Anxiety as a differentiating variable in emotional recognition in juvenile offenders with high callous-unemotional traits.

BACKGROUND: The presence of so-called callous-unemotional (CU) traits-lack of remorse/empathy, callous use of others and shallow/deficient affect-defines an important subgroup of children and adolescents with more severe and stable antisocial behaviours over time and may be a precursor to so-called psychopathy in adults. There are two main hypotheses to account for such traits, one emphasising deficits in recognition of specific emotions-the distress specific-and the other in aspects of facial recognition-the attention to the eyes hypothesis, but it may be that the manifestation of deficits is affected by the person's own emotional state. AIMS: To test the effect of anxiety scores on emotion recognition among young people high scoring for CU traits. METHODS: 14- to 21-year-olds serving sentences in youth justice institutions across Spain were invited to participate. Only those scoring above the cut-off on the Kimonis Inventory of Callous and Unemotional Traits were included. Anxiety was measured using the State-Trait Anxiety Inventory. Emotion recognition was assessed using the Emotional Face and Emotional Gaze Tasks. RESULTS: Of 91 (90% male) eligible participants, 53 had above threshold anxiety scores. The latter group recognised the emotional expressions of sadness, anger and fear earlier than their non-anxious peers, both when only the eye region was presented and when full faces were presented. There was less difference between groups in the case of the emotions of disgust and happiness, with both groups recognising these emotions earlier and more accurately when a full face was presented. CONCLUSIONS: Our findings suggest that 14- to 21-year old who struggle with callous emotional traits should not be treated as a homogenous group but that testing for other relevant problems, including anxiety, may inform optimal routes to the emotion recognition training that is likely to help them relate to others more prosocially.

Eliciting an offence narrative: what types of questions do forensic mental health practitioners ask?

Maximising the accuracy and detail of information elicited through a clinical-forensic interview may increase the reliability and validity of an individual's assessment. Despite this, there is little empirical research on what questions forensic mental health practitioners employ, and whether these correspond with empirically established interviewing strategies. In this study, 22 forensic mental health practitioners participated in a mock interview of a young person referred for a sexual risk assessment. The results highlighted that participants asked very few 'open' questions, over-relied on 'specific' questions and an average of 13% of questions were leading. Finally, practitioners predominantly used 'yes/no' questions when exploring the young person's thoughts, feelings, and physiological responses. Overall, the study demonstrated that empirically supported interviewing techniques were not commonly employed and highlighted the need for further professional development and training around clinical forensic interviewing strategies that best elicit the information needed to inform risk assessment.

The predictive and incremental validity of ADHD beyond the VRAG-R in a high-risk sample of young offenders.

The VRAG-R is a well-established actuarial risk-assessment instrument, which was originally developed for assessing violent recidivism risk in adult male offenders. Whether or not the VRAG-R can also predict violent recidivism in young offenders is unclear so far. In the emergence of juvenile offending, attention-deficit/hyperactivity disorder (ADHD) seems to be of major importance suggesting that it could be relevant for risk assessment as well. Thus, we examined the predictive accuracy of the VRAG-R in a high-risk sample of N = 106 (M = 18.3 years, SD = 1.8) young offenders and assessed the incremental predictive validity of ADHD symptomatology beyond the VRAG-R. Within a mean follow-up time of M = 13 years (SD = 1.2), n = 65 (62.5%) young offenders recidivated with a violent offense. We found large effect sizes for the prediction of violent and general recidivism and re-incarcerations using the VRAG-R sum scores. Current ADHD symptomatology added incremental predictive validity beyond the VRAG-R sum scores concerning the prediction of general recidivism but not of violent recidivism. The results supported the use of the VRAG-R for predicting violent recidivism in young offenders. Because ADHD symptomatology improves the predictive performance of the VRAG-R regarding general recidivism, we argue that addressing ADHD symptoms more intensively in the juvenile justice system is of particular importance concerning a successful long-term risk management in adolescents and young adults.

