Simple screening can help decrease teen risk behaviors

April 30, 2007

Providence, RI -- Research shows that adolescents who engage in one form of risky behavior, like drug or alcohol use, are likely to engage in other risky behaviors like self-harm, or having unprotected sex, but often times these behaviors are not discussed during a medical or mental health exam. Now, a new study shows that a simple and brief screening measure called the adolescent risk inventory (ARI) can quickly identify the broad range of risk behaviors found among adolescents.

"This constellation of behavior problems is really the thing we are trying to avoid. So, identifying early that a teen is engaging in a risky behavior may prevent that behavior from being the gateway to further risky behaviors," says lead author Celia Lescano, PhD with the Bradley Hasbro Children's Research Center and The Warren Alpert Medical School of Brown University.

This study appeared in the April 2007 issue of the journal Child Psychiatry and Human Development.

Prior research indicates that teenagers who engage in one risky behavior are more likely to be involved in others and that this has an additive effect. The authors note that risk behaviors among teens are prevalent and can lead to increased morbidity, mortality, and health care costs, so identifying and dealing with problematic issues as they arise can help teens be safer and healthier.

Researchers studied 134 youth ages 12 to 19 with psychiatric disorders. Each study participant was given the adolescent risk inventory (ARI) (a paper and pencil measure). The ARI included questions about sexual history (have you ever been pregnant or been a dad?), self-harm (have you ever attempted suicide?), and attitudes towards acting out (do you break rules for no reason?).

"We found that the ARI is reliable and comprehensive and can be useful in quickly identifying a wide range of teen risk behaviors," says Lescano. This is important, the authors say, because when teens are seen for medical and/or mental health care, risk behavior issues are often neglected. Time and relevance are often seen as barriers that prevent providers from obtaining this important information.

"Given that the ARI is brief and broad in it assessment of behaviors, these barriers can be overcome and allow pediatricians, family doctors and mental health professionals to make referrals based on the information they get from the teen," explains Lescano.

The analyses also provided intriguing data on the relationship between sex risk, psychopathology, and behavior in that abuse or self-harm behaviors were highly predictive of sex risk. This is important because while many clinicians are aware of the sexual risks that aggressive youths take, many are unaware of the association between risky sexual behavior and emotional distress, abuse and self-harm. Behaviors like self-cutting thoughts, suicidal thoughts or attempts, or a history of sexual abuse should alert clinicians to the potential for significant sexual risk, the authors say.

Oftentimes, research programs that target the identified risk behavior can be found in nearby communities or even through the medical or mental health offices in which the teens are being seen.

"Referral to these programs, as well as to mental health professionals to help treat the negative emotions that can precipitate risk behaviors may be useful avenues to decreasing risky behaviors in teens," says Lescano.
Founded in 1931, Bradley Hospital ( was the nation's first psychiatric hospital operating exclusively for children. Today, it remains a premier medical institution devoted to the research and treatment of childhood psychiatric illnesses. Bradley Hospital, located in Providence, RI, is a teaching hospital for the Warren Alpert Medical School of Brown University and ranks in the top third of private hospitals receiving funding from the National Institutes of Health. Its research arm, the Bradley Hasbro Children's Research Center (BHCRC), brings together leading researchers in such topics as: autism, colic, childhood sleep patterns, HIV prevention, infant development, obesity, eating disorders, depression, obsessive-compulsive disorder (OCD) and juvenile firesetting. Bradley Hospital is a member of the Lifespan health system.


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