Psychopathology and offense types in detained male juveniles

The effectiveness of cognitive bias modification in reducing substance use in detained juveniles: An RCT

BACKGROUND AND OBJECTIVE

Young offenders show high levels of substance use. Treatment programs within detention settings are less effective. Cognitive bias modification (CBM) is a promising supplement to substance use treatment. This study tests the effectiveness of CBM in young offenders to reduce cannabis and alcohol use, and delinquent recidivism.

METHOD

A randomized controlled trial added CBM to treatment as usual (TAU), among 181 youth in juvenile detention centers. In a factorial design, participants were randomly assigned to either active- or sham-training for two varieties of CBM, targeting attentional-bias (AtB) and approach-bias (ApB) for their most used substance. Substance use was measured with the Alcohol and Cannabis Use Disorder Identification Tests. Delinquent recidivism was measured with the International Self-Report Delinquency (ISRD) survey.

RESULTS

At pretest, participants showed AtB but no ApB for both substances. For alcohol, a decrease was found in AtB in the active-training group. For cannabis, a decrease was found in AtB for both active- and sham-training groups. Regardless of condition, no effects were found on substance use or ISRD scores at follow-up.

LIMITATIONS

The sample is judicial, not clinical, as is the setting. TAU and participant goals are not necessarily substance related.

CONCLUSIONS

Young offenders show a significant attentional-bias towards substance cues. CBM changed attentional-biases but not substance use. Combining CBM with a motivational intervention is advised. Follow-up research should better integrate CBM with running treatment programs. New developments regarding CBM task design could be used that link training better to treatment.

The effects of emotion and juvenile diagnoses on parole release decisions: An experimental approach

Parole boards are often required to make many release recommendations after reviewing a substantial amount of information in a short timeframe. While making release decisions, parole board members might be motivated to sacrifice accuracy and, instead, use heuristics, such as their emotions. Emotions might increase the reliance on risk or threat related information, such as an inmate's mental illness status. The current study applies the appraisal tendency framework of emotion to assess the impact of emotion on parole decisions involving juvenile mental health diagnoses. Using a 3(emotion: anger, compassion, and control) x 4(mental illness: conduct disorder, oppositional defiant disorder, depression, and control) factorial design, this study examined the extent to which mock parole board members' emotions impacted evaluations of inmates with juvenile mental illness diagnoses and subsequent release decisions. Results indicated that there was no effect of emotion on parole decisions. However, the inmates' mental illnesses did play a role in parole release decisions. Specifically, parole candidates with depression were released on parole at higher rates compared to conduct disorder, oppositional defiant disorder, and the control condition. Policy implications are discussed.

[Forensic adolescent psychiatry: the care situation in Austria]

In Austria there is a lack of registered experts in the field of forensic child and adolescent psychiatry. Their tasks include the assessment of young people in various legal issues, but there is also a lack of child and adolescent psychiatrists for treatment and care for mentally ill adolescents in prison. This lack means that child psychiatric questions are often answered by psychologists or adult psychiatrists.In the group of incarcerated young people, there is an increased proportion of mental illnesses. However, it is also known that young people with-primarily externalizing-mental illnesses also show a significantly increased risk of becoming delinquent. Specialized youth psychiatric treatment can also have a (relapse) preventive effect.To ascertain the exact requirement in Austria, the figures are lacking. These numbers should be collected urgently.Furthermore, a structured training for forensic child and adolescent psychiatrists should be expanded and a platform for exchange and supervision of child psychiatrists working in forensic topics would be desirable. If it is possible to cover the need in this area, the goal that children and adolescents are only examined by specially trained child and adolescent psychiatrists, can be achieved.

