Rom J Leg Med [22] 193-198 [2014]
DOI: 10.4323/rjlm.2014.193
© 2014 Romanian Society of Legal Medicine Psychopathological symptoms in adolescents with delinquent behavior
Anda Maria Jurma1,*, Catalina Tocea4, Oliver Iancu4, Maria Ciocani2, Alexandra Enache34
_________________________________________________________________________________________
Abstract: Young people who end up in the justice system have an increased risk for mental health problems, which may
contribute to delinquent behavior and can affect the rehabilitation process. The aim of the study was to identify the presence of
the psychiatric symptoms in adolescents with delinquent behavior.
We studied 51 adolescents with delinquent behavior such as theft (35), fight (6) and roguery (10), examined within
the forensic psychiatric expertise in Timisoara, aged 14-18 years, all males and a control group of 47 males adolescents without
delinquent behavior, with the same characteristics. It was used Youth Self Report from the battery of tests ASEBA (Achenbach
System of Empirically Based Assessment).
The results showed that juvenile offenders had higher scores with clinical significance on symptoms of anxious/depressed
(11,8%), withdrawn/depressed (15,7%) as well as the rule-breaking (31,4%) and aggressive behavior (15,7%) and also affective
problems (13,7%), ADHD problems (20%) and conduct problems (26%), according to DSM-IV. The correlation’s analysis showed
a strong correlation between internalizing and externalizing symptoms, especially between affective problems and behavioral
problems of delinquent adolescents.
The relationship between delinquency and psychiatric disorders, although being a complex one, reveals that juvenile
offenders are at high risk for psychopathology in adult life; the diagnosis and the effective treatment of psychiatric disorders may
reduce the risk of delinquent behavior and the relapses, the absence of psychiatric treatment could contributes to the increased of
crime rates and the psychiatric disorders in the adult life.
Key Words: adolescents, juvenile delinquency, psychiatric disorders, psychopathology.
F
orensic psychiatric research, in collaboration
with professionals from all fields concerned
(psychiatrists, psychologists, sociologists, forensic
doctors, lawyers, police officers) contribute to elucidate
the etiological factors in finding measures to reduce the
phenomenon of juvenile delinquency, the recovery of
young people and relapse prevention of deviant behaviors.
Many criminological theories have demonstrated the
existence of strong ties between the decision of a young
man to choose a deviant behavior and bio-psychosocial factors such as low intelligence, temperament,
impulsivity with immediate responses to stimulus,
1) Professor Assistant, “Victor Babes” University of Medicine and Pharmacy, Department of Child and Adolescent
Psychiatry, Senior specialist in Child and Adolescent Psychiatry at Commission Forensic Psychiatric Expertise for
Juveniles, Forensic Medicine Institute, Timisoara, Romania
* Corresponding author: 7 Corbului Street, Timisoara, Romania, Tel. +40256494434, Email: [email protected]
2) Senior specialist in Forensic Medicine, Forensic Medicine Institute, Timisoara, Romania
3) Professor at “Victor Babes” University of Medicine and Pharmacy Timisoara, Department of Forensic Medicine,
Forensic Medicine Institute, Timisoara, Romania
4) Resident doctor in Child and Adolescent Psychiatry, Child and Adolescent Neurology and Psychiatry Clinic, Timisoara,
Romania
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Jurma A.M. et alPsychopathological symptoms in adolescents with delinquent behavior
Timisoara, between October 2012
and September 2013. Juveniles were
aged 14-18 years (mean age 15.1;
SD 0.95), all males. Regarding to
the number of delinquent acts, 30
(59%) adolescents have committed
a single act, 16 (32%) of them have
committed two or three acts, a
small percent of them committed
more than three acts (9%). The
control group consisted of 47 male
adolescents without delinquent
behavior, diagnosed with various
psychiatric disorders (depressive
disorder, anxiety disorder, conduct
Figure 1. Mean scores for Syndromes scale.
disorder, ADHD) in the Clinic
of Psychiatry and Neurology for
Children and Adolescents from
Timisoara in the same period, aged
between 14 and 17 years (mean age
15,5; SD 1.06). The protocol of the
study was approved by the local
Ethics Committee from the two
institutions involved. To identify
the psychopathological symptoms
in adolescents was used Youth Self
Report from the battery of tests
ASEBA (Achenbach System of
Empirically Based Assessment).
