Teen dating violence among adolescents

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Background

Healthcare providers (HCPs) play an important role in promoting healthy relationships and addressing teen dating violence (TDV). Approximately one-third of Canadian youth experience TDV (Figure 1)^[1]. TDV is associated with immediate and long-term adverse health consequences^[2][3]. TDV can affect youth of any sexual or gender identity and occur in relationships of any duration.

Figure 1. Prevalence of teen dating violence (TDV) victimization in the previous 12 months among a nationally representative sample of Grades 9 and 10 Canadian students (N = 3064), 2021/22

Data source: Canadian Health Behaviour in School-Aged Children (HBSC) Study^[1].

Definitions

Healthy teen dating, romantic, and sexual relationships are safe, supportive, and violence-free (Table 1).

Adapted with permission from reference^[4]

Unhealthy relationships lack many of the characteristics in Table 1, but do not include violent or abusive behaviours.

TDV includes different types of violent or abusive behaviours experienced in a dating, sexual, or romantic relationships that include at least one young person under age 18^[5] (Figure 2). TDV can start when youth start dating (~Grade 6/age 11), and can be experienced in-person or via technology, or both simultaneously^[6].

Figure 2. Types of teen dating violence (TDV) behaviours

Information drawn from reference ^[7]

TDV has different patterns: youth can experience violence, use violence, or both (i.e., bidirectional TDV). Although bidirectional TDV is common^[8], it does not imply that two partners have the same level of power or that violence is used for the same reasons by both partners (e.g., one partner may use violence for self-defense^[9]).

Risk and protective factors

Youth from socially marginalized groups experience higher rates of TDV (Figure 3). This disproportionality reflects broader systems of oppression (e.g., racism) and discrimination at individual, relationship, community, and societal levels. To provide equitable care, HCPs need to understand the role of these structural factors and actively work to avoid perpetuating harm or stigma within healthcare settings.

Figure 3. Examples of youth at elevated teen dating violence (TDV) risk due to social and structural marginalization

There are a number of risk factors for TDV victimization and perpetration^[10]. Among the most common risk factors are other experiences of violence, including:

• child maltreatment
• witnessing intimate partner violence at home
• peer group aggression (e.g., bullying, sexual harassment)
• past use or experience of TDV

For perpetration, other risk factors include internalizing (e.g., depressive symptoms) and externalizing (e.g., substance use) behaviours.

There are also important protective factors for both TDV victimization and perpetration, including:

• parental monitoring and support
• positive parent-child relationships
• prosocial peer groups
• school attachment

The paediatric provider’s role

HCPs should initiate conversations about healthy relationships during routine and incidental adolescent visits^[11]-[14]. Normalizing these discussions at every visit helps build rapport and provides opportunities to share knowledge with youth and caregivers.

The goal of these conversations is not to elicit disclosures of TDV but to connect youth with supportive resources and create a safe environment in which youth can talk about violence, immediately or later on^[13]. Providers can also make TDV-related information visible in clinic spaces (e.g., bathrooms), which can increase access to resources and reduce stigma around discussing TDV (see Resources, below). Resources should be gender-neutral and inclusive of youth of all sexual and gender identities.

Recommendations for practice

HCPs can use the CUES approach to discuss TDV and healthy relationships with their patients: discussing limits to Confidentiality, providing Universal Education, and, if TDV is disclosed, providing Support via a warm hand-off to appropriate services (Table 2^[13]). CUES prompts can be integrated into existing social history assessments, such as the SSHADESS/HEADSS^[15], and are typically brief to implement^[16]. The CUES approach can also be used in telehealth settings. However, when TDV is disclosed, providers should arrange timely, in-person follow-up^[13][17].

When sharing digital resources (including QR codes) with youth, HCPs should first discuss potential safety concerns related to digital privacy because partners may monitor online activity. When digital privacy is in question, ask whether printed materials may be a safer alternative.

Suspected and disclosed TDV

A structured approach for responding to TDV disclosures should be developed before implementing CUES^[12][13][20]. The approach includes understanding what resources are (and are not) available in your area, such as local violence prevention and mental health services to facilitate a warm hand-off, and relevant online resources. Documentation following disclosure should focus on observed behaviours and youth-reported experiences rather than labelling (e.g., “victim”, “perpetrator”), to avoid stigmatization and potential bias in future care. As with all sensitive discussions, HCPs should maintain a nonjudgmental and open stance and limit follow-up questions to those directly relevant to the youth’s care.

Because TDV often overlaps with other common adolescent health concerns (e.g., substance use), it should be considered as part of the differential diagnosis when evaluating related presentations, such as unexplained somatic symptoms or frequent requests for STI or pregnancy testing^[12][21]. In these situations, HCPs can offer harm reduction strategies through brief counselling and share information about relevant community resources. Discussions about harm reduction should be collaborative, trauma- and violence-informed, and youth-centred, recognizing that youth generally understand the dynamics within their own relationships best. For more information, visit CPS’s statement on harm reduction.

Summary

TDV is a prevalent problem with both immediate and long-term adverse health consequences. HCPs should use the CUES approach as part of their social history-taking to discuss TDV and healthy relationships with all young patients. Providers should develop a structured approach to TDV disclosures before using CUES, while being aware of supportive local or online resources for youth.

Resources on healthy youth relationships

Up-to-date Canadian resources (French and English) for adolescent HCPs, including two patient education resources that can be downloaded and shared directly with youth at no cost, are available from PREVNet.

Acknowledgements

This practice point was reviewed by the Child and Youth Maltreatment Section Executive and the Community Paediatrics and Mental Health and Developmental Disabilities Committees of the Canadian Paediatric Society.

CANADIAN PAEDIATRIC SOCIETY ADOLESCENT HEALTH COMMITTEE (2025-2026)

Members: Megan Harrison MD (Chair), Ayaz Ramji MD (Board Representative), Ellie Vyver MD (Past Chair), Alene Toulany MD, Ashley Vandermorris MD MSc, Amy Robinson MD, Chris Kobylka-Pang MD (Resident Member)
Liaison: Allison Rodrigues MD (CPS Adolescent Health Section)
Principal authors: Allison Rodrigues MD, Deinera Exner-Cortens PhD MPH, Ruchi Vijh MSc MPH, Amy Robinson MD, Alene Toulany MD, Ashley Vandermorris MSc MD, Megan Harrison MD

Potential Conflict of Interest

Dr. Deinera Exner-Cortens reported receiving project grants or funding for clinical trials from: Public Health Agency of Canada (PHAC), CIHR, Government of Alberta, SSHRC, Silver Gummy Foundation, National Center for Education Research, and the Ontario Ministry of Education. Ms. Ruchi Vijh reported receiving a graduate scholarship from the Alberta Children’s Hospital Research Institute. No other disclosures were reported.

All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

Funding

There is no funding to declare.

References

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Disclaimer: The recommendations in this position statement do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate. Internet addresses are current at time of publication.