in one study believe there are circumstances under which juveniles should face the death penalty (Sherman, 1994).
These changes and debates about the future of juvenile justice rest partially on a judgment about whether
violent adolescent offenders can be successfully rehabilitated. Lack of successful treatment for this group could
be used to support the use of more retributive, proportionality-based approaches to disposition, whereas the
existence of effective treatment has potential both to
challenge retributive policies and to argue for the wisdom
of retaining more individualized judgments. This article
September 1995 • American Psychologist
Copyright 1995 by the American Psychological Association, Inc. 0003-066X/95/S2.00
Vol. 50. No. 9. 777-781
University of Virginia
University of Virginia
Western Psychiatric Institute and Clinic, University of
Pittsburgh School of Medicine
briefly reviews the literature about the effectiveness of
strategies used in treating violent adolescents as part of
the effort to address an important policy question: Should
society continue to invest in the treatment of violent juvenile offenders?
Problems in Evaluating Interventions
With Violent Youth
A number of problems arise when trying to evaluate our
knowledge of the interventions with violent juveniles.
First, violence and violent offenders have been denned in
multiple ways. Whereas some studies have used the Federal Bureau of Investigation's (1991) definition of violent
offenses to define group membership, others have conceptualized violence more generally. Throughout the research literature, the terms violence and aggression are
often used interchangeably, even though aggression is a
broader term that includes "the entire spectrum of assertive, intrusive, or attacking behaviors"; violence may
be considered a subset of aggression (Leventhal, 1984).
Ambiguity about what constitutes violence has led to a
diversity of samples being designated as violent juvenile
offenders, including incarcerated adolescents from detention centers or residential institutions, children and adolescents who are being treated in mental hospitals, and
noninstitutionalized individuals who have been identified
as aggressive. In addition, even within specific groups of
individuals, a considerable amount of heterogeneity exists
with regard to the use and meaning of aggressive behavior
(Dodge, 1991). Consideration of these different sampling
sources and individual meanings of violence is rarely undertaken; instead, juvenile offenders are described with
a range of ill-defined adjectives, including violent, aggressive, chronic, serious, and antisocial. Thus, comparisons between studies are difficult.
A second problem is that few studies evaluating
treatment of violent and aggressive adolescents are without methodological flaws (Sechrest & Rosenblatt, 1987).
Studies consistently lack adequate no-treatment, cornDavid C. Tate and N. Dickon Reppucci, Department of Psychology,
University of Virginia; Edward P. Mulvey, Western Psychiatric Institute
and Clinic, University of Pittsburgh School of Medicine.
Correspondence concerning this article should be addressed to David
C. Tate, Department of Psycholology, University of Virginia, Gilmer
Hall, Charlottesville, VA 22903-2477.
777
parison-treatment, or attention-only control groups and
often focus solely on the outcome of the treatment program without examining the process of how it was implemented and how it currently functions. Most studies
are inadequate in their descriptions of the characteristics
of their samples, the specific nature of the treatment, the
conditions under which the treatment occurred, and possible effects of the administrator of treatment. Without
this information, it is difficult to draw conclusions about
the true potential of the tested intervention and to make
comparisons across programs. Moreover, the interventions tested are often not grounded solidly in a theory
that articulates the specific mechanisms through which
the treatment promotes change (Hawkins & Nederhood,
1987).
Finally, the measurement of outcomes may be problematic. Although recidivism is the outcome measure in
which policymakers are most interested, it is not necessarily a good index of renewed violent behavior. Whether
defined as rearrest, readjudication, or reincarceration,
recidivism involves discretionary judgments of juvenile
justice personnel and therefore does not correspond exclusively to the criminal behavior it is ideally designed to
appraise (Reppucci & Clingempeel, 1978). Few studies
incorporate self-reports or reports of collateral observers,
both of which provide a more comprehensive assessment
of violent behavior.
Interventions With Violent Delinquents
With these methodological shortcomings in mind, we now
review general treatment approaches and specific programs targeted toward youth who demonstrate violent or
aggressive behavior, including violent offenses. Even
though the definitional problem of "violent offenders"
makes it difficult to ascertain that interventions always
deal with the same type of adolescent, we review only
studies in which a majority of the research participants
demonstrated violent behavior, defined as the intentional
use of physical force to inflict harm on another person.
