U.S. Department of Justice 

Office of Justice Programs 

Office of Juvenile Justice and Delinquency Prevention 

J. Robert Flores, Administrator April 2006

Of fice of Justice Pr ograms • Par tnerships for Safer Communities • www.ojp.usdoj.gov 

Psychiatric Disorders of 

Youth in Detention 

Linda A. Teplin, Karen M. Abram, Gary M. McClelland, 

Amy A. Mericle, Mina K. Dulcan, and Jason J. Washburn 

The juvenile justice system faces a significant challenge in identifying and responding to the psychiatric disorders of detained youth. In 2001, more than 104,000 

juvenile offenders were in custody in 

juvenile residential placement facilities 

(Sickmund, Sladky, and Kang, 2004). 

Understanding the psychiatric disorders 

of juvenile detainees is an important step 

toward meeting their needs. Providing 

such youth with psychiatric services may 

be critical to breaking the cycle of recidivism. Without sound data on the prevalence of psychiatric disorders, however, 

defining the best strategies to use and 

allocating the juvenile justice system’s 

scarce mental health resources are 

difficult. 

Earlier Research 

Although epidemiological data are key to 

understanding the psychiatric disorders 

of juvenile detainees, few empirical studies exist. Table 1 (page 3) lists studies 

published in the United States since 1990 

that have examined the diagnostic characteristics of incarcerated and detained 

juveniles. These studies do not provide 

data that are sufficiently comprehensive 

to guide juvenile justice policy in this 

area. Six studies in table 1 present rates 

of multiple disorders, and four of those 

examine patterns of psychiatric comorbidity among juvenile detainees (Domalanta 

et al., 2003; Duclos et al., 1998; Pliszka et 

al., 2000; Shelton, 2001). However, the 

studies’ findings are inconsistent. The 

prevalence of major affective disorder in 

the studies varies from 5 percent to 88 

percent; substance use disorders from 20 

percent to 88 percent; and psychosis from 

12 percent to 45 percent. Such inconsistencies may arise from discrepancies in 

methodology: 

Sampling strategies. Samples varied substantially among the studies. Some studies 

used random samples. Others relied on 

nonrandom samples, for example, consecutive admissions over a specified time 

period. Only a few studies reported racial 

and ethnic differences; some studies did 

not report the racial or ethnic composition of the sample. Females were excluded 

entirely from some investigations. 

Small samples. Some severe disorders 

have low base rates, between 1 and 4 

percent. Low base rates require large 

sample sizes to generate reliable estimates (Cohen, 1988). Sample sizes among 

the studies varied substantially. Many of 

the studies sampled too few subjects to 

generate reliable rates, even for the more 

common disorders. Most studies did not 

Access OJJDP publications online at www.ojp.usdoj.gov/ojjdp 

identifying and responding to such 

mental health needs are challenging. 

A Message From OJJDP 

A significant number of youth in 

detention suffer from psychiatric 

disorders. To address the needs of 

such offenders, justice officials need 

to know the kinds of disorders that 

are most common and their prevalence among juvenile detainees. 

Research indicates that providing 

detained youth with mental health 

services may reduce recidivism, but 

This Bulletin draws on research conducted by the Northwestern Juvenile 

Project, which measured the prevalence of alcohol, drug, and mental 

disorders among youth detained at 

the Cook County Juvenile Temporary 

Detention Center in Illinois. The study 

examined the prevalence of psychiatric disorders among youth by gender, race and ethnicity, and age. 

According to the study, nearly twothirds of males and three-quarters of 

females met diagnostic criteria for 

one or more psychiatric disorders. 

Many of these youth had two or more 

disorders. 

Youth with serious mental disorders 

should receive appropriate treatment 

while they are detained. This Bulletin 

presents information that can help the 

juvenile justice system detect youth 

with psychiatric disorders and 

respond with an integrated system of 

services. 
have enough participants in key demographic subgroups to compare participants 

by gender, race and ethnicity, or age. 

Measurement. Some studies in table 1 

used nonstandard or untested instruments, 

did not assess if the disorder impaired the 

ability of juveniles to function, or reported 

data on only one category of diagnoses 

(e.g., substance use disorders, anxiety 

disorders, personality disorders). 

