Job Diagnostic Questionnaire
Social Security Disability And Fibromyalgia
Establishing "Disability" For Claimants With Fibromyalgia and Chronic Fatigue Syndrome
Social Security disability benefits are often the ultimate safety net for persons suffering from medical impairments that make it impossible for them to work. For many people, however, struggling through the Social Security Administration's bureaucracy is frustrating, confusing and slow. For people suffering from conditions such as Fibromyalgia and Chronic Fatigue Syndrome, the requirements of the Social Security Act can become overwhelming. This article will explain and simplify in general terms the requirements of the Social Security disability program and describe the application and appeals process.
Two Different Programs - SSDI and SSI
There are two programs under the Social Security Act providing benefits for persons who are unable to work. The first is the Social Security Disability Insurance (SSDI) program found in Title II of the Social Security Act. The second is the Supplemental Security Income program contained in Title XVI of the Social Security Act. The medical test for both programs is identical. The differences are in the non-medical eligibility requirements.
Non-Medical Requirements
SSDI benefits are paid to totally disabled individuals who have worked and paid into the Social Security system with the FICA taxes that are deducted from paychecks. These FICA taxes are analogous to insurance premiums paid for automobile, homeowners or other private insurance. The FICA payments, which are matched by employers, buy coverage under the Social Security Retirement, Disability and Medicare programs. For SSDI, there are two requirements: a worker must have worked and paid FICA taxes for at least 40 quarters lifetime (10 years) and, also 20 quarters had to have been paid in during the ten years prior to the date of becoming totally disabled. For example, a 40 year-old Claimant who became disabled in 2003 would have had to have worked and paid FICA taxes for at least 10 years during his lifetime, and for at least 5 years between 1992 and 2002.
If approved for SSDI the Social Security Administration pays a monthly benefit based upon how much was earned and paid into the Social Security system. Benefits are also paid to dependent children who are under 16 years old, or who are under 18 years old and still in high school. Medicare eligibility begins twenty-nine months after the onset date of total disability.
The SSI program requires that an individual be totally disabled and "indigent." "Indigent" basically means that a single Claimant has little or no income and less than $2,000.00 in non-exempt assets. A home and furniture are not counted. One car is exempt. Bank accounts, IRAs, profit sharing plans, cash value life insurance and similar assets are all included in determining assets, even if penalties and taxes would be incurred if the asset were converted to cash. In addition, a spouse's assets and income are "deemed" to the disabled Claimant - this deeming rule wreaks havoc on many disabled persons, particularly the stay-at-home parent.
In 2004 SSI will pay a basic monthly benefit of $564.00 which may be supplemented by some states. A disabled person receiving SSI will also be eligible for food stamps and a Medicaid card from the state.
The Social Security disability program is designed to pay benefits to claimants suffering from medical problems causing symptoms so severe that it becomes impossible to sustain function at any type of work. Issues of employability, job existence, insurability and location or desirability of alternative work will not be considered, although age and education are often important factors. The fact that a person can not do the work performed in the past is usually not determinative. This is a medical program that focuses upon medically proven symptoms and their impact on the ability to perform work activities.
Therefore, the focus in on function, not on diagnosis; SSA often admits that Claimants have medical problems and are "impaired," but denies that they are "totally disabled." The debate is over what the Claimant can "do" despite the medical problems.
The Social Security Administration's Regulations require determination of disability be based upon on "objective proof" of both the medical problem and of the severity of the symptoms. "Objective proof" means the findings contained in medical tests that are not dependent on the patient's subjective responses. A MRI, a cardiac treadmill test, an x-ray and a pulmonary function test are all "objective" tests. Asking a patient if she is in pain is "subjective." In Fibromyalgia and CFS claims, it is often difficult to objectively prove either the existence of the disease, or the severity of the symptoms. This has caused many claims based upon these conditions to be denied - especially at the first two levels of review.
The focus in all disability claims is upon the medical evidence, i.e. the treating physicians' clinical findings, office notes, reports, and medical test results. This evidence is primary and is often more important than the testimony of the Claimant. While a Claimant's description of the impact on daily activities, social functioning and concentration must be considered by SSA, the content of the medical documentation is the most important source of evidence in deciding the claim.
In Fibromyalgia claims the clinical notes and a report of the treating rheumatologist are most important. A 1996 decision by the Seventh Circuit Court of Appeals established that a rheumatologist is the primary source for proof of this disease. Office notes from the rheumatologist should consistently document the positive findings for the tender points which are diagnostic for this disease. In addition, the patient should be complaining at each office visit of the fatigue and pain that are consistent with this condition. A report that establishes that all other causes for the symptoms have been ruled out helps establish the existence of the disease.
Since the extent of fatigue and pain can not be measured, consistency of complaints in the various medical records will be important. The use of pain medications, even if just for trial periods is an important consideration in evaluating the severity of pain. Use of mild analgesics indicates less severe symptoms; prescription of stronger narcotics indicates that the treating specialist felt the pain problems more severe. Also, documentation by the physicians of concentration impairments, and the inability to perform routine daily activities such as housework, shopping, and social functioning, are also factors considered by Social Security Administration decision makers.