The all-Wales forensic adolescent consultation and treatment service (FACTS): A 5-year referral cohort study.

BACKGROUND: FACTS is a Wales-wide mental health service for 10-17-year-olds with needs beyond the remit of mainstream child and adolescent mental health services (CAMHS). As a purely consultation-liaison service, it differs from other UK services in the field. AIMS: To describe a complete cohort of referrals to FACTS 2013-2017 with service exit by June 2018. METHODS: Clinical, social and offending data were extracted from FACTS records. RESULTS: 80 young people completed a FACTS episode, averaging nearly a year (309 days; range 13-859 days). Mostly boys (65, 81%) of mean age 15.4 years (range 9-18), two-thirds (n = 53) had three or more referral reasons, one invariably being threatened/actual harm to others; only half were criminal-justice involved. Half (41, 51%) were committing sexually harmful acts. Half were self-harming (41, 51%). All but seven had had at least one adverse childhood experience (ACE), nearly half (35, 44%) four or more. Nevertheless, post-traumatic stress disorder (PTSD) was rarely diagnosed (7, 9%); just over one-quarter (23, 29%) had no diagnosis at all. Correspondence analyses endorsed two distinct Attention deficit hyperactivity disorder groups, distinguished by presence/absence of evidenced brain damage or dysfunction. Suicide-related behaviours clustered with the other diagnoses, flashbacks and psychotic symptoms with no diagnosis. Change in home circumstances during a FACTS episode was slight. CONCLUSIONS: The complexity of presenting problems and service involvement evidences need for FACTS. The extent of persistently harmful sexual behaviours is a novel finding, suggesting need for more expert input for this at other service levels. Rarity of PTSD diagnoses was surprising given the extent of ACEs. This raises concerns that services focus on disorder signs rather than the child's inner life. Given the extent of problems, minimal change may be a positive outcome - especially when remaining in the community. Further development of this service should include explicit case-by-case goals and indicative outcome markers.

Developmental language disorders and risk of recidivism among young offenders.

BACKGROUND: Although factors such as adverse family background have been widely examined, little is known about the prevalence or potential impact of developmental language disorder (DLD) on risk of recidivism in young people with history of criminal justice system contact. METHODS: A total of 145 young offenders participated. An adversity score was constructed based on information found in youth justice service records. Data collected included standardised measures of expressive and receptive language, nonverbal IQ and the inventory of callous-unemotional traits. Survival analysis was performed to examine differences in reoffending risk between young offenders with and without DLD. RESULTS: The cumulative incidence of reoffending within a year of the young person's court order was markedly raised in the DLD group (62%; 95% CI 52, 72) versus the non-DLD group (25%; 95% CI 16, 39). Furthermore, in the final multivariable survival analysis the independent elevation in risk linked with DLD was not greatly attenuated with adjustment for nonverbal IQ, adversity score, age at first offence, number of previous offences and deprivation score. DLD was the most significant predictor with an adjusted hazard ratio of 2.61 (95% CI 1.80, 3.78). CONCLUSIONS: Young offenders with DLD are more than twice as likely to reoffend than their unaffected offending peers. DLD is a powerful predictor of recidivism above and beyond other known risk factors.

Young female offenders and the New Zealand Youth Justice System: the need for a gender-specific response.

Young female offenders comprise approximately one fifth of the New Zealand youth offender population; however, they remain an understudied population of offenders. This paper aims to provide a current overview of the key characteristics of this population and recommendations for how the youth justice system could better cater to this population. These recommendations include more training of professionals (specifically judges, youth advocates and justice coordinators) and practitioners (specifically social workers, psychologists and youth workers) in the youth-justice system in matters specific to young female offenders. A gender-responsive and trauma-informed approach to addressing offending behaviour is also necessary. There is a need for new empirical research in the New Zealand context on young female offenders and the best way to address offending by this group. Finally, a focus on the diversity of young female offenders is a priority, given the over-representation of indigenous and ethnic-minority communities in justice jurisdictions worldwide.