The Northwestern 

Juvenile Project 

The Northwestern Juvenile Project was 

designed to overcome these methodological limitations. It includes a random sample of juvenile detainees ages 10–18 and a 

widely accepted and reliable measurement 

tool, the Diagnostic Interview Schedule for 

Children (DISC) Version 2.3 (Shaffer et al., 

1996), to measure diagnoses of alcohol, 

drug, and mental disorders. It also uses 

accepted criteria for identifying functional 

impairment (Friedman et al., 1996). 

Estimates are presented for demographic 

subgroups (gender, race and ethnicity, 

and age) for six categories of disorders: 

affective (major depressive episode, 

dysthymia, manic episode); psychosis; 

anxiety (panic, separation anxiety, overanxious, generalized anxiety, obsessivecompulsive disorders); attention-deficit/ 

hyperactivity disorder (ADHD); disruptive 

behavior (oppositional-defiant and conduct disorders); and substance use (alcohol and drug disorders). 

Methods 

Subjects were a randomly selected sample 

of male and female youth who were arrested and subsequently detained at the Cook 

County Juvenile Temporary Detention 

Center (Cook County Detention Center) in 

Illinois between November 20, 1995, and 

June 14, 1998. The sample was stratified 

by gender, race and ethnicity (African 

American, non-Hispanic white, Hispanic), 

age (10–13 or 14–18 years old), and legal 

status (processed as a juvenile or an 

adult). The final sample (N =1,829) comprised 1,172 males (64.1 percent) and 657 

females (35.9 percent), 1,005 African 

Americans (54.9 percent), 524 Hispanics 

(28.7 percent), 296 non-Hispanic whites 

(16.2 percent), and 4 detainees of other 

racial and ethnic groups (0.2 percent). 

The mean age of participants was 14.9 

years old. 

Similar to national trends for juvenile 

detainees, approximately 90 percent of 

the Cook County Detention Center detainees were male and most were racial 

or ethnic minorities: African American 

(77.9 percent), Hispanic (16.0 percent), 

non-Hispanic white (5.6 percent), and 

other racial or ethnic groups (0.5 percent). Their age and offense distributions 

were also similar to other U.S. juvenile 

detainees (Sickmund, Sladky, and Kang, 

2004). 

Although no single site can represent 

the nation, Illinois’ criteria for detaining 

juveniles are similar to other states’. 

Pretrial detention is allowed if a juvenile 

needs protection, is likely to flee, or is 

considered a danger to the community 

(Grisso, Tomkins, and Casey, 1988; Illinois 

Criminal Justice Information Authority, 

1997). Details of the data collection and 

sampling procedures can be found in 

Teplin et al., 2002, and Abram et al., 2003. 

Statistical Analysis 

Because the sample was stratified by gender, race and ethnicity, age, and legal status, prevalence estimates were weighted 

to reflect the detention center’s population. A simplified version of the results are 

presented in this Bulletin. Details of the 

statistical analyses and the results can be 

found in Teplin et al., 2002, and Abram et 

al., 2003. 

Psychiatric Diagnoses 

The DISC Version 2.3 assesses affective 

disorders, anxiety disorders, disruptive 

behavior disorders, substance use disorders, and psychosis within the past 

6 months (Bravo et al., 1993; Shaffer 

et al., 1996). 

Diagnoses of psychosis and ADHD required special management. The psychosis module of the DISC is a broad 

symptom screen and does not generate 

a specific diagnosis. Instead, it flags subjects if they indicate any essential symptoms of psychosis or at least three associated symptoms. More than one-quarter 

of the subjects scored positive on the 

screen. To minimize false positive diagnoses, these subjects were counted as 

psychotic only if their symptoms persisted for at least 1 week; they had not used 

alcohol, drugs, or medication during this 

time; and the psychiatrist or clinical psychologist who reviewed the case judged 

that the symptoms were probably indicative of psychosis. Twelve subjects met 

these criteria. The study counted as 

psychotic another eight subjects who, 

although they denied symptoms, appeared to have auditory hallucinations, 

thought disorders, or delusions during 

their interviews. 

ADHD among youth is difficult to 

assess via self-report and is particularly challenging to diagnose among delinquent youth (Schwab-Stone et al., 1996; 

Thompson et al., 1996). The Diagnostic 

and Statistical Manual of Mental Disorders, third edition, revised (DSM–III–R) 

(American Psychiatric Association, 

1987), requires that ADHD symptoms 

be present before age 7. Most subjects 

who reported symptoms of ADHD 

could not remember when their symptoms began. To reduce the risk of 

underreporting ADHD, rates were calculated in the conventional manner 

(requiring that the subject report that 

symptoms were present before age 7) 

and by counting the disorder as present regardless of the reported age of 

onset, as long as the duration criterion 

was met. (This Bulletin presents only 

the latter rates; the former are available from the authors.) Details on the 

DISC can be found in Teplin et al., 2002, 

and Abram et al., 2003. 