Differences in Offending Behaviors, Aggression, Substance Use, and Mental Health Problems between Male Drug Dealers and Non-Drug Dealers in Belgian Youth Detention Centers

This study investigated whether drug dealing juvenile offenders in Belgium differ from non-drug dealers in levels of violent and non-violent offending behaviors, aggression, substance use, and mental health needs. The current study examined data from 226 16- to 17-year-old male juvenile offenders. Information relating to drug dealing, substance use, and mental health needs were collected through self-report questionnaires. A structured diagnostic interview was used to collect information about past violent and non-violent behaviors. Chi-square tests and multivariate analysis of variance compared non-dealers and dealers and explored if hard-drug dealers and soft-drug dealers differed from each other. Relative to non-drug dealers, drug dealers engaged in more violent offending behaviors, exhibited higher levels of aggression, substance use and oppositional defiant problems, and displayed lower levels of anxiety. Soft- and hard-drug dealers did not differ from each other. To conclude, detained drug dealers are characterized by severe antisocial behavior.

Coping motives mediate the relationship between PTSD and MDMA use in adolescents with substance use disorders

BACKGROUND

Post-traumatic stress disorder (PTSD) and substance use disorders (SUDs) often co-occur in adolescent patients. Previous research has shown that these patients differ from SUD patients without PTSD in terms of their substance use patterns. In this study, we aimed to test whether substance use in this population is related to an attempt to self-medicate PTSD-related symptoms.

METHODS

German adolescent patients (aged 13-18 years) at an outpatient clinic for SUD treatment, n = 111 (43% female), completed a self-designed questionnaire on use motives, a measure of PTSD-related experiences, and underwent a standardized psychiatric interview including structured substance use questions. Participants were subsequently classified as 'no traumatic experiences ('noTEs' but SUD), 'traumatic experiences but no current PTSD diagnosis' ('TEs' with SUD), and 'PTSD' with SUD. After establishing a self-designed motive measurement through exploratory and confirmatory factor analyses, we calculated non-parametric group differences and a mediation analysis in a linear regression framework.

RESULTS

The past-year frequency of MDMA use was highest in the PTSD group and lowest in the noTE group (H (2) = 7.2, p = .027, η2 = .058), but no differences were found for frequencies of tobacco, alcohol, cannabis, or stimulant use (all H ≤ 4.9, p ≥ .085, η2 ≤ .033). While controlling for sex, the three groups showed a similar pattern (highest in the PTSD group and lowest in the noTE group) for coping scores (F (103) = 5.77, p = .004, η2 = .101). Finally, mediation analyses revealed an indirect effect of coping score (b = 0.61, 95% CI [0.29, 1.58], p = .145) on the association between group membership and MDMA use frequency.

CONCLUSIONS

In adolescent SUD patients, we found an association of current PTSD and lifetime traumatic experiences with higher MDMA use that could be partially explained by substance use being motivated by an attempt to cope with mental health symptoms. This indicates a coping process involved specifically in MDMA use compared to the use of other psychoactive substances, possibly due to unique psychoactive effects of MDMA.

Non-invasive neuromodulation can reduce aggressive behaviors in humans: A critical perspective

Containing aggressive behavior is an ongoing challenge in modern society. Aggressiveness is a multi-level construct that can be driven by emotions (reactive aggression) or can be "cold-blooded" and goal-directed (proactive). Aggressive behavior could arise because of a misjudgment of others' intentions or can follow frontal brain lesions leading to a reduction of impulse control and emotion regulation. In the last few years, interventional and basic research studies adopting Non-Invasive Brain Stimulation (NIBS) have significantly risen. Those techniques have been used both in healthy people, to better understand the role of certain brain regions in psychological processes, and in aggressive subjects to improve their symptoms. From an overview of the literature, focusing on the paper that uses transcranial direct current stimulation (tDCS) to reduce aggressiveness, it emerges that tDCS can (i) enhance facial emotion expression recognition, (ii) improve impulses control, and (iii) affect approach/withdrawal motivation. The current work shows the strengths and weaknesses of tDCS intervention on aggressive individuals, suggesting that this instrument could be adopted on violent people, and paves the way for intervention in some applied settings such as prison.

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.

