Adolescent Forensic Psychiatry Research Articles

Forensic Psychiatry Education in Child and Adolescent Psychiatry (CAP) Fellowship: Results from a Multi-site Survey.

This study examined the current state of forensic education among child and adolescent psychiatry (CAP) fellowship programs, regarding specific forensic topics, teaching resources, methods, and experiences. The authors aimed to gather and analyze this data to assess the need for additional standardization of forensic psychiatry education in CAP fellowship, such as broader access to resources, and/or inform the development of a standardized curriculum, including milestones, in child and adolescent forensic psychiatry. The authors collaboratively developed a survey instrument on child and adolescent forensic psychiatry education, which was then sent to 135 accredited CAP fellowship programs. The items included in the survey instrument were designed based on literature review, expert consensus, and a 1992 American Association of Directors of Psychiatric Residency Training survey on teaching ethics and forensic psychiatry. Completed response data was returned by 25 of the 135 programs surveyed. Complete responses came primarily from academic institutions (52% public, 36% private) with small- or medium-sized programs (1-12 total fellows, 88%; 11-29 faculty members, 56%). Programs reported on CAP forensic rotation sites, faculty members' level of expertise and involvement in forensic CAP, common forensic topics and experiences offered, and programs' attitudes towards specific topics and experiences. Child and adolescent psychiatrists must gain a clear understanding of the essential components of CAP forensic psychiatry during CAP fellowship, to mitigate discomfort when interacting with the legal system and meet the rising need for forensic CAP expertise across systems and structures impacting youth populations.

Violent behaviour in adolescents: assessment and formulation using a structured risk assessment tool

SUMMARYTeenagers often present in crisis with risk issues, mainly risk to self but sometimes risk to others. Adolescent violence is commonplace and is not just the remit of adolescent forensic psychiatry. Clinicians may lack confidence assessing risk of violence and can neglect vital areas that are essential to reduce risk. Use of structured violence risk assessments enables the multi-agency professional network to formulate a young person's presentation and their violence in a holistic way and consequently develop targeted risk management plans addressing areas such as supervision, interventions and case management to reduce the risk of future violence. Of the several validated tools developed for young people, the Structured Assessment of Violence Risk – Youth (SAVRY™) is that most used by UK-based forensic adolescent clinicians. This article outlines the epidemiology, causes and purposes of violence among adolescents; discusses types of risk assessment tool; explores and deconstructs the SAVRY; and presents a fictitious risk formulation.

Study of child and adolescent forensic psychiatry : procedure and clinical profile Abstract

IntroductionForensic psychiatry is a specific field of practice in child psychiatry where skills are applied for legal purposes and the expert is faced with certain difficulties.ObjectivesOur objective was to determine the characteristics of the forensic procedure and the clinical profile of the consultants.MethodsCross-sectional and retrospective descriptive study concerning patients consulting the child psychiatry department of Mongi Slim Hospital between January 2018 and December 2019 in the context of a forensic expertise, excluding administrative expertise. Telephone interviews were carried out for the medicolegal follow-up.ResultsThe average age was 9 [+/- 3.1] years and the sex ratio was 0.97. The majority of the requests for expertise came from the specialised unit for violence against women and children (40%). The expert’s task was to carry out a child psychiatric examination in 44% of cases and to establish credibility in 6.8% of cases. Apart from 3 cases of perpetrators, the requests concerned victims of physical (40.1%), sexual (38.6%) and psychological (21.3%) aggression. The assault had taken place within the family in 52% of cases and the alleged aggressor was the father in 36%. The average time between the incident and the request for an expert opinion was significantly longer in cases of sexual assault (p =0.01). The physical assaults concerned more boys (p = 0.05) while those of a sexual nature concerned female children (p=0.005). Victims of sexual aggression showed more sexualised behaviour (p<0.05). No significant differences were found in psychiatric diagnoses according to the type of assault, but an examination without abnormalities was prevalent in cases of psychological assault (p=0.009). Claims were significantly more difficult to interpret in preschool children (p=0.05). Child victims of sexual abuse had more subsequent requests for further investigations (p=0.05) and a judgment, pronounced in 34% of cases, was most often related to psychological abuse (p=0.05).ConclusionsThe practice of forensics requires a specific competence that requires extensive training. Better coordination between the professionals involved is needed as well as the creation of specialised forensic units.Disclosure of InterestNone Declared

