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| Comorbidity |
Comorbidity
Comorbidity, the phenomenon of meeting the criteria for two or more psychiatric diagnoses (Caron & Rutter, 1991), is often overlooked in the discourse about mental health of detained youth. The rate of comorbidity in delinquent youth is much higher than the rate of comorbidity in community samples. The implications for the system are compounded when the majority of detained youth have two psychiatric diagnoses for which they are not receiving treatment.
Many youth in juvenile justice have a mental health problem and a co-occurring substance abuse disorder. Dual diagnosis refers to co-occurring substance dependency and psychiatric disorder that are unrelated but meet diagnostic criteria. For example, a youth can have a diagnosis of depression and alcoholism as a dual diagnosis requiring two different interventions. So, why is this discussion about comorbidity important?
Youth in juvenile justice may have common combinations of psychiatric disorders. For example, youth may have psychiatric disorder combinations such as ADHD and conduct disorder, bipolar disease and ADHD, and anxiety and depression. (Kazdin, 2000; Korn, 2004; Timmons-Mitchell, et al, 1997; Weller, Calvert, & Weller, 2003). All of these combinations may be affected by an addiction disorder, or comorbidity.
Different psychiatric disorders require treatment with different psychopharmacology and behavior management techniques so it follows that interventions are different, especially if a substance use disorder is diagnosed. Psychiatric disorders predict social problems that affect how youth manage interaction and relationships with other people across the life span. Psychiatric and subsequent substance use behaviors in adolescence are harbingers of adult behavior. Current research indicates a significant association and prevalence of substance abuse disorders and anxiety disorders across the lifespan (Grant, Stinson, Dawson, Chou, Dufour, Compton, Pickering, & Kaplan, 2004). And finally, adolescent externalizing behaviors, or the delinquent acts they demonstrate, can obscure secondary or tertiary diagnoses that, without assessment and intervention, decrease functionality and health status over time (Abram, et al, 2003; Kazdin, 2000; Shelton, 2000).
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HOPING FOR A BETTER LIFE: A MENTAL HEALTH PROCESS
VOICED BY YOUTHFUL OFFENDERS
By
Carol Elizabeth Bonham
