What Kind of Therapy Works With Juveniles Who Have Sexually Offended? A Randomized-Controlled Trial of Two Versions of a Specialized Cognitive Behavioral Outpatient Treatment Program

There is ongoing debate about whether specialized treatment is effective to reduce sexual recidivism in juveniles who have sexually offended (JSOs). Although most treatment programs are based on cognitive behavioral therapy principles for preventing sexual offending, accordant scientific evidence is poor. Following CONSORT guidelines, the present study aimed to evaluate two versions of a short-term outpatient treatment program for JSOs in Switzerland: (a) the Therapy Program for Adequate Sexual Behaviors Version 1 (ThePaS-I), which included offending-specific skills training; (b) the ThePaS-II, which included general socioemotional skills training. Based on changes in self-reported mental health, sexual behaviors, victim empathy, and therapist-rated risk, as well as comprehensive data on sexual and general recidivism, we found some similarities regarding the effects of the two treatments. ThePaS-II showed better short-term changes in self-reported mental health than the ThePaS-I. However, JSOs in the ThePaS-I showed lower rates of sexual reoffending (but not general reoffending) after treatment than those in the ThePaS-II. Despite some methodological limitations, the current findings favor offending-specific skills-based therapy over general skills-based ones for preventing sexual reoffenses. The findings may encourage further methodologically sound studies to examine different treatment approaches for juveniles and adults who have committed criminal offenses.

Sexualized Behavior Among Adolescents Who Sexually Offended

Early or excessive sexualized behaviors and preoccupations with sexuality (SB) exhibited by juveniles who have sexually offended (JSO) are considered risk factors for sexual recidivism. However, research into SB among JSO is scarce. The present study retrospectively examined prevalence rates and patterns of SB among JSO prior to sexual offending and their relation to psychopathology and sexual recidivism. We systematically assessed information from psychiatric and psychological expert reports in case files of 230 JSO aged 12-18 years (M = 14.46, SD = 1.49) from a population sample of JSO with contact sexual offenses. A total of 93 (40.4%) JSO exhibited SB prior to the index sexual offense. Latent class analysis revealed three SB profiles: (1) "low/no SB" (n = 188), (2) "preoccupied SB" (preoccupation with sexuality, e.g., early pornography consumption, excessive masturbation; n = 29), and (3) "dysregulated SB" (exhibiting inappropriate sexualized behaviors toward others, e.g., sexualized speech, touching others inappropriately; n = 13). The preoccupied SB and the dysregulated SB groups showed higher prevalence of psychiatric disorders than the low/no SB. However, none of the JSO of the preoccupied SB or dysregulated SB groups reoffended sexually within 365 days after conviction for the sexual index offense (low/no SB: 12.8%). Overall, our findings do not support a general notion of the presence of SB as an indicator of high risk for persistent sexual offending among JSO. Instead, JSO with SB appear particularly burdened regarding a range of psychiatric disorders that should be treated accordingly.

Temperament and Offending Behaviors in Male Adolescents

The aim of the current paper was to examine temperament profiles and temperament dimensions as risk factors for persistent criminal behavior in juveniles who offended (JOs). A sample of 137 male adolescents from a Swiss detention center and 137 age and sex matched community controls were included in the present study. Temperament was measured with the Junior Temperament and Character Inventory (JTCI). Using Latent Profile Analysis (LPA), three temperament profiles were found, a "moderate," an "adventurous-disinhibited" (higher levels of novelty seeking, lower levels of harm avoidance, reward dependence, and persistence), and a "worried-passive" profile (higher levels of harm avoidance, low persistence). None of the profiles and dimensions were associated with detention sample (i.e., JO) status. In JOs, the "novelty seeking" scale predicted recidivism after release from detention even when controlling for other covariates. Further research should address temperament profiles and temperament dimensions in larger samples of JOs to elaborate their relation to previous and future offending behavior.

