Mental Disorders Among Adolescents in Juvenile Detention and Correctional Facilities: Posttraumatic Stress Disorder is Overlooked

Abstract

In their study, published in the September 2008 issue of the Journal, Fazel et al. reported a significantly higher prevalence for depression, attention-deficit/hyperactivity disorder (ADHD), and psychotic illnesses among adolescents in juvenile detention and correctional facilities when compared with the general population. What they did not address, unfortunately, is the prevalence of posttraumatic stress disorder (PTSD) in this population. Previous studies have pointed out the elevated prevalence of both trauma and PTSD in juveniles in detention compared with community samples. The potential involvement with substance abuse and violence places many youths at particular risk for PTSD. Abram et al. reported that 11.2% of their sample population of 898 juveniles in detention met criteria for PTSD within the past year, according to the Diagnostic Interview Schedule for Children, version IV. The relevance of recognizing PTSD is underscored by the American Academy of Child and Adolescent Psychiatry Practice Parameters for the Assessment and Treatment of Children and Adolescents with Posttraumatic Stress Disorder. Posttraumatic stress disorder has a high rate of comorbidity with other psychiatric diagnoses, including depression, substance abuse, ADHD, and conduct disorder. Youths with PTSD may demonstrate numbing or avoidance symptoms such as restlessness, hyperalertness, poor concentration, and behavioral problems, making them more likely to be diagnosed with ADHD. Alternatively, youths with preexisting ADHD may be more vulnerable to developing PTSD after a traumatic experience. Furthermore, PTSD in youthsmay result in loss of impulse control and diminished control of aggression and anger, which may explain the comorbidity of PTSD with conduct disorder and oppositional defiant disorder. Given the significant prevalence of PTSD in juveniles in detention and correctional facilities, as well as its high comorbidity with other psychiatric disorders, it is clear that this disorder cannot be ignored in this population, and data pertaining to PTSD should have been addressed by Fazel et al. Michelle Guchereau, M.D. Oxana Jourkiv, M.D. Children’s National Medical Center Washington, DC