Providentia

Postconcussive Symptoms and PTSD in Veterans

Romeo Vitelli — Thu, 05 Nov 2009 08:00:00 -0500

Veterans with a history of mild traumatic brain injury (mTBI) are reporting postconcussive symptoms in addition to experiencing postdeployment physical and emotional comorbidities. The Veterans Health Administration has mandated specialized evaluation and treatment for veterans with a history of mTBI and has suggested widespread use of the Neurobehavioral Symptom Inventory (NSI) as a measure of postconcussive symptoms. A study published in a recent issue of Rehabilitation Psychology evaluated the NSI’s factor structure and assessed the impact of posttraumatic stress (PTS) on the scale at the item and factor levels. Five hundred twenty-nine charts of returning veterans who screened positive for traumatic brain injury were reviewed, and 345 who met criteria for mTBI were included in the study. The study results were examined and the resulting factor analysis on the NSI revealed a difficult-to-interpret factor structure that was inconsistent with the results of civilian studies. PTS explained 5%–38% of the variance in individual postconcussive symptoms, and after controlling for this variance, the factor structure more closely paralleled findings from the civilian literature. The authors conclude that posttraumatic stress is an important variable to account for when evaluating PCSx in veterans. The authors also discuss research and clinical implications for the measurement and interpretation of self-reported postconcussive symptoms.

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Teen 'Hero' Unmasked as Serial Arsonist

Romeo Vitelli — Tue, 03 Nov 2009 08:00:00 -0500

On July 26, John and Gina Richardson were awakened by the sound of someone banging on their door and warning them that their bungalow was on fire.After helping the elderly couple out of their Nottinghamshire, U.K. home, 19-year old Ben Welbourn then rushed back inside to save their dog. Although the blaze had largely destroyed their home, they were grateful to Welbourn for saving their lives and even posed with him afterward for pictures that were prominently displayed in the local newspaper. The Richardsons' daughter publicly thanked Ben Welbourn for saving her parents' live. Two weeks later, on August 8, a second fire began at the home of 89-year old Faye Florio. Once again, Ben Welbourn was on the scene to help the frightened woman out of her burning home and to accept praise for his courage. This time however, a sharp-eyed neighbour recognized Welbourn from his previous rescue and contacted the fire service.

After an investigation, Ben Welbourn was arrested and charged with two counts of arson and reckless endangerment. Pleading guilty in a Nottinghamshire court, he was sentenced to four years in prison. The revelation that Ben Welbourn was responsible for both fires left his victims devastated. The Richardsons, who had lost all their personal belongings in the fire, were especially vocal and Gina Richardson stated that, " I feel terrible. I feel he has taken everything away from me. Everything in that home was very precious."

In handing down his decision, Judge Michael Stokes informed Welbourn that, "'I'm prepared to accept that on the first occasion you probably didn't appreciate the unpredictability of what you were doing and you no doubt were taken aback by the way the fire spread. There can be no such explanation for your conduct on the second occasion." Although Welbourn is not considered to be mentally ill, Judge Stokes advised him to seek treatment for his psychological problems.

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The Michigan Wildcat

Romeo Vitelli — Sun, 01 Nov 2009 08:00:00 -0500

Adolph ("Ad") Wolgast was definitely a champion.

Born in 1888 in Cadillac, Michigan, he was the oldest in a family of seven (two of his younger brothers became championship boxers as well). After distinguishing himself in amateur boxing, Ad turned professional in 1910 and captured the World Lightweight title a year later. The forty-round brawl with Battling Nelson that earned him his title was the stuff of boxing legends as Wolgast did the impossible and survived the bloody fight. Eager sports reporters labeled him "the Michigan Wildcat" as Ad won all but one of his first eight-nine bouts. In one famous bout with Joe Rivers in 1912, Ad and Rivers both knocked each other out. Ad was awarded the fight because he was seen to get up first before they were both counted out (there was some controversy over this decision). He became legendary for his ability to take (and give out) horrendous head punches but Ad Wolgast didn't keep the title long. In a vicious 1912 bout with Willie Ritchie, Ad finally lost his title although his boxing career went on.