Figure 2. Frequency of clinical significant problems for Syndromes scale .
The questionnaire was filled in by
all adolescents from the study after
extroversion, psychiatric disorders criminal parents, life they signed the informed consent form.
After completing the questionnaire the results
disturbed family, school failure, involvement in a group were grouped into two scales: the scale that measures
of adolescent offenders.
Young people who end up in the justice system syndromes grouped into internalizing symptoms (anxiety/
have an increased risk for mental health problems, which depression, withdrawn/ depression, somatic complaints)
may contribute to delinquent behavior and can affect and externalizing symptoms ( social problems, thought
the rehabilitation process among juvenile offenders problems, attention problems, rule-breaking behavior,
in detention centers [1], occurring many psychiatric aggressive behavior ) and the scale derived DSM IV
disorders with an increased frequency of affective (Diagnostic and Statistical Manual of Mental Disorder –
IV-R ) to identify the presence of psychiatric disorders:
disorders, or conduct disorders [2].
The prevalence of mental disorders among affective problems, anxiety problems, somatic complaints,
minors falling under justice proved to be about 66% [3], ADHD problems, oppositional defiant problems and
three times higher than in the general population, half conduct problems. Results were analyzed according
of them being with substance use disorder and almost a to the mean scores obtained on the two scales and also
the frequency of the problems with clinical significance,
quarter being diagnosed with conduct disorder [4-6].
The objective of the present study was to analyze for the subjects in the study group compared with the
the psychiatric symptoms in adolescents with delinquent results obtained from the subjects in the control group;
comparative analysis was performed using the test One
behavior in the forensic psychiatric expertise.
Way ANOVA’s. We also analyzed the results in relation
with the type of delinquent acts as well the correlations
Method
between the presence of emotional problems and
There were studied 51 adolescents with delinquent behavior problems, using the Pearson’s correlation.
Statistical data processing was performed using
behavior such as theft (35), fight (6) and roguery (10), examined within the forensic psychiatric expertise in SPSS 17.0 for Windows.
194
Romanian Journal of Legal Medicine Vol. XXII, No 3(2014)
the adolescents with theft acts had
more ADHD problems (20%) and
conduct problems (34%) with
clinical significance.
Adolescents in the control
group without delinquent behavior
obtained similar results (Figure
3) with more affective problems
(mean 10.41; SD 4.92), ADHD
problems (mean 5.78; SD 4.19) and
conduct problems (mean 7.43; SD
Figure 3. Mean scores for DSM IV scale.
6.80), also with clinical significance
(Fig. 4). The difference between
delinquent teenagers and those
without delinquent behavior was
statistically significant only for
ADHD problems (p = .017) and the
conduct problems (p = .006).
The correlation’s analysis showed
that both delinquent teenagers
and those without delinquent
behavior had a strong correlation
between
internalizing
and
externalizing symptoms, especially
between
affective
problems
Figure 4. Frequency of clinical significant problems for DSM IV scale.
(anxiety and depression) and
behavioral problems of children as shown in Table 1.
Results
The results from measuring scales syndromes
(Fig. 1) showed very similar results for the young who
committed acts of theft/fight, with higher scores on
symptoms of anxious/depressed (mean 8.22; SD 3.44/
mean 8.66; SD 4.63), as well on the rule-breaking behavior
(mean 13.62; SD 6.27/ mean 13.16; SD 4.21) and aggressive
behavior (mean 12.37; SD 7.54/ mean 12.33; SD 8.23), the
same symptoms having also clinical significance (Fig. 2).