Rates of disorder using DSM–III–R criteria with and without diagnostic-specific 

or global functional impairment were 

examined. The rates were substantially 

similar. (Tables are available from the 

authors.) Rates of DSM–III–R diagnoses 

without impairment are presented in 

the following tables. 

Findings 

Table 2 (page 7) shows that nearly 

two-thirds of males and nearly threequarters of females met the diagnostic 

criteria for one or more of the disorders listed. Overall rates excluding 

conduct disorder were also calculated 

because many of its symptoms are 

related to delinquent behaviors. Excluding conduct disorder, overall 

rates decreased only slightly. 

Prevalence by Gender 

The most common disorders among 

males and females were substance use 

and disruptive behavior. One-half of 

males and almost one-half of females 

met criteria for a substance use disorder; more than 40 percent of males and 

females met the criteria for disruptive 

2 
Table 1: Published Studies of Psychiatric Disorders in Incarcerated, Detained, and Secured Juvenile 

Populations in the United States, From 1990 to 2003 

Author(s)/Year Sample* Diagnostic Measures* Major Findings* 

Davis et al., 1991 

Eppright et al., 1993 

Rohde, Mace, and 

Mathews, 1997 

et al., 1997 

N: 173 

Age: N/R 

Gender: N/R 

Race/ethnicity: Equally divided 

between white and nonwhite 

N: 52 

Age: 16 

Gender: Male 

Race/ethnicity: African American: 63%; 

white: 37% 

detention center 

N: 100 

Age: 14.6 

Gender: 21 females; 79 males 

Race/ethnicity: African American: 

detention facility 

N: 60 

Age: 14.9 

Gender: 16 females; 44 males 

Race/ethnicity: African American: 

Hispanic: 7%; American Indian: 

youth 

N: 85 

Age: 16.6 

Gender: Male 

Race/ethnicity: African American: 38%; 

Hispanic: 27%; white: 30%; other: 5% 

Institutionalized 

delinquents 

N: 50 

Age: 15.7 for females; 15.9 for males 

Gender: 25 females; 25 males 

Race/ethnicity: N/R 

Other: Of the total sample of 173 

(DSM–III–R criteria) 

DISC–2 

DICA–R; SCID–II 

K–SADS–PL (additional 

items added for 

DSM–III–R criteria) 

Psychiatric Diagnostic 

DISC (modified) 

SUD/AUD: 

CD: 81% 

Other: 

17%; ODD: 5% 

MDD: 33% 

CD: 

Anxiety: Overanxious: 40% 

Other: ADD: 27% 

CD: 87% 

Other: Antisocial PD: 75%; avoidant PD: 4%; 

1%; schizotypal PD: 0%; self-defeating PD: 2% 

Lifetime (%) 

Dysthymia 8 8 

MDD 40 23 

SUD/AUD 

Alcohol abuse 7 2 

Alcohol dependence 42 18 

7 2 

dependence 33 17 

Marijuana abuse 5 3 

Marijuana 

dependence 43 23 

CD 73 73 

Anxiety 18 10 

Other 

ADHD 17 13 

ODD 17 2 

Anxiety: 

32% met full criteria. 

Male (%) Female (%) 

Psychosis 16 12 

72 88 

SUD 88 56 

CD 100 96 

Anxiety 52 72 

Other 

ADHD 76 68 

0 

68 72 

Forehand et al., 1991 

Seeley, 1997 

Steiner, Garcia, and 

Timmons-Mitchell 

Participants: Youth in a state 

residential facility 

Participants: Youth in a juvenile prison 

Participants: Youth in a juvenile 

32%; white: 68% 

Participants: Youth in a secure 

2%; Asian/Pacific Islander: 2%; 

5%; white: 83%; other: 2% 

Participants: Violent incarcerated 

Participants: 

subjects, 50 were interviewed 

using DISC. 