The damage that Ad Wolgast took during his boxing career seems incredible. In his one hundred and thirty-five bouts, he sustained numerous injuries include cauliflower ears, numerous broken bones (hands, ribs, and arms), and a disfigured face. His wife, Mildred, threatened to divorce him if he didn't quit the ring and he arranged for plastic surgery to rebuild much of his face (including having his nose injected with paraffin to regain its former shape-the paraffin later leaked out). Milwaukee, Minnesota was a major fight center at the time and, through radio broadcasts of his boxing matches, Ad quickly gained fans across the country. After a brief attempt at retirement in 1916 (and the end of his marriage), the fact that Ad was suffering from "punch drunkenness" (a.k.a. dementia pugilistica) became apparent soon enough.

By the age of thirty, the "Michigan Wildcat" seemed far older than he really was. One Milwaukee reporter said that, "a glance at Wolgast's head is enough to show what he had one through". Hospitalized after a "nervous breakdown", Ad Wolgast was declared mentally incompetent in 1917 by a Milwaukee court. During his competency hearing, two psychiatrists who had assessed him testified that, "there was hardly a chance for him to regain his health". He spent a year in Minnesota hospitals before drifting to California and eventually being placed in the psychopathic ward at California's Stockton State Hospital. As a trained boxer, his involuntary confinement definitely led to problems, including beatings by staff, until a California court ruled that he was legally competent in December, 1918.

Since fighting was all Ad knew, he joined a gym owned by Los Angeles fight promoter, Jack Doyle. Although Ad Wolgast dreamed of a comeback, Doyle (who had assumed unofficial guardianship) simply allowed Wolgast to train with no intention of ever letting him box again. Most of the money that Ad had earned in prizefighting ended up going to his ex-wife so he was left destitute (Doyle gave him free access to the gym). Veteran fighters and boxing fans often dropped by to see Ad train and he reveled in their praise of his fighting skills. He also insisted on being treated like a world champion and often became agitated whenever anyone failed to give him the respect that he felt he deserved.

When his condition gradually deteriorated, Ad Wolgast was readmitted to hospital in 1927. While he remained there for the rest of his life, Ad continued to train in his room.; According to his obituary, that typically involved frequent shadowboxing, bobbing, and uppercuts against imaginary opponents. Ad Wolgast seemed largely unaware of his surroundings except on rare occasions when he would plaintively ask where he was and when he would be allowed to leave. His boxing career may have been long over but it still took two hospital attendants to restrain him whenever he was forced to do something he didn't want to do. By all reports, his "tough guy" reputation and violent temper earned him numerous beatings in hospital but he always recovered quickly enough. He went blind in the final few years of his life.

Adolph Wolgast died on April 14, 1955 of heart complications after having spent more than half of lifetime in hospitals. Although he was elected to the Ring Boxing Hall of Fame in 1958 and the International Boxing Hall of Fame in 2000, he islargely remembered today only as an object lesson in the dangers associated with professional boxing. While not as famous as other cases of dementia puglistica including Chris Benoit, Ad Wolgast's sad story highlights the cumulative damage resulting from repeated head injuries in boxing and other professional sports.

The dangers involved in professional boxing were clear enough even in Ad Wolgast's day but the lure of fame and fortune seemed attractive enough for eager boxers to take the risk. Ad's lifetime earnings were estimated at more than $200,000 (a hefty amount even in 1915 dollars) although most of that eventually went to his ex-wife. He certainly had countless fans across the country, while his fame lasted. Even when he recognized how badly he had been hurt by boxing, Ad's attempts at retirement were always brief. In one famous 1916 interview, Ad told reporters, "You just can't quit after all.&They say a criminal is drawn back irresistibly to the scene of the crime. Well, so is a fighter drawn back to the old rings, the old crowds, and the old excitement. Why not let the old ex-champs have their little pipedreams?"

In the end, Adolph Wolgast paid the price for his dream.

Chronic Pain and Traumatic Brain Injury

Romeo Vitelli — Thu, 29 Oct 2009 08:00:00 -0400

Chronic pain conditions are common sequelae of traumatic brain injury (TBI). Unfortunately, the incidence of TBI among personnel deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) is significant, and there is growing evidence that ongoing pain, particularly headaches, will be a primary concern for these individuals. In a recent paper published in Rehabilitation Psychology, the authors examined empirical data from civilian and veteran populations and clinical experience with OEF/OIF personnel with multiple traumas to provide recommendations for the assessment and treatment of chronic pain among those with TBI. The available data signal the need for the incorporation of early and aggressive pain management strategies into existing treatment models. Challenges to providing effective pain management for OEF/OIF veterans are numerous and include comorbid cognitive, medical, and emotional impairments that complicate readjustment to civilian life. It is likely that the problem of polytrauma pain and associated comorbid conditions such as posttraumatic stress disorder and postconcussive syndrome will require the development of integrated approaches to clinical care which bridge traditional subspecialty divisions.