The adolescents who committed aggressive acts had also
high scores for attention problems (mean 9.83; SD 5.30).
The adolescents from the control group obtained
similar results with a top of the following symptoms:
anxious /depressed (mean 9.58; SD 5.30), withdrawn/
depressed (7.10; SD 3.48), social problems (mean 7.71;
SD 5.06) and aggressive behavior (mean 11.19; SD
7.86). Also this time the differences between juveniles
with delinquent behavior and adolescents in the control
group were statistically insignificant except for somatic
complaints (p = .026), social problems (p = .006) and
rule-breaking behavior (p = .001).
The analysis of the results obtained from the
scales derived DSM IV (Fig. 3) showed that adolescents
with delinquent behavior, independently of delinquent
acts (theft, fight or roguery) had more frequently affective
problems, ADHD problems and conduct problems (Fig.
4). However the clinical significance of the symptoms
was higher for anxiety problems (33%) and ADHD
problems (33%) in adolescents with fighting acts, while
Discussions
Adolescents with delinquent behavior associated
with emotional and behavioral problems manifest these
problems in different contexts, home, school, community
but the involved institutions are not prepared to handle
these complex situations. So, it is necessary a detailed
neuropsychiatric and psycho-educational assessment
because the aggressive behavior may divert attention
from some psychiatric disorders or neurological
problems [7]. The degree of psychiatric problems was
directly related with indicators of family adversity,
physical abuse, parental divorce, domestic violence and
other psychosocial variables or substance abuse [8].
Moreover, some studies show higher rates of
internalizing symptoms (anxiety, depression), but also
externalizing symptoms (aggressiveness, rule – breaking
behavior, hyperactivity) among juvenile offenders in
detention centers comparing with non-delinquents [9 10].
Depression and delinquent behavior / conduct
problems are two of the most common mental health
problems involving adolescents [11]. It is therefore
imperative to identify risk factors involved. For example,
adolescents with depressive symptoms and delinquency
could represent risks to future school failure, substance
abuse, victimization or interpersonal problems.
Our study found that among juvenile offenders
195
Jurma A.M. et alPsychopathological symptoms in adolescents with delinquent behavior
Table 1. Pearson’s correlations between emotional and behavioral symptoms for the adolescents with delinquent behavior
PC*
Sig.
Anx/
Depr.
With/
Depr
Som.
Compl
Soc.
Pb.
Thoug.
Pb.
Atten.
Pb.
Rule
Brk.
Agress.
Behav.
Affect.
Pb.
Anx.
Pb.
Som.
Pb.
ADHD
Pb.
OD
Pb.
CD
Pb
Anx/
Depr
With/
Depr
Som.
Soc.
Compl. Pb.
Thoug. Atten. Rule
Pb.
Pb.
Brk.
Agress. Affect
Behav. Pb.
Anx.
Pb.
Som.
Pb.
ADHD OD
Pb.
Pb.