Chronic Fatigue Syndrome claims have been made clearer by the adoption of Social Security Ruling 99-2p. This Ruling finally acknowledges that CFS is a medically determinable impairment and describes the various findings that can establish the diagnosis. This Ruling is quite useful and can be found at the SSA's web site, www.ssa.gov. Generally, the focus is on a longitudinal view of the medical evidence and the extent and nature of the treatment provided by the various physicians. The clinical findings and summaries of the patient's complaints in the office notes are critical in terms of establishing the existence of a medical impairment. As to whether the symptoms are totally disabling, SSA will consider the medical opinions, as well as the statements of the Claimant and third parties, as in any other disability claim.
Claimants who suffer from depression should also seek treatment from a mental health professional. Whether the depression is a symptom of the disease, or results from the significant impact on a Claimant's lifestyle, or is a separate disabling medical condition, the treatment notes and histories often lend credibility to the claim. However, SSA will generally not give significant weight to depression treated by a family doctor or social worker - emphasis will always be given to the records and reports of an M.D. psychiatrist or Ph.D. psychologist. Depression does not usually negate the existence of other underlying impairments but instead confirms the severity of their impact. On occasion, this diagnosis provides an alternative theory for an Administrative Law Judge who wishes to award benefits but will not approve a claim based on CFS or Fibromyalgia.
The Application Process
There are multiple levels of review of an application filed under the Social Security Act. In an effort to increase productivity, and decrease processing time, the Social Security Administration is testing different review models across the country. This article will describe the basic system which is still in place throughout most of the United States.
A claim is initiated by filing an application. This can be done over the telephone, on SSA's web site at www.ssa.gov (for SSDI claims only) or, preferably, in person at the local Social Security Administration District Office. The application will require a list of all of the jobs performed during the last 15 years, a list of all medical providers, a list of current medications, names and dates of all prior marriages and divorces, and a copy of the Claimant's birth certificate. Generally our practice is to recommend as much be done with Social Security face to face at the District Offices - this decreases the chance for errors. At the time of this writing, only SSDI claims can be filed over SSA's web site.
After the application is filed, the Social Security Administration will send the file to a Disability Determination Service (DDS) administered by that State. Each state has a contract with SSA to perform the first two levels of review. At the DDS the file will be assigned to an adjudicator who will be responsible for gathering medical documentation, getting any additional information from the Claimant, arranging for consultative examinations and obtaining medical and vocational opinions from the DDS's internal experts. A written decision is issued in about 90 days on average, although the time frame can vary widely. Historically only about 36% of claims are paid at this level.
If denied, the second step is the filing of a Request for Reconsideration at the SSA District Office. A Claimant is allowed 60 days from the date of the initial denial to file this appeal, although there is usually little to gain by waiting. The Request for Reconsideration is also processed by the state DDS. Historically only about 17% of claims are approved at this level and SSA is testing elimination of this step.
The third level of review, for those claims denied at Reconsideration, is the hearing before the Administrative Law Judge (ALJ). These are informal administrative hearings held before independent judges who hear testimony, review the medical records and issue written decisions. While progress had been made in reducing the backlog in setting hearing dates, the delays have been increasing once more. Time frames vary widely across the nation, many hearing offices now take at least twelve months from the date the Request for Hearing is filed to set a hearing date.
The hearing is critical to the review process because it is the only time that a Claimant has the opportunity to see, and talk to, the decision maker. Up until this time all decisions are based upon paper, i.e. medical reports and written questionnaires. This is the only time in the process where the decision maker gets to see and question the Claimant. That face to face observation is critical and in this author's experience is one of the factors causing ALJs to reverse many reconsideration denials.
While all Social Security cases first focus on medical proof, the testimony at an administrative law judge hearing may tip the scale in favor of a sympathetic and credible Claimant. It is important that a Claimant fully explain the limitations and the effects of the disease on their daily activities. Testimony, which is consistent with the medical evidence and credible, can persuade a Social Security judge to award benefits in a claim based upon Fibromyalgia or CFS.
The final two steps in the review process are the Appeals Council, and if unsuccessful, the United States District Court. These reviews are primarily based upon the medical evidence and testimony from the ALJ hearing. Since there is no additional testimony, and very little additional medical evidence can be supplied, these two levels of review are helpful in only a small percentage of claims. The backlog at the Appeals Council is now almost two years.
NOTE: SSA has begun testing different application processes in different parts of the nation. Some Claimants will not have a reconsideration stage; some will not have Appeals Council review. All Claimants will have an opportunity for an Administrative Law Judge hearing.
Representation
This Social Security disability application and appeals process was designed so that Claimants are not required to obtain representation. However, people with representation have much higher success rates. Familiarity with SSA's Regulations, Rulings, the federal caselaw interpreting the Act, and with SSA's internal guidelines called the POMS and HALLEX, help guide preparation of a claim. Representatives do not have to be licensed attorneys and there are paralegals and other non-attorneys who do provide representation.