The Manitoba Youth Justice Program: empowering and supporting youth with FASD in conflict with the law.

Fetal alcohol spectrum disorder (FASD) describes a constellation of physical, cognitive, neurologic, and behavioral impairments resulting from prenatal exposure to alcohol. FASD is recognized as being one of the most common causes of preventable brain injury in children. There had long been concerns that some youth in conflict with the law may be affected with FASD given repetitive patterns of offending and apparent lack of understanding of the consequences of their actions. In 2004, funding was received from Justice Canada for a pilot project with a cross-departmental steering committee working together to determine a best way of working across systems to provide FASD assessments to these youth. It was recognized that provision of timely FASD assessments would allow the court to provide more meaningful sentences taking into account the youth's strengths and challenges and enhance the changes of decreased recidivism and increased changes of rehabilitation. This paper describes the basic science around FASD and its diagnosis, provides a history of the FASD Youth Justice Program, and reports on legal issues, structure, statistics, accomplishments, and ongoing future challenges.

Coping strategies and traumatic brain injury in incarcerated youth: a mediation analysis.

OBJECTIVE: Investigation into whether coping strategies mediated the relationship of traumatic brain injury (TBI) on depression/anxiety and alcohol and drug problems within incarcerated youth. SUBJECTS: A non-probability sample of youth (N = 227) adjudicated for a variety of offences. METHODS: Cross-sectional study within two long-term residential facilities for youth offenders in Pennsylvania. TBI assessed with question about lifetime head injury with blackout. Coping measured with Coping Strategies Inventory that included domains of acting-out coping, internalised coping, partying coping, prosocial coping, and expressing coping. Outcomes of depression/anxiety as well as alcohol and drug problems measured with Massachusetts Youth Screening Instrument-Version 2. RESULTS: Mediation was suggested for acting-out coping and internalised coping with 45% and 48% of the total effect mediated between TBI and depression/anxiety, respectively. For alcohol and drug problems, mediation was indicated for acting-out coping and partying coping. Acting-out coping mediated 33% and partying coping mediated 51% of the total effect between TBI and alcohol and drug problems. CONCLUSION: Study results suggest that addressing the use of avoidant coping, such as acting-out coping, internalised coping, or partying coping, by youth with TBI in the criminal justice system could help ameliorate depression/anxiety and abuse of alcohol and drugs.

Language impairment and comorbid vulnerabilities among young people in custody.

BACKGROUND: While the prevalence of language and communication difficulties among young people in custody is well established, holistic understanding of the complexity and co-occurrence of additional vulnerabilities among this population are rare. METHODS: Ninety-three young people in a young offenders institution in England were assessed using the Comprehensive Health Assessment Tool, the Test of Word Knowledge, and a range of additional assessments of communication, cognition, and neurodevelopmental difficulties. RESULTS: Forty-seven percent of the young people demonstrated an aspect of language skills significantly below the population average, with more than one in four identified as having impairment. Only one in four of those with an impairment had previously accessed speech and language services. Language needs were associated with difficulties with social communication and nonverbal cognition, as well as higher risk of self-harm and substance misuse. CONCLUSIONS: Earlier identification of language difficulties requires routine assessment of young people at risk of engagement in offending behavior. Where language difficulties are identified, holistic assessments of needs should be undertaken. There is a need for speech and language therapy provision within youth justice services, as well as in other services accessed by young people at risk of engagement in offending.

The prospective usefulness of callous-unemotional traits and conduct disorder in predicting treatment engagement among detained girls.