Diagnostic Accuracy of the Drug Use Disorder Identification Test and Its Short Form, the DUDIT-C, in German Adolescent Psychiatric Patients

Background

A common screening instrument for substance use disorders (SUDs) is the Drug Use Disorders Identification Test (DUDIT) which includes a short form regarding only drug consumption (DUDIT-C). We aim to assess if a German version of the DUDIT, adapted for adolescents, is a suitable screening instrument in a sample of adolescent psychiatric patients.

Methods

N = 124 (54 female) German adolescent (M = 15.6 + 1.5 years) psychiatric patients completed the DUDIT and received a diagnostic interview (MINI-KID) assessing DSM-5 SUD criteria. A confirmatory factor analysis (CFA), receiver operating characteristic (ROC) curves, the area under the curve (AUC), and Youden’s Index were calculated.

Results

A two-factor model of the DUDIT shows the best model fit (CFI = 0.995, SRMR = 0.055, RMSEA = 0.059, WRMR = 0.603). The DUDIT as well as the DUDIT-C show high diagnostic accuracy, with AUC = 0.95 and AUC = 0.88, respectively. For the DUDIT a cut-off value of 8.5 was optimal (sensitivity = 0.93, specificity = 0.91, J = 0.84), while for the DUDIT-C the optimal cut-off value was at 1.5 (sensitivity = 0.86, specificity = 0.84, J = 0.70).

Conclusion

This is the first psychometric evaluation of the DUDIT in German, adolescent psychiatric outpatients, using the DSM-5 diagnostic criteria. The DUDIT as well as the DUDIT-C are well suited for use in this population. Since in our sample only few patients presented with a mild or moderate SUD, our results need to be replicated in a sample of adolescents with mild SUD.

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.

Responsive Aggression Regulation Therapy (Re-ART): An Evaluation Study in a Dutch Juvenile Justice Institution in Terms of Recidivism

This article describes a quasi-experimental study of the effectiveness of Responsive Aggression Regulation Therapy (Re-ART) in terms of recidivism for 16- to 21-year-old juveniles with aggression problems and high risk of recidivism. In a Dutch juvenile justice institution, an experimental group received Re-ART ( n = 63, Re-ART group) and a waitlist control group received Treatment as Usual ( n = 28, TAU group). Results indicated that Re-ART is significantly more effective than TAU in reducing the juveniles' recidivism risk for violent offending. Compared with the TAU group, the Re-ART group showed significantly less violent crimes after 2 and 3 years, less property crimes after 2 years, and less general recidivism after 2 and 3 years. There was no significant difference between groups in recidivism of property crimes with violence. Ethnicity, mild intellectual disabilities, substance abuse, and age did not moderate the effects on recidivism outcome, which indicates that Re-ART was equally effective for various groups.

Pathways to prevention: protocol for the CAP (Climate and Preventure) study to evaluate the long-term effectiveness of school-based universal, selective and combined alcohol misuse prevention into early adulthood

BACKGROUND

Alcohol use and associated harms are among the leading causes of burden of disease among young people, highlighting the need for effective prevention. The Climate and Preventure (CAP) study was the first trial of a combined universal and selective school-based approach to preventing alcohol misuse among adolescents. Initial results indicate that universal, selective and combined prevention were all effective in delaying the uptake of alcohol use and binge drinking for up to 3 years following the interventions. However, little is known about the sustainability of prevention effects across the transition to early adulthood, a period of increased exposure to alcohol and other drug use. This paper describes the protocol for the CAP long-term follow-up study which will determine the effectiveness of universal, selective and combined alcohol misuse prevention up to 7 years post intervention, and across the transition from adolescence into early adulthood.

METHODS

A cluster randomized controlled trial was conducted between 2012 and 2015 with 2190 students (mean age: 13.3 yrs) from 26 Australian high schools. Participants were randomized to receive one of four conditions; universal prevention for all students (Climate); selective prevention for high-risk students (Preventure); combined universal and selective prevention (Climate and Preventure; CAP); or health education as usual (Control). The positive effect of the interventions on alcohol use at 12-, 24- and 36-month post baseline have previously been reported. This study will follow up the CAP study cohort approximately 5- and 7-years post baseline. The primary outcome will be alcohol use and related harms. Secondary outcomes will be cannabis use, alcohol and other drug harms including violent behavior, and mental health symptomatology. Analyses will be conducted using multi-level, mixed effects models within an intention-to-treat framework.

