ADHD symptom profiles, intermittent explosive disorder, adverse childhood experiences, and internalizing/externalizing problems in young offenders

Attention-deficit/hyperactivity disorder (ADHD) and co-existing psychiatric/psychological impairments as well as adverse childhood experiences (ACEs) are common among young offenders. Research on their associations is of major importance for early intervention and crime prevention. Intermittent explosive disorder (IED) warrants specific consideration in this regard. To gain sophisticated insights into the occurrence and associations of ADHD, IED, ACEs, and further psychiatric/psychological impairments in young (male and female) offenders, we used latent profile analysis (LPA) to empirically derive subtypes among 156 young offenders who were at an early stage of crime development based on their self-reported ADHD symptoms, and combined those with the presence of IED. We found four distinct ADHD subtypes that differed rather quantitatively than qualitatively (very low, low, moderate, and severe symptomatology). Additional IED, ACEs, and further internalizing and externalizing problems were found most frequently in the severe ADHD subtype. Furthermore, females were over-represented in the severe ADHD subtype. Finally, ACEs predicted high ADHD symptomatology with co-existing IED, but not without IED. Because ACEs were positively associated with the occurrence of ADHD/IED and ADHD is one important risk factor for on-going criminal behaviors, our findings highlight the need for early identification of ACEs and ADHD/IED in young offenders to identify those adolescents who are at increased risk for long-lasting criminal careers. Furthermore, they contribute to the debate about how to best conceptualize ADHD regarding further emotional and behavioral disturbances.

Mental Health in Young Detainees Predicts Perpetration of and Desistance From Serious, Violent and Chronic Offending

Mental health problems are common among young offenders but their role in predicting criminal recidivism is still not clear. Early identification and treatment of young offenders at risk of serious, violent, and chronic (SVC) offending is of major importance to increase their chances to develop into a healthy and non-criminal future and protect society from further crime. In the present study, we assessed mental health among 106 young offenders while incarcerated and analyzed their criminal careers up to 15 years after release. We found high rates of mental health issues, especially externalizing problems, but also concerning illegal substance and alcohol use patterns as well as personality disorders. Rule-breaking behavior and internalizing problems were negatively related to incarceration time until study assessment, but withdrawal and internalizing problems were positively associated with remaining time to release. Whereas, SVC status before assessment and after release were not statistically dependent, mental health issues predicted perpetration of and desistance from SVC offending after release. Alarming alcohol use appeared to be of specific importance in this regard. Findings indicate that young offenders at risk of future SVC offending may benefit from mental health treatment with specific focus on problematic alcohol consumption to prevent ongoing crime perpetration.

Correlates and predictors of re-incarceration among Turkish adolescent male offenders: A single-center, cross-sectional study

BACKGROUND

Adolescents involved in the legal system are known to be under elevated risk for repeat offending. There may be many reasons for recidivism. Specifically, we aim to investigate the clinical, socio-demographic, and familial factors and psychopathology among adolescents in a penal institution and to determine risk factors for re-incarceration.

METHODS

This single-center cross-sectional survey was conducted at Tarsus Closed Penal Institution for Children and Youth. This institution is for males only, and all male adolescents detained at the center within the study period were evaluated with semi-structured interviews (K-SADS-PL). The adolescents completed Meaning and Purpose of Life Scale, The EPOCH measure of Adolescent Well-being, Family Sense of Belonging Scale, Children's Alexithymia Scale, Beck Depression Inventory, and State-Trait Anxiety Inventory for themselves. Descriptive and inferential analyses were used. P was set at 0.05.

RESULTS

Ninety adolescent offenders with a mean age of 16.6 years (S·D = 0.7) were enrolled. Mean age at first offense was 14.6 years (S·D = 2.1). The most common reason for offenses was reported as as being with peers who were offenders, too (57.8%). Most common diagnoses were substance use (36.7%), attention deficit/hyperactivity disorder (33.3%), and conduct disorder (26.7%). Rates of offending and conviction in first-degree relatives were 62.2% and 60.0%, respectively, and most of the adolescents had at least one peer with a criminal record (n = 71, 78.9%). Re-incarcerated adolescents had lower education, committed more violent crimes, and reported elevated use of substances, suicide attempts, and psychopathology. However, in regression analysis, age of onset was the sole predictor of re-incarceration.

CONCLUSION

Turkish male adolescents in forensic settings may be screened for externalizing disorders and referred for treatment. Re-incarcerated Turkish youth may be more susceptible to peer influence, substance use and externalizing disorders. It may be prudent to systematically screen offending youth for psychiatric disorders regardless of the individual's request for treatment and refer identified cases to treatment. Integration of child and adolescent psychiatrists with penal institutions serving youth may help in this regard.

Exploring the mental healthcare needs of Swiss pre-trial detainees: A pilot investigation of an on-site psychiatric day clinic

INTRODUCTION

Research has established that justice-involved individuals experience significant mental health problems. However, mental healthcare in correctional settings is often not sufficiently accessible to meet the demand. Hence, to improve the availability of mental healthcare services, especially for pre-trial detainees, the first Swiss on-site psychiatric day clinic (PDC) was established in 2019. The present cross-sectional observational study aimed to evaluate the need of psychiatric care in pre-trial detention and the PDC's potential to improve it.