We excluded studies that demonstrated reduced recidivism with nonviolent offenders and studies of programs
for violent offenders that have not been systematically
evaluated (e.g. Agee, 1979). A caveat: Although we have
used a restrictive definition of violent behavior, no systematic study, as far as we can discern, has ever focused
exclusively on juveniles who have committed the sorts of
heinous crimes (e.g., serial killings, torture/rape, and
drive-by shootings) that have engendered fear and loathing
in the public. Although such cases constitute a very small
proportion of "violent" youth, the research we present
may not be applicable to them. Moreover, although descriptions exist of youth who have killed their parents
(e.g., Cornell, 1990), these youth are not generally representative of violent youth. For a complete review of the
intervention literature for all juvenile offenders, see Mulvey, Arthur, and Reppucci (1993).
Targets of Treatment: Individuals, Groups, and
Families
Although individual therapeutic approaches—especially
those with insight and relationship emphases—have been
778
the most frequently used strategies for treating delinquents
in general both within institutions and in the community
(Mulvey et al., 1993), they have not been demonstrated
to be effective with violent adolescents (Guerra, Tolan,
& Hammond, 1994). Likewise, although group therapy
is thought to be more cost-effective than individual therapy because of more efficient use of staff time, outcome
research also has given little reason for faith in group
therapy. Studies of guided-group interaction and similar
peer group interventions often used in delinquency treatment programs have not yielded consistent or impressive
positive results (Henggeler, 1989). These findings may be
attributed in part to poor implementation, in that program administrators often have not given careful attention
to leader and participant characteristics or specific elements of the particular treatment modality (Lavin,
Trabka, & Kahn, 1984).
Over the past two decades, family therapy has become an increasingly popular option for the treatment of
delinquents. Although behavioral parent training has been
an extensively studied approach (Gordon & Arbuthnot,
1987; Patterson, DeBaryshe, & Ramsey, 1989) and has
produced favorable results with young, aggressive children
(Barton, Alexander, Waldron, Turner, & Warburton,
1985; Garrett, 1985), little evidence exists to support its
efficacy with violent adolescent offenders (Henggeler,
1989). Moreover, no studies of family therapy per se have
demonstrated success with violent delinquents.
Type of Intervention
Biological interventions.
Several different bio-
logical conditions and neurological processes are hypothesized to be linked to violent behavior, including genetic
influences, neurophysiological abnormalities, and functioning of steroid hormones and neurotransmitter systems
(Reiss & Roth, 1993). Therefore, it is possible that some
violent behavior may be reduced or prevented by altering
relevant neurological states or conditions. Research on
pharmacological interventions in violent correctional
populations is quite rare—most studies examine inpatient
psychiatric populations. There is, no doubt, a subsample
of adolescents for whom organic and neurological impairments are important contributors to their violent behavior; however, our present level of understanding regarding these problems is very limited. Nevertheless, there
is much enthusiasm regarding the future of biological
and pharmacological interventions per se and in their
ability to improve the effectiveness of psychological approaches to treatment (Eichelman, 1988).
Cognitive-behavioral
approaches.
Cognitive
interventions assume that an angry, aggressive state is
mediated through a person's expectations and appraisals
and that the likelihood of violence is increased or decreased as a result of this process. Chronically violent
individuals have constricted problem-solving skills, in part
because of their lowered ability to reason abstractly and
their hostile appraisals of neutral situations (Davis &
Boster, 1992). Such cognitive deficiencies (insufficient
problem-solving skills) and cognitive distortions (dysSeptember 1995 • American Psychologist
functional thinking processes) have been identified as
leading to aggression (Kendall, Ronan, & Epps, 1991).
Studies have now documented the presence of socialcognitive difficulties among violent adolescents (Dodge,
Price, Bachorowski, & Newman, 1990; Lochman &
Dodge, 1994; Slaby & Guerra, 1988). Two prevalent cognitive-behavioral approaches attempt to address these
social-cognitive difficulties.
Social skills training. The most well-studied example of social skills training is Aggression Replacement
Training (ART)-a multimodal, psychoeducational intervention designed to alter the behavior of chronically aggressive youth. It incorporates "skillstreaming" (designed
to teach a broad range of prosocial behaviors), anger control training (a curriculum for modifying anger responses),
and moral reasoning training (Goldstein & Glick, 1994).