DISCUSSION

This study will provide the first ever evaluation of the long-term effectiveness of combining universal and selective approaches to alcohol prevention and will examine the durability of intervention effects into the longer-term, over a 7-year period from adolescence to early adulthood.

TRIAL REGISTRATION

This trial was registered in the Australian New Zealand Clinical Trials Registry ( ACTRN12612000026820 ) on January 6th 2012.

Associations between substance use and type of crime in prisoners with substance use problems - a focus on violence and fatal violence

Aim

The present study aimed to study the associations between substance use patterns and types of crimes in prisoners with substance use problems, and specifically whether substance use patterns were different in violent offenders.

Methods

Interview data of prisoners with substance use problems (N=4,202, mean age 33.5 years, SD 9.8), derived from the Addiction Severity Index, were run against criminal register data on main types of crimes in the verdict.

Results

In binary analyses, compared to those with acquisitive and drug crimes, violent offenders had lower prevalence of illicit drugs and homelessness, but higher prevalence of binge drinking, and higher prevalence of sedative use than clients sentenced with drug crimes. Clients with violent crime had lower prevalence of injecting drug use, compared to all other crimes. In logistic regression, binge drinking and sedatives were positively associated with violent crime (as opposed to non-violent crime), whereas heroin, amphetamine, cocaine, and injecting drug use were negatively associated with violent crime. Among violent offenders only, sedatives tended to be associated with fatal violence (p=0.06), whereas amphetamine, homelessness, age, and (marginally significant, p=0.05) heroin were negatively associated with fatal violence, as opposed to non-fatal violence.

Conclusion

Treatment and risk assessment in violent perpetrators with substance use may need to address sedatives and alcohol specifically. Limitations of the study are due to self-reported and cross-sectional data and because a large majority of the prison sample studied here are men.

Substance use disorders in prisoners: an updated systematic review and meta-regression analysis in recently incarcerated men and women

AIMS

The aims were to (1) estimate the prevalence of alcohol and drug use disorders in prisoners on reception to prison and (2) estimate and test sources of between study heterogeneity.

METHODS

Studies reporting the 12-month prevalence of alcohol and drug use disorders in prisoners on reception to prison from 1 January 1966 to 11 August 2015 were identified from seven bibliographic indexes. Primary studies involving clinical interviews or validated instruments leading to DSM or ICD diagnoses were included; self-report surveys and investigations that assessed individuals more than 3 months after arrival to prison were not. Random-effects meta-analysis and subgroup and meta-regression analyses were conducted. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

RESULTS

In total, 24 studies with a total of 18 388 prisoners across 10 countries were identified. The random-effects pooled prevalence estimate of alcohol use disorder was 24% [95% confidence interval (CI) = 21-27], with very high heterogeneity (I²  = 94%). These ranged from 16 to 51% in male and 10-30% in female prisoners. For drug use disorders, there was evidence of heterogeneity by sex, and the pooled prevalence estimate in male prisoners was 30% (95% CI = 22-38; I²  = 98%; 13 studies; range 10-61%) and, in female prisoners, was 51% (95% CI = 43-58; I²  = 95%; 10 studies; range 30-69%). On meta-regression, sources of heterogeneity included higher prevalence of drug use disorders in women, increasing rates of drug use disorders in recent decades, and participation rate.

CONCLUSIONS

Substance use disorders are highly prevalent in prisoners. Approximately a quarter of newly incarcerated prisoners of both sexes had an alcohol use disorder, and the prevalence of a drug use disorder was at least as high in men, and higher in women.