Although treatment engagement (TE) is crucial for treatment success it is not well known how likely detained girls are to engage in treatment and what features may impede them from doing so. This study is the first to examine the prognostic usefulness of two features of potential interest, being callous-unemotional (CU) traits and conduct disorder (CD), in relation to TE. Detained girls and their parents (n = 75) were interviewed with the Diagnostic Interview Schedule for Children to assess CD, and completed the Antisocial Process Screening Device to assess CU traits dimensionally and categorically as in the new diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) CU-based specifier. One to two months later, the girls reported how much they engaged in treatment. At the zero-order level, self-, but not parent-reported CU traits and CD were predictive of lower levels of TE. The incorporation of CU traits into a diagnosis of CD identified girls with lower levels of future TE, a finding that held across different informants. Of note, the aforementioned findings only became apparent when using a dimensional measure of CU traits, and not when using the categorical measure of CU traits currently included in DSM-5. This study showed that CU traits can help developing an understanding of what factors hinder TE among detained girls. Our findings also support recommendations to incorporate CU traits into the CD diagnosis, and suggest that dimensional approaches to do so may yield relevant information about future levels of TE.

Young Offenders, Maltreatment, and Trauma: A Pilot Study.

Although a large number of studies offer consistent and persuasive evidence that exposure to childhood maltreatment and subsequent juvenile offending behaviours are related, relatively few studies have investigated the mechanisms by which maltreatment might increase risk in young offender populations. The aim of this pilot study was to collate data on the key areas of need from 28 young male offenders in secure care in an Australian jurisdiction, with a specific focus on the inter-relationship between scores on self-report measures of maltreatment, trauma, and mental health. The findings provide preliminary evidence that these key constructs are linked to other proximal risk factors for juvenile offending, such as poor anger regulation and antisocial thinking patterns. They offer a rationale for considering the sequelae of maltreatment in the development of service delivery frameworks for young offenders.

Service users as the key to service change? The development of an innovative intervention for excluded young people.

BACKGROUND: Excluded young people, especially those affected by street gangs, often have complex unmet needs and high levels of health and social inequalities. This paper outlines the development of Music & Change, an innovative and comprehensive intervention accessible to young people, which aimed to holistically meet the mental health and other needs of its participants and ultimately to reduce offending rates. Its central principle was coproduction and partnership with its potential users. METHOD: The setting was an inner-city housing estate; the core group of participants was 15 young people aged 16-22 years. The intervention used contemporary music skills (e.g. DJ-ing and lyric writing) and other coproduced project activities as a vehicle to build relationships with practitioners and address young people's multiple needs. Data were gathered using a focused ethnography, largely from field notes, and analysed using thematic analysis in order to ascertain users' perceptions of its delivery. RESULTS: Young people identified six key principles of the intervention, such as the need for consistent relationships with trusted staff, mental health support to be wrapped round other youth-led activities and local service delivery within their safe territories. CONCLUSIONS: Music & Change was valued by young people who do not easily engage with professionals and services. The findings led to the development of the 'Integrate' model, which is using these coproduced principles to underpin several new pilot projects that aim to address the health and social inequalities of excluded young people.

Improving communication outcomes for young offenders: a proposed response to intervention framework.

BACKGROUND: Speech, language and communication needs (SLCN) are strongly overrepresented in young offender populations, and there is growing commitment internationally to ensuring access to speech-language therapy services for such young people. However there is currently no framework in which such interventions might be conceptualized, delivered and evaluated. This is significant given the role of language competence in the development of prosocial skills and also in the transition to literacy. AIMS: To present Response to Intervention (RTI) as a framework in which SLCN of young offenders might be systematically addressed and evaluated within youth justice settings, led by speech-language therapists, in conjunction with other education and welfare team members. METHODS & PROCEDURES: Literature regarding prevalence rates of SLCN in young offenders is reviewed, together with the limited extant evidence on interventions for this group. The importance of applying evidence-based interventions is argued, and a framework for adapting RTI for SLCN in custodial settings is outlined. MAIN CONTRIBUTION: A framework for adapting RTI to design, deliver and evaluate speech-language therapy interventions in youth custodial settings is presented. CONCLUSIONS: Speech-language therapy interventions for young offenders will be better addressed at policy, practice and research levels if a framework such as an RTI adaptation is employed. It is expected, however, that this model will evolve over time, as intervention evidence pertaining to the youth offender population emerges.