For more information.

Dealing with Animal Hoarders

Romeo Vitelli — Tue, 27 Oct 2009 08:00:00 -0400

As part of a new initiative to cope with the problems associated with animal hoarding, a workshop sponsored by the Central Arizona Animal Cruelty Task Force will be held in Casa Grande to provide a public forum to address the complex mental health and animal welfare issues involved. The workshop is intended to provide an overview of the problem of animal hoarding on a national basis and will include mental health professionals and representatives from animal welfare agencies. The workshop arose following a recent case in a nearby town where 185 animals were forcibly removed from a home and the owners were subsequently charged with neglect.

Defined as having a higher than usual number of pets without the resources to care for them, animal hoarding is a growing problem in many jurisdictions in the United States, Canada, and Europe. Animal hoarders begin taking in pets with good intentions, but develop an inability to recognize that their pets are being neglected. Linked to compulsive hoarding disorders such as Diogenes Syndrome and Obsessive-Compulsive Disorder, animal hoarding has also been associated with certain forms of dementia and delusional disorder. In addition to problems with neglect and malnutrition, animal hoarding has led to significant health risk for humans including sanitation concerns (including the spread of parasites and dangerous ammonia levels), possible epidemics of animal-borne diseases such as toxoplasmosis, rabies, and bubonic plague, and the potential link between animal hoarding and other forms of abuse (i.e, child and elder abuse).

While most jurisdictions have no clear legal definition of animal hoarding, humane societies and animal welfare agencies across North America and Europe have organized "Hoarding Prevention Teams" to work with hoarders to deal with their pets. Stronger legislation is also being proposed in many jurisdictions to help control animal hoarding.

For more information.

Saving Civilization (Part 3)

Romeo Vitelli — Sun, 25 Oct 2009 08:00:00 -0400

Continued from Part Two

With the outbreak of the war, Lothrop Stoddard began working as a foreign correspondent in Nazi Germany. Although he was definitely not a Nazi supporter, his racist credentials helped him to get interviews with Adolf Hitler and Joseph Goebbels which were later published in Time magazine.Through his newspaper articles and a book that he released in 1940, Stoddard tried his best to distance himself from the Nazis. The Holocaust still lay in the future but news reports about Aktion T4 and similar excesses placed him in an awkward position. In trying to defend his own ideas while denouncing the Nazis for pursuing similar goals, all that he could say was that, while the Nazi ideals were justified, their methods were too severe.

By the end of World War II, the rest of the world was stunned to discover just how far the Nazis had been willing to go to support their ideology. Revelations surrounding Aktion T4, the Holocaust, and the vicious persecution directed against Jews, Roma, and other racial groups in the name of racial purity robbed the eugenics movement of what little support it had. It probably didn't help that testimony from the Nuremberg War trials showed the powerful influence of Madison Grant and Lothrop Stoddard on the early Nazi movement. During his trial, Karl Brandt particularly cited American racist theorists as an inspiration for the Nazi euthanasia program and as proof that the Nazis were hardly unique in their beliefs. Brandt's defense wasn't very effective (he was executed) but the Nazi connection conferred a stigma on the eugenics movement that it never lost.

