I read the following abstract with much dismay:
(note, a comment below notes that I made a mistake, a large mistake, in assuming that “coercive institutional care” was a term for criminal incarceration. I apologize for the error)
Ståhlberg O, Anckarsäter H, Nilsson T.
Forensic Psychiatry, University of Lund, Lund, Sweden, ola.stahlberg@neuro.gu.se.
AbstractMany international studies show that adolescents in coercive institutional care display high prevalences of mental disorders, especially in the form of disruptive behavior disorders [including attention-deficit/hyperactivity disorder (AD/HD), oppositional defiant disorder, and conduct disorder], anxiety disorders, and mood disorders. High degrees of overlap across mental disorders have also been reported. In addition, institutionalized adolescents are often traumatized. Despite this well-documented psychiatric morbidity, the mental health care needs of detained adolescents are often overlooked. The main objective of this study is to assess prevalences of psychiatric disorders, results of intelligence tests, and previous contacts with child and adolescent psychiatric services among adolescents in institutional care. DSM-IV diagnoses, mental health contacts, substance abuse, neurocognitive abilities, and school performance were registered in 100 adolescents (92 boys, 8 girls) aged 12-19 years (mean age 16.0; SD ± 1.5) consecutively committed to Swedish juvenile institutions between 2004 and 2007. At least one psychiatric disorder was diagnosed in 73% of the subjects: 48% met DSM-IV diagnostic criteria for AD/HD, 17% for an autism spectrum disorder, and 10% for a mental retardation. The collapsed prevalence for psychiatric disorders requiring specialist attention was 63%. Our data indicate that systematic diagnostic procedures are crucial in the treatment planning for institutionalized adolescents. Adequate treatment strategies need to be designed and implemented to meet the extensive mental health care needs of this vulnerable population.
I admit, I don’t have the paper. I am assuming “coercive institutional care” means juvenile jail. 73% of those in such care had at least one psychiatric disorder. 17% were autistic. 10% had intellectual disability.
So many questions come up. The authors note the need to identify conditions and provide appropriate treatment. One also must ask if the high percentage of people with these conditions means that (a) there is a high percentage of perpetrators who have these conditions and/or (b) is there a higher conviction rate for people with these conditions.
I know I’m not phrasing this well, but this really bugs me.
Left Brain Right Brain 
Coercive treatments make all mental health disorders worse. It is the cycle of violence. It also tends to make people more violent. That doesn’t alway happen, but always mental health problems get worse. Especially in children.
Daedalus,
I similar thought came to my mind. Actually, it seems conceivable that institutionalization could CAUSE a psychiatric disorder. I was particularly struck by the line about “disruptive behavior disorders”. This called to mind my “Tasmanian devil” joke: “Put Tasmanian devil in barrel. Had grad student poke devil with a stick. Devil viciously bit grad student’s finger off. Gave grad student longer stick. Conclusion: Tasmanian devil vicious when poked with a stick.”
Hi
The prevalence of Psychiatric disorder in UK jails for both adult and adolescents is also high. I visit jails and from my own limited overview social dysfunction has a high association with mental health and cognitive disorders which have no other place to be treated.
@ David N. Brown,
That was my first thought too.
A quick comment on the overall prevalence – they included “conduct disorder” which is essentially defined as committing criminal and/or antisocial acts. I think the statistics on ASD and MR are disturbing to say the least, but the overall estimate of how many have any type of DSM disorder may be slightly high because of the CD issue.
You really should read the paper before jumping to conclusions. (There’s really no excuse not to read it, as it is open access.) The sample of 100 cases reported includes only 22 institutionalized as a result of criminal sentences. (Among 17 cases identified as ASD, only one was in the offender group.)
Morgan,
point well taken. When I got the pubmed abstract and followed it to the site, I couldn’t obtain the paper. I certainly should have followed up on this.
I did try to search the terminology used to see what exactly they meant. The searches I did find indicated to me that the term “coercive institutional care” was a term for what would be called here “juvenile detention”, or, basically, jail.
Perhaps I can be forgiven for thinking that if a large percentage of those incarcerated were autsitic, that this would be a cause for some considerable dismay.
I appreciate greatly you bringing this correction to my attention, and apologize for the mistake.
re
“Disruptive behavior disorders
Attention-deficit/hyperactivity disorder (AD/HD)
Oppositional defiant disorder (stubborness)
Conduct disorder (criminality)
Anxiety disorders (fear)
Mood disorders (self-pity or “depression”)
Mental retardation (low IQ)
Substance abuse
High degrees of overlap across mental disorders have also been reported. In addition, institutionalized adolescents are often traumatized. Despite this well-documented psychiatric morbidity, the mental health care needs of detained adolescents are often overlooked. At least one psychiatric disorder was diagnosed in 73% of the subjects: 48% met DSM-IV diagnostic criteria for AD/HD, 17% for an autism spectrum disorder, and 10% for a mental retardation.”
These psychiatric diagnosis represent
1. Frontal lobe syndromes
2. Amygdala (fear centre) dysfunction
3. Hippocampal (memory centre) dysfunction
They overlap to some degree. Psychiatric diagnostic terminology just makes things more complicated. People with frontal lobe dysfunction are usually hypersensitive/obsessive and can use substances to alleviate bad feelings of fear (anxiety), self-pity (depression), resentment (hatred) and dishonesty (criminality). Often these people have been exposed to some form of physical or psychological trauma in the past. There is often a family history of similar behavior.
http://emedicine.medscape.com/article/1135866-overview
Professor Maxwell Bennett has suggested that fMRI brain scans could be useful in such people.
Click to access Bennett%20Paper.pdf
Some have to be removed from society or society will break down but it is unlikely that hoarding them all together in prison will be of any benefit to them. Some people with autism can be dishonest to the point of criminality and may need to be removed from society.
http://www.associatedcontent.com/article/2493475/autismaspergers_and_lying.html?cat=70
Dr. Treg,
I was surprised to see your statement that “Some people with autism can be dishonest to the point of criminality and may need to be removed from society,” and followed your link to the reference. However, this link to your own article about lying and ASDs failed to back this up with any studies of criminally dishonest people with autism. It mentioned that people with autism can learn to lie, and that parents often see this as a milestone towards “normal” behavior, but there’s a big difference between “No, Mom, the cat knocked over the vase” and the sort of deceit that would justify removing someone from society.
Could you please provide references to statistics (not just a few case reports) of autistics who are also criminally dishonest? If it’s a few case reports, all that says to me is that autistics, just like other humans, can be imperfect–not that we should put autistics under particular scrutiny. I would never say that we should assume an autistic person can’t lie, but we should not (as you seem to imply) suspect them of this more than any other person.
I was seeking this particular information for a long time. Thank you and best of luck.