This author's strong preference is to become involved in a claim as early in the process as possible. The earlier a Claimant understands the issues in her particular situation, and the earlier the review of the existing available medical proof, the greater the chance the assistance will be granted at some point in the process. In addition, care needs to be exercised in the completion of many of the early questionnaires sent by the DDS adjudicators - many answers on these forms end up being twisted and serving as the basis for denials by adjudicators and ALJs.
Almost all attorneys who focus in this area of the law will agree to representation on a contingency fee basis - that means that fees are only awarded in the event of a favorable outcome. In addition, the Social Security Administration always retains the right to review attorney fees.
Conclusion
Many claims for SSDI and SSI benefits are approved for persons with Fibromyalgia and Chronic Fatigue Syndrome. Claimants must have the support of their treating specialists - especially the rheumatologist and/or pain specialist and must maintain good communication regarding their symptoms and limitations. If depression has become an issue then treatment with either a Ph.D. psychologist or M.D. psychiatrist is important. The earlier a Claimant obtains experienced representation the greater the chance for success, and the less stressful the battle through the various levels of appeal and review. Perseverance will prevail and disabled persons can obtain this much needed assistance.
Nothing in this article is intended to be specific legal advice or to create an actual or implied attorney-client relationship. This article has been a brief summary of the basic law and persons seeking benefits should contact experienced representatives for advice upon which they can rely. Hopefully, however, this brief analysis will provide some insight into the disability system.
About the Author
At the law firm of Jeffrey A. Rabin & Associates, located in Des Plaines, Illinois, representing veterans, SSDI and SSI claimants throughout Chicago, Illinois, if you need a Social Security Disability lawyer to assist you at any stage of the process, we can help, even if you have a claim that has been denied. We will assist you with your Social Security Disability or disabled Veterans appeal. Contact us for a free consultation at Jeffrey A. Rabin & Associates, ltd at 847-268-3304.
In need of advice on how to learn more about diagnostic imaging for a complete novice!?
I work in the diagnostic imaging field and I want to know more about everything so that when patients ask me questions I'm not always looking for someone else to answer them or giving them my best guess. I schedule patients as well and meet their needs at the front desk and I travel to different facilities and its an ever changing environment so I just feel like the more knowledge I have the better I can help people and the better I can do my job! We do it ALL mammos, mri, ct, pet/ct, xray, us...we have these questionnaires when we are scheduling but I would really like to know more about them so that when I am asking someone if they are allergic to shellfish I can give more explanation then "oh well the contrast is made of iodine and you cant have the contrast if you are allergic" I want to know! I don't want to guess and give my best answer but the only books I am finding are textbooks and well Where is the DIAGNOSTIC IMAGING FOR DUMMIES GUIDE when you need it!? Thanks for any help!
www.radiologyinfo.org is an excellent website published by the RSNA and ACR. It has information which is useful for both patients and medical professionals. It even has some short video clips which give basic descriptions of various procedures. It would be a good place to start. I am a Radiation Safety Officer at several hospitals, and this is where I refer technologists and patients who are looking for additional information.
Job Diagnostic Questionnaire
Radiology Jobs, Diagnostic Imaging
Juvenile Violence : An Examination of its Causal Factors
1 Introduction
The commission of violent crime by adolescents in this country is a significant problem. Overall reported violent crime statistics decreased for the year 2002 by 1.4 percent from the previously reported figures of 2001 (Federal Bureau of Investigation, 2001, 2002). The downward trend of reported violent crimes in recent years, however, indicates that this decrease does not equally apply to all domains of violent crime. Reports of both murder and forcible rape have maintained a steady increase since 1999, according to the most recent Uniform Crime Report (Federal Bureau of Investigation, 2002). For this reason, the need for research focusing on violent crime and predictors that can be targeted for early intervention are needed.
An increase in adolescent violence is an alarming trend that seems to be occurring as well. The United States far exceeds other industrialized nations in its level of violence (Snyder & Sickmund, 1999). Violent crime arrest rates as committed by adolescents in the United States are twice that of those committed by youth in Canada (Kashani, et al., 1999). Indeed, In recent times, there have been numerous instances where seemingly well adjusted adolescents have acted out violently against others. Most prominently have been school massacres such as Jonesboro and Columbine, which have brought increased attention to the struggle that schools are undertaking to keep their students safe from violence. Within the past decade there have been numerous cases in which children younger than 18 were responsible for the killings of multiple victims within school settings. Incidents of violence on and off school campuses have necessitated the examination of why young people are increasingly acting out violently. Even with the drop in overall crime, a persistent increase in adolescent violent crime has been observed. Murders and rapes committed by adolescents appear to be increasing, rather than decreasing, and as a consequence of this increase, the study of the precipitating factors to violent behavior is required.
