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Rhyme Reason and Risk. Dr Julie Withecomb Consultant Forensic Adolescent Psychiatrist. Young people in care and offending Interplay between care/parenting experiences, offending and mental health Genesis of very high risk behaviours What works?.

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rhyme reason and risk

Rhyme Reason and Risk

Dr Julie Withecomb

Consultant Forensic Adolescent Psychiatrist

Young people in care and offending
  • Interplay between care/parenting experiences, offending and mental health
  • Genesis of very high risk behaviours
  • What works?
Children & teenagers make up 25% of the total population in the UK.
  • Criminal activity peaks at 15-17 years for males and 13-15years for females.
  • Theft, car crimes and criminal damage account for over 90% of crime.
Of children who have experienced care by 16 years, about one third will go to custody and two thirds will have a conviction by early 20’s
The prevalence of mental health problems in young people in custody around three times higher than general population (Hagell, 2002)
  • Bailey and Harrington (2004) - 31% of a YOT and incarcerated group had mental health needs: depression (18%); anxiety (10%); PTSD (9%); and hyperactivity (7%). 25% LD
Young people in care are up to 4 times more likely to drink, smoke and use drugs and likely to start earlier and use more heavily
  • Of 500 young people in the secure estate, 97% has used an illegal drug
Structured Assessment of Violence Risk in Youth
    • Borum, R, Bartel, P and Forth, A
Domestic violence
  • Experience of abuse or neglect
  • Care giver criminality
  • Early care giver disruption
  • Poor parental management
Conduct Disorder is a persistent pattern of behaviour in which the rights of other are violated
  • most commonly occurring psychiatric disorder in 5- to 15-year-olds, (5% of young people in Meltzer’s (1999) study)
Conduct problems shown to predict later offending (Kratzer and Hodgins, 1997), with earlier onset and a wider range of antisocial behaviours increasing later risk.

Covert pathway

-recidivist delinquency


Overt pathway

-violence and homicide

Authority conflict

-early onset, early



Stable traits
    • Aggression
    • Callous unemotional disregard
    • Anxiety
    • Executive functioning and social skills
Callous unemotional disregard
    • Found in subset of those with conduct problems
    • Highly heritable
    • Expression influenced by social factors
As maltreatment increases
  • adolescent conduct disorder increases
  • and adult violence becomes more likely
Experience of early abuse and maltreatment leads to changes in neurotransmitters e.g MAOA
  • Changes in MAOA leads to changes in response of amygdala to aversive stimuli
Offending associated in schizophrenic group with psychopathic traits
  • Poor parenting increases risk of violence in those with schizophrenia
Sexually harmful behaviour
  • Assessment, Intervention and Moving on (G-Map in Manchester)
Poorer outcome associated with:
  • Experience of trauma or neglect of any kind including exposure to domestic violence
  • Family dysfunction especially harsh discipline
  • Pattern of discontinuous care or poor attachment
  • Rejected by carers
  • Poor parental supervision
Better outcome associated with:
  • Consistent care history
  • Good communication in family
Firesetting Risk Interview
    • Kolko, D J & Kazdin, A E (1989) Journal of Abnormal Psychology
    • Home visit from fire-fighter
    • Fire safety education
      • Instruction and practice in safety skills
    • Cognitive behavioural therapy
      • Enhancing pro-social skills
      • Improving parent-child relationship
what works
What works?
  • Pharmacotherapy
  • Emotional regulation; reward deferral; interpersonal skills training; cognitive behavioural approach
  • Attachment
  • Parenting programmes
  • Multi-systemic therapy
  • Specialist foster placements