Risk and protective factors as predictors of outcome in adolescents with psychiatric disorder and aggression

To identify predictors of behavioral outcomes in high-risk adolescents with aggression and serious emotional disturbance (SED).

Three hundred thirty-seven adolescents from a statewide North Carolina treatment program for aggressive youths with SED were followed between July 1995 and June 1999 from program entry (T1) to approximately 1 year later (T2). Historical and current psychosocial risk and protective factors as well as psychiatric symptom severity at T1 were tested as predictors of high and low behavioral functioning at T2. Behavioral functioning was a composite based on the frequency of risk-taking, self-injurious, threatening, and assaultive behavior.

Eleven risk and protective factors were predictive of T2 behavioral functioning, while none of the measured T1 psychiatric symptoms was predictive. A history of aggression and negative parent-child relationships in childhood was predictive of worse T2 behavior, as was lower IQ. Better T2 behavioral outcomes were predicted by a history of consistent parental employment and positive parent-child relations, higher levels of current family support, contact with prosocial peers, higher reading level, good problem-solving abilities, and superior interpersonal skills.

Among high-risk adolescents with aggression and SED, psychiatric symptom severity may be a less important predictor of behavioral outcomes than certain risk and protective factors. Several factors predictive of good behavioral functioning represent feasible intervention targets.