Young offenders — structured clinical viva

Epidemiology anchors. Cite Fazel 2008 and Beaudry 2021: detained adolescents show very high CD and SUD, with elevated ADHD, depression, and related morbidity; psychosis elevated vs community but not modal. Teplin/Abram establish multi-disorder burden and comorbidity as the rule; trauma/PTSD is substantial.[1][2][3][9]

Developmental pathways. Moffitt LCP vs AL: early onset and neurodevelopmental/adversity load versus peer-contextual adolescent onset with greater desistance potential. Follow-up supports differentiation — formulate probabilistically, not fatalistically. Do not diagnose ASPD under 18.[4][5]

Assessment. Multi-source (youth, caregiver, school, youth justice, health). Risk triad: suicide/self-harm, violence, vulnerability/exploitation. SAVRY SPJ domains plus protective factors — structure judgment, not crystal-ball scores. Fitness/capacity in youth uses developmental maturity principles; statutes are local.[8]

Suicide/self-harm systems. Reception and early custody are high-risk windows. Observation ladder, means restriction, treat drivers, never isolation-as-care. Self-harm is clinical, not pure discipline.[2]

Interventions. Least-restrictive diversion; multi-agency plans; MST and FFT as named multi-system/family models with outcome literature; TFCO-type foster care concepts for high-need community alternatives. Treat ADHD, depression, PTSD, SUD, psychosis on their merits with youth monitoring — do not medicate “offending.”[6][7]

Special populations. Girls (trauma/self-harm), Indigenous youth (cultural safety, structural over-representation), ID/ASD, LGBTQ+ placement safety.[3][9]

Throughcare. Release and age-18 transfer are continuity risk peaks; 15-year data show psychiatric continuity after justice involvement — plan long-horizon care.[10]

“Quote base rates.” Meta-analyses: CD and SUD dominate; ADHD and depression common; psychosis elevated vs community adolescents but minority prevalence; comorbidity typical.[1][2][3]

“How is SAVRY different from adult HCR-20?” Youth-specific SPJ with explicit protective factors and developmental social contexts; still structured judgment, not pure actuarial destiny.[8]

“Name two evidence-linked psychosocial programmes.” MST and FFT (plus TFCO/MTFC principles as placement alternative).[6][7]

“Isolation request.” Refuse as treatment; increase clinical contact; least restrictive step-down; hospital transfer if needed.[2]

“Will treating ADHD stop crime?” May improve regulation and school function; associated long-term criminal risk elevated in ADHD cohorts; treatment is indicated for the disorder but is not a recidivism guarantee.[10]