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Factors Affecting Engagement

Factors Affecting Engagement

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Published by Ver Chew
Factors Affecting Engagement
Factors Affecting Engagement

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Published by: Ver Chew on Jun 12, 2013
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06/12/2013

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Anti-social behaviour

Mental Disorder

Criminal behaviour Substance Use & Misuse

Self-harming Behaviour

1

THE YOUTH JUSTICE SYSTEM IN ENGLAND & WALES Lord Chancellors Education Home Office Health Courts Local Authority Chief Executive YOUTH JUSTICE BOARD Youth Offending Teams (YOTs) 154 – Local Focus Health Probation Education Police Prison Service 16 Units – 2800 beds Local Authority Secure Units 15 units – 235 places Independent Custodial Sector (STC’s) 4 Units – 274 beds Substance Misuse Connexions 2 Social Services .

OVERVIEW  Almost 2 million crimes are committed by young people each year.  Strong continuity of antisocial behaviour into adulthood  Services patchy and lack of continuity of care  Providing services requires an integrated approach from agencies involved in their care  High levels of co-morbidity 3 .

of  What is the prevalence of psychopathy in childhood and adolescence?  Does its presentation mimic that in adulthood and has it construct and concurrent validity?  What is the developmental stability of psychopathy over the lifespan?  What is the predictive validity of current childhood and adolescent measure of psychopathy?  What is the impact of attributing a label of psychopathy in childhood and adolescence? 4 .KEY ISSUES  How early can psychopathic traits be reliability detected?  Are there developmentally appropriate measures psychopathy for use in children and adolescents.

a three-factor structure has been proposed (Cooke & Michie. involving dishonesty. grandiosity and glibness. Behavioural manifestations of impulsiveness. 1998). irresponsibility and sensation-seeking 5  . which includes:   An arrogant. poor empathy. shallow emotions and a lack of responsibility for one’s own actions. comprising an interpersonal/affective element (factor 1) and a social deviance component (factor 2). The early literature suggested that it was an uni-dimensional phenomenon. but subsequent studies revealed that measures of psychopathy had at least a two-factor structure. Defective emotional experience. deceitful interpersonal style.Psychopathy is a personality disorder characterised by a constellation of interpersonal. More recently. 2001). involving lack of remorse. manipulation. affective and behavioural characteristics (Hare.

There are. 6 . psychopathy.Conduct disorder. however. as described by Hare (1991). significant difference between them and their associated correlates. Whereas conduct disorder and antisocial personality disorder primarily focus on behavioural problems. emphasises deficits in affective and interpersonal functioning. antisocial personality disorder and psychopathy are often seen as developmental disorders that span the life course and the terms are sometimes used interchangeably.

The biological and environmental factors responsible for the development and maintenance of antisocial behaviour and psychopathy are not well understood:     Family background variables. The prefrontal cortex and behaviour The amygdala and affect The relationship between callous-unemotional traits and conduct disorder 7 .

and suggests that psychopathology assessment in juveniles may be a means of early detection and intervention in high risk groups. 2002). 8 . Hart et al. 2001. 2002. Frick (2002) argues that psychopathy presents no more of a challenge than any other measure of psychopathology in children and adolescents. how closely the construct mimics that in adulthood and the potentially negative impact of attaching a label of psychopathy to those who have not yet reached maturity. the developmental appropriateness of these measures.PSYCHOPATHY IN CHILDREN AND ADOLESCENTS The existence and assessment of psychopathy in children and adolescents is a contentious issue (Edens et al. Seagrave & Grisso. Key concerns centre on the reliability and validity of current assessment tools.

 Does the presentation mimic that in adults?  Prevalence of psychopathy in forensic samples  Comorbidity  Outcome  Psychopathy as a predictor of violence?  Are the neurocognitive markers similar in young people and adults? 9 .