Predictors of rapid reincarceration in mentally ill young offenders.

OBJECTIVE: Describe characteristics of mentally ill young offenders released from custody and predictors of those who rapidly returned to custody. METHOD: Ambidirectional cohort study of 51 young males with mental disorders released from the largest New South Wales Juvenile Justice Centre (2005-2007), a health file audit at time of release and prospective determination of reincarceration. RESULTS: Overall 47% were Aboriginal, 43% originated from regional communities, substance disorders were highly prevalent and only 12% accessed prior community mental health care. Over half (57%) satisfied diagnostic criteria for schizophrenia spectrum disorder. In custody, 39% were suicidal and 18% were homicidal. A majority (90%) returned to custody over a median of 28 months; half within five months of release. Schizophrenia/schizophreniform disorder (p<.001), bipolar disorder (p=.001) and schizoaffective disorder (p=.005) predicted rapid reincarceration, with shorter community survival than those without those diagnoses (p=.009). Antipsychotic treatment (p=.006) and treatment duration in custody (p=.006) predicted longer community survival. Aboriginality, younger age, prior incarceration and substance disorders were not predictive of rapid reincarceration. CONCLUSIONS: Serious mental illness was a significant predictor of rapid reincarceration in young offenders. Treatment improved community survival. The findings highlight the need for optimal psychiatric treatment and post-release care for young offenders with mental illness.

Mural art therapy for young offenders hospitalised with a mental illness.

OBJECTIVE: To describe a mural art therapy project completed within an adolescent unit of a secure forensic psychiatric hospital. METHOD: The planning, implementation and consecutive stages of the mural art therapy project are described. Pertinent themes are identified. RESULTS: A cohort of adolescent forensic inpatients was engaged in a group therapeutic process involving collaboration, design and the completion of an art mural. The participants generally approved of the project and identified themes of gaining a sense of achievement, empowerment, teamwork, involvement and ownership. The art mural transformed and improved the visual and spatial environment of the Adolescent unit courtyard. CONCLUSIONS: Mural art therapy was acceptable to young offenders hospitalised with mental illness, which has relevance for adolescent psychiatric units and youth detention centres.

No Matter Your Age, "It's Your Life, It's Your Choice": Compulsory Persuasion and Informal Rehabilitative Support in Youth and Adult Intensive Supervision Programs.

Although existing literature identifies that public protection and risk reduction are the primary goals of intensive supervision programs (ISP), little is known about how or whether rehabilitation of high-risk offenders is prioritized outside of enforcing court-mandated conditions. Using qualitative semi-structured interviews and focus groups within two Canadian metropolitan ISPs, our study explores how rehabilitative support is offered to youth and adult high-risk offenders in the absence of formal conditions. Using the framework of late-modern rehabilitation and compulsory persuasion, we draw on themes of offender responsibilization and coercion to interrogate the provision of informal rehabilitative support. Our findings indicate that officers negotiate "voluntary agreements" with select high-risk offenders, which hierarchicalizes them into two groups: those worthy of informal support and those who "choose" not to want to rehabilitate. We also find that youth and adults are treated similarly despite substantive differences between the types of crimes committed.

Enuresis in young offenders - a study on prevalence and mental health comorbidity.