Lothrop Stoddard's popularity didn't survive the Nazi association. By the time of his death in 1950, he was largely forgotten. Oher eugenicists managed to adapt to the new era by changing their message to escape Stoddard's fate. While never really abandoning his eugenicist leanings, Paul Popenue is largely remembered today as the father of marriage counseling. His warnings about the decline of masculinity and the need to assert traditional roles in marriage are still quoted in conservative circles though. Despite die-hards like Carleton Coon, the use of racial theories in social sciences were largely abandoned (with some high-profile exceptions). Most of the researchers who had been known for racial studies in previous decades either retired or shifted to other fields of research entirely. Advocates of hereditarian theories of human intelligence still managed to carve out a niche for themselves (controversies notwithstanding).;

That's not to say that the laws that the eugenicists and scientific racists helped foster weren't still in place, though. The last of the anti-miscegenation laws in the United States weren't repealed until 1967 following the Loving v. Virginia Supreme Court ruling (South Carolina and Alabama didn't formally remove anti-miscegenation language from their constitutions until much later). Involuntary sterilization laws remained in force for numerous countries around the world including Sweden, Japan,Switzerland, India, and many Warsaw Pact nations. While the eugenics argument had been discredited, other rationalizations for sterilization were typically adopted (which usually focused on "protecting" patients regarded as mentally disabled). In the U.S., involuntary sterilization continued in some states until the 1980s while in Canada, cases of sterilization continued as recently as 1972. Despite a few high profile compensation cases, the identity of most involuntarily sterilized patients remains unknown.

While the eugenics movement (and scientific racism in general) seem unlikely to regain its former popularity, the debate surrounding the role of heredity and environmental factors in human traits seems unlikely to go away. Controversies have a way of springing up as new books are released for popular consumption. There are also organizations such as the Pioneer Fund that continue to support research into racial differences in intelligence despite widespread condemnation by mainstream scientists. The complex ethical issues surrounding eugenics may well become more heated as genetic screening techniques become more widely available and key markers for "undesirable" traits are identified. Only time can tell what new controversies genetic engineering will bring in future.

As a postscript to this series, there have been a number of articles of late that have attempted to invoke the specter of eugenics and Nazism in discrediting Charles Darwin and the theory of evolution. The crux of the argument seems to be that Darwin's theory had a heavy influence on Nazi philosophy and can be held personally responsible for the Holocaust and other Nazi crimes. Whatever role that biologists payed in the early eugenics movement, it's hard to dismiss the fact that scientists were also the most vocal critics of the eugenics movement from the very beginning. In the meantime, even church leaders in some countries supported various eugenics policies over the years. There is enough blame to go around for every political or ideological group and nobody has a valid reason to be smug.

Responding to Medication and Therapy in Depression

Romeo Vitelli — Thu, 22 Oct 2009 08:00:00 -0400

A study reported in the August 2009 issue of Journal of Consulting and Clinical Psychology examined the relative success rates for medication and cognitive therapy in depression. Previous research has shown the two treatments to be roughly equivalent in alleviating chronic depression although evidence suggests that patient factors may affect relative treatment success. A randomized controlled trial found nearly equivalent response rates for antidepressant medications and cognitive therapy in a sample of moderate to severely depressed outpatients. In the study, the authors attempted to identify the variables that were associated with response across both treatments as well as variables that predicted superior response in one treatment over the other. The sample consisted of 180 depressed outpatients: 60 of whom were randomly assigned to cognitive therapy; 120 were assigned to antidepressant medications. Treatment was provided for 16 weeks in both groups. Factors such as chronic depression, older age, and lower intelligence each predicted relatively poor response across both treatments. Three patient variables—being married, unemployment, and having experienced a greater number of recent life events—were identified, and each predicted superior response to cognitive therapy relative to antidepressant medications. Overall, six 6 markers of treatment outcome were identified, each of which might be expected to carry considerable clinical utility. The 3 prognostic variables identify subgroups that might benefit from alternative treatment strategies; the 3 client variables identify groups who appear to respond particularly well to cognitive therapy. The authors suggest that there are different mechanisms at work in both treatment modalities which can interact with client factors to affect outcome.

For more information.

Gunman Howard Unruh dies at 88

Romeo Vitelli — Tue, 20 Oct 2009 08:00:00 -0400

It has been six decades since Howard Unruh's shocking mass murder but surviving family members of his victims still remember the terror of that day on September 6, 1949 when Unruh's rampage claimed thirteen lives. Many of those family members expressed satisfaction on learning that the 88-year old Unruh died yesterday at a Trenton N.J. nursing home following a long illness. Diagnosed as a paranoid schizophrenic and confined to the New Jersey Hospital for the Insane (later the Trenton Psychiatric Hospital) after the rampage, Howard Unruh had been a model patient who lived for decades without incident.