USE OF PSYCHOPATHY ASSESSMENTS IN THE CRIMINAL JUSTICE SYSTEM A number of researchers and clinicians in the field have advocated caution in the use of current psychopathy assessment tools as a means of informing the criminal justice system on sentence planning for young people. particularly in light of the fact that in adults a diagnosis of psychopathy can result in more severe sentences. Instruments developed for assessing psychopathy in child and adolescent populations require further validation in a variety of populations and settings before they can be fully accepted. Only then can they be used with confidence in the criminal justice system 10 .

aggression. The limited data on the psychometric properties of current instruments. however.g. is still very limited. neurocognitive deficits. There have been no published longitudinal studies of that stability of psychopathy as assessed by any of the currents measures and it remains unclear to what degree the antisocial behavioural items that contribute to the psychopathy label change over time. There seems to be reasonable evidence that juvenile psychopathy shows similar correlates (e. For this reason many researchers in this field refer to juveniles with “psychopathic characteristics” rather than using the term “psychopathy”. stability and consequences of juvenile psychopathy. 11 . suggest that it is premature to assign this label to younger cohorts.The assessment of psychopathy in children and adolescents is a very important area of research and it is still in its infancy. Our knowledge about the nature. particularly information on recommended or specific cut-off scores for prototypical psychopathy. substance misuse) to adult psychopathy. given what we know about adolescent-limited antisocial behaviours.

there is no general agreement on whether or not psychopathy exists in childhood and adolescence. At present. 12 . and they can inform clinical assessments of risk and treatment planning. these instruments do include items we know to be associated with high-risk behaviours.However. future work needs to disentangle these constructs from a phenomenological and aetiological perspective. A consensus is likely to be reached only when we have longitudinal studies demonstrating the stability of psychopathic traits over the lifespan and evidence that the same aetiological factors contribute to this disorder at all ages. As there is significant overlap between the behavioural aspects of juvenile psychopathy and ADHD and between the callous-unemotional dimension of psychopathy and autisticspectrum disorders.

there are few treatment outcome studies in juveniles with psychopathic traits.As yet. and there is some evidence that identification of psychopathic traits in young people has a number of benefits which include:  Identifying high risk offenders  Reducing misclassification that have negative ramifications for children and adolescents  Improving and optimising treatment planning for young people with psychopathic traits.. although the limited data suggest that these traits might be a moderator of outcome. who may require more intensive and risk-focused therapeutic approaches. Most clinicians view youth psychopathy as a potentially treatable disorder. 13 .

PTSD Mood disorders (depression. mania) Autism / developmental disorders 14 . phobias. OCD. Psychological Problems Hallucinations/delusions. anxiety.ASSESSING NEED NEEDS Health Food Leisure Activities Self care / skills Impact of physical illness / disability Cultural Identity N/A Not a problem Currently Met Met In Part Unmet Don’t Know (info not available) Money / benefits / allowances Living Situation Mood and Thoughts. ADD. psychotic illness Psychological problems Eating disorders.

language.NEEDS Behaviour and Lifestyle N/A Not a problem Currently Met Met In Part Unmet Don’t Know (info not available) Destructive behaviour Hostile behaviour towards people Oppositional disruptive behaviour Sexually inappropriate behaviour Deliberate Self-Harm Substance / alcohol misuse Relationships Peers Family (inc. hearing Educational performance Specific/global learning difficulties Educational attendance Weekday occupation 15 . vision. any with significant problems) School / Work Communication problems.

RELEVANCE OF SPECIFIC DISORDERS TO AGGRESSION & VIOLENCE Affective disorders  Depression is commonly present in delinquents. 16 .  The risk of depression often goes unrecognised due to antisocial youths being viewed as difficult and disruptive.  The risk of substance misuse and suicide attempts is high where depression and conduct disorder coexist.

Early-onset psychosis  Most young people with schizophrenia are non-delinquent. but the risk of violence may be increase with active symptoms.  Risk of violence is related to:  subjective feelings of tension  ideas of violence  delusional symptoms  persecutory delusions  fear of imminent attack  feelings of sustained anger and fear  reduced self-control 17 . especially with misuse of drugs or alcohol.

 Identification is critical to the understanding of offending.  Reasons for offending & aggression in people with autism:  social naivety  aggression from disruption of routines  lack of understanding of social cues  reflection of obsessions 18 .Autistic spectrum disorders & learning disability  Autistic spectrum disorders are often overlooked in forensic groups.

FACTORS AFFECTING ENGAGEMENT  Cognitive limitations  Poor literacy skills  Attitudes to mental health  Poor motivation/compliance  Limited range of emotional expression  Chaotic life history 19 .

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