When their children were 6 years old, primary caregivers were interviewed by trained examiners using the Achenbach Child Behavior Checklist (CBCL), a measure of caretaker reports of child behavior. The CBCL yields age- and gender-normed T-scores for children's internalizing, externalizing, and total behavior problems. T-scores greater than 70 are considered the clinical cutoff for referral. At the same visit, the Exposure to Violence Interview (EVI) was also administered to the caregiver. The EVI is a research tool developed at our site and used throughout the past 10 years in this study to measure an individual's exposure to violence during the prior 12 months. The EVI covers 6 types of violent events: yelling, kicking and punching, attacking with a weapon, threatening with a weapon, rape, and knifing. The caregiver reports whether the child witnessed the event in the last 12 months (range, 0-6 months) and how many times. Prior to administering the EVI, the caregivers are instructed to respond to the questions regarding what the child may have seen or heard on the street, at home, or in school; but not on TV, on the news, or in the movies. This item has been administered to caregivers approximately every year for their child's entire lifetime, with the same instructions to exclude media violence. The EVI was analyzed as a 3-level variable: (1) no exposure, or yelling only; (2) low exposure (the most violent event witnessed was kicking or punching); (3) high exposure (witnessed threatening with a weapon, knifing, attacking with a weapon, or rape). At the same visit, other examiners who were blinded to the child's prenatal history of drug exposure and to caregivers' reports, independently interviewed the 6-year-old children using the Levonn, which assesses children's distress symptoms over witnessed violence.5 Created by Richters, Valla, and Martinez at the National Institute of Mental Health (Bethesda, Md) in 1990, the Levonn assesses similarities between the child's experience with that of a cartoon character named Levonn, and includes a 2 to 3 sentence script that the interviewer reads at each cartoon ("Here is Levonn feeling very sad for a whole day. He gets up in the morning feeling sad, he feels sad all day, and he still feels sad at bedtime. How many times have you felt like Levonn?"). The format for indicating frequency consists of thermometers filled with varying degrees of mercury that are coded as 1 to 3 (never, some of the time, a lot of the time) yielding a possible range of 39 to 117. Test-retest reliability for a composite score of distress ratings was 0.81 for a random subsample of 22 first- and second-graders in Washington, DC, with a significant relation to parent CBCL scores (r76 = 0.30) and to parent rating of child distress based on the CCDS (r76 = 0.32).