Associations of interpersonal trust with juvenile offending/conduct disorder, callous-unemotional traits, and criminal recidivism

Interpersonal trust has been described as a core dimension of cooperative, mutually beneficial interpersonal relationships but it is unclear if it is related to antisocial behaviours in youth. The present study aimed at analysing a subsample of male juveniles who committed serious violent offenses and met criteria of conduct disorder (JO/CD), and a subsample of healthy controls (HC) using a series of trust games (TGs). Twenty-four male JO/CD and 24 age matched male HC performed a series of eight one-shot TGs against different unknown human respectively computer opponents. Mixed model analyses found a non-significant trend that JO/CD invested less points than HC during TGs. In the subsample of JO/CD, the overall investment in TGs was found to be negatively associated with self-reported uncaring behaviours and officially reported general re-offenses. Our findings suggest some indication of an impaired ability of JO/CD to initiate mutually trusting relationships to others that should be addressed in further research. Trust is a promising factor to predict general criminal recidivism and can be a target for treatment of juveniles who committed violent offenses, for example through the building of stable relationships to care givers. This study encourages future studies to investigate the effects of trust-increasing psychosocial interventions.

Validity of Risk Assessment Instruments Among Juveniles Who Sexually Offended: Victim Age Matters

Research has identified meaningful subtypes among the heterogeneous population of juveniles who sexually offended (JSO). However, studies that test the validity of risk assessment tools with JSO subtypes are limited. This study compared JSO who offended against a child victim (JSO-C) and JSO who offended against an adolescent/adult victim (JSO-A) with regard to rates of recidivism and the predictive validity of two risk assessment tools (Estimate of Risk of Adolescent Sexual Offense Recidivism [ERASOR] and Juvenile Sexual Offender Assessment Protocol-II [J-SOAP-II]). Data were analyzed from case files of 185 JSO-C and 297 JSO-A aged 12 to 18 years (M = 14.11, SD = 1.44) from a consecutive sample of JSO with contact sexual offenses. A total of 34 (7.1%) juveniles reoffended sexually, with no significant difference between the subtypes. The present results suggest that the ERASOR, particularly the structured professional judgment, and to a lesser degree the J-SOAP-II are better suited to predicting sexual recidivism in JSO-A than in JSO-C.

Psychische Störungen und kriminelle Rückfälle bei männlichen jugendlichen Gefängnisinsassen

Zusammenfassung. Fragestellung: Die Prävalenz psychischer Störungen unter inhaftierten Jugendlichen ist hoch. Offen ist die Frage, ob damit eine erhöhte kriminelle Rückfälligkeit einhergeht. Methodik: Zwischen dem 01.08.2010 und 31.10.2012 wurden im kantonalen Jugendgefängnis Zürich alle inhaftierten männlichen Jugendlichen bei Eintritt psychiatrisch untersucht (N = 122). Die psychischen Störungen wurden anhand eines standardisierten Interviews erfasst. Nach der Haftentlassung wurden die Probanden im Kantonalen Rechtsinformationssystem betreffend Rückfälligkeit während eines Jahres nachkontrolliert. Ergebnisse: 90.2 % der Insassen litten unter mindestens einer psychiatrischen Störung. Über 70 % der Jugendlichen waren zum Zeitpunkt ihrer Inhaftierung von mehreren psychiatrischen Erkrankungen betroffen. Es konnten vier voneinander unabhängige Störungskategorien unterschieden werden: affektive Störungen, Angststörungen, Verhaltensstörungen und Abhängigkeitserkrankungen. Betreffend Rückfälligkeit fand sich, dass Jugendliche mit Verhaltensstörungen und/oder einer Abhängigkeitserkrankung häufiger mit einer Gewaltstraftat rückfällig wurden als aus dem Gefängnis entlassene Jugendliche ohne psychische Erkrankungen. Zudem zeigte sich, dass je jünger die inhaftierten Jugendlichen waren, desto kürzer war die Zeit nach ihrer Entlassung, bis sie eine Gewaltstraftat verübten. Schlussfolgerungen: Aufgrund der hohen Prävalenz von psychischen Störungen unter inhaftierten Jugendlichen ist es notwendig, dass diese Minderjährigen auch jugendpsychiatrisch-psychologisch untersucht und adäquat behandelt werden. Neben der psychiatrischen Versorgung der minderjährigen Gefängnisinsassen kann so auch den Anforderungen eines effektiven Opferschutzes und dem Sicherheitsbedürfnis unserer Gesellschaft entsprochen werden.