Child and Adolescent Forensic Psychiatry Experiences During the COVID-19 Pandemic

Child and Adolescent Forensic Psychiatry Experiences During the COVID-19 Pandemic

Child and Adolescent Forensic Psychiatry Examination and Analysis of U.S. Citizen Children with Illegal Immigrant Parents Facing Deportation.

Although the citizenship clause of the fourteenth amendment guarantees citizenship to persons born in the United States, the 1996 Immigration Act does not allow illegal immigrant parents to avoid deportation unless such deportation would cause extreme and exceptional hardship to a U.S. citizen relative. This paper reviews the potential adverse effects of such deportation on a child. It presents 12 cases where child and adolescent forensic psychiatric evaluations of U.S. citizen children supported their immigrant parents' petitions for legal resident status. Parent-child attachment, as well as the child's educational status, language proficiencies, acculturation to U.S. culture, and psychiatric distress at the potential deportation, are the factors most helpful in elucidating a child's reaction to this threatened deportation. During the child and adolescent psychiatry evaluations, the parents were interviewed, school records were reviewed and, where appropriate, pediatric records were considered. All the children were examined alone and then as a family unit with their parents using standard DSM-IV-TR diagnostic criteria [1]. Firstly, considering their clinical diagnoses, a clinical prognosis was made for the possibility if the child were to be forced to go to their parents' country of origin with their deported illegal immigrant parent(s). Secondly, each case was examined and analyzed individually to determine the clinical prognosis of the U.S. citizen child if they were to stay in the United States while the illegal immigrant parent(s) was forced to leave. In all of the 12 cases, there was already pre-existing anxiety in the children secondary to the fear of a negative outcome for the parents in the immigration legal cases. In all of the 12 cases it was also determined that the prognosis for the child's adjustment to being without their parent but remaining in the US would have produced a significant exacerbation of the psychopathology already seen. Furthermore, in all of the 12 cases, were the children to be relocated to their parental culture, unfamiliar to the child's American culture, again, the prognosis was made that a significant exacerbation of psychopathology would occur. On the basis of the findings of the child and adolescent psychiatric evaluations and analyses presented to the court, all of the illegal immigrant parents were permitted to receive permanent resident status.

In the Child's Best Interest: The Contribution of Child and Adolescent Psychiatry

Child and Adolescent Forensic Psychiatry involves a multidisciplinary assessment at the courts' requested to assist them in the process of justice delivery. Retrospective study which included 233 forensic requests to two child and adolescent psychiatrists from Coimbra's HP-CHUC Child and Adolescent Psychiatry Department between 1998 and 2012. Biographic, psychopathology, social and family aspects were analyzed. The response time throughout the process, the origin and nature of the request's and the type of process which originated the request were also assessed. The authors identified the involved professionals and whether they needed to go to court. When there were questions, they evaluated the capacity to answer them, the forensic difficulties and solutions found, and the presence of recommendations. The obtained results met the clinical experience and literature regarding demography and psychopathology. As for the difficulties, there were a number of aspects which could be improved by both parts, aiming to ameliorate the articulation between Health and Justice. With this study it was possible to reflect on the authors forensic practice, in order to develop a closer partnership with the courts to promote the real 'best interests' of children/adolescents and their families.

Adolescent forensic psychiatry training in the Top End

Adolescent forensic psychiatry training in the Top End

Ethical issues in child and adolescent forensic psychiatry: a review

Ethical challenges in child and adolescent forensic psychiatry arise, on the one hand, from the dilemmas commonly faced in forensic psychiatry with adult patients, such as the dual role of the forensic psychiatrist, questions of criminal responsibility, autonomy and competence and involuntary treatment, and, on the other, from the immaturity and dependent position of the minor. Child and adolescent forensic psychiatry deals with minors involved in crime, not only as offenders, but also as victims. In this review, we attempt to describe ethical challenges in child and adolescent psychiatry using as a frame of reference the principles of biomedical ethics according to Beauchamp and Childress.