[The epidemiology of mental disorders in youth : A narrative review including Austrian data]

For decades, epidemiological studies have consistently and impressively demonstrated the frequency of mental illness in childhood and adolescence. Mental health disorders are among the most common causes of diminished quality of life among young people, sometimes casting long shadows into adulthood. This narrative review looks at this phenomenon using a selection of research findings dealing with overall prevalence figures, with the prevalence of individual disorders, and with the progression of mental illness from childhood and adolescence to adulthood. Austrian epidemiological studies supplementing these findings are also presented.

Mental health problems in male young offenders in custodial versus community based-programs: implications for juvenile justice interventions

BACKGROUND

Young offenders are known to be a population with high prevalence of mental health disorders. In most cases, these disorders are neither identified nor treated properly, with the majority of them being chronic and difficult to treat. In many countries, the prevalence rates of psychopathology in male young offenders are still unknown and no psychotherapeutic interventions are delivered. Therefore, the main goal of the present study was to assess mental health problems in Portuguese male young offenders placed in either custodial or community-based programs and discuss treatment implications within the juvenile justice interventions.

METHODS

Participants in this study included 217 male young offenders aged between 14 and 20 years old that were randomly selected using a random number table. From the total sample, 122 (56.3 %) participants were placed in juvenile detention facilities, and 95 (43.7 %) were receiving community-based programs. Participants were interviewed with the Mini-International Neuropsychiatric Interview for Children and Adolescents, a structured interview that assesses DSM-IV Axis I Mental Disorders. Participants aged 18 years or older were also assessed with the antisocial personality disorder section from the Structured Clinical Interview for DSM-IV Axis II Personality Disorders.

RESULTS

Results showed a high prevalence of mental health disorders, with a global prevalence of 91.2 % in the total sample. In both groups, global prevalence rates were equally high (93.4 % in youth in custodial versus 88.4 % in youth in community-based programs). Substance-related disorders were more prevalent in youth placed in juvenile facilities, whereas anxiety and mood disorders were more often found in the community-based group. Moreover, oppositional defiant disorder was more prevalent in youth from the community, whereas antisocial personality disorder and conduct disorder were less prevalent than expected in this same group. A high comorbidity rate was also found, with the majority of participants from both groups' fulfilling criteria for two or more disorders. Additionally, participants with conduct disorder were over four times more likely to fulfill criteria for substance abuse.

CONCLUSIONS

Our findings inform about specific needs concerning mental health intervention that should be taken into account when deciding and planning rehabilitation programs for male young offenders, either from custodial or community-based programs.

The associations of cumulative adverse childhood experiences and irritability with mental disorders in detained male adolescent offenders

BACKGROUND

Adverse childhood experiences (ACEs) and psychiatric disorders are common in juvenile detainees. Emotional dysregulation resulting from cumulated ACEs may be characterized by symptoms of irritability. The present study examined whether the accumulation of ACEs, irritability, or both predicted mental disorders in incarcerated adolescents with and without controlling for one another and for socio-demographic factors.

METHODS

One hundred thirty male detained juvenile offenders (aged 13.8-19.5 years) were assessed by structured clinical interviews and a self-reporting scale for irritability. Univariate and multivariate regression models were used to examine the shared and distinct associations of ACEs and irritability with psychiatric diagnoses.

RESULTS

A total of 75 % of the participants reported more than one ACE. The ACE total score was positively related to self-reported irritability. The ACE total score predicted depressive disorders, suicidality, post-traumatic stress disorder (PTSD), and anxiety disorders. Irritability was positively related to depressive disorders, suicidality, disruptive behavior disorder (DBD), substance use disorder (SUD), and attention deficit hyperactivity disorder (ADHD). These associations remained significant in multivariate models.

CONCLUSIONS

This study provides evidence for the predictive impact of self-reported ACEs and irritability with regard to adolescent psychiatric disorders in young male inmates. Both variables differed in their predictive power for PTSD, internalizing, and externalizing disorders indicating the need for specific therapeutic interventions. Taking a close look at their trauma history seems to be of special importance for juveniles suffering from PTSD and anxiety disorders. For delinquent adolescents with DBD, ADHD and SUD, the training of emotion regulation techniques appears most promising. Approaches focusing on both, ACEs and emotion-focused contents may be implemented in the treatment of depressive disorders and suicidality.