Patterns of Adverse Childhood Experiences in Juveniles Who Sexually Offended

Juveniles who sexually offended (JSOs) are differentially burdened with adverse childhood experiences (ACEs). The present study used Latent Class Analysis (LCA) to derive subtypes of JSOs according to their patterns of 10 different ACEs. An extensive file analysis of 322 male JSOs ( M = 14.14, SD = 1.94) revealed five subtypes with (a) multiple (9.0%), (b) mainly family related (17.1%), (c) mainly peer related (21.7%), (d) mainly neglectful (18.6%), and (e) little/no (33.5%) ACEs. Differences among ACE subtypes with regard to several offense and victim characteristics (e.g., the use of penetration or violence, the choice of a child, a male, a stranger, or multiple victims) were examined. Whereas no differences were found for the use of physical violence or the choice of male, stranger, or multiple victims, binary logistic regressions revealed associations of the multiple-ACE subtype with the choice of a child victim, the family-ACE subtype with the use of penetration as well as further nonsexual delinquency, the peer-ACE subtype with the use of penetration and the choice of a child victim, and the neglect-subtype with the choice of a child victim. Additional analyses including single ACE categories instead of LCA-derived subtypes supported these results. Findings highlight the need for a comprehensive consideration of ACEs in research and clinical work to understand developmental pathways to juvenile sexual offending.

Testing the validity of criminal risk assessment tools in sexually abusive youth

Although accurate risk appraisals are mandatory to provide effective treatment to juveniles who have sexually offended (JSOs), the current knowledge on the validity of risk assessment instruments for JSOs is inconclusive. We compared the predictive validities of the Juvenile Sex Offender Assessment Protocol II (J-SOAP II), the Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR), and the Violence Risk Appraisal Guide-Revised (VRAG-R) scores concerning sexual, nonsexual-violent, and general criminal recidivism (based on both official and nonregistered reoffenses) in a consecutive sample of 597 male JSOs (Mage = 14.47 years, SDage = 1.57 years) while accounting for different recidivism periods, offense severities, and cumulative burden of adverse childhood experiences (ACEs). Receiver Operator Characteristic (ROC) curves and Cox regression analyses indicated that the tools allowed valid predictions of recidivism according to their intended purposes: The ERASOR was best suited to predict sexual recidivism within 0.5 and 3 years, the J-SOAP II was valid for predictions of sexual and nonsexual-violent recidivism within these recidivism periods, and the VRAG-R showed potential strengths in predicting nonsexual-violent recidivism, especially when committed above age 18. Elevated offense severity and burden of ACEs impeded predictive accuracies of the J-SOAP II and the VRAG-R, particularly in case of sexual recidivism. Our findings emphasize that risk assessment for JSOs must not rely solely on scores derived from risk assessment instruments, but a comprehensive consideration of a JSOs offense severity and psychosocial adversities is additionally necessary to approach accurate risk appraisals. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Type and timing of maltreatment influence criminal persistence in sexually abusive adolescents

The development of sexuality is a major goal in the normative course of puberty. However, some adolescents start and maintain sexually coercive behaviors. Maltreatment appears as a contributing factor in juvenile criminal persistence, although its role regarding reoffenses in juveniles convicted of sexual offenses (JSOs) is unclear. We examined time-dependent associations of maltreatment categories and subtypes with criminal persistence in JSOs. Files of 278 male JSOs (M = 14.64 years, SD = 1.58 years) were analyzed for experiences of emotional abuse, physical abuse, sexual victimization, emotional neglect, and physical neglect. We found 3 subtypes reflecting severe maltreatment, neglectful experiences, and low maltreatment. Severe maltreatment proved to be a consistent predictor of nonsexual criminal persistence, whereas overall neglectful experiences were related to sexual criminal persistence. More specifically, physical neglect (including lack of parental supervision) appeared of major importance for criminal persistence. Results indicate that maltreatment is a contributing factor in criminal persistence in JSOs and emphasize the potential gain of applying family oriented interventions to reduce criminal persistence in JSOs. (PsycINFO Database Record

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.