Oxytocin and callous-unemotional traits: towards a social-cognitive approach to forensic analysis.

Callous-unemotional (CU) traits in children and adolescents are an important risk factor for forensic behaviors in youth and in adulthood. There is a strong biologic basis in CU traits, offering the possibility to design biological interventions to address this risk factor. This paper advances the hypothesis that the administration of exogenous oxytocin is a biological intervention worthy of further investigation to address CU traits and moderate future risk factors for forensic behaviors. The evidence for this assertion rests in the empiric evidence that social cognitive deficits play a major role in child and adolescent CU traits and psychopathy. Simultaneously, emerging evidence suggests that youth with CU traits have defined neuroendocrinological correlates within the oxytocin system. A review of the normal neurohormonal physiology of this system is presented to provide a groundwork for the delineation of these correlates. That deficits in this system are found in alternate psychopathologies that present with deficits in social cognition serves as the basis for the hypothesis that these deficits may play a key role in the development and manifestation of CU traits. Their correction through psychopharmacologic and alternate means may provide a future route to addressing a central area of adolescent forensic psychiatry.

Challenges in Establishing Adolescent Forensic Mental Health Services Within Australian Youth Detention Centres

Young people in custody rank amongst the most marginalized in Australia, and have high rates of mental health disorders. However, the knowledge base to support the emerging field of adolescent forensic psychiatry is limited. Following an appraisal of Australia's state-based youth justice systems, it is proposed that three key challenges need to be addressed: the challenge of advocating for change, the challenge of building an evidence base, and the challenge of developing integrated transitional models of service delivery. Adolescent forensic mental health services that view their role as existing solely within the walls of youth detention centres or community juvenile justice services have too narrow a vision. While not seeking to trivialize their patients’ criminal behaviour, psychiatrists need to drive the delivery of innovative mental health services within youth detention centres and collaborate with those in the political, legal, youth justice, education and child safety sectors to inform debate of the challenges faced by young people in custody.

The Minimum Age of Criminal Responsibility: Clinical, Criminological/Sociological, Developmental and Legal Perspectives

One of the most complex, contested and controversial questions confronting modern juvenile/youth justice systems concerns the minimum age of criminal responsibility: the age at which a child is deemed to be sufficiently ‘mature’ to be held responsible before the substantive criminal law. In the three UK jurisdictions − England and Wales, Northern Ireland and Scotland − the minimum age of criminal responsibility falls significantly below the European average. In England and Wales, for example, the largest UK jurisdiction by some distance, children are held to be fully responsible in criminal proceedings once they reach the age of 10 years. The legitimacy, or otherwise, of exposing such young children to the full weight of criminal law is increasingly a source of lively debate, attracting interest from a broad range of stakeholders. It is timely, therefore, to subject the minimum age of criminal responsibility to analytical scrutiny. It is within this context that the Royal College of Psychiatrists’ Adolescent Forensic Psychiatry Special Interest Group took the initiative, in October 2012, to convene a conference in order to explore the question of criminal responsibility from different disciplinary perspectives: clinical, criminological/sociological, developmental and legal. The substantive articles that form the basis of this ‘special issue’ began life at that conference. They have since been developed and subjected to peer review and what follows is an attempt to open up an informed inter-disciplinary discussion. It is no coincidence, given the low minimum ages of criminal responsibility that prevail, that each article centres its analytical focus on youth justice jurisdictions within the UK. That being said, each article also draws upon a wide-ranging international literature in addressing questions that extend far beyond any single, and nationally bounded, juris492050 YJJ13210.1177/1473225413492050Youth JusticeChurch et al. 2013

New Special Interest Group – Child and adolescent forensic psychiatry

New Special Interest Group – Child and adolescent forensic psychiatry

The Child and Adolescent Track in the Forensic Fellowship

Exposure to child and adolescent forensic issues is limited in general psychiatry residency and child and adolescent psychiatry residency programs. There is no Graduate Medical Education Program for child and adolescent forensic psychiatry that is approved by the American Council on Graduate Medical Education (ACGME). Forensic psychiatry residency directors can create a child-focused forensic training opportunity that meets the needs of the ACGME program in forensic psychiatry. By creating didactic, clinical, and research experiences relevant to child and adolescent forensic psychiatric issues, this much-needed training can be provided to qualified psychiatrists.