Violent youths who received ART, compared with those
who did not, showed significant increases in constructive,
prosocial behaviors, and decreases in rated levels of impulsivity, within the institutional setting. They also advanced significantly in moral reasoning. However, ART
youths did not differ from controls in either the number
or intensity of acting-out behaviors (Goldstein, Glick,
Reiner, Zimmerman, & Coultry, 1986). In sum, ART
shows promise because of its multimodal approach, its
ability to be delivered within secure juvenile correctional
facilities, and its production of some cognitive-behavioral
changes in violent adolescents. However, its effectiveness
for reducing violent behavior both before and after release
of the youth from a correctional facility has yet to be
demonstrated.
Problem-solving skills training. Another cognitive-behavioral technique that has demonstrated some
success is problem-solving skills training. Treatment emphasizes the development of cognitive strategies to increase the adolescent's self-control and social responsivity.
The Viewpoints Training Program, which focused on violent youth, was designed to (a) effect changes in beliefs
and attitudes about the legitimacy of violence in response
to conflict and (b) emphasize specific social problemsolving skills (Guerra & Panizzon, 1986). Guerra and
Slaby (1990) conducted a controlled evaluation study with
a sample of 120 adolescents incarcerated for violent
crimes. Adolescents who attended a 12-session workshop
on social problem solving showed increased skills in solving problems and decreased endorsement of beliefs supporting aggression. In addition, they were rated by staff
as less aggressive and impulsive than an attention control
group and a no-treatment group. There were no group
differences, however, in the number of parole violators
24 months after release.
Multisystemic Therapy: A Promising Program
Multisystemic therapy (MST) may be a cost-effective
strategy for reducing the number of incarcerated youthful
offenders while reducing their antisocial behavior (Henggeler, Melton, & Smith, 1992). To date, it is the only
treatment program to demonstrate short- and long-term
efficacy with chronic, serious, and violent juvenile ofSeptember 1995 • American Psychologist
fenders (Borduin et al., 1994; Henggeler et al., 1992;
Henggeler, Melton, Smith, Schoenwald, & Hanley, 1993).
MST interventions are child-focused, family-centered,
and directed toward solving multiple problems across the
numerous contexts in which youths are embedded: family,
peers, school, and neighborhood. Services are provided
in home and community settings to enhance cooperation
and promote generalization, and interventions are tailored
to the specific needs of the adolescent, the family, and
surrounding systems.
Henggeler et al. (1992) studied 96 youths at risk
for out-of-home placement because of serious criminal
activity. Over half of the youths had been convicted for
a violent offense, and an additional 37% were "chronic
offenders" (three or more nonviolent convictions) who
reported having committed violent offenses. Juveniles
were randomly assigned to MST or the usual Department of Youth Service programs of institutional treatment and community probation and parole. A battery
of measures related to ultimate goals (nonrecidivism)
and instrumental goals (improved family relations, peer
relations, and social competence) was administered before and after treatment. Approximately 59 weeks after
referral, MST youths had half as many arrests as the
usual-service clients, and only 20% of MST participants
(compared with 68% of the usual-service group) were
incarcerated during the period. Family cohesion improved and peer aggression scores decreased significantly
for youths who received MST. Further follow-ups at two
and four years postreferral showed sustained effects in
arrest rate and self-reported offenses (Borduin et al.,
1994; Henggeler et al., 1993). At the four-year followup, MST youths were less likely to be arrested for violent
offenses than youths who received individual therapy,
even after accounting for pretreatment violent crime arrest rates (Borduin et al., 1994). It is important to note
that the relative efficacy of MST was neither moderated
by demographic characteristics (i.e., race, age, social
class, gender, and arrest and incarceration history) nor
mediated by psychosocial variables (i.e., family relations,
peer relations, social competence, behavior problems,
and parental symptomatology).
Conclusions and Policy Implications
The empirical literature on interventions with seriously
violent adolescents is rather limited. Moreover, it offers
little resolution for those looking for a simplistic answer
to the question of whether intervention with violent juveniles is justified by scientific evidence. Clearly no single,
proven effective approach to working with these adolescents exists. There is, however, initial evidence that certain
comprehensive interventions show promise of success.
We know that particular approaches have been developed to an impressive level of sophistication and applied systematically enough by numerous researchers to
produce measurable change in violent adolescents. Specifically, interventions that address the documented social-cognitive skill deficits that exist among violent youths
have been shown to produce change with these youths
779
while incarcerated. We do not, however, have evidence
that these changes endure. The fact that treated adolescents committed further offenses once released suggests
that intervention should be continued on reentry into the
community. Beyond this, we know that comprehensive,
individualized, community-based, family-oriented interventions appear to hold promise and have impressive initial findings of success. The work of Henggeler et al. (1992)
shows positive changes in the behavior of violent youth.