Oppositional defiant disorder dimensions and subtypes among detained male adolescent offenders

BACKGROUND

In adolescent offenders, oppositional defiant disorder (ODD) and its dimensions/subtypes have been frequently ignored due to the stronger focus on criminal behaviours. The revised criteria of the DSM-5 now allow diagnosing ODD in older youths independent of conduct disorder (CD). This study aimed at analysing ODD dimensions/subtypes and their relation to suicidality, comorbid psychiatric disorders, and criminal behaviours after release from detention in a sample of detained male adolescents.

METHODS

Suicidality and psychiatric disorders (including ODD symptoms) were assessed in a consecutive sample of 158 male adolescents (Mage  = 16.89 years) from the Zurich Juvenile Detention Centre. Based on previous research findings, an irritable ODD dimension and a defiant/vindictive ODD dimension based on ODD symptoms were defined. Latent Class Analysis (LCA) was used to identify distinct subtypes of adolescent offenders according to their ODD symptom profiles. Logistic regression and Cox regression were used to analyse the relations of ODD dimensions/ODD subtypes to comorbid psychopathology and criminal reoffenses from official data.

RESULTS

The ODD-irritable dimension, but not the ODD defiant/vindictive dimension predicted comorbid anxiety, suicidality and violent reoffending. LCA identified four subtypes, namely, a no-ODD subtype, a severe ODD subtype and two moderate ODD subtypes with either defiant or irritable symptoms. The irritable ODD subtype and the severe ODD subtype were related to suicidality and comorbid affective/anxiety disorders. The irritable ODD subtype was the strongest predictor of criminal (violent) reoffending even when controlling for CD.

CONCLUSIONS

The present findings confirm the presence of ODD dimensions/subtypes in a highly disturbed adolescent offender sample. Irritable youths were at risk of suicide and persistent criminal behaviours. Due to the severe consequences of irritability, a standardized assessment approach and a specific treatment is needed in prison to prevent suicide among the detainees and further harm to the society. As defined in the DSM-5, the present findings confirm the validity of ODD and ODD dimensions/subtypes as a diagnostic category among older youths.

[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.

Criminal history and future offending of juveniles convicted of the possession of child pornography

Most child pornography is distributed online. It is estimated that 3% to 15% of child pornography consumers are juveniles. The present study analyzed a consecutive sample of 54 male juveniles convicted of the possession of child pornography. Demographic characteristics, criminal history, and subsequent offending were assessed from criminal files and official reports. Juvenile possessors of child pornography were compared to three different groups of juveniles: Juvenile possessors of other illegal pornography (n = 42), juveniles who committed a sexual contact offense against a child (n = 64), and juveniles who committed a sexual contact offense against a peer or adult (n = 104). Juvenile possessors of child pornography were found to have downloaded the illegal material more frequently and over a longer time period than juvenile possessors of other illegal pornography. Furthermore, juvenile possessors of child pornography differed from juveniles who had committed a sexual contact offense in terms of demographics and showed fewer previous and subsequent offending than juveniles who sexually offended against a peer or adult. We conclude that juvenile possessors of child pornography need a specific target intervention focusing on dysfunctional Internet use and sexually deviant arousal.

Parent- and self-reported dimensions of oppositionality in youth: construct validity, concurrent validity, and the prediction of criminal outcomes in adulthood

BACKGROUND

Different dimensions of oppositional defiant disorder (ODD) have been found as valid predictors of further mental health problems and antisocial behaviors in youth. The present study aimed at testing the construct, concurrent, and predictive validity of ODD dimensions derived from parent- and self-report measures.