2 Literature Review
There are multiple explanations for adolescents engaging in violent and criminal behaviors. Some adolescents commit crimes in youth as part of a transitory developmental process. These individuals typically desist with their rule-breaking behaviors as they develop. This theory is reinforced by crime statistics indicating that the incidence of youth committing crimes increases around the age of 12 and decreases after the age of 18 (Moffitt, 1993), seemingly moving through the developmental phase where thrill seeking and boundary pushing may result in the development of aggressive tendencies. Alternatively, there are those youth whose criminal behavior is more chronic in nature. These individuals represent approximately 5% of adolescent offenders who have developed their antisocial behavior through various pathways (Loeber & Strouthamer-Loeber, 1998).
Research on the causes for youth violence has identified multiple factors that influence the development of aggressive or deviant behavior. These factors include family environment and influence, peer relations, societal factors, and substance usage. This section of the study will review the literature on the causal factors of adolescent violence.
2.1 Peer Influence
Some theories focus on adolescent violence as a function of peer interaction and influence. Kraeger (2004) performed a study to attempt to determine if adolescent violence is actually tied to the influence of their peers. He also examined the differences in behaviors and projected violence and aggression between individuals who were isolated from any peers, and those individuals who have positive and negative peer interaction. This study was conducted using data from the Add Health survey, a part of the National Longitudinal Survey of Adolescent Health, which examines friendship networks and behaviors of adolescents. The survey sampled adolescents enrolled in grades 7-12 between 1994 and 1996 from across the country, with a final N = 9,624 who completed all of the requisite instruments in the study (Kraeger, 2004).
The study findings suggest that even more problematic than influence of violent peers on an individual is that of isolation of an individual from peer interaction, coupled with lack of familial support. This study concludes that adolescents may be isolated due to peer rejection, resulting from a combination of poor parenting and poverty. As a result of this rejection, the adolescent is isolated and will tend to seek out positive support from sources outside of his or her peer and family groups, thereby increasing the potential for gang affiliation and violent behavior (Kraeger, 2004). Additionally, the study found that the influence of aggressive peers is less instrumental in determining violent behavior than the lack of peer bonding in general. Isolated individuals demonstrated higher rates of violence in general (Kraeger, 2004). Although findings from this study support the influence of peers in determining aggression, they also highlight the impact of family functioning on the type of peer interaction.
2.2 Familial Environment
In an effort to validate previous research, Madden-Derdich, Leonard, and Gunnell (2002) examined the impact of perception of family interaction processes and family functioning on adolescent violence. Their findings were consistent with previous research, in that they determined that there is a significant link between family interaction processes (e.g., parent-child relationships, conflict resolution, and parenting practices) and youth's behavior. They further stated that the overall level of family functioning was key in determining how the child might utilize the family relationship as either a protective or risk factor (Madden-Derdich, et a1, 2002).
A study that sampled 228 sixth grade adolescents attending New York City public middle schools focused on examining the interaction between family structure, parenting, and gender on the prediction of adolescent violent behaviors (Griffin, Botvin, Scheier, Diaz, & Miller, 2000). Researchers had students complete self-report questionnaires consisting of demographic items and measures for substance use and interpersonal aggression. In addition, parent telephone interviews were completed to assess parental involvement, monitoring and communication between parent and child. The findings indicated that boys from single parent homes exhibited higher rates of aggression, than girls overall. Additionally, boys from single parent homes were more likely to exhibit maladaptive behaviors than any child from two-parent homes (Griffin, et al., 2000). Another significant finding for this study was that parental monitoring was found to directly impact levels of, and tendencies towards, aggressive and violent adolescent behaviour. Specifically, more parental monitoring of adolescents was found to be associated with lower levels of violent behavior. Although there are limitations identified by the researchers in their ability to examine causal pathways among variables due to the cross-sectional design of the study, these findings suggest the need to further explore the impact of relationships and family structure within the home environment on the development of violent behavior (Griffin, et al., 2000) .
A study of risk factors for children's problem behavior was conducted (Gerard & Buehler, 1999). The goal of this study was to determine how particular risk factors operate in conjunction with one another. The main focus of the study was on the family environment and how it impacted risk for the development of violent adolescent behavior. The researchers further worked to identify whether risk factors are: 1) independent-additive in nature, whether or not independent risk factors have an independent or main effect on violent behavior, 2) interactive model, meaning that there is at least one conditional relationship between two risk factors, or 3) exponential, meaning there is a cumulative effect of risk factors impacting the level of subsequent accumulated risk. Researchers sampled 335 youth from families recruited from middle schools in Knox County, Tennessee, as a part of a larger project developed to assess family life with an emphasis on interparental conflict (Gerard & Buehler, 1999). Particular schools were selected to insure variability in socioeconomic status.