Taken together, these findings have two clear policy
implications. First, social-cognitive interventions should
be encouraged as a critical component of institutional
and community-based programs. Second, and more fundamentally, service provision should be reconceptualized
as an ongoing care model that emphasizes intervention
in multiple spheres of an adolescent's life. The most
promise lies in a comprehensive, long-term commitment,
not in the development of any singular, more powerful
approach.
There is a clear need for methodologically sophisticated studies of treatment effectiveness that are more
precise with regard to their definition of violence and that
either exclusively target or conduct separate analyses for
violent juveniles. However, as the science of program design and evaluation continues to become more refined
(e.g., Palmer, 1994), psychologists' abilities to draw
meaningful conclusions about the effectiveness of interventions with violent juveniles will also expand. Psychologists can contribute significantly to the development
and refinement of public policies by (a) replicating the
findings of promising prevention and intervention programs, (b) specifying the conditions under which and the
populations with which these interventions work best, (c)
clarifying unique characteristics and different typologies
of violent adolescents (e.g., Cornell, Benedek, & Benedek,
1987), (d) exploring specific childhood risk and buffering
factors that promote or inhibit future violent behavior,
and (e) developing more valid and reliable means of risk
assessment.
The public's reaction to increasing rates of youth
violence has resulted in recent policy initiatives that have
centered on offense-based punishments. Several states
have increased the number of crimes and lowered the age
for which transfer from the juvenile to the adult court is
possible or automatic. Moreover, the courts have now
developed minimum sentencing for specific offenses, some
of which are crimes against persons, but others are not.
This approach may be necessary for a small subgroup of
youths who may be too dangerous or incorrigible to treat
in any fashion other than long-term incarceration.
The problem with these approaches comes from the
difficulty of determining to whom they should apply.
Clearly, a small group of juvenile offenders is responsible
for a large proportion of violent offenses (Farrington,
1991; Grisso, 1993), but the methods for identifying these
adolescents early in their careers are still being developed
(Loeber & LeBlanc, 1990). Offense-based strategies unfortunately assume that adolescents who commit a violent
act are a homogeneous group and should be treated ac780
cordingly. This does not take into account individual differences, such as adolescents' maturity, competence, and
judgment in decision making (Scott, Reppucci, & Woodward, 1995), or circumstances that may make a youth
more or less amenable to treatment (Mulvey, 1984). The
result will be an overidentification of potentially repetitively violent adolescents, with a larger number automatically subjected to an adult court system that focuses
on punishment rather than rehabilitation.
There are two potential costs to this approach. The
first is economic. Surprisingly, treatment programs that
work may be much less costly than correctional incarceration. In 1992, it cost an average of $105.27 per day
to keep a juvenile in a correctional facility (Camp &
Camp, 1993). This figure may be compared with $31.43
per day for MST-approximately $3,300 per client for 15
weeks of treatment (S. W. Henggeler, personal communication, July 25, 1994). In addition to saving on programming costs, successful treatment would reduce costs
associated with recidivism, including court costs, additional time in correctional facilities, and costs to victims.
The second cost is the rippling effect that retributive
strategies could have on the search for preventive interventions. Ideally, it would be better to prevent the development of violent behavior, and comprehensive interventions aimed at interrupting the developmental pathways
for violence certainly appear to hold promise (Mulvey,
Arthur, & Reppucci, 1993; Yoshikawa, 1994). Understanding which interventions will be most successful in
preventing youth violence, however, must come from rigorous, long-term evaluation studies of promising prevention programs (see Guerra et al., 1994). Such efforts could
certainly be hindered by a shift of resources and attention
to the goals of retribution.
As mentioned in the beginning of this article, the
policy debate regarding violent delinquents is usually
structured so that empirical support for rehabilitative approaches is taken as a counterweight to the case for punishment or retribution. However, given what we know
and are likely to discover about successful interventions
for these adolescents, this formulation may be counterproductive. It may be futile to frame the question of what
it takes to have an impact with violent juvenile offenders
in terms of whether rehabilitation or punishment is the
most desirable course. This may not be an "either-or"
situation; a combination of the two might be required.
The intensive, comprehensive, community-based approaches may be most acceptable only when they have a
clear monitoring and sanctioning component or after
some period of incarceration. Similarly, the retributive
strategies may only be workable when they incorporate
treatment for selected subgroups of violent offenders. Effective intervention could likely lie somewhere in the
middle, where ideology could give way to reasoned program design.
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