METHOD

Confirmatory factor analyses were performed to test a three-dimensional model (ODD-irritability, ODD-headstrong, and ODD-hurtful) and a two-dimensional model (ODD-irritability, ODD-headstrong/hurtful) based on items of the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR) collected in a Swiss community study of 1,031 adolescents (519 boys, 512 girls) aged between 10.7 and 17.9 (M = 13.85, SD = 1.63) years. Logistic regression analyses were applied to predict scores in the clinical range of concurrent CBCL/YSR-anxiety/depression, CBCL/YSR-attention problems, and CBCL/YSR-delinquent behavior and depression as measured by the Center for Epidemiological Studies Depression Scale (CES-D) as well as to predict the presence of adult criminal convictions.

RESULTS

CFA findings were in favor of a three-dimensional model rather than a two-dimensional model of ODD. The CBCL/YSR-ODD-irritability scale was related to concurrent self-reported depression, but also to attention problems and delinquent behavior. CBCL/YSR-ODD-hurtful and less strongly also the combined YSR-headstrong/hurtful scale predicted adult criminal outcomes.

CONCLUSIONS

As proposed by the DSM-5 workgroup, different ODD-dimensions were confirmed by the present study. ODD-irritability predicts psychiatric comorbidity and ODD-hurtful symptoms should be specifically considered in youth at risk for criminal outcomes.

Internalizing and externalizing problems, depression, and self-esteem in non-detained male juvenile offenders

BACKGROUND

High rates of mental disorders have been found in detained juvenile offenders, whereas the role of psychopathology in non-detained offenders is less clear. Therefore, the present study compared psychopathology in male non-detained delinquent juveniles and two matched samples from the community and an adolescent psychiatric clinic.

METHODS

125 male adolescents aged 11 to 19 years (m = 16.2 years, SD = 1.5 years) from an outpatient adolescent forensic clinic were compared to a community sample from the Zurich Adolescent Psychology and Psychopathology Study (ZAPPS) and a referred sample from a psychiatric clinic matched for age and nationality. All subjects responded to questionnaires measuring internalizing and externalizing problems, depressive symptoms and self-esteem.

RESULTS

The sample of non-detained juvenile offenders showed similar rates of self-reported internalizing and externalizing problems when compared to the community sample, whereas the clinic sample displayed an increased rate of various disturbances. Similar results were found also for self-esteem. In agreement with these findings, non-detained juvenile offenders less frequently had a psychiatric diagnosis after full clinical assessment when compared to the clinical sample. However, a diagnosis of conduct disorders and a lower IQ range was found more frequently in non-detained juvenile offenders. Offenders with serious delinquent acts and involving weapons showed higher depression scores than the rest of the offenders.

CONCLUSION

In non-detained assessment situations before court examination, juvenile offenders present rather normal behaviour. Their lack of awareness of potential behavioural problems should be considered during assessment and treatment of this group of offenders.

Psychopathology and offense types in detained male juveniles

A substantial proportion of violent crime is committed by juveniles. In detained juveniles, high rates of psychopathology have been found. The objective of this study was to determine psychopathology associated with offense characteristics in detained male adolescents. The Mini International Neuropsychiatric Interview was used to assess juvenile detainees. The final sample included 275 males (mean age=16.45, S.D.=1.27 years). Multivariate logistic regressions yielded significant associations between psychopathology and specific offense types: The presence of substance use disorders (without alcohol) (SUD) was found to predict drug-related crimes, and the presence of alcohol use disorders (AUD) without further SUD were a predictor of violent crime, especially in older juveniles. The absence of anxiety disorder, especially in younger juveniles, was found to be relevant for the prediction of robbery. The results of the study suggest that the use and abuse of legal and illegal substances might be a trigger for serious violent and drug-related crimes in juveniles. In particular, the presence of AUD is presumed to have a pivotal role in the development of impulsive aggression. These findings are important when considering the serious social impact of violent behaviors in adolescents.

