Prathiba Chitsabesan

Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders

PURPOSE To review the effectiveness of cognitive behaviour therapy (CBT) as a treatment for anxiety disorders of childhood and adolescence. METHOD Studies were included if they treated young people (under 19 yrs) with diagnosed anxiety disorder (excluding trials solely treating phobia, PTSD or OCD), had a no-treatment control group, and used diagnosis as an outcome variable. A search of the literature, incorporating electronic databases, hand search and expert consultation, yielded 10 randomized controlled trials that were appropriate for inclusion. RESULTS The outcome of interest was remission of anxiety disorder. Employing conservative criteria, the remission rate in the CBT groups (56.5%) was higher than that in the control groups (34.8%). The pooled odds ratio was 3.3 (CI = 1.9-5.6), suggesting that CBT has a significant effect. CONCLUSIONS CBT is useful for the treatment of anxiety in children over the age of 6 years. However, we still know little about the treatment of younger children or about the comparative efficacy of alternative treatments. Most of the trials were efficacy trials, and have limited generalizability. Reporting of many aspects of the trials was weak.

Predicting repeat self-harm in children: How accurate can we expect to be?

Abstract. The main objective of the study was to find which variables predict repetition of deliberate self-harm in children. The study is based on a group of children who took part in a randomized control trial investigating the effects of a home-based family intervention for children who had deliberately poisoned themselves. These children had a range of baseline and outcome measures collected on two occasions (two and six months follow-up). Outcome data were collected from 149 (92 %) of the initial 162 children over the six months. Twenty-three children made a further deliberate self-harm attempt within the follow-up period. A number of variables at baseline were found to be significantly associated with repeat self-harm. Parental mental health and a history of previous attempts were the strongest predictors. A model of prediction of further deliberate self-harm combining these significant individual variables produced a high positive predictive value (86 %) but had low sensitivity (28 %). Predicting repeat self-harm in children is difficult, even with a comprehensive series of assessments over multiple time points, and we need to adapt services with this in mind. We propose a model of service provision which takes these findings into account.

Mental health, educational and social needs of young offenders in custody and in the community.

Purpose of review The purpose of this review is to highlight recent findings from research on mental health, educational and social needs of young offenders and the implications for key agencies that commission or provide services. Recent findings Young offenders have high levels of morbidity in a number of areas, including mental health. A substantial number of young offenders have learning disabilities, which has implications for educational provision and delivering interventions. Other learning problems, such as low reading and comprehension ages, also have consequences for society in a number of areas, including occupational functioning and the associated development of a skilled workforce. There is some evidence that female offenders and persistent offenders are particularly at risk of psychosocial problems. Need is often unmet due to the lack of adequate assessment. Other reasons include inaccessibility of services and difficulties experienced in engaging young people in treatment. Young offenders in the community and those from ethnic minorities are particularly at risk of having poor access to services. Summary Providing services for young offenders requires investment from all the agencies in prioritising their needs. Research can continue to contribute by informing policy and practice, although further understanding of the developmental trajectories of high-risk groups is still needed.

The prevalence of traumatic brain injury among young offenders in custody: a systematic review.

Objectives:To examine the prevalence of traumatic brain injury (TBI) among young people in custody and to compare this with estimates within the general youth population. Design:Systematic review of research from various national contexts. Included studies were assessed for the relevance of the definition of TBI and the research population, and the quality of the study design. Results:Ten studies were identified for inclusion in the review. Four of these studies included control groups. No studies examining comorbidity of TBI and other neurodevelopmental disorders among incarcerated young people were identified. Conclusion:Reported prevalence rates of brain injury among incarcerated youth range from 16.5% to 72.1%, with a rate of 100% reported among a sample of young people sentenced to death. This suggests considerable levels of need among incarcerated young people. Where control groups or directly comparable studies within the general population exist, there is strong and consistent evidence of a prevalence of TBI among incarcerated youth that is substantially greater than that in the general population. This disparity is seemingly more pronounced as the severity of the injury increases.

Learning disabilities and educational needs of juvenile offenders

This article is based on a study that was commissioned by the Youth Justice Board for England and Wales. We report on the learning profiles and education needs of a cohort of young offenders who were recruited for the study. The research was a national cross‐sectional survey of 301 young offenders who were resident in custodial settings or attending youth offending teams in the community. The young people were assessed using the WASI and the WORD measures to obtain psychometric information (IQ scores and reading/reading comprehension ages). One in five (20%) young people met the ICD‐10 criteria for mental retardation (IQ<70), while problems with reading (52%) and reading comprehension (61%) were common. Verbal IQ scores were found to be significantly lower than performance IQ scores, particularly in male offenders. It is clear from these results that a large proportion of juvenile offenders have a learning disability, as characterised by an IQ<70 and significantly low reading and reading comprehension ages. The underlying aetiology of this association is less clear and may be a consequence of both an increased prevalence of neurocognitive deficits and the impact of poor schooling. There is some evidence that developmental pathways may be different for boys compared with girls.