Background: Enuresis is a common disorder in the school-age period, and is often associated with a variety of behavioral, psychological, and social problems. While early studies suggested an association between enuresis and delinquent behavior, there has been no recent research assessing the prevalence of enuresis and its comorbid psychopathology in young offenders. The aim of this study was to therefore assess the prevalence of enuresis and its associated psychiatric comorbidity in incarcerated young offenders. Methods: The prevalence of past and current enuresis and comorbid psychopathology was assessed using a semi-structured psychiatric interview and self-reports from 366 incarcerated male young offenders [age 14 to 19 years (mean age = 16.4)] from Northern Russia. Results: Seventy-three (20.0%) adolescents reported a previous history of enuresis, and in addition almost 10% of the youth reported current enuresis symptoms. Delinquent youth with enuresis did not significantly differ from other youth in the prevalence of comorbid psychiatric diagnoses when assessed by a clinical diagnostic interview, but had significantly higher levels of self-reported mental health problems, and suicidal ideation and attempts. Conclusion: Problems with enuresis are common among delinquent youth and may be associated with increased mental health problems. Given the potentially increased risk for suicidal thoughts and behavior in young offenders with enuresis, comprehensive mental health screening of those who are detected with this condition should be considered in the juvenile justice system.

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.

Occupational Therapy and Imprisoned Adolescents: An Analysis of Professional Practices.

The care of adolescents in reclusion has been a field of work for occupational therapists in different parts of the world. The objective of this study was to describe and analyze Brazilian occupational therapists' practices with adolescents in reclusion. Research conducted in Brazil, identifying 56 professionals, invited to answer a questionnaire (n = 43); participate in discussion groups (n = 9); and interview (n = 4). Professionals reported different visions that guide their practices, including the identification of individual skills and the profession's possibilities for social action. Occupational therapists have specificities to work in these institutions, highlighting the possibilities of acting with a focus on social change. Practices in occupational therapy can lead to social change if focused on social issues. Social occupational therapy offers theoretical and methodological elements that inform the profession. Reflections on the practice carried out, according to a critical perspective, enable a performance in occupational therapy that intends social change.

OBJECTIVE: The objective was to describe and analyze the practice of occupational therapists in custodial units of the Brazilian juvenile justice system. METHODOLOGY: Mapping and identification of occupational therapists in institutions of juvenile incarceration; questionnaire; workshops; semi-structured interviews; and synthesis meeting. RESULTS AND DISCUSSION: Forty-three professionals with diverse practices participated in this study. The collected data in the different stages of the research were analyzed based on social occupational therapy. CONCLUSION: Occupational therapy practices can lead to social change if focused on social issues. Social occupational therapy offers theoretical and methodological elements for that.

Occupational Therapy and Imprisoned Adolescents: An Analysis of Professional PracticesIntroduction: In Brazil, the number of adolescents convicted of infractions is increasing. Judicial sanctions may be imposed on this population, including imprisonment. There are occupational therapists working with these adolescents, but their practices are little recorded and debated.

Exploring the Relationship between Callous-Unemotional Traits and Implicit Attitudes toward Violence.

Past research has associated callous-unemotional traits (CU) in young people with serious conduct problems and antisocial behavior. However, whether CU traits influence implicit attitudes toward violence remains largely unexplored. We assess this hypothesis in two independent samples: a sample of youth with no criminal records (Study 1, N = 86), and in a sample of young offenders (Study 2, N = 61). Both groups were not compared due to theoretical (very different demographics) and statistical reasons (the total sample was insufficient to be able to reach the statistical power required in the comparison of both groups). Further, we use an implicit procedure to examine whether CU traits modulate wanting for violent stimuli. Across two samples of youth, we found little evidence of an association between CU traits and implicit violent cognition. In youth with no criminal records, implicit attitudes toward violence were related to the unemotional factor of CU traits, but unrelated to other factors and to a global CU traits score. CU traits were not associated with implicit attitudes toward violence in young offenders. The latter finding was mirrored in the implicit wanting task. Overall, our findings cast some doubts on the adequacy of implicit measures to assess implicit violent cognition in youth with CU traits. We discuss potential methodological limitations of this research (e.g., characteristics of the sample and performance in the implicit procedures) that may impact our results.