[Psychosocial disadvantages in incarcerated girls and boys]

OBJECTIVE

Longitudinal studies found that criminal behavior in juveniles often concurs with neighborhood disadvantage and family dysfunction, especially in girls. In this study we assessed the psychosocial background in incarcerated juveniles and analyzed the data for each gender separately.

METHOD

The Multidimensional Clinical Screening Inventory for delinquent juveniles (MCSI) was used to assess school history, psychiatric history, family background, abuse and neglect and motive for crime. The sample consisted of 294 juveniles (46 females and 248 males).

RESULTS

Innerfamilial abuse/neglect was reported by 91% (girls) and 79% (boys). 76% (girls) and 88% (boys) reported school-problems. 57% (girls) and 29% (boys) reported to have recieved psychiatric pretreatment. In girls we found significantly higher prevalence rates for parental divorce, incarceration of mother, abuse/neglect and psychiatric pretreatment. Significantly more girls reported a co-occurrence of school-problems and experiences of separation and loss and abuse (65.2% vs. 46.4%, χ²=5.51, df=1, p<.05).

CONCLUSION

Incarcerated juveniles, especially females, are and have been exposed to multiple psychosocial burdens. Therefore it is necessary to implement prevention programs for psychosocially stressed families. Forensic intervention in and after detention has to include a family centered approach.

Gender differences in psychiatric disorders and clusters of self-esteem among detained adolescents

Detained minors display substantial mental health needs. This study focused on two features (psychopathology and self-esteem) that have received considerable attention in the literature and clinical work, but have rarely been studied simultaneously in detained youths. The aims of this study were to examine gender differences in psychiatric disorders and clusters of self-esteem, and to test the hypothesis that the cluster of adolescents with lower (versus higher) levels of self-esteem have higher rates of psychiatric disorders. The prevalence of psychiatric disorders was assessed in 440 Belgian, detained adolescents using the Diagnostic Interview Schedule for Children-IV. Self-esteem was assessed using the Self-perception Profile for Adolescents. Model-based cluster analyses were performed to identify youths with lower and/or higher levels of self-esteem across several domains. Girls have higher rates for most psychiatric disorders and lower levels of self-esteem than boys. A higher number of clusters was identified in boys (four) than girls (three). Generally, the cluster of adolescents with lower (versus higher) levels of self-esteem had a higher prevalence of psychiatric disorders. These results suggest that the detection of low levels of self-esteem in adolescents, especially girls, might help clinicians to identify a subgroup of detained adolescents with the highest prevalence of psychopathology.

Psychosocial functioning of drug treatment court clients: a study of the prosecutor's files in Ghent, Belgium

Purpose

– Problem solving courts are a result of the therapeutic jurisprudence movement. Drug treatment courts (DTCs), for instance, aim to divert substance using offenders away from the criminal justice system (CJS) to (drug) treatment services. DTCs are associated with reduced criminal offending and substance use. Psychosocial outcomes of DTCs, such as employment, health and family relations, received only little attention. The paper aims to discuss these issues.

Design/methodology/approach

– This paper focuses on the outcomes regarding substance use and psychosocial variables of a Belgian DTC situated in the Ghent region, which were investigated by a naturalistic evaluation study with a pre- post-design using judicial files.

Findings

– The results show that Ghent DTC clients were diverted to drug treatment and financial counselling services. Next the Ghent DTC produced beneficial outcomes regarding employment. Contrary to criminal offending (De Keulenaer and Thomaes, 2013), substance use was not significantly reduced in the Ghent DTC sample. Yet more compliance with opioid maintenance treatment was observed. Information on more client centred outcomes such as health and social relations was lacking, precluding a full outcome measurement of psychosocial variables.