Offender types and criminality dimensions in male juveniles convicted of sexual offenses

Previous studies have described juveniles who sexually offended (JSO) as a rather heterogeneous population. In consequence, different typologies of JSO have been proposed for a better understanding of the causes and interventional needs of JSO. Three previously described types have received support in previous studies, namely, the victim age type (JSO offending against children vs. adolescents or adults), the co-offender status type (JSO offending as singles vs. in groups), and the crime history type (JSO with vs. without a previous history of crime). The validity of these types is tested in a consecutive sample of 223 criminal male adolescents, who had been convicted of a sexual offense between 2000 and 2008 in the Canton of Zurich (Switzerland). By analyzing nine offender characteristics, four victim characteristics and six offense characteristics, the best evidence is found for the victim age-based type. The co-offender status and the crime history types are less well supported. However, all three types are related to each other and do not provide a comprehensive characterization of JSO. Therefore, an additional principal component analyses is performed searching for basic dimensions of juvenile sexual delinquency and leading to the following factors: "single offender with severe molestation of a related child," "persistent general delinquent with migrant background," "older offender with alcohol use and familial constraints," "multiple and aggressive offender with social adversities," and "offender with unselected and multiple victims." These five dimensions reflect different relevant factors of sexual offending behavior in male juveniles and may have further impact on forensic and clinical practice.

Predicting sexual and nonsexual recidivism in a consecutive sample of juveniles convicted of sexual offences

Reliable and valid risk assessments are essential for responding adequately to juveniles who have sexually offended (JSO). Given the lack of specific research focusing on the JSO population, the present study aims at confirming and expanding previous findings based on clinical samples dealing with risk assessments of JSO. The predictive power of the Juvenile Sex Offender Assessment Protocol (J-SOAP-II) and the Sexual Offence Severity (SOS) Scale are evaluated retrospectively by analyzing forensic, police, and judicial files in a consecutive sample of 223 adolescents (mean age of 15.7 years, SD=2.1 years) who had been convicted of a sexual crime in the Canton of Zurich, Switzerland, between 2000 and 2008. Based on local official recidivism data (mean follow-up period=4.3 years; SD=2.5 years), univariate and multivariate predictions of sexual and nonsexual recidivism are tested by use of the J-SOAP-II and the SOS Scale in logistic regression and receiver operating characteristics (ROC) analyses. Sexual recidivism (n=7, 3.1%) is best predicted by a multivariate model, including the J-SOAP-II Adjustment Scale and the SOS Scale (ROC: Area under the curve [AUC]=.818). Nonsexual violent (n=37, 16.6%) and general recidivism (n=100, 44.8%) are only moderately predicted by the J-SOAP-II impulsive/antisocial behavior scale (AUC=.677 and .662, respectively). In conclusion, the J-SOAP-II adjustment scale, the J-SOAP-II impulsive/antisocial behavior scale, and the SOS Scale may be helpful for screening purposes in JSO, but additional risk assessment seems necessary. Overall, further research is necessary for a comprehensive understanding of risk factors in JSO.

Psychopathologische und komorbide Störungen inhaftierter Jugendlicher in Österreich

Fragestellung: Inhaftierte Jugendliche zeigen hohe Prävalenzraten an psychiatrischen Störungen und gehäuft psychiatrische Komorbidität. Im Strafvollzug tätige Kinder- und JugendpsychiaterInnen stehen vor der Versorgungsaufgabe und der Notwendigkeit, störungsspezifische Behandlungsansätze auszuarbeiten. Die in dieser Studie erhobenen psychiatrischen Störungen bei inhaftierten Jugendlichen wurden im Hinblick auf störungsspezifische Behandlungsaspekte geschlechtsspezifisch ausgewertet. Methodik: Das Mini International Neuropsychiatric Interview für Kinder und Jugendliche wurde angewandt, um die Psychopathologie bei in Österreich inhaftierten Jugendlichen zu erheben. Die endgültige Stichprobe umfasste 333 Jugendliche (58 Mädchen und 275 Jungen). Ergebnisse: 90 % der inhaftierten Jugendlichen litten an mindestens einer psychiatrischen Störung, über 60 % zeigten zwei oder mehr koexistierende Störungsbilder. Mittels Faktorenanalyse wurden für männliche Jugendliche drei klinisch relevante Störungsmuster anhand von psychopathologischen Merkmalen ausgearbeitet: ADHS/Störung des Sozialverhaltens und Drogenmissbrauch; Angst und Depression; Trennungsangst/PTBS und Alkoholmissbrauch. Für weibliche Jugendliche ergaben sich vier Störungsmuster: Trennungsangst/Sozialphobie/Dysthymie; PTBS und Drogenmissbrauch in Kombination mit entweder ADHS oder Störung des Sozialverhaltens; Depression und Alkoholmissbrauch. Schlussfolgerungen: Aufgrund der hohen Raten an Psychopathologien bei inhaftierten Jugendlichen ist eine umfassende und strukturierte Diagnostik unerlässlich für die weitere Behandlungsentscheidung, da bei inhaftierten Jugendlichen verschiedene Störungsmuster berücksichtigt werden müssen. Die gefundenen Störungsmuster könnten im Zusammenhang mit der Entstehung delinquenten Verhaltens, mit unterschiedlichen Behandlungsbedürfnissen und mit dem Risiko für erneute Delikte wichtig sein.

