Larkin S. McReynolds

The Voice DISC-IV With Incarcerated Male Youths: Prevalence of Disorder

OBJECTIVES (1) To accurately assess rate of psychiatric disorder in incarcerated juveniles, and (2) to examine the feasibility of using a self-administered, comprehensive structured psychiatric assessment with those youths. METHOD In 1999-2000, 292 recently admitted males in secure placement with New Jersey and Illinois juvenile justice authorities provided self-assessments by means of the Voice Diagnostic Interview Schedule for Children-IV, a comprehensive, computerized diagnostic instrument that presents questions via headphones. RESULTS Assessments were well tolerated by youths, staff, and parents; 92% of approached youths agreed. Rates of disorder were comparable to prior diagnostic assessment studies with interviewers. Beyond expectable high rates of disruptive and substance use disorders, youths reported high levels of anxiety and mood disorders, with over 3% reporting a past-month suicide attempt. Youths with substance use disorder were significantly more likely to be incarcerated for substance offenses than were youths with no disorder or those with other, non-substance use disorders. CONCLUSIONS Although the study identified rates of disorder generally comparable to those of prior investigations, some differences, understandable in the context of measurement variations, are apparent. Those variations offer recommendations for mental health assessment practices for youths in the justice system that would include using a comprehensive self-report instrument, pooling across parent and youth informants for certain disorders, focusing on current disorder, and flexibility regarding consideration of impairment.

Developmental and sex differences in types of conduct problems

Maternal report of types of conduct problems in a high-risk sample of 228 boys and 80 girls (ages 4–18) were examined, using a version of the Child Behavior Checklist, expanded to include a range of covert and overt antisocial items (stealing, lying, physical aggression, relational aggression, substance use, and impulsivity). Age and sex effects were investigated. Boys were significantly more physically aggressive than girls. There were no sex differences for stealing, lying, relational aggression, and substance use. Lying and substance use increased with age, whereas relational aggression and impulsivity peaked during early adolescence. A small group of girls had pervasive conduct problems across multiple domains. For some domains such as stealing, lying, and relational aggression, girls showed at least as many problems as boys. Girls, in general, tended to have fewer conduct problems. On the other hand, when assessed across multiple domains, conduct problems in high-risk girls were possibly more pervasive than in high-risk boys, suggesting the possibility of a gender paradox.

Psychiatric Disorder, Comorbidity, and Suicidal Behavior in Juvenile Justice Youth

Results of collaborations with juvenile justice agencies nationwide were examined to provide generalizable estimates of psychiatric disorder and suicidality among justice system youth. Diagnostic assessments were aggregated from 57 sites (N = 9,819) from an automated computer-assisted self-interview (Voice Diagnostic Interview Schedule for Children). Disorder was predicted from setting type (system intake, detention, corrections), adjusting for demographic and offense characteristics, and for cross-site variability within settings. Race by comorbid disorder interactions were examined in predicting substance use disorder (SUD). White youth, repeat offenders, and those with further justice system penetration reported higher rates of most disorders; girls reported higher rates of internalizing conditions only. Although presence of another disorder increased SUD for most groups, SUD was high in American Indians regardless of either affective disorder or recent suicide attempt. Findings highlight (a) varying mental health needs across settings, (b) prior justice contact relating strongly to need, (c) girls’ elevated rates of internalizing disorder, and (d) racial/ethnic differences in diagnostic profiles.

The Contribution of Psychiatric Disorder to Juvenile Recidivism

Youths formally referred to probation authorities in Texas (791 male, 200 female) self-administered a structured diagnostic interview at intake. Data on demographics, offense characteristics, and reoffending (within 12 months of baseline) were extracted from official justice records. Logistic regression analyses were used to evaluate the contribution of diagnosis to recidivism, adjusting for demographic and offense characteristics. Baseline externalizing disorders were associated with increased recidivism risk for both genders, whereas youths’ recidivism risk was not influenced by anxiety disorder. Girls with comorbid substance use and affective disorder were nearly four times more likely to reoffend than girls with no disorder. In contrast, among males, this disorder profile was associated with only approximately half the level of recidivism risk. Results substantiate practice guidelines that recommend comprehensive mental health assessment in juvenile justice settings and identify youths with certain mental health needs who might be well served by diversion programs.

Screening for Emergent Risk and Service Needs among Incarcerated Youth: Comparing Maysi-2 And Voice Disc-Iv.