CD
Pb
1
.671**
.000
.174
.223
.578**
.000
.145
.318
.583**
.000
.326*
.019
.413**
.003
.532**
.000
.797**
.000
.264
.062
.460**
.001
.185
.195
.301*
.32
1
.149
.296
.469**
.001
.199
.161
.456**
.001
.333*
.017
.536**
.000
.574**
.000
.602**
.000
.157
.271
.466**
.001
.373**
.007
.420**
.002
1
-.141
.322
.-023
.871
-.037
.798
.009
.949
-.037
.797
.484**
.000
.085
.552
.770**
.000
.007
.962
.096
.502
.020
.890
1
.078
.588
.635**
.000
.174
.221
.375**
.007
.163
.253
.645**
.000
.015
.915
.448**
.001
.181
.204
.309*
.027
1
.250
.076
.150
.295
.307*
.028
.059
.683
.113
429
.063
.661
.475**
.000
.210
.156
.406**
.003
1
.366**
.008
.555**
.000
.321*
.022
.678**
.000
.141
.323
.745**
.000
.320*
.022
.493**
.000
1
.715**
.000
.287*
.041
.316*
.024
-.056
.694
.562**
.000
.636**
.000
.849**
.000
1
.198
.164
.540**
.000
-.043
.762
.701**
.000
.748**
.000
.827**
.000
1
.335*
.016
.385**
.005
.164
.249
.216
.128
.243
.086
1
.251
.076
.452**
.001
.362**
.009
.357*
.010
1
.055
.699
.001
.995
-.020
.891
1
.501**
1
.000
.685** .651**
1
.000
.000
PC - Pearson correlation; * correlation is significant at the 0.05 level (2-tailed); ** correlation is significant at the 0.001 level (2-tailed)
Anx/Depr. (Anxious/Depressed);With/Depr. (Withdrawn/Depressed); Som.Compl. (Somatic Complaints); Soc.Pb.(Social Problems); Thoug.Pb. (Thought Problems);
Atten.Pb. (Attention Problems); Rule Brk. (Rule Breaking Behavior); Agress. Behav (Aggressive Behavior); Affect.Pb. (Affective Problems); Anx. Pb.(Anxiety
Problems); Som.Pb.(Somatic Problems); ADHD Pb.(ADHD Problems); OD Pb.(Oppositional Defiant problems); CD Pb. (Conduct Problems).
examined within the forensic psychiatric expertise were
identified numerous emotional and behavioral symptoms,
mostly with clinical significance framed within the
psychiatric disorders according to DSM –IV like affective
disorders (13.7 % ), anxiety disorders ( 14%), ADHD (
20%) and conduct disorder (26%).
Mordre's study [6] shows that three psychiatric
disorders in children are positively associated with
delinquency in adult life: conduct disorders (56%),
ADHD (Attention Deficit/Hyperactivity Disorder)
comorbid with conduct disorders (54%) and conduct
disorders associated with emotional disorders (33%).
The study conducted in 2007 [12] shows that 70 %
of juveniles subjects falling under the justice system have
at least one mental disorder such as conduct disorder or
substance use disorders, but even after excluding these
disorders a 66 % percentage of minors end up having
other psychiatric disorders, 26 % were diagnosed with an
anxiety disorder and 14% with affective disorders.
Our results also showed that among juvenile
196
delinquents were present many emotional symptoms
(depression, anxiety, and social problems) and behavioral
problems (attention problems, rule-breaking behavior,
aggressiveness).
White's study [13] uses also YSR to identify
psychiatric problems in adolescents with delinquent
behavior. The juveniles who were referred to court are
studied over three years that followed the appearance of
psychiatric problems to them. He finds increased levels
of depression and anxiety in adolescents who fall under
justice, but this fact is not related to the situation of
being caught itself, the explanation being the existence
of comorbidity between anxiety and/or depression and
conduct disorders.
Regarding ADHD, in our study the clinical
frequency of these symptoms among juvenile offenders
was lower for the adolescents who stole comparing to
that of the youths with aggressive acts (possible due to the
impulsivity of ADHD symptoms) and of non-delinquent
juveniles, but higher than the frequency of clinical
Romanian Journal of Legal Medicine affective symptoms (14 %) or ODD (Oppositional Defiant
Disorder) symptoms (6%). These results are somewhat
inconsistent compared to the findings of Pardini and
Fite [8], which aim to examine the symptoms of conduct
disorder and oppositional symptoms and those of ADHD
as predictors for the subsequent evolution of children
and adolescents in many psychological areas. Their study
shows that the children with ADHD and ODD have an
increased rate of anxiety and /or depression and also
social problems and academic failure for the children
with ADHD. The same study shows that if the symptoms
of conduct disorder are controlled, the presence of ODD
symptoms only increases the risk of delinquency. On the
other hand Pardini’s study shows that ADHD does not
predict criminal behavior only in terms of the association
of conduct problems and ODD, and only when these
symptoms are not controlled.