Howard Unruh had been a returning veteran of World War Two who had become alienated in his civilian life in Camden, New Jersey. Deeply affected by his wartime experiences, he lived in an apartment building with his mother. Despite being a war hero, he remained unemployed and seemed to have little to do with his time except look at the medals and other war memorabilia decorating his bedroom walls and care for his considerable collection of firearms. He also maintained a target range that he set up in the basement of his apartment building which didn't prevent him from getting into trouble with his neighbours.The spectacle of a grown man being financially supported by his mother who worked at a local factory made him the target of considerable teasing as a "mama's boy". In his diaries, he kept careful note of every personal grievance (real or imagined). When the diaries were later examined, it was found that he had written the word "retal" (short for retaliate) next to the name of every neighbour whom he had thought deserving of special consideration.

On September 6, 1949, Howard came home from a local movie theatre to find that the new gate that he had built onto the front of the apartment building had been stolen. That was the apparent trigger that led to his rampage. After dressing up in his best suit and arming himself with a German luger and thirty-three rounds of ammunition, Unruh went hunting for those he felt had wronged him. In the twelve-minute rampage that followed, Howard shot at over twenty-six people, killing thirteen and wounding a number of others.Most of the victims were from his list but many others were apparently just in the wrong place at the wrong time. Hearing the approaching sirens, he returned to his mother's apartment and prepared to make a final standoff. After being wounded, he was convinced to turn himself in. He was eventually charged with thirteen counts of murder and three counts of "atrocious assault and battery" According to the two psychiatrists who examined him before his trial, Unruh stated that "I'm no psycho. I'd have killed a thousand if I had bullets enough".

Although he was found mentally fit to stand trial, Unruh was sent to a psychiatric hospital to serve his life sentence. Other returning veterans had committed acts of violence following the end of the war but Howard Unruh certainly stood out as the first spree killer in U.S. history.

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Saving Civilization (Part 2)

Romeo Vitelli — Sun, 18 Oct 2009 08:00:00 -0400

Continued from Part 1

While not implicitly racist in itself, eugenics certainly played a role in "racial purity" policies. Although laws banning interracial marriage (i.e., miscegenation) date back to the 18th century in North America, both in French and British colonies, the eugenics movement helped give new impetus to preventing racial mixing in the United States. When Madison Grant published his highly influential The Passing of the Great Race in 1916, he railed against the changing "stock" of immigrants to the U.S. and the decline of the "Nordic" race that had made the country great. As a dedicated eugenicist (who, like Galton never had children of his own), Grant pushed for stronger restrictions on immigration laws and despaired of the prospect of racial mixing which would undermine "Nordic purity". In addition to immigration controls, sterilization of the unfit, and anti-miscegenation laws, Grant also advocated placing inferior races in separate "ghettos" where they could be controlled more thoroughly.

Grant's influence almost certainly played a role in attempts to include an anti-miscegenation clause into the U.S. constitution during that same period (leading to the "one drop of blood rule" for defining race). Between 1913 and 1948, thirty states enacted laws enforcing racial purity while the Immigration Act of 1924 enacted a quota system to exclude Asians and other "inferior" racial groups from immigrating to the U.S. Grant also helped draft racial purity legislation in several states. While Madison Grant was strongly opposed by a coalition of social scientists led by Franz Boas, his work was widely read around the world and helped inspire the growing Nazi movement in Germany (Adolf Hitler personally praised Grant's book as his "bible").

For all his influence, Madison Grant never had great popular appeal and his work was quickly overshadowed by the 1930s. Another prominent name in scientific racism was Charles B. Davenport. As director of the Eugenics Record office at the Cold Spring Harbor Laboratory, Davenport became famous for his reporting on the dire consequences of racial mixing.& Although he admitted that sufficient research had not been done in the area, that didn't stop him from making outrageous conclusions about the mental and physical abnormalities resulting from miscegenation. He concluded that,"hybridized people are a badly put together people and a dissatisfied, restless, ineffective people. One wonders how much of the exceptionally high death-rate in middle life in this country is due to such bodily maladjustments".