Results found that conflict style and poor parenting were significant risk predictors, regardless of gender, grade level or parental marital status. This supported the independent-additive influence of these risk factors on youth adjustment. Researchers found that the interactive model, indicating that there is at least one relationship between risk factors, was not supported and that they ruled out the effects of particular family variables as either buffering or exacerbating of other risk factors. Finally, they found that there is an exponential increase in the level of youth behavior problems with their previous exposure to risk (Gerard & Buehler, 1999). This research suggests that family environment, including parenting and conflict style are significant risk factors for adolescent violence across a variety of socioeconomic levels, but also that the presence of multiple risk factors can increase the individual's level of risk incrementally and exponentially. In addition to the family of origin, children spend a significant amount of time in their school environment. For this reason, examination of the impact of the school environment on developing aggressive and violent behavior is necessary.
2.3 School and Social Environment
A research project was conducted using a portion of the data collected from the Canadian National Longitudinal Survey of Children and Youth (NLSCY). The NLSCY study examined a variety of issues around family, parenting, cognitive and behavior development, neighborhoods and schools. The participants included a nationally representative sample of children identified at birth and up to 11 years old. Participants were studied every two years until they reached the age of 25 (Sprott, 2004). Sprott (2004) utilized data included in the national study to investigate the impact of school and classroom climates on the development of early violence and property offending. Findings suggest that the impact of a supportive school environment on 10 to 12-year-olds was related to lower levels of violence at a two year follow up. Specifically, research found that favorable social relationships within the classroom are significantly related to lower than expected violent offending. Additionally, offenses related to property were found to be impacted by instrumental support (support that facilitates accomplishment of individual and group tasks), focusing on academic success. Researchers found that overall school climate does not appear to have any direct effect on violent or property offending (Sprott, 2004).
A recent study attempts to add to this literature and expand the information regarding the role of ethnicity as a mediating factor for violence (Vazsonyi & Pickering, 2003). Researchers (Vazsonyi & Pickering, 2003) sampled 877 high school adolescents. Data was originally collected as part of the International Study of Adolescent Development (ISAD). This study sought to explore the importance of family; specifically family closeness, parental monitoring and conflict, as well as school influence; namely looking at such aspects as grades, educational aspirations, and commitment to school and their impact on the development of adolescent violence. Additionally, these researchers were interested in looking at the impact of ethnicity, if any, on violent behavior. Findings of this research indicated that both family and school domains were predictive of the development of aggressive behavior. Their research findings are consistent with previous research, which indicates that disruption in the family system, and negative school influence can increase the likelihood of adolescent violence. When looking at ethnicity as a contributing or mediating factor to adolescent violence, this research showed similar rates of deviance for both Caucasian and African American adolescents (Vazsonyi & Pickering, 2003). This research concludes that there do not appear to be any significant differences in the behavioral antecedents of family background and school influence on adolescent violence outcomes by race or ethnicity.
Research by Shahinfar, Kupersmidt, and Matza (2001) examined community violence exposure and its impact on the development of aggressive behavior using the social learning theory. A sample of 110 highly aggressive incarcerated boys between the ages of 13 and 17 years old were given questionnaires as part of a clinical battery that included a self-report measure for exposure to community violence. This measure looked at witnessing of and victimization of 10 different violent events, including whether or not the participant was a victim, witness, both, or had never been exposed to the event. Participants were also surveyed as to their beliefs about aggression based upon several different scenarios, they were asked to identify some social cues and rate their aggressive responses, as well as answer questions on conflict resolution (Shahinfar, et al., 2001). Findings in this research were mixed and indicated that victimization by severe violence is significantly related to the use of aggression in social situations, difficulty in accurately interpreting social cues, and the maladaptive social goals. Additionally, witnessing severe violence was found to be significantly relates to the perception that a positive outcome would result from the use of aggression. This research outlines the necessity for further research as to exposure to violence, its severity, and the environmental impact of violence (Shahinfar, et al., 2001).
Research in the area of adolescent violence clearly indicates that causal factors can be identified as coming from multiple sources of influence. The development of violence or law-breaking behavior has been linked to a variety of aspects of familial relationships for children and adolescents. The influence of school environment and peer relationships can impact the likelihood of violence through lack of interaction and negative influence. Identified risk factors have also been found to have an accumulated effect that may increase their level of risk and propensity to violent behavior. There has been a limited amount of research focusing on the identification of the unique factors that may contribute to a chronic and serious violent adolescent. In order to begin to differentiate this population, it is necessary to develop a rationale for research in specific areas of violent offenders. To that end, a theoretical underpinning of the ecological systems model will be employed.
2.4 Ecological Systems Model
In order to identify ecological influences on the development of violent behavior at an early age, it is important to examine the child's early environment and the accompanying risk and protective factors. An ecological framework is a useful perspective in examining the complex person and environmental dynamics involved.