METHODS

File record data were collected from the Office of Corrections and Rehabilitation of the Canton of Zurich. Differences in primary psychiatric care consultations and psychiatric hospital admissions between pre-trial detainees and sentenced prisoners were examined. In addition, a total cohort of pre-trial detainees of the first 18 months of PDC operations was examined to identify differences between three treatment groups: (1) pre-trial detainees exclusively treated in the PDC (n = 41), (2) pre-trial detainees exclusively treated in a psychiatric hospital (n = 58), and (3) pre-trial detainees treated in both the PDC as well as a psychiatric hospital (n = 16).

RESULTS

In the 5 years before the PDC opened, pre-trial detainees had significantly more primary psychiatric care consultations and were admitted to psychiatric hospitals on significantly more occasions than were sentenced prisoners. In the first 18 months of the PDC, psychiatric hospital admission rates for pre-trial detainees decreased by 18.5% and pretrial detainees exclusively treated in the PDC differed significantly from other treatment groups concerning mental disorder, gender, and alleged index offense. They were more likely to be diagnosed with adjustment disorders and were less likely to be diagnosed with schizophrenia spectrum disorder.

CONCLUSION

The use of mental health care among pre-trial detainees is significantly more frequent than among sentenced prisoners concerning both primary care and inpatient treatment. Since establishment of the novel on-site PDC admissions to psychiatric hospitals were found to decrease. Data indicates that especially male pre-trial detainees with adjustment disorders benefitted from this innovative path forward in correctional healthcare. Further research is needed to improve the PDC's service for female pre-trial detainees.

Ethische Herausforderungen in der forensischen Kinder- und Jugendpsychiatrie. Eine qualitative Beobachtungsstudie und ein Instrument zur Früherkennung und Frühintervention

Die forensische Kinder- und Jugendpsychiatrie steht in einem komplexen Spannungsfeld medizinischer, rechtlicher und sozialer Anforderungen. Die ethischen Herausforderungen, die sich daraus für den stationären Maßnahmenvollzug ergeben, sind bisher kaum untersucht, spezifische Hilfestellungen für Behandelnde fehlen. Diese Studie hat zum Ziel, ethische Themenfelder und Probleme in diesem Bereich zu identifizieren und ein Instrument zur Früherkennung und -intervention ethischer Probleme im Klinikalltag zu entwickeln. Methode: Eine systematische Literaturrecherche sowie eine Beobachtungstudie in der Jugendforensik der Universitären Psychiatrischen Kliniken Basel werden durchgeführt. Die Beobachtungsdaten werden mittels qualitativer Inhaltsanalyse ausgewertet. Das Instrument wird auf der Basis der Resultate nach einer neuen Methode entwickelt. In der Literaturrecherche wurden 14 valide Publikationen identifiziert, die hauptsächlich ethische Probleme der Gerichtspsychiatrie thematisieren wie professionelle Rollenkonflikte, ethische Probleme der Diagnostik und Begutachtung oder der Umgang mit vertraulichen Informationen. Empirische oder empirisch-normative Studien fehlen. In der Beobachtungsstudie wurden 24 ethische Themen und spezifische Probleme identifiziert, besonders häufig sind ethische Fragen zu Moralkompetenzen der Jugendlichen, zur Behandlungsqualität, zum Umgang mit Regeln und Sanktionen und zur Freiheits- und Privatsphäre. Das Instrument zur Früherkennung und -intervention ethischer Probleme (FIEP) enthält die vier Kernelemente Risikofaktoren, Indikatoren, Interventionsplanung und Entscheidungsfindung. Der Maßnahmenvollzug der forensischen Kinder- und Jugendpsychiatrie offenbart ein breites Spektrum ethischer Themen mit spezifischen ethischen Problemen, welche in der Literatur bisher nur unzureichend untersucht sind. Das hier entwickelte Instrument FIEP unterstützt Behandelnde dabei, ethische Probleme frühzeitig zu erkennen und effizient zu bearbeiten.

A Cumulative Substance Use Score as a Novel Measure to Predict Risk of Criminal Recidivism in Forensic Juvenile Male Outpatients

This longitudinal study aimed to evaluate a newly developed cumulative measure for substance use problems as predictor of criminal recidivism in youth. Questionnaires-based substance-related behaviors (tobacco, alcohol, cannabis and further drugs), and interview-based psychiatric disorders were assessed in a sample of 142 male adolescent forensic outpatients in Zurich, Switzerland (mean age 16.8 years, SD = 1.4 years). Cox regressions were used to test whether substance use behaviors/disorders were predictors of officially recorded criminal offenses 365 days after the initial assessment. The cumulative substance problem score (SPS) was a valid measure for assessing the risk of criminal recidivism for youth having 2-3 (OR 2.24-2.56) and 4+ problems (OR 3.40-4.37) in comparison to youth with 0-1 problems. Forensic experts and clinicians should comprehensively assess substance use patterns in juvenile offenders and may use the SPS as an indicator for further criminal risks. Additional analysis of the SPS in other forensic samples and cultures would be worthwhile.