Pathology Is Rule for Youth Offenders

Article excerpt

MIAMI BEACH -- Data on the prevalence of mental and substance-related disorders among youth in juvenile justice systems--such as those who are on probation, involved in juvenile/family court, on detention, or in juvenile correctional facilities or other settings--are limited, but available numbers suggest these problems are far more common in juvenile offenders than in other youth.

In fact, 65%-75% of juvenile offenders have one or more psychiatric disorders, Dr. Joseph V. Penn, a child, adolescent, and forensic psychiatrist, said at the annual meeting of the American Society for Adolescent Psychiatry.

Common disorders in this population include oppositional defiant disorder, conduct disorder, attention-deficit hyperactivity disorder, mood disorders, adjustment disorders, substance abuse and dependence, posttraumatic stress disorder and anxiety disorders, and learning disorders. Comorbidity is the norm.

Other typical clinical issues include suicidal ideation, suicide attempts, self-mutilative behaviors, aggression/violence, and other risk-taking behaviors such as truancy, delinquency, and promiscuity.

In evaluating youthful offenders, it is particularly important for psychiatrists to be clear and direct about their role and about the purpose of evaluations. For example, if a psychiatric evaluation is court ordered and information will have to be disclosed to a probation officer or the court, the youth should be told this up front.

"It is amazing how self-revealing youth will be as long as they know the parameters of how much and to whom I disclose their personal information," said Dr. Penn of the Bradley Hasbro Children's Research Center and Brown University, Providence, R.I.

Clinicians should attempt to gather relevant collateral information whenever possible from family members; clinical, education, and probation/correctional staff; previous service providers; treatment records; and educational records. In addition, it is important to look for motivation and compliance with past treatment and any inconsistencies, he said at the meeting, which was cosponsored by the University of Texas at Dallas.

In particular, physicians need to be alert for medication noncompliance or diversion and substance abuse, which are very common among juvenile offenders. …