Bronfenbrenner's (1979) ecological systems model details the impact of various environmental systems upon the individual. It is a means of assessing the bridge between the internal functioning of the family and the influence of the external environmental systems. Bronfenbrenner developed his theory as an adaptation of physical science principles and applied those scientific principles to human behavior. The ecological systems model has, at its center, people who function within their individual microsystem. This microsystem in turn interacts with the outside mesosystems, exosystem and macrosystem (Bronfenbrenner, 1979). The microsystem includes the direct personal interaction of an individual on a daily basis with others. These interactions include families, friendships, small workplaces and any other groups small enough to have face to face interaction with the individual. The next level of interaction is the mesosystem, which consist of those settings that a person is involved in through the lifetime, such as school and work. Multiple microsystems make up the mesosystem. The mesosystem differs from the microsystem in that there is no direct contact or interaction with the setting, such as a school system. The exosystem is a larger extension of the mesosystem. The final level is the macrosystem that encapsulates all other systems and includes the surrounding society, governments, cultures, and institutions beyond local communities (Bronfenbrenner, 1979).
According to Bronfenbrenner (1979), changes in each system reverberate and impact the other systems in different ways. For example, although there appears to be no direct impact on the individual when a new presidential election occurs, this may result in change in tax legislation, resulting in increased unemployment, which will impact the family unit and may increase the amount of family violence, decrease family cohesion, or increase any number of stressors on the family. The result is an increase in those factors that can lead to or impact the development of violent criminal behavior in the adolescent.
Similarly, the impact can move from the individual committing violent crime, to an increase in community crime rates that may impact the amount of available jobs in the area, further affecting local economy, and so on. Thus, with each change at a given level, the impact is felt on all coexisting levels of the system. It is similar to the analogy of the small stone causing the ripples in the pond. Each action affects all the systems in some way because they are inherently interconnected and interdependent. The relationship between risk and behavioral outcomes is dependent on the context in which the risks are experienced (Bronfenbrenner, 1979). It is for this reason that although we may choose to focus our research in a specific area, we must be mindful of the impact of the accompanying systems on the area of research.
In order to examine the effects of the family, or microsystem, on serious violent adolescent offenders, it is necessary to be aware of the fact that there are complex relationships that contribute to the development of violent tendencies. According to the meta-analysis of research on predictive risk factors for serious violent behaviors by Lipsey and Derzon (2005), there are a number of key predictors of violent behavior. Among those that are most predictive of violent or serious behavior for children between the ages of 6-11, are previous general offenses, gender, substance abuse, and a host of family factors including family socioeconomic status, antisocial parents, and other family related factors. Family relationships alone may not be the sole risk or protective factors in the lives of these individuals, although they may be key predictors of the development of these violent behaviors and may be instrumental in targeting early intervention.
3 Analysis
As was indicated through the foregoing review of the literature on the causal factors of adolescent violence, there are numerous factors functioning on multiple ecological levels that influence the development of violent behavior, including individual personality traits, family problems and media saturation with violence. Some of the major elements contributing to violence are found to be lack of family involvement, violence in the home, and a breakdown of family relationships. From a personal perspective, and as influenced by the literature on the topic, in order to begin examining the predictors to violent adolescent behavior, it is logical to look at the most basic ecological unit, the individual.
When examining the most basic ecological system, we must look at the individual personality and how it may impact the development of violent behavior. At the personality level of functioning, psychopathy, or some sort of psychological disorder may influence the development of a violent personality. One diagnosis that may help to explain the development of violent behavior is antisocial personality disorder (American Psychiatric Association, 2006). One major feature of this diagnosis is the requirement of a history of symptoms and a diagnosis of conduct disorder. This diagnosis involves four areas of specific behavior that include: violence to people and animals, destruction of property, deceitfulness or theft, or serious violations of rules (American Psychiatric Association, 2006). These behaviors are consistent with current research on serious violent adolescent offenders. Specifically, the early onset of behavioral problems and legal infractions, as well as the seriousness of crimes fit with the current defining characteristics of violent adolescent offenders (Loeber & Farrington, 2005). The implication here is that while sociological theories have provided adequate and valid explanations of the social factors which contribute to the development of adolescent aggression, they are general. They cannot explain individual cases and it is precisely because of this that it is imperative to engage in an individual personality analysis of those who have been diagnosed with conduct disorder.
In order to diagnose conduct disorder, a precursor of antisocial personality disorder, early onset of behaviors must be evident. Typically, there is a pattern of rule violation and aggression that occurs by the age of 13; however, there may be an onset of behaviors even before the age of 10. With the onset of these behaviors occurring at such young ages, it is easy to hypothesize that the quality and characteristics of home life and family environment must have a significant impact on the development of conduct disorder and serious violent criminal behavior in adolescents. Similarly, a child with behaviors consistent with the diagnosis of oppositional defiant disorder (ODD) would likely be at risk to engage in violent behavior (American Psychiatric Association, 2006). This diagnosis is characterized by negativistic, hostile, and defiant behavior often expressed through unwillingness to comply with, and defiance of, instructions by adults or peers.