The development of the comprehensive health assessment tool for young offenders within the secure estate

Health inequalities are high among offending groups. The comprehensive health assessment tool (CHAT) is a semi-structured assessment developed to provide a standardised approach to health screening for all young offenders admitted to the secure estate. The four sections of the CHAT (physical health, mental health, substance misuse and neurodisability) were evaluated within a two-phased study of male adolescents (aged 15–18 years) within a young offenders institution in the north-west of England. Within Phase 1, a consecutive sample of 127 new receptions was assessed using the physical health, mental health and substance misuse sections of the CHAT against a range of reference standard assessments. Phase 2 of the study evaluated the neurodisability section on 93 male adolescents against reference standard tools. The four sections of the CHAT demonstrated fair to good convergent validity when compared against reference standard tools in male offenders. The diagnostic accuracy rate was 76% for mental health, 63% for physical health, 83% for substance misuse and 53% for neurodisability when compared against reference standard assessment tools. The introduction of the CHAT offers the opportunity to enhance existing reception screening practices and create an integrated approach to the assessment of health needs across the secure estate.

Traumatic brain injury in juvenile offenders: findings from the comprehensive health assessment tool study and the development of a specialist linkworker service

Background:Young people in contact with the youth juvenile justice system have well-documented vulnerabilities including high rates of mental health and neurodevelopmental disorders. Studies have suggested that they may also be at increased risk of traumatic brain injury (TBI). Objective:(1) To describe the profile of a cohort of juvenile offenders with TBI and associated comorbidity with other neurodevelopmental disorders, mental health needs, and offending behavior. (2) To describe the development of a specialist brain injury service for juvenile offenders with TBI within custody. Methods:Ninety-three male participants aged 15 to 18 years were consecutively admitted to a custodial secure facility. They were evaluated using a range of different neurocognitive and mental health measures including the Rivermead Post-Concussion Symptoms Questionnaire and the Comprehensive Health Assessment Tool. Results:Eight-two percent of those interviewed reported experiencing at least 1 TBI, and 44% reported ongoing neuropsychological symptoms. Eighteen percent of those sustaining a TBI reported moderate-severe postconcussion symptoms. Conclusions:There is a high prevalence of TBI in juvenile offenders in custody, with many experiencing multiple episodes. This study highlights the need for further research in this area. An example of a specialist brain injury linkworker service is described as one example of a model of service delivery for this group.

A systematic review of the prevalence of foetal alcohol syndrome disorders among young people in the criminal justice system

Abstract Given the established association between foetal alcohol spectrum disorders (FASD) and risk of criminality and criminalisation, this systematic review examines the prevalence of FASD within youth justice systems. Four relevant sources were identified. Each source suggests a disproportionate prevalence in comparison to the general youth population. However, this masks significant variation between studies, and a much-heightened prevalence of FASD among Aboriginal youth in custody. The continued lack of research establishing prevalence, limits the potential for strong conclusions and suggests an imperative for improved processes of identification. This highlights systematic deficits in the ability to assess or even screen for FASD, with particular challenges for the youth justice system. Until such challenges can be resolved, it is likely that young people with FASD will remain hidden within a system in which they are at great risk of inadequate support, discrimination and criminalisation.

Traumatic brain injury: a potential cause of violent crime?

Traumatic brain injury (TBI) is the biggest cause of death and disability in children and young people. TBI compromises important neurological functions for self-regulation and social behaviour and increases risk of behavioural disorder and psychiatric morbidity. Crime in young people is a major social issue. So-called early starters often continue for a lifetime. A substantial majority of young offenders are reconvicted soon after release. Multiple factors play a role in crime. We show how TBI is a risk factor for earlier, more violent, offending. TBI is linked to poor engagement in treatment, in-custody infractions, and reconviction. Schemes to assess and manage TBI are under development. These might improve engagement of offenders in forensic psychotherapeutic rehabilitation and reduce crime.

Language impairment and comorbid vulnerabilities among young people in custody

BACKGROUND While the prevalence of language and communication difficulties among young people in custody is well established, holistic understanding of the complexity and co-occurrence of additional vulnerabilities among this population are rare. METHODS Ninety-three young people in a young offenders institution in England were assessed using the Comprehensive Health Assessment Tool, the Test of Word Knowledge, and a range of additional assessments of communication, cognition, and neurodevelopmental difficulties. RESULTS Forty-seven percent of the young people demonstrated an aspect of language skills significantly below the population average, with more than one in four identified as having impairment. Only one in four of those with an impairment had previously accessed speech and language services. Language needs were associated with difficulties with social communication and nonverbal cognition, as well as higher risk of self-harm and substance misuse. CONCLUSIONS Earlier identification of language difficulties requires routine assessment of young people at risk of engagement in offending behavior. Where language difficulties are identified, holistic assessments of needs should be undertaken. There is a need for speech and language therapy provision within youth justice services, as well as in other services accessed by young people at risk of engagement in offending.