Dorothy Otnow Lewis

Child Abuse: Adolescent Records vs. Adult Recall.

In a follow-up study of incarcerated Connecticut youth, 69 subjects were interviewed during young adulthood. On follow-up, 26 gave histories of abuse discrepant with histories obtained from records and interviews conducted in adolescence. Eleven subjects agreed to an additional clarification interview, at which time they were apprised of the discrepancies. Of these, eight had adolescent records indicating that abuse had occurred but denied abuse during the adult follow-up interview. The remaining three had adolescent records indicating no abuse had ever occurred, but, on follow-up, reported having been abused. The additional clarification interviews revealed that all 11 subjects with discrepant histories had, in fact, been abused. Reasons for these discrepant data and strategies to enhance the investigators ability to obtain accurate data regarding abuse are discussed.

From Abuse to Violence: Psychophysiological Consequences of Maltreatment

This paper reviews the psychophysiological literature related to violent behaviors. It explores the interactions of environmental influences, pain, stressors, hormones, and neurotransmitters. It presents ways in which maltreatment in the form of abuse or neglect exacerbates preexisting psychobiological vulnerabilities. It proposes that whatever forces increase impulsivity and irritability, engender hypervigilence and paranoia, diminish judgment and verbal competence, and curtail the recognition of pain in the self and others, will enhance violence, and presents evidence that maltreatment has all of these effects.

Toward a theory of the genesis of violence: a follow-up study of delinquents

The results of a follow-up study of 95 formerly incarcerated delinquents are reported. Adult F.B.I. and state police records were used. All but six of the subjects had adult criminal records. The average number of adult offenses was 11.58. Juvenile violence alone did not distinguish well between those who would and would not go on to adult violent crime. Seventy-seven percent of the more violent juveniles and 61% of the less violent juveniles committed adult aggressive offenses. The interaction of intrinsic vulnerabilities (cognitive, psychiatric, and neurological) and a history of abuse and/or family violence was a better predictor of adult violent crime.

A Follow-up of Female Delinquents: Maternal Contributions to the Perpetuation of Deviance

Twenty-one female delinquents, neuropsychiatrically evaluated while in a juvenile correctional facility, were followed up to 7 to 12 years later. Compared with a matched sample of male delinquents, they committed fewer and less violent offenses. Unlike the males, early biopsychosocial variables were not predictive of adult criminality; however, most females were seriously impaired neuropsychiatrically. Mortality rates were high. Having come from abusive households, the female delinquents became suicidal, alcoholic, drug addicted, enmeshed in violent relationships, and unable to care for their children.

A clinical follow-up of delinquent males: ignored vulnerabilities, unmet needs, and the perpetuation of violence.

OBJECTIVE This paper describes the adult adaptation of a group of 97 formerly incarcerated male delinquents. METHOD Follow-up clinical interviews were administered to subjects, approximately 9 years after discharge from juvenile corrections. The records of the correctional school, state police, FBI, state psychiatric hospitals, and state health department also were reviewed. RESULTS All but six had adult criminal records, most for violent crimes. Only 10% were graduated from high school; 30% received minimal job training; most worked sporadically at unskilled jobs. Few married. Although 35 had fathered children, only 5 were living with them. Psychiatric treatment for identified vulnerabilities was negligible. Upon discharge, the most neuropsychiatrically impaired and violent subjects tended to be placed in adult corrections; the most intact were placed in special schools and psychiatric hospitals. Numbers of vulnerabilities continued to contribute most significantly to violent outcome regardless of placement. Placement in families was associated with fewer adult aggressive offenses than was institutional placement, even while controlling for vulnerabilities and early juvenile violence. CONCLUSION Based on their well-documented early vulnerabilities and needs, this sample of delinquents did not obtain the kinds of supports subsequent to juvenile incarceration that might have enabled them to function independently in society.

Intrinsic and Environmental Characteristics of Juvenile Murderers

Abstract The biopsychosocial characteristics of a sample of 13 juvenile murderers, evaluated after committing homicide, were compared with those of 14 violent, incarcerated delinquents and those of 18 nonviolent incarcerated delinquents. The juvenile murderers did not differ significantly from other very violent but nonhomicidal delinquents. A constellation of neuropsychiatric and family characteristics, however, distinguished the murderers from the nonviolent delinquents. The 13 juvenile murderers evaluated after their homicidal acts were also compared with nine juvenile murderers evaluated before committing homicide. Differences between these groups are described in relation to the timing of their evaluations.

The Undoing of Residential Treatment: A Follow-Up Study of 51 Adolescents

Abstract A follow-up study of 51 children who had previously been in residential treatment for an average of 25.5 months revealed that the majority had a poor outcome in terms of subsequent psychopathology and social adaptation. Differences in age, nature of psychopathology, and parental psychiatric illness were found between good-outcome and poor-outcome children. Numbers of prior placements did not distinguish the groups. Independent rating and documentation of life events were found to be more accurate measures of outcome than clinical assessments. Implications of the findings are discussed.

Psychiatric Correlates of Severe Reading Disabilities in an Incarcerated Delinquent Population

Abstract The neuropsychiatric status and reading grade level of 59 adolescent incarcerated male delinquents were studied. Contrary to expectation, there were no significant neurological differences between the severely reading-disabled subjects and the better readers, although abnormal EEGs, choreiform movements, and inability to skip were somewhat more characteristic of the poorer readers. The most striking differences were psychiatric in that paranoid ideation, illogical thought processes, and visual hallucinations were significantly more prevalent in the group of especially poor readers. They also had problems with calculation and short-term memory. Poor readers were more violent than better readers. The findings of severe behavior problems and reading disability are considered in relation to Piagetian cognitive theory.

Encopresis and sexual abuse in a sample of boys in residential treatment

The purpose of this paper is threefold: (a) to report an unusually high prevalence of encopresis in a sample of boys in psychiatric residential treatment; (b) to explore the possible relationship of sexual abuse to the development of encopresis in these cases; and (c) to discuss the diagnostic and treatment implications of our findings.

The medical assessment of seriously delinquent boys: a comparison of pediatric, psychiatric, neurologic, and hospital record data.

This study documents a high prevalence of medical disorders, especially head and face injury, seizures, and other neurological problems in violent incarcerated adolescent delinquents. It documents the failure of three different medical specialities--pediatrics, psychiatry, and neurology--to consistently elicit significant potentially treatable disorders during routine evaluations. It explores possible causes for overlooking significant medical factors in these youngsters and proposes ways to improve the health evaluations of delinquent adolescents.