This study examined the pathways from violence exposure to aggressive behaviors in urban, elementary school youth. We utilized structural equation modeling to examine putative causal pathways between children's exposure to violence, development of posttraumatic stress symptoms, permissive attitudes towards violence, and engagement in aggressive behaviors. Self-report measures were administered to 259 4th-grade students from urban schools. Almost 100% of participants reported exposure to at least one experience with violence. Results demonstrated that both posttraumatic stress symptoms and attitudes toward violence mediated the relation between exposure to violence and aggression. This model suggests that the relation between violence exposure and youth violence and aggression is multidetermined, suggesting the need for both the developmental adaptation of tertiary prevention and intervention strategies so as to be suitable for younger children, as well as the need for multiple or multifaceted interventions. (Contains 2 figures and 3 tables.)