The true dean of scientific racism was undoubtedly Theodore Lothrop Stoddard. Born in 1883 of an old New England family, Stoddard graduated from Harvard Law School in 1908 but quickly converted to the

eugenics cause, particularly the dangers posed by Nordics being overwhelmed by "inferior" races with higher birthrates. Stoddard blamed Jean Jacques Rousseau for undermining Western civilization with his idea of the Noble Savage as well as the notion of "equality between all men".While Madison Grant had at least tried to base his racist ideas on scientific principles (more or less), Stoddard was far less patient. He viewed the threat posed by the low Nordic birthrate as being too critical to wait for more scientific research to be done. An active propagandist, Stoddard wrote twenty-two books and numerous articles in popular magazines.;

Throughout his books, there was one common theme: that the Nordic race had "clean, virile, genius-bearing blood, streaming down the ages through the unerring action of heredity, which, in anything like a favorable environment, will multiply itself, solve our problems, and sweep us on to higher and nobler destinies." Stoddard viewed World War I as being a disaster for the Nordic race since it was mainly the Nordic soldiers who fought and died while the "inferior Mediterraneans stayed placidly at home". He also warned of the growing Communist threat since, "in every quarter of the globe...the Bolshevik agitators whisper in the ears of discontented colored men their gospel of hatred and revenge. Every nationalist aspiration, every political grievance, every social discrimination, is fuel for Bolshevism's hellish incitement to racial as well as to class war."; Traveling widely, Stoddard took keen interest in foreign policy and wrote about the dangers arising from the geopolitical ambitions of the "coloured" people of Asia, Africa and Latin America.; He also sounded an early warning against the rise of Islam and the dangers of Muslim fanatics. Although a few reviewers had the courage to speak out against Stoddard's books, he was far too popular to be ignored. While hardly the only apostle of scientific racism and eugenics during the 1920s and 1930s, Stoddard was the most well known.

Of course things were changing by then. Despite a greater crackdown on immigration (with the help of eugenics supporters such as Calvin Coolidge and Warren Harding), the actual science on which eugenics/scientific racism was supposedly based became increasingly flimsy. Franz Boas continued his crusade to undermine scientific racism while the mental testing movement began to question whether racial differences in intelligence actually existed. C.C. Brigham, who had written on the superiority of Nordic immigrants on intelligence during the 1920s later reversed himself completely stating that, "comparative studies of various national and racial groups may not be made with existing tests". On the biology front, genetic research completely undermined the concept of race and racist theories in general.

Things were changing on the world front as well. By the late 1930s, Hitler's Germany was showing the entire world what a racist ideology was really capable of doing if taken to extremes. Adolf Hitler and his fellow Nazis hardly needed to depend on Lothrop Stoddard and Madison Grant to support their ideology though. Many of their policies relating to racial theory, antisemitism, and Lebensraum could be traced back to homegrown social scientists such as Alfred Rosenberg and Otto Weininger. While German propaganda films such as Erbkrank were shown by eugenics societies around the world, rumours of what was happening in Germany made even the true believers uncomfortable. Despite reports of forced sterilization, ghettoes, and persecution, the full extent of the Nazi eugenics program didn't become apparent until after the end of World War II.

Continue to Part Three

New Study Finds High Rates of Childhood Exposure to Violence and Abuse in US

Romeo Vitelli — Thu, 15 Oct 2009 08:00:00 -0400

A new study published in a recent issue of Pediatrics is reporting that nearly half of all children in the United States are being exposed to violence or abuse. Jointly sponsored by the U,S, Department of Justice, Office of Juvenile Justice and Delinquency Protection, and the Centers of Disease Control and Prevention, the study was conducted by a team of researchers from the University of New Hampshire. Based on a nationwide sample of 4,549 children up to the age of seventeen as well as caregivers, the researchers collected information of victimization experiences through direct interviewing. Their results indicated that three out of five children were exposed to violence, abuse, or criminal victimization in the past year. These numbers include 46 percent who had been physically assaulted, 10 percent who had been abused by a caregiver, 6 percent who had been sexually victimized, and 10 percent who had witnessed an assault in their family. More than a third of the children had two or more different kinds of violent exposure in the past year and 11 percent had five or more. In outlining their results, the researchers urge child care workers, teachers, and parents to be more aware of the range of potentially violent situations that children may face, including dating violence and bullying.

In addition to the journal publication, the results have also been released in an Office of Justice Programs/OJJDP bulletin titled "Children's Exposure to Violence: A Comprehensive National Survey."

For more information.

To download a copy of the OJJDP Bulletin.