Research limitations/implications

– Future DTC studies should address more client centreed outcomes by gathering information through DTC clients and treatment services instead of solely relying on judicial data sources. In addition, DTCs should develop a clear and uniform registration system regarding these outcomes.

Originality/value

– Since the therapeutic jurisprudence movement continues to expand, discussion regarding the roles and tasks of the CJS as well as treatment and counselling services is vital. Each actor should maintain its own role and task, regarding monitoring and substantive work, to insure a “problem solving approach” that is in line with the recovery philosophy.

Problem coping skills, psychosocial adversities and mental health problems in children and adolescents as predictors of criminal outcomes in young adulthood

The purpose of this study was to test child and adolescent psychosocial and psychopathological risk factors as predictors of adult criminal outcomes in a Swiss community sample. In particular, the role of active and avoidant problem coping in youths was analysed. Prevalence rates of young adult crime convictions based on register data were calculated. Univariate and multivariate logistic regressions were used to analyse the prediction of adult criminal convictions 15 years after assessment in a large Swiss community sample of children and adolescents (n = 1,086). Risk factors assessed in childhood and adolescence included socio-economic status (SES), migration background, perceived parental behaviour, familial and other social stressors, coping styles, externalizing and internalizing problems and drug abuse including problematic alcohol consumption. The rate of any young adult conviction was 10.1 %. Besides externalizing problems and problematic alcohol consumption, the presence of any criminal conviction in young adulthood was predicted by low SES and avoidant coping even after controlling for the effects of externalizing problems and problematic alcohol use. The other predictors were significant only when externalizing behaviours and problematic alcohol use were not controlled. In addition to child and adolescent externalizing behaviour problems and substance use, low SES and inadequate problem-solving skills, in terms of avoidant coping, are major risk factors of young adult criminal outcomes and need to be considered in forensic research and criminal prevention programs.

Opportunities, threats and limitations of neuroscience data in forensic psychiatric evaluation

PURPOSE OF REVIEW

In the last decade, a number of studies have been published to shed light on the interaction between neuroscience and the law, notably on the introduction of neuroscience data in forensic psychiatric evaluation (FPE). Even if there is a growing consensus on the relevance of neuroscience in clinical practice, the role of neuroscience in FPE is still controversial.

RECENT FINDINGS

The use of neuroscience data in FPE can support the detection of psychopathological disabilities (e.g. deficit of self-control, aggressiveness) that may be involved in criminal action. Traumatic brain injury-related clinical disorders that may lead to misconduct have a relevant role in the debate. Traditionally, literature refers also to rare and weird cases in which brain tumours, infections and morphological abnormalities were supposed to be significantly associated with disorders leading to criminal action.

SUMMARY

After reviewing recent literature from both legal and neuroscientific perspectives, we consider a broader range of clinical conditions (e.g. disorders of consciousness in sleepwalking, dopamine replacement therapy in Parkinson's disease, misattributions of self in delusional experience) that may have implications in legal settings. Obviously, it would be possible to consider also different clinical conditions. We conclude by suggesting further experimental and theoretical analysis.

Association of family structure to later criminality: a population-based follow-up study of adolescent psychiatric inpatients in Northern Finland

The influence of family structure on criminality in adolescents is well acknowledged in population based studies of delinquents, but not regarding adolescent psychiatric inpatients. The association of family structure to criminality was examined among 508 adolescents receiving psychiatric inpatient treatment between 2001 and 2006. Family structure and DSM-IV based psychiatric diagnoses were based on the K-SADS-PL-interview and criminality on criminal records provided by the Finnish Legal Register Centre. After adjusting for socio-demographic, clinical and family factors, the adolescents from single parent families, child welfare placements and those not living with their biological parents showed an increased risk of committing crimes at an earlier age than adolescents from two parent families. Lack of a safe and stable family environment has important implications for adolescents with severe mental disorder. When these adolescents are discharged from hospital, special attention should be focused on organizing stable and long term psychosocial support which compensates for the lack of stable family environment and seeks to prevent future adversities.