Preteen girls more likely than boys to retaliate

Girls in middle and elementary schools involved in violent incidents may be more likely than boys of the same age to be retaliating for a previous event, to experience the violence at home, and to have a family member intervene. Researchers at The Children's Hospital of Philadelphia surveyed 190 children aged 8 to 14 brought to the hospital's emergency department for injuries caused by interpersonal violence.

The study appeared in the June issue of the Archives of Pediatric and Adolescent Medicine. "Although interpersonal violence is not uncommon among pre-adolescent and young adolescent girls, little research has focused specifically on females," said Cynthia J. Mollen, M.D., an emergency medicine physician at The Children's Hospital of Philadelphia, and first author of the study. "If health care providers know more about specific patterns of violence, they may be able to better prevent future incidents." In the study, research assistants interviewed a sample of patients presenting to the hospital's emergency department during a one-year period.

The researchers used a survey they had previously developed in focus group sessions with urban youth at a local community center. Injuries that were unintentional, self-inflicted or caused by child abuse were not included in the study, and the researchers chose children aged 14 and younger, to exclude most cases of dating violence.

After obtaining consent from the patients and parents, the researchers usually interviewed the children without the parent being present. Of the 190 patients studied, 58 (31 percent) were female and 132 (69 percent) were male. Seventy-eight, or 40 percent, of the patients were less than 12 years old, and still in elementary school. The vast majority of the injuries (88 percent) were classified as minor; of the 22 remaining injuries, including concussions and fractures, only one occurred in a female. For most of their analyses, the researchers compared violent events involving at least one girl (74 events) to those involving only boys (116 events).

The patients classified 67 percent of the events as fights and 30 percent of the incidents as assaults, in which the patient did not respond physically to the attack. For both genders, the most common reason for a fight was "being disrespected" or "teasing," but in contrast to male-only incidents, female- involved events were more commonly a recurrence of a previous fight. The most common site of the violent event was school, but incidents involving females were more likely than all-male incidents to occur at home. Furthermore, among females, a family member was more likely to intervene to stop the violence.

Weapons were more often present in events involving at least one female, and females were more likely than males to be injured by a weapon, especially blunt objects such as sticks or rocks. Weapons could be unlikely objects, including clothes hangers and rollerblades. Only five of the 190 patients had firearm injuries. "While much further research remains to be done on interpersonal violence involving children, this study provides information for parents and caregivers," said Dr. Mollen. "For instance, because 'disrespect' appears so prominently as a trigger for violence, children and parents could benefit by learning techniques for responding to perceived insults in a nonviolent manner.

We know from previous research that a parent's attitude about appropriate triggers for violence has an effect on children's behavior. "In addition," she added, "because girls were more likely to offer retaliation as a reason for violence, healthcare providers could screen injured girls about their safety concerns and their plans for retaliation. Understanding gender differences in violent behavior could help us in designing school-based and community intervention programs for children in this age group."

The researchers identified the patients in the study through the Violence Intervention Project, an ongoing health surveillance program at Children's Hospital and the Hospital of the University of Pennsylvania that refers violently injured youth to appropriate community organizations. Co-authors of the study with Dr. Mollen were emergency medicine physicians Joel A. Fein, M.D. and Dennis R. Durbin, M.D., of The Children's Hospital of Philadelphia, and A. Russell Localio, J.D., M.P.H., of the Center for Clinical Epidemiology and Biostatistics of the University of Pennsylvania. The American Academy of Pediatrics and the William Penn Foundation supported the study through the Ken Graff Young Investigator Award.