Assessment and Treatment of Juvenile Offenders:Quality Evaluations and considerations of ADHD

Randall T. SalekinDepartment of PsychologyDisruptive Behavior ClinicUniversity of Alabama

DSM-5 Disorders ODD CD

Early Onset specifier Limited Prosocial Emotion specifier

ADHD

ODD Angry/Irritable

Often loses temper Often touchy or easily annoyed Often angry or resentful

Oppositional Often argues with authority Often actively defies or refuses to comply Often deliberately annoys others Often blames others

Spiteful Spiteful or vindictive within past 6 mos. (CU traits LPE)

Conduct Disorder Aggression to People and Animals Destruction of Property Deceitfulness or Theft Serious Violation of Rules

Specify Early v late onset Specify mild, moderate, severe

LPE specifier 1) Lack of remorse or guilt 2) Callous-lack of empathy 3) Unconcerned about performance 4) Shallow or deficient affect

ADHD Inattention Hyperactivity/Impulsivity

Specify: Predominantly inattentive or hyperactive

Personality and temperament Openness Conscientiousness Extraversion Agreeableness Neuroticism

Juvenile Evaluations and Treatment Introduction, laws and the system Political and social climate Mental health concepts Research behind the concepts Preparation for the evaluation/ Training Data collection Interpretation Report writing Testimony Treatment Future directions

history of Juvenile Justice System and PsychologyLawsThe systems

e.g., Local LawsAge

AL 14 yearsCol, Missouri, Montana 12Kansas, Vermont, Wisconsin 10

Statutory Decision points

Kent v US (1966)In re Gault (1967)

Hodgins v Minnesota (1990)Roper v Simmons (2006)

4 Eras Parens Patriae Due Process Crime Control (get Tough) Rehabilitative (inspired by neuroscience)

Antonin Scalia

“APAs flip flop”

Number of different systems The Court System (attorneys) Juvenile Court Judges and Referees Probation system Detention Centers Department of Youth Services

Major Statutory Decision PointsPrecharge Post charge-preadjudication

Release Diversion Arrest Adjudication Dismissal Referral to mental health

system Adjudication of delinquency Disposition sentencing

Pretrial detention Referral to adult system Diversion to Alternative

program Adjudication Probation Secure Custody

Mechanisms for transfer

Waiver Prosecutor direct file Automatic transfer Reverse transfer

Sources of Information Juvenile court statistics report (OJJDP) Juvenile offenders and victims (OJJDP) Juvenile transfer (OJJDP) National Council of Juvenile Court Data Archive National Council of Juvenile and Family Court Judges

Teplin et al. (2002) – 6 month prevalence (Archives of General Psychiatry)

Any diagnosis 66.3% (73.8) Affective 18.7% (27.6) Psychotic 01% (01) Anxiety 21.3% (30.8) DBD 41.4 (45.6) SU 50.7 (46.8)

Disposition and Transfer

Juvenile Offender Assessments: The Role of the MHP

Provide clear information on the young person and hopefullly a roadmap for change

Structuring the Evaluation

In juvenile offender cases: Veracity Personality/ Mental Health Problems Risk (Are they dangerous?) Maturity Treatment Amenability/Readiness Assessment and Management RST-i

Risk Maturity Amenability

Veracity

Every evaluation needs to consider the veracity of the report

A Developmental GuidelineAge Expected Deceptive Capabilities

<3 Lack of evidence to support deception; lies told are likely denials of transgressions to avoid punishment

3-4 Able to tell very basic and unsophisticated lies; have difficult understanding the concept of truth and lie

5-6 Can tell rudimentary lies (unable to sustain the deception over time)

6-12 Evidence shows capable of intentional deception (instilling false beliefs)

12-18 Capable of intentional deception and engaging in more sophisticated lies

Examples of Deception Cases Greenfeld (1987)

14 yo girl - psychosis Lu & Boone (2002)

9 yo boy – neurological deficits Conti (2004)

Two 16 yo with CD faking ADHD Evans (2000)

Faking school phobia Bools et al. (1990)

53% of school refusals malingering

Presentation Style and Potential MotivesPresentation Potential Motives & GoalsDefensive/healthyAppear self-reliant Desire for increased autonomyAppear brave Desire for autonomy and strong self-

imagePresent as non-sx Not want to be seen as ill, different,

weakPresent normal IQ Avoid being ostracized by peers Faking/PathologicalPresent as uncaring Protect from potentially harmful

relationsPresent as dependant Avoid responsibility/seek helpPresent as callous Appear tough and not in need of helpPresent as mentally ill Gain help or avoid responsibility

Model of Deception

In terms of the evaluation it is probably best to:

First, view deception as a form of adaptationNext, maladaptive behavior

Finally, pathological

Primal fear

Model of Deception

adaptive pathological

Model for Adolescent DeceptionSalekin, Kubak, & Lee (2008)

Development Staus Internal izing

Externalizing

no pathology

Situation/Context

AdaptationDeceptive Strategy

Personality/ DSM-5 Need some framework for assessing youth -> DSM-5, (ICD-11), RDoc -> Personality

p. 469

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Personality and Life Outcomes

The importance of studying personality is that certain traits will be able to predict certain outcomes for children and adolescents

In psychology we sometimes focus on the negative aspects of personality

Big 5 and Positive and Negative OutcomesTrait Positive Outcome Negative Outcome

Extraversion Social competence; promotes good healthBetter romance/ l-t relationships

Antisocial behavior; callousness

Neuroticism Conscience development; guilt when expected

Poor relationships; relation conflict; relation abuse; less competent parenting; risk for unemployment

Conscientiousness School adjustment; educational and occupational achievement; job performance

obsessive

Agreeableness Social competence; positive parenting; responsible parentingBetter grades

Exposure to risksLow agreeableness linked to antisocial outcomes

Openness Exploring; friendliness; academic achievement

Exposure to risks

Why personality plus DSM dx? Has both positive and negative outcomes associated

with single domains (less negative in describing youth) It offers parsimony and easily understood Explanatory model (explain DSM “outcomes”) As an expert it is also important to be able to speak in

different languages (temperament, personality, DSM-5, ICD-11)

Perhaps most importantly, can feed directly into the psycho-legal constructs!