A developmental approach to violence, hostile attributions, and paranoid thinking in adolescence

Research within the area of paranoid thinking has focused primarily on adults and has only recently looked at the effects during the critical life stage of adolescence, with even less research in the context of the juvenile justice system. This article aims to explore the relationship between antisocial behaviour in adolescence and the development of paranoid thinking, set within wider contexts that surround the juvenile justice system. The information presented is drawn from both the current research and the clinical experiences of those working in adolescent forensic psychiatry services. The relationships with other disorders such as conduct disorder, ADHD, PTSD, and depression are also explored.

Enhancing the learning curve in child and adolescent forensic psychiatry: inter-professional relationships, resource and policy development

Enhancing the learning curve in child and adolescent forensic psychiatry: inter-professional relationships, resource and policy development

Current adolescent forensic psychiatry in Japan

Log in or Register Subscribe to journalSubscribe Get new issue alertsGet alerts Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. Subscribe to eTOC Secondary Logo Journal Logo All Articles Images Videos Podcasts Blogs Advanced Search Toggle navigation Subscribe Register Login Articles & Issues Current IssuePrevious IssuesPublished Ahead-of-Print For Authors Submit a ManuscriptInformation for AuthorsLanguage Editing ServicesAuthor PermissionsLippincott® Preprints VideosJournal Info About the JournalEditorial BoardAdvertisingOpen AccessSubscription ServicesReprintsRights and Permissions All Articles Images Videos Podcasts Blogs Advanced Search

Juveniles Standing Trial: Waiver to Adult Court

Guest columnist, DIANE H. SCHETKY, M.D., practices child, adolescent, and adult forensic psychiatry in Rockport, Maine, and is Clinical Professor of Psychiatry at the University of Vermont College of Medicine at Maine Medical Center. She has published extensively in child forensic psychiatry, recently co-editing Principles and Practice of Child and Adolescent Forensic Psychiatry, and is the winner of the 2003 Manfred Guttmacher Award for the book’s outstanding contribution to the forensic psychiatry literature. This guest column by Dr. Schetky provides an overview of legal and psychiatric issues related to allowing juvenile defendants to stand trial as adults (referred to here as “waiver”) and offers a commentary concerning the effectiveness of the waiver concept.

