This Letter to the Editor reports on an informal surveillance of 1,786 children & adolescents discharged from psychiatric services at an Arkansas Hospital (1988-92). Case profiles of the 5 homicides identify common features: family substance abuse, personal sexual/physical abuse, dysphoria, conduct dysfunction, & neurodevelopmental deficits (in 4 cases). All of these are associated with increased risk to commit violent acts; the author suggests they may also be risk factors for victimization.