Utility of TOCA-R scores during the elementary school years in identifying later violence among adolescent males.

OBJECTIVE: To evaluate the utility of a teacher-rating instrument (TOCA-R) of aggressive behavior during elementary school years in identifying boys at risk for later violence.
METHOD: A community epidemiological sample of 415 public school boys was rated at six time points during elementary school regarding their level of aggressive/disruptive behavior. Violence was measured using juvenile police and court records.
RESULTS: The risk for later violence varied as a function of the boys' level of aggressive behavior. This relationship peaked in third grade, where more aggressive boys compared to less aggressive boys were twice as likely to commit later violent acts. In respect to identifying at-risk boys, three intervention scenarios were compared. When minimizing false positives, the optimal test was found in the fall of first grade, with 83% of the high-risk compared to 22% of the low-risk boys later having a violent arrest record. When minimizing false negatives, the optimal test was found in the spring of fourth grade (30% of the high-risk boys versus 0% of the low-risk boys). Focusing on both false positives and false negatives, the optimal test was found in the spring of third grade (52% of the high-risk boys versus 14% of the low-risk boys).
CONCLUSIONS: Early levels of aggressive behavior are strong and robust predictors of later violence but are of limited utility in the early identification of boys at risk. Consequently, universal interventions followed by selected/indicated interventions based on a multistage assessment promise the highest utility in preventing youth violence. Future research is needed to identify other indicators that can strengthen the screening utility of aggressive behavior.