Principles and Practice of Child and Adolescent Forensic Psychiatry

Back to table of contents Previous article Next article Book ReviewsFull AccessPrinciples and Practice of Child and Adolescent Forensic PsychiatryKamlyn Haynes, M.D.Kamlyn HaynesSearch for more papers by this author, M.D.Published Online:1 Oct 2003https://doi.org/10.1176/appi.ps.54.10.1416-aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail From the front cover's inviting photo of arctic poppies to the back cover's poetic explanation for the choice of this flower, Principles and Practice of Child and Adolescent Forensic Psychiatry is a carefully crafted and comprehensive textbook. It offers indispensable assistance for those of us beginning our careers as child and adolescent forensic psychiatrists. As the authors suggest, a wide audience, including mental health clinicians, forensic examiners, attorneys, and judges, will find in this book a user-friendly, well-organized, unique reference that succeeds in shedding a bright academic light on an all too often neglected subspecialty.The book is divided into six sections: "Basics," "Child Custody," "Child Abuse," "Youth Violence," "Juvenile Offenders," and "Legal Issues." Each of these sections includes five to seven chapters and serves as either an encyclopedic introduction or a succinct summary, depending on the reader's experience with the topic. Most chapters follow a fairly consistent yet nonrestrictive format that begins with evocative clinical examples. These examples are followed by concise descriptions of the relevant legal or clinical issues. When appropriate, an overview of the evolution of the relevant legal or clinical matters places current concerns in a historical context. Some chapters follow the case examples by clarifying key legal or clinical issues, which is necessary for a more complete understanding of the text to come. Although these explanations were very helpful for those chapters, this neophyte frequently wished that the editors had included a forensic glossary.Most chapters offer helpful warnings and recommendations to the practicing clinician and end with a section titled "Case Example Epilogues." Although I found the coverage of certain types of evaluations disappointingly superficial and a few others not optimally well organized, other discussions were extremely helpful mini-manuals on how to perform certain types of forensic evaluations—for example, parenting assessment in cases of abuse and neglect and termination of parental rights.The chapters on foster care and adoption, introduction to forensic evaluations, sexually aggressive youths, prevention of youth violence, and forensic ethics are all commendable chapters that stand out as well-written introductions to their respective topics. Each of these chapters spells out the inherent difficulties in working with the population or topic reviewed, yet each manages to do so honestly while offering younger, inexperienced clinicians reason to hope for progressive changes on the horizon. Chapter 2, "Introduction to the Legal System," was an absolute joy to read—it is the only chapter during which I laughed out loud twice.After reviewing the relevant data and simplifying the complex topic of what happens to children's developmental trajectories when they are maltreated, Chapter 19, "Neurodevelopmental Impact of Violence in Childhood," addresses the political reality that society has always and will always reap what it sows. Without preaching, the author, Bruce D. Perry, M.D., Ph.D., ends his chapter by suggesting that increased evidence of the detrimental effects of violence should and can provide parents, professionals, public officials, and policy makers the evidence they need to advocate for policies that ultimately decrease the amount of violence in youngsters' lives. The entire textbook reflects a similar style.Without ever climbing on a soapbox, the various authors of the chapters in this volume advocate for increased professionalism, better collaboration, and an honest appraisal of one's motivations. In many ways, the book urges its readers to bring rigor and discipline to more fairly evaluate and assist the legal system in the care, protection, treatment, and disposition of youths who are involved with the juvenile justice system, family courts, and foster care. This is a welcome and valuable text, and I highly recommend it.Dr. Haynes is a newly graduated child and adolescent psychiatrist in private practice in Worcester, Massachusetts.edited by Diane H. Schetky, M.D., and Elissa P. Benedek, M.D.; Washington, D.C.,American Psychiatric Publishing, Inc., 2002, 432 pages, $67 FiguresReferencesCited byDetailsCited byNone Volume 54Issue 10 October 2003Pages 1416-a-1417 Metrics PDF download History Published online 1 October 2003 Published in print 1 October 2003

Principles and Practice of Child and Adolescent Forensic Psychiatry

Principles and Practice of Child and Adolescent Forensic Psychiatry

Juvenile homicide offenders: 10 years' experience of an adolescent forensic psychiatry service

Psychosocial characteristics were retrospectively studied in 46 juvenile perpetrators of homicide who had been referred to an adolescent forensic service in a 10-year period. Results of analysis were compared with a sample of 106 fire-setters referred to the same service. The profile of British homicidal juveniles is similar to that cited in the American literature in that the majority are male and come from disturbed family backgrounds. Compared with a delinquent sample of fire-setters, however, significantly more homicidal juveniles were male and had a history of frequent changes of schools, alcohol abuse and alcohol intoxication at the time of the offence. By contrast, when compared with delinquent juveniles, significantly fewer of the homicidal juveniles suffer from psychotic illness and are known to professional services prior to referral to the service. In a discriminant analysis a history of psychosis, being in care, alcohol intoxication at the material time and prior psychology contact were the most significant variables predicting group membership for homicidal and fire-setting delinquents. Abused homicidal youths do not differ markedly from those who do not suffer abuse but are characterized as coming from families with higher rates of paternal psychopathology. Prevention needs to focus on issues such as quality of parenting and alcohol abuse.