OBJECTIVE To examine associations between the Massachusetts Youth Screening Instrument-Second Version (MAYSI-2) and Diagnostic Interview Schedule for Children-Present State Voice Version (DISC-IV) and the extent to which they overlap in identifying youths with mental health concerns. METHOD Among 325 New Jersey and South Carolina correctional youths, associations were examined using receiver operating characteristic analyses and logistic regression (binomial and multinomial). RESULTS MAYSI-2 subscales generally mapped best onto homotypic DISC-IV disorders; however, many subscales mapped almost as well onto heterotypic disorders. Alcohol/Drug Use and Suicide Ideation, respectively, identified youths reporting substance disorder and recent attempt; other subscales did not identify parallel DISC-IV disorders as well. CONCLUSIONS MAYSI-2 identifies some DISC-IV disorders better than others. Lack of overlap may result from MAYSI-2s combining diagnostic constructs into single subscales. Substantial percentages of disordered youths were not identified by corresponding subscales. In systems with multiple avenues of referral, the MAYSI-2 is a useful intake screen, but its utility as the sole means for identifying diagnoses for treatment purposes is limited. The authors differentiate between screening for emergent risk and service needs, recommending best practices for a comprehensive approach to mental health assessment among justice youth.

The Influence of Mental Health Disorders on Severity of Reoffending in Juveniles

The authors conducted secondary data analyses on mental health assessment and offense history data for 700 juveniles referred to juvenile justice agencies in Alabama (probation and detention). Multiple regression analysis was applied to predict subsequent offense severity by disorder profile, adjusting for prior offense severity and background variables. Juveniles with a substance use disorder with or without co-occurring disorders were at greater risk for escalations in offense seriousness over time. Early in juvenile justice system contact, juveniles should get effective treatment for substance use to prevent offending escalation.

Paper and Voice MAYSI-2 Format Comparability and Concordance With the Voice DISC-IV

The authors examine the comparability of paper and voice formats of the Massachusetts Youth Screening Instrument-Second Version (MAYSI-2) as well as each format’s concordance with the Voice Diagnostic Interview Schedule for Children (DISC) among adjudicated youth. Comparability is assessed among 248 youths admitted to a South Carolina Assessment Center. Mean scores and alpha coefficients are calculated, and area under the curve and positive and negative predictive values are used to compare concordance to the DISC. Paper and voice formats are significantly correlated, have similar alpha coefficients, and have comparable concordance with the DISC, suggesting that the MAYSI-2 paper and voice formats are comparable instruments. The voice format may be preferable to the paper format for screening justice youth for mental health problems because it may reduce incomplete data and increase reporting of stigmatized behaviors and because of its ability to automatically generate scored reports and aggregate data.

Service referral for juvenile justice youths: associations with psychiatric disorder and recidivism

Secondary multiple regression analyses related disorder profile, probation officers’ mental health/substance use service referrals, and recidivism in 361 juvenile justice youths. Those with externalizing (disruptive behavior or substance use) disorder or substance offenses were most likely to receive service referrals. Substance disordered youths with service referrals had lower recidivism risk compared to counterparts without referrals; referral lowered the recidivism odds to approximately that for youths without a substance use disorder. Providing juvenile justice youths with systematic mental health assessment and linking those with substance use disorder to mental health and substance use services likely reduces recidivism risk.

The influence of adolescent psychiatric disorder on young adult recidivism

This study examined the influence of adolescent psychiatric disorder on young adult recidivism and compared findings with earlier studies of juvenile recidivism. Logistic regression analysis examined subsequent adulthood recidivism (through age 23 years) by disorder profile, adjusting for prior offense severity and background variables, in 340 Alabama juveniles referred to juvenile justice agencies (probation and detention). Youths with comorbid internalizing and disruptive behavior disorder had a sixfold increased risk for young adult recidivism compared with nondisordered counterparts. Comorbid internalizing disorder likely is a marker for the severity of a youth’s disruptive behavior disorder; similarly, offending that continues into adulthood likely betokens a more serious course of offending behavior. The severity underlying disorder and offending behavior is probably the common link between them. To prevent reoffending into adulthood, the mental health needs of juvenile justice youths’ internalizing and externalizing problems should be addressed.

Juvenile Probation Officers’ Mental Health Decision Making

We reviewed case records for 583 juvenile delinquency intakes in four county juvenile probation offices; 14.4% were receiving mental health or substance use services at case opening, and 24.9% were newly identified during probation contact. Youths were significantly more likely to be newly identified if they were repeat offenders, if their probation officer knew more about mental health and if they resided in a county without a shortage of available mental health professionals. Probation officers were especially likely to underidentify internalizing disorders. Policy implications for promoting identification of mental health needs and improving linkage to community service providers are discussed.