Personality and its connection to psycho-legal constructs Attention and control (developmental maturity) Positive emotion (reduced risk) Conscientiousness and agreeableness

(maturity/amenability) Openness (better treatment amenability) Neuroticism (development of conscience, lower risk)

Psychological Stage models might also be important to consider (Erikson Marcia)

Should clinicians still use the DSM-5 and/or ICD? Yes Some conditions are not picked up with personality

ADHD ASD Mood

It provides a formal way of talking about the case ADHD and others can all be assessed with the

Structured Interviews

Connecting the Big 5 to Specific Childhood Disorders and the RDoc

Externalizing (Extraversion, low Conscientiousness, low Agreeableness)“disinhibition”

Internalizing (high Conscientiousness, high Neuroticism)“fear”

ODD Separation Anxiety

CD Depression

ADHD Generalized AnxietyOCD

Substance Use Eating Disorders

RST-I SAVRY YLS/CMI

Risk Subscales

Risk

R-VAT R-PEX R-PPF

Developmental Maturity Subscales

Maturity

S-AUT S-COG S-EMO

Developmental Maturity – need to be careful about extreme statements There are plenty of examples of adolescents who are

relatively mature and conscientious

In everyday environments, there are adolescents who hold down jobs, perform well in school earning As and Bs, pitch in at home when asked, care for their family.

Such youth elicit positive reinforcement from the environment (beaming smile from a parent!).

What are the defining features? Frequency

“Criminal Sophistication”

Developmental MaturitySalekin(2002) bottom up

Autonomy Cognitive Capacities Emotional Skills

Steinberg & Cauffman (1996) top down Responsibility Perspective Temperance

Developmental Model of MaturitySalekin & Grimes (2008)

Development Status Envi ronment

Externalizing

Internal izing

No pathology

Situation/Decision

Amenability Subscales

Amenability

T-PAT T-RES T-CAT

Treatment Amenability Personality stability research shows that there

is flexibility in youth (stability data- step-like).

Brain research too, Musicians who show stronger connections in certain brain regions (somatosensory cortex). Jugglers

medical

2 time point assessment For developmental maturity (considering ADHD),

especially, you may need a 2 time point evaluation.

T1 T2

Further information for D-M BASC- “attention,” “leadership,” “adaptability,” and

“social skills” scales Personality – conscientiousness, agreeableness

(ADHD) TAT (Westen) Eventual research measures may be helpful:

Psychosocial maturity inventory Weinberger adjustment inventory Consideration of future consequences Stanford time perspective inventory Criminal decision making questionnaire

Further information on Treatment Amenability PAI-A – “treatment rejection” scale Research measures:

Treatment motivation questionnaire Rhode Island change assessment scale Stages of change questionnaire Treatment readiness questionnaire Quality of motivation questionnaire

Your knowledge Used to be only a few journals to read. AP first

published in 1946.

Preparation for the evaluation

Many more journals since APA published its first issue of the American Psychologist.

APS has its own panel of journals

Should be familiar with subfields 1) forensic psychology (div 41) 2) lifespan developmental (div 7) 3) clinical child and adolescent (div 53) 4) children, youth, and families (div 37) 4) association for child and adolescent mental health 5) society for research on child development 6) American correctional association

Interpretation

Make a table (validity, SIs, self reports, etc) Sort through discrepancies (re-interview where

necessary) Either/or strategy or consensus

The goal Accurately tell the youth’s life story/ watch out for

labels

Relate to current situation

Help with intervention

Where can one get training - No specific programs (be part of development) University of Alabama has an emphasis (1st) University of Massachusetts (internship/postdoc) Brown University (internship) Emory University postdocs UNC-Chapel Hill School of medicine for psychiatry NYU Medical school for psychiatry Yale – Medical school for psychiatry

Treatment of ADHD, CD, ODD Salekin (2002). Psychopathy and therapeutic

pessimism: Clinical lore or clinical reality? Clinical Psychology Review

Salekin et al. (2010) Mental Models. Behavioral Sciences and the Law

Salekin, Tippey, & Allen (2012). BSL

Fig. 15-6, p. 605

Treatment Individual Facility

Parenting Pretty simple really Only two things parents have to do. What are they?

2 keys to effective parenting Warmth Guidance

Individual treatment for ADHD, ODD, CD and CD + (LPE) Some of the basic principles work for many of the

disruptive behavior disorders Myths about parenting Catching kids doing things right Reframing negatives into positive Changing the environment for kids Making the reinforcements potent and meaningful

Myths About Effective Parenting Punishment works More reminders lead to better behavior Explaining to your child why behavior is wrong

will lead him or her to stop that behavior Lots of praise just spoils your child My other child did not need this attention so this

child does not need it either Doing it once or twice means your child can do it

regularly

EEG Findings

Thank you. Randy Salekin, PhDDepartment of PsychologyDisruptive Behavior ClinicThe University of Alabamarsalekin@ua.edu