Book Review

Children in a Violent Society

N Engl J Med 1997; 337:943-944September 25, 1997

Article

Children in a Violent Society
Edited by Joy D. Osofsky. 338 pp. New York, Guilford, 1997. $38.95. ISBN: 1-57230-183-X

Violence has become a major issue in the lives of children in the United States. Its effects on their physical and mental health have created a real need to understand the extent of the problem, its implications for children's health, and strategies for reducing exposures to violence and responding to them. An extensive literature is beginning to develop on the subject; one of the more recent books is Children in a Violent Society. This excellent book provides a broad overview of childhood exposure to violence and some thoughtful strategies for addressing the problem.

The book contains an extensive range of information for professionals in the fields of health care, mental health, criminal justice, child advocacy, public health, and social and human services. It has two sections: one reviews the problem of children's exposure to violence, and the other presents and discusses ways to address the problem.

The first section examines the scope of the problem comprehensively in the context of child development. There are strong, useful chapters on the extent of exposure to violence, firearm injuries, and media influences. These are followed by three impressive and thoughtful chapters that give a developmental context for understanding the known and potential effects of violence on children at various points in their lives. The first of these, on infancy, presents a convincing case for identifying infants exposed to violence and the need for a better understanding of the effects of such exposure. The developmental perspective is extended in chapters on neurodevelopmental factors and the relation between attachment factors and the risk of involvement with violence. Altogether, this section provides a wealth of information and, equally important, a context and a model for thinking about violence and its impact on children.

The second section attempts to provide strategies for addressing the problem. Billed as an effort to examine both prevention and intervention, this section deals mainly with programs that respond to children already exposed to violence. It describes specific programs that represent solid examples of intervention strategies applicable to many settings and communities. There are chapters on a medically based program, an effort based in elementary schools, a model based on mental health, and community policing. There are also several excellent chapters on the perceptions of violence among children, parents, and police. This section provides a set of programmatic illustrations that others can consider, replicate, or at least learn from as they attempt to respond to violence in their specific clinical setting or broader community.

The book's main shortcoming is the lack of any detailed discussion of primary prevention. Although it is important to understand the effects of exposure to violence and to respond to such exposures, it is also very important to reduce the exposures themselves. This is acknowledged in the closing chapter but only briefly discussed. Readers will need to seek out other sources for an understanding of primary prevention, but they still stand to expand their knowledge greatly on the subject of children and violence by reading this well-written book.

Howard Spivak, M.D.
Tufts University School of Medicine, Boston, MA 02111