The rates of mental disorder in adolescents are similar to or higher than those in adults. The rates of all mental disorders
(psychosis, depression, post-traumatic stress disorder, substance misuse) are substantially higher in young offenders than in
young people in the community. This is to be expected as so many of them have experienced events in their lives that are
known to increase the risk of mental disorder. Over one-third have been ‘looked after’ children in Local Authority care. The
levels of previous physical, sexual and emotional abuse, school exclusion, low educational achievement and unemployment
are all high and many are teenage parents. In addition, a significant group of young people are exposed to further
victimisation (eg bullying, violence, unwanted sexual attention) while in prison.
The prevalence of antisocial, paranoid or emotionally unstable (‘borderline’) personality disorders (or combinations of
these) in the 16–21-year group is also very high. The prevalence of mental retardation and pervasive developmental
disorders (eg autism) in adolescents in prison in England and Wales is not known, but levels in delinquent populations are
significantly higher than in the general population. Specific learning difficulties such as dyslexia (reading disorder) and
difficulties with spoken communication are over-represented among young offenders in prison. Reading problems are
strongly linked with psychiatric problems in general and behavioural problems in particular.
For a summary of the epidemiological information about psychiatric morbidity in young offenders.
Issues in assessment
To identify what is abnormal, it is necessary to have an understanding of normal development. Adolescents are engaged in
particular developmental tasks (eg becoming independent from others while still maintaining appropriate emotional
closeness to them; developing a sense of identity, including a sexual and cultural identity, a body image and self-esteem).
The behavioural problems that peak in the teenage years such as delinquency, substance misuse, deliberate self-harm and
anorexia nervosa often involve exaggerated and unresolved versions of ordinary adolescent development. As a result,
abnormal behaviour in adolescents is more likely to be interpreted or dismissed as a normal response to life events by
healthcare professionals, teachers, parents and the patients themselves, resulting in missed or late diagnoses. A good
working knowledge of adolescent development can help prevent this, as can a thorough assessment that includes
information from a variety of informants.
(psychosis, depression, post-traumatic stress disorder, substance misuse) are substantially higher in young offenders than in
young people in the community. This is to be expected as so many of them have experienced events in their lives that are
known to increase the risk of mental disorder. Over one-third have been ‘looked after’ children in Local Authority care. The
levels of previous physical, sexual and emotional abuse, school exclusion, low educational achievement and unemployment
are all high and many are teenage parents. In addition, a significant group of young people are exposed to further
victimisation (eg bullying, violence, unwanted sexual attention) while in prison.
The prevalence of antisocial, paranoid or emotionally unstable (‘borderline’) personality disorders (or combinations of
these) in the 16–21-year group is also very high. The prevalence of mental retardation and pervasive developmental
disorders (eg autism) in adolescents in prison in England and Wales is not known, but levels in delinquent populations are
significantly higher than in the general population. Specific learning difficulties such as dyslexia (reading disorder) and
difficulties with spoken communication are over-represented among young offenders in prison. Reading problems are
strongly linked with psychiatric problems in general and behavioural problems in particular.
For a summary of the epidemiological information about psychiatric morbidity in young offenders.
Issues in assessment
To identify what is abnormal, it is necessary to have an understanding of normal development. Adolescents are engaged in
particular developmental tasks (eg becoming independent from others while still maintaining appropriate emotional
closeness to them; developing a sense of identity, including a sexual and cultural identity, a body image and self-esteem).
The behavioural problems that peak in the teenage years such as delinquency, substance misuse, deliberate self-harm and
anorexia nervosa often involve exaggerated and unresolved versions of ordinary adolescent development. As a result,
abnormal behaviour in adolescents is more likely to be interpreted or dismissed as a normal response to life events by
healthcare professionals, teachers, parents and the patients themselves, resulting in missed or late diagnoses. A good
working knowledge of adolescent development can help prevent this, as can a thorough assessment that includes
information from a variety of informants.
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