AAPL Practice Resource for the Forensic Psychiatric Evaluation of Competence to Stand Trial

thinking: children’s and adolescents’ perceptions and decisions may be based on overly concrete ideas. They may view rights as discretionary or conditional, as opposed to automatic and inalienable. Perceived autonomy: children’s and adolescents’ lack of perceived autonomy can manifest as passivity, inattention, or compliance with authority. Self-regulation: children and adolescents tend to be less able to control impulsive behavior and choices compared with adults. Case examples illustrate this psychosocial immaturity in adolescents: A 9-year-old agrees to plead “guilty” to a charge despite limited evidence against him because he wants to be released to his parents quickly and pleading “not guilty” would require him to remain in custody. Here, the minor does not appropriately weigh the longer-term consequences of pleading guilty (time perspective). A 15-year-old who has stolen property and faces strong evidence against him may refuse to agree to a plea bargain in an attempt to appear “cool” to his peer group (peer influence). A 10-year-old arrested for and charged with a serious crime may believe, “The judge always finds the truth, so I don’t have anything to worry about” (abstract thinking). C. Mental Disorders and Illness Youths in juvenile detention facilities are much more likely to have mental disorders than are youths in the general population. Approximately 69 percent of juvenile pretrial detainees or delinquents meet DSM criteria for a mental disorder (including substance abuse and dependence or conduct disorder, as defined by DSM-IV-TR). However, research is mixed with regard to the strength of psychopathology as a risk factor for incompetence. Generally, conventional wisdom has held that mental disorders have less impact on JAC than developmental immaturity (DI), perhaps because psychotic disorders are relatively rare in minors (with a mean age at onset in the late teens or early 20s), whereas cognitive and psychosocial DI is a characteristic of almost all juveniles. In adult offenders, psychotic disorders (e.g., schizophrenia, bipolar type I (manic phase with psychosis)) and intellectual developmental disorder (IDD) are those mental disorders that typically call adjudicative competence into question. Disorders such as major depressive disorder or attentiondeficit/hyperactivity disorder (ADHD) typically are not considered serious enough to impair adjudicative competence in a significant fashion. In contrast, subthreshold disorders can have significantly more negative repercussions on JAC, mostly because of the relatively immature cognitive processes of those individuals younger than 15 years. This factor is especially relevant because many juvenile detainees who require mental health services for potentially competence-impairing mental disorders do not receive treatment before adjudication of their cases. For example, Teplin et al. found that only 16 percent of youths with potentially competence-impairing mental disorders receive treatment before adjudication or within six months of intake at a juvenile detention facility. Despite these factors, most youths with mental disorders meet the minimum threshold for adjudicative competence. However, these disorders often negatively affect the effectiveness of these youths’ participation in the trial process, particularly when combined with their baseline cognitive and psychosocial immaturity.