Our study also have identified numerous conduct
problems to the minors with delinquent behavior,
especially for those who stole or were beaten, the highest
percentage being clinical significant. The different results
obtained by us can be explained by the fact that in our
study we aimed to identify symptoms of psychopathology
in juveniles with delinquent behavior, but not considering
the possible psychiatric comorbidities in these patients.
Other studies, however, show that adolescents with
ADHD are at risk of entering in the justice system
compared to their peers without ADHD, with increased
risk of detention in adolescence [14-16].
Numerous studies [11, 12] show that more than
30 % of adolescents who meet criteria for a depressive
disorder meet the criteria for conduct disorder too,
and 50 % of those who have conduct disorder have
also depressive disorder. Kofler’s study [11] shows
that depressive symptoms and delinquent behavior in
adolescence are closely related; both vary according to
the age, depressive symptoms can predict delinquent
behavior, and delinquent behavior can also lead to
depressive symptoms. His study shows that early
emergence of depressive symptoms increase the risk for
delinquent behavior occurrence. This is probably going
through a developmental process through which the
irritability associated with the depression may initially
lead to increased aggression and the breaking rule
behavior.
Over time, these behaviors can have a negative
impact on relationships with parents and peers, ultimately
leading to adolescents association with deviant peers and
ultimately to delinquency. In our study we have found
numerous significant correlations between emotional
and behavioral problems in delinquent adolescents, the
most important being between the symptoms of anxious/
depressed, withdrawn/depressed and attention problems
or aggressiveness, respectively anxiety problems and
ADHD or ODD problems.
Vol. XXII, No 3(2014)
The main limitation of our study was that the
study design was cross- sectional, juvenile delinquents
are examined only once, when they were placed under
justice. Recent studies in the field of juvenile delinquency
have a longitudinal design that follows the evolving
delinquent behavior, aimed specifically to identify the
risk factors involved in the development of delinquent
behavior playing an important role in prevention. Another
important limitation of the study was not discussing
demographic factors with possible involvement in
occurrence of the delinquent behavior (family, schooling,
mental level) this happened because the group of teens
as taken in the study was small and statistical processing
according demographic variables was not possible.
Although the control group could have been
chosen from non - delinquent adolescents without
psychiatric disorders, the fact that the results we have
obtained after performing the study were very similar
to those obtained by teens who already had a diagnosed
psychiatric disorder without behavioral delinquent,
suggested that the presence of an undiagnosed or
untreated psychiatric disorder may have as a consequence
the occurrence of delinquent behavior.
If childhood psychiatric status is a risk factor for
crime, then the diagnosis and the effective treatment of
psychiatric disorders may reduce the risk of delinquent
behavior and the relapses[5], the absence of psychiatric
treatment could contributes to the increased of crime
rates and the psychiatric disorders in the adult life [10].
Conclusions
Often disruptive or delinquent behavior of young
people is the result of a symptom of undiagnosed or
untreated mental health problem. The problem can occur
when the child came to the attention of justice. In these
situations it is necessary to refer the juvenile to a mental
health service for medical assessment, this time making it
ideal for preventing the recidivism of delinquent behavior
[13].
Forensic psychiatric expertise must identify the
genuine reasons and circumstances of the offense and any
anti - social tendencies that continue to place the minor
in the area of criminal deviance and recommend medical
and psychosocial measures for targeting the young in
one desirable direction. Reduction of discernment is
an important element for guiding the penalty for nonpunitive alternative applicable in the community to
promote a positive future development.
Recommendations made to eliminate risk factors
such as individual, family, school, and social environment
will assess whether the measures can be applied within
the community of the child or if such measures have little
chance of success. Administration of measures involving
deprivation of liberty leaves the impression of young
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Jurma A.M. et alPsychopathological symptoms in adolescents with delinquent behavior
irrecoverable when in fact they have committed the crime
because of psychiatric disorders. For them there is a real
chance of recovery so that deprivation of liberty should
be avoided because of the danger of negative induction
rehabilitation centers and labeling.
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