ODD usually becomes evident before the age of eight and no later than adolescence. Again, this would be consistent with the early predictors of adolescent violence in both the age range of onset and the non-serious aggressive behavior evident in the early stages of the development of the seriously violent adolescent offender. It appears both from literature on seriously violent adolescent offenders and both conduct disorder and ODD that a key and vital risk factor is the characteristic early onset and the propensity for early rule-breaking and non-violent behavioral deficits that may lead to later violent behavior. In other words, the diagnosis of risk behaviors is integral to the later prevention of the development of adolescent violence.
Additional research indicates that there may be some basic personality characteristics, as opposed to diagnosable disorders, that are different in those individuals who commit violent acts. Bush, Mullis and Mullis (2000) looked at altruism or social support variables between offenders, those adolescents who were incarcerated for committing violent acts, and non-offender youth, and high school students without a history of aggression. Their sample in this study consisted of 76 male and female offenders and 33 male and female non-offender youth each between the ages of 12 and 18 years old. Although they did not find a significant difference between offending groups, they did find evidence to suggest that there is a difference between those adolescents who commit crime and those who do not. Two of the empathy variables, emotional tone and family structure, were found to be predictive of whether or not they were at risk of being adolescent offenders (Bush, et al., 2000). Emotional tone is defined as the degree of affective harmony and stability within the personality structure. This research suggests that there are some differences in family structure and emotional tone to help identify adolescent offenders. Further research of these types of characteristics may demonstrate differences between violent and nonviolent adolescent offenders. The development of individual personality traits that may lead to violent behavior can be influenced from multiple areas. Along with intrapsychic and innate personality traits, a primary area of influence on personality development is the environment in which an individual is raised. Examination of the family system is a key environmental factor for the tendency toward violence.
Even though the research literature strongly supports the hypothesis that basic personality characteristics are key determinants of predilection towards adolescent violence, it appears that the family environment is the primary determinant of adolescent violent behavior. In other words, assuming that the individual possesses the characteristics identified as supportive of the development of aggression and violence, the family environment functions to either suppress those characteristics or to facilitate their maturation. This last is strongly supported by the research literature on the topic.
Indeed, there has been a significant amount of research that identifies the family environment as the most important predicator of the development of adolescent violent behavior. As the primary environment in early childhood, according to the ecological systems model, the ecology of a child's life has an impact on their development, particularly in high risk environments. As more research is done in this area, the evidence supporting the importance of family on the development of children and on adolescent violence is increasing (Schuck & Bucy, 1997). Examination of the family microsystem is integral to understanding the development of adolescent violent behavior.
Matherne and Thomas (2001) found that cohesiveness of the family reliably predicted violent acts in non-traditional (families without a mother and father in the home) families using the Family Adaptability and Cohesion Evaluation Scale (FACES-111) to assess family structure. This research did not differentiate between types of adolescent violence, but its findings support the hypothesis that family cohesiveness may impact adolescent violence under certain conditions. Further research is warranted to obtain more definitive results, and particularly focusing on SVJ offenders. A multiyear longitudinal study of children was done to examine family interaction patterns (Loeber, Drinkwater, Yin & Anderson, 2000). The research findings indicated that various negative family interaction patterns are linked to different forms of deviant child behavior, including offending and that the best predictors of childhood deviance, such as family environment, parenting styles and family relationships, can serve as predictors to adolescent violence. The implication here is that familial dynamics can contribute to the development of youth aggression, if the individual in question has the necessary personality characteristics.
The fact that family dynamics, relationships and communication patterns can contribute to the development of youth aggression was also established in a study undertaken by Paschall, Ennett, and Flewelling (1996). These researchers examined whether family environment as a predicator of adolescent aggression held true irrespective of race. For determination of the stated, they examined 163 African American and 397 Caucasian youth, specifically focusing on familial conflict, interaction patterns and levels of intra-familial stress. Their research subjects were all adolescent males who were involved in school drug intervention programs and, hence, had already established themselves as particularly susceptible to violent behavior. The participants responded to a self-administered questionnaire that included questions pertaining to family structure, attachment to parents, family stress and conflict and violent behavior. The study's findings indicated that there were some differences between black and white youths as to what factors contributed to violent behavior. For the black males, both family structure and family stress and conflict were associated with fighting at school and having attached someone in school during the previous month, respectively. For the white male respondents, family stress and conflict was also related to past-year fighting and attacking someone, while family structure had no impact. The study supports a conclusion that ethnicity is less of a variable in predicting violent behavior than problems within the home environment (Paschall, et al., 1996).
Thus, it is apparent that the home environment is seminal in predicting the development of violent behaviors. Another potential strong predictor is whether or not there is violence in the home. According to the findings of Howe, Tepper, and Parke (1998) children from violent homes have more conflict in relationships in and out of the home environment than those who come from homes without violence. Additionally, they feel less validated and less cared for by peers. This exposure to violence early in the development of personality can lead to violence as a learned behavior and a solution to frustration and anger.