[Biomorphology of the Bacterial Invasion in Chronic pharyngotonsillitis ]

BACKGROUND

The study investigates whether relapses of chronicpharyngotonsillitis result from new infections caused by theoro-pharyngeal microbial flora or are reactivations of persistent bacterial infections of the tonsils.

METHODS

90 patients, who were surgically treated for chronicpharyngotonsillitis (age 13 months to 38 years, at least 5 episodes of disease and antibiotic treatment in the past) were included. The surgery was performed in the antibiotic- and symptom-free period (at least 6 weeks after the last exacerbation). Sections of tonsillar tissue were investigated for invasive bacteria using fluorescence in situ hybridization (FISH) with group and species-specific 15/23S RNA based probes.

RESULTS

Abundant foci of invasive bacteria were found in 86% of the resected tonsils, despite previous treatment with antibiotica and absent symptoms of ongoing infection. The diffuse infiltration of the tonsils was most predominant in the youger children. Local invasive processes such as abscesses, fissures filled with pus and superficial infiltration of the tonsillar epithelium were more typical for adults. All of the foci were polymicrobial and contained up to 10 different species or groups of bacteria. The local concentrations of invasive bacteria were up to 1012 bacteria/ml.

CONCLUSIONS

The chronic pharyngotonsillitis is the result of persistent invasive bacterial infections. The polymicrobial nature of the infectious foci enables them to resist the antibiotic treatment and to exacerbate afterwards. The surgical treatment is unavoidable as long as antibiotic treatment fails to clear the infection.

Spatial organisation of microbiota in quiescent adenoiditis and tonsillitis

BACKGROUND

The reasons for recurrent adenotonsillitis are poorly understood.

METHODS

The in situ composition of microbiota of nasal (5 children, 25 adults) and of hypertrophied adenoid and tonsillar tissue (50 children, 20 adults) was investigated using a broad range of fluorescent oligonucleotide probes targeted to bacterial rRNA. None of the patients had clinical signs of infection at the time of surgery.

RESULTS

Multiple foci of ongoing purulent infections were found within hypertrophied adenoid and tonsillar tissue in 83% of patients, including islands and lawns of bacteria adherent to the epithelium, with concomitant marked inflammatory response, fissures filled with bacteria and pus, and diffuse infiltration of the tonsils by bacteria, microabscesses, and macrophages containing phagocytosed microorganisms. Haemophilusinfluenzae mainly diffusely infiltrated the tissue, Streptococcus and Bacteroides were typically found in fissures, and Fusobacteria,Pseudomonas and Burkholderia were exclusively located within adherent bacterial layers and infiltrates. The microbiota were always polymicrobial.

CONCLUSIONS

Purulent processes persist during asymptomatic periods of adenotonsillitis. Most bacteria involved in this process are covered by a thick inflammatory infiltrate, are deeply invading, or are located within macrophages. The distribution of the bacteria within tonsils may be responsible for the failure of antibiotic treatment.