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Introduction: Violence risk assessment is one of the most frequent reasons for child and adolescent psychiatry consultation with adolescents in the pediatric emergency department (ED). Here we provide a systematic review of risk factors for violence in adolescents using the risk factor categories from the MacArthur Violence Risk Assessment study. Further, we provide clinical guidance for assessing adolescent violence risk in the pediatric ED.Methods: For this systematic review, we used the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2009 checklist. We searched PubMed and PsycINFO databases (1966–July 1, 2020) for studies that reported risk factors for violence in adolescents.Results: Risk factors for adolescent violence can be organized by MacArthur risk factor categories. Personal characteristics include male gender, younger age, no religious affiliation, lower IQ, and Black, Hispanic, or multiracial race. Historical characteristics include a younger age at first offense, higher number of previous criminal offenses, criminal history in one parent, physical abuse, experiencing poor child-rearing, and low parental education level. Among contextual characteristics, high peer delinquency or violent peer- group membership, low grade point average and poor academic performance, low connectedness to school, truancy, and school failure, along with victimization, are risk factors. Also, firearm access is a risk factor for violence in children and adolescents. Clinical characteristics include substance use, depressive mood, attention deficit hyperactivity disorder, antisocial traits, callous/unemotional traits, grandiosity, and justification of violence.Conclusion: Using MacArthur risk factor categories as organizing principles, this systematic review recommends the Structured Assessment of Violence Risk in Youth (SAVRY) risk- assessment tool for assessing adolescent violence risk in the pediatric ED.

Polygenic scores for educational attainment and related variables, such as IQ and "mathematical ability" are now readily available via direct-to-consumer genetic testing companies. Some researchers are even proposing the use of genetic tests in educational settings via "precision education," in which individualized student education plans would be tailored to polygenic scores. The potential psychosocial impacts of polygenic scores for traits and outcomes relevant to education, however, have not been assessed. In online experiments, we asked participants to imagine hypothetical situations in which they or their classmates had recently received polygenic scores for educational attainment. Participants prompted to answer multi-choice questions as though they had received their own low-percentile score, compared to a control condition, scored significantly lower on measures of self-esteem and of self-perceived competence, academic efficacy, and educational potential. Similarly, those asked to evaluate a hypothetical classmate as though the classmate had received a low-percentile score attributed significantly lower academic efficacy and educational potential, compared to a control condition. Through possible mechanisms of stigma and self-fulfilling prophecies, our results highlight the potential psychosocial harms of exposure to low-percentile polygenic scores for educational attainment.

Implementing genome and exome sequencing in clinical practice presents challenges, including obtaining meaningful informed consent. Consent may be challenging due to test limitations such as uncertainties associated with test results and interpretation, complexity created by the potential for additional findings and high patient expectations. We drew on the experiences of research teams within the Clinical Sequencing Exploratory Research (CSER1) Consortium on informed consent for clinical genome and exome sequencing (CGES) to negotiate consensus considerations. We present six considerations for clinicians and 12 key points to communicate as they support patients in deciding whether to undergo CGES. These considerations and key points provide a helpful starting point for informed consent to CGES, grounded in the Clinical Sequencing Exploratory Research (CSER1) experience.

Although informed consent is critical for all research, there is increased ethical responsibility as individuals with intellectual or developmental disabilities (IDD) become the focus of more clinical trials. This study examined decisional capacity for informed consent to clinical trials in individuals with fragile X syndrome (FXS). Participants were 152 adolescents and adults (80 males, 72 females) with FXS who completed a measure of decisional capacity and a comprehensive battery of neurocognitive and psychiatric measures. Females outperformed males on all aspects of decisional capacity. The ability to understand aspects of the clinical trial had the strongest association with the ability to appreciate and reason about the decision. Scaffolding improved understanding, suggesting researchers can take steps to improve decisional capacity and the informed consent process.

Recent research has suggested that people more readily make genetic attributions for positively valenced or desirable traits than for negatively valenced or undesirable traits—an asymmetry that may be mediated by perceptions that positive characteristics are more 'natural' than negative ones. This research sought to examine whether a similar asymmetry in genetic attributions would emerge between positive and negative health outcomes. Across seven experiments, participants were randomly assigned to read a short vignette describing an individual experiencing a health problem (e.g. hypertension) or a corresponding healthy state (e.g. normal blood pressure). All participants provided ratings of naturalness and genetic attributions for the outcome described in their assigned vignette. For diagnoses other than addictive disorders, participants rated the presence of a diagnosis as less genetically caused than its absence; for addictive disorders, the presence of a diagnosis was rated as more genetically caused than its absence. Participants consistently rated the presence of a health problem as less natural than its absence. Even within a single domain of health, people ascribe differing degrees of 'naturalness' and genetic causation to positive versus negative health outcomes, which could impact their preferences for treatment and prevention strategies. [ABSTRACT FROM AUTHOR]

People tend to rate prosocial or positive behavior as more strongly influenced by the actor's genes than antisocial or negative behavior. The current study tested whether people would show a similar asymmetry when rating the role of genes in their own behavior, and if so, what variables might mediate this difference. Participants were prompted to think about an example of their own behavior from the past year that was either prosocial or antisocial. Those in the prosocial condition rated the role of genetics in causing the behavior as significantly greater than did those in the antisocial condition. A mediation analysis suggested that this asymmetry could be accounted for by a tendency to view prosocial behavior as more natural and more aligned with one's true self than antisocial behavior. These findings add to a growing body of evidence suggesting that people's reasoning about genetics may be influenced by evaluative judgments. [ABSTRACT FROM AUTHOR]