According to Kashani, et al. (1999) there is a variety of psychosocial factors that impact the development of violent adolescent behavior, including a family history of criminal behavior, family conflict, parental attitudes favorable to crime, and substance abuse. The factor that they found most significant is that of intrafamilial violence. Adolescents who grow up in homes in which they were maltreated commit more violence than children who do not. Additionally, Thornberry (1994) found that when there are multiple forms of violence in the home, such as spousal and child abuse, the rates of violent offenses increase as compared to those adolescents from homes with less violence (cited in Kashani, et al., 1999). Violence within the home appears to be a key variable in predicting the development of violent behavior in adolescents. This may occur in the form of physical or sexual abuse of the child, as well as witnessing physical abuse in the home. Hawkins, Herrenkohl, Farrington, Brewer, Catalano, and Harachi (2007) state that an examination of child physical and sexual maltreatment had higher rates of violent criminality as compared to adults with no prior abuse history. Moreover, they state that there is a positive relationship between frequency of abuse or maltreatment and the development of violent behavior. Thus, the more violence experienced by the child or adolescent, the higher the risk that he or she will become a violent offender.
Exposure to violence in the home has been found to be a key factor in the development of a violent or aggressive personality. A model of a violent system within the family of origin may be transmitted intergenerationally to develop a violent individual (Avakame, 1998). The Social Learning Theory by Bandura (1977) is a widely accepted mechanism by which to understand this process of transmission of violent tendencies between generations. It is thought that the modeling of behaviors that children have observed in their home environment, specifically witnessing or experiencing violence within the family of origin, may lead the adolescent to adopt these violent or aggressive values as their mode of functioning (Avakame, 1998).
Graham-Bermann and Brescoll (2000) surveyed 221 children between the ages of 6 and 12 years old and their mothers to assess the amount of abuse in the home, family characteristics and the child's view on gender and family roles. Children and mothers were recruited for the study through various advertising methods requesting that they respond if they had some level of domestic violence. The researchers wanted to examine the validity of stereotyped beliefs about families and gender roles. Additionally, they sought to examine the role of domestic violence, and stereotyped patriarchal beliefs about families. Finally, they examined how the impact of these beliefs about families and roles had on the child's psychological adjustment. One finding that was of particular interest was, as the researchers predicted, a direct relationship between the amount of physical and emotional abuse experienced by the mother and the child's belief in the superiority and privilege of men in the family. Specifically, they found that the children believed that violence was not only an acceptable, but even necessary part of family interactions (Graham-Bermann & Brescoll, 2000). The researchers concluded that the cognitive belief systems of these children might be affected by witnessing the abuse of their mothers, specifically related to their cognitions about gender and violence (Graham-Bermann & Brescoll, 2000).
Proceeding from the above analysis, it is evident that the development of adolescent violence cannot be traced to a single causal factor. Nevertheless, the available empirical evidence strongly suggests that the family environment is the most important of all the causal factors identified in this research. The importance of recognizing this stems from the imperatives of confronting the societal challenges posed by adolescent violence. This imperative dictates the importance of first identifying risk behaviors in the pre-adolescent stage and, secondly, upon the detection of the risk behaviors, the examination of both the familial and the psychosocial factors and circumstances which could lead to the development of adolescent aggression. The implication here is that there are strategies for both identifying the at-risk-youth population and of constructively responding to the challenge for the purposes of avoiding, or minimizing, the potential of the identified to develop into violent adolescent offenders. It is within the context of the stated that research into the causes of adolescent violence is important – it is important because identification is the first step towards the resolution of the problem.
4 Conclusion
Violent crime is not a new problem, however, it is one that continues to plague our society. In recent times it has become more and more apparent that these crimes are being committed not only by adults, but also increasingly by adolescents (Kashani, Jones, Bumby, & Thomas, 1999). Although there has been extensive research done on adolescent aggression, the area of violent adolescent offenders is lacking, specifically in identifying risk and protective factors against aggression unique to this population (Loeber & Farrington, 2005). Factors for predicting adolescent aggression have included a multitude of domains such as individual personality traits, environmental, familial and societal factors (Heide, 1999). Serious violent offenders differ in several ways from other nonviolent adolescent offenders, namely, regarding the onset of violent behavior and the development of violent behavior in general (Loeber, Farrington & Waschbusch, 2005). Although adolescent aggression generally shares similar predictors, serious violent adolescent offenders appear to differ in how these factors may present themselves. As a result of these differences, it is important to try and differentiate those characteristics that may be identified as risk factors for violence in order to have the best chance at early intervention and prevention of serious violent offenses.
Clearly there are multidimensional and multifaceted risk factors that can influence how a child can develop their personality to become a serious adolescent offender. In order to begin to identify those key variables, research must be conducted in specific areas of the child's ecological system. As the cornerstone of the child's microsystem, and likely the most influential system to impact the entire ecosystem at an early age of the child's development, the family is the focus of much of the research on this topic. While several other factors have been identified as playing a seminal role in the development of adolescent aggression, chief amongst which one may mention peer networks, personality traits and school and community networks, the family remains the most important predicator of the phenomenon in question.
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