Clinical interview 

Interview–Revised 

Affective: Dysthymia: 17%; MDD: 15% 

Alcohol abuse disorder: 34%; 

alcohol dependence disorder: 12%; drug 

abuse disorder: 45%; drug dependence 

disorder: 19% 

ADD: 19%; adjustment disorder: 18%; 

any developmental disorder: 17%; any PD: 

Affective: 

Group delinquency: 58%; solitary 

aggression: 23% 

borderline PD: 27%; dependent PD: 7%; 

histrionic PD: 3%; narcissistic PD: 8%; 

obsessive-compulsive PD: 2%; paranoid PD: 

17%; passive aggressive PD: 14%; schizoid PD: 

Current (%) 

Affective 

Hard drug abuse 

Hard drug 

20% met “partial criteria” for PTSD; 

Affective 

Eating disorder 16 

Sleep disorder 

(continued) 

3 
T a b le 1—Continued 

Author(s)/Year Sample* Diagnostic Measures* Major Findings* 

Duclos et al., 1998 

Atkins et al., 1999 

Pliszka et al., 2000 

N: 189 

Age: 17.2 for females; 16.6 for males 

Gender: 96 females; 93 males 

Race/ethnicity: 

Male (%) Female (%) 

African American 38 21 

Hispanic 27 29 

White 30 23 

Other 5 27 

facility 

N: 150 

Age: 15 (median) 

Gender: 65 females; 85 males 

Race/ethnicity: 100% American Indian, 

Other: 

facility 

N: 75 

Age: 15.5 

Gender: 4 females; 71 males 

Race/ethnicity: African American: 77%; 

non-Hispanic white: 23% 

N: 51 

Age: 17.5 

Gender: Male 

Race/ethnicity: African American: 28%; 

Hispanic: 12%; white: 57% 

center 

N: 50 

Age: 15.4 

Gender: 5 females; 45 males 

Race/ethnicity: N/R 

Adjudicated youth 

N: 419 

Age: 16.9 

Gender: 34% female; 66% male 

Race/ethnicity: African American: 21%; 

Asian/Pacific Islander: 9%; Hispanic: 

29%; non-Hispanic white: 34%; 

biracial: 4%; other: 3% 

Other: 

(n=

based on the total subsample 

Psychiatric Diagnostic 

(PTSD module only) 

DISC 2.3; CIDI 

DISC 2.3 

and Adolescents 

DISC 2.3 

CIDI (SUD module only) 

Anxiety: PTSD: 32% (male); 49% (female) 

Male (%) Female (%) 

Dysthymia 0 0 0 

MDD 6 

SUD/AUD 37 39 38 

CD 21 11 17 

Anxiety (any) 2 7 

Generalized 0 8 3 

Overanxious 0 5 

PTSD 2 0 1 

Other 

ODD 1 3 2 

ADHD 6 8 

Comorbidity† 17 27 21 

Psychosis: 45% 

24% 

SUD: 20% 

CD: 40% 

Anxiety: 33% 

Other: ODD: 15%; ADHD: 1% 

Comorbidity: Mean of 2.4 diagnoses per 

youth 

Anxiety: Lifetime PTSD: 45%; 

42%; MDD: 20%; mania: 20% 

SUD: Alcohol dependence: 28%; marijuana 

dependence: 46%; other: 14% 

CD: 60% 

Other: ADHD: 18%; ODD: 24% 

Comorbidity‡ 

Lifetime (%) 

SUD/AUD (any) 62 37 

AUD 49 28 

Amphetamine 23 10 

Cannabis 46 15 

Cocaine 2 0.5 

Hallucinogen 9 3 

Opiate 0.5 0 

Cauffman et al., 1998 

Erwin et al., 2000 

Aarons et al., 2001 

Participants: Incarcerated wards 

Participants: Youth in a detention 

specific group(s) N/R 

77% status offenders 

Participants: Youth in a detention 

Participants: Youth in a secure juvenile 

treatment facility 

Participants: Youth in a detention 

Participants: 

Participants from a subsample 

1,036) of a larger study titled 

“Patterns of Care”; age and race 

Interview—Revised 

Clinician-Administered 

PTSD Scale for Children 

Total (%) 

Affective 

16 10 

13 

13 

11 

Affective: 

current PTSD: 18% 

Affective (any): 

Past Year (%) 

(continued) 

4 
T a b le 1— Continued 

Author(s)/Year Sample* Diagnostic Measures* Major Findings* 

Garland et al., 2001 Participants: Adjudicated youth Computer-assisted Affective (any): 7%; dysthymia: 0%; 

N: 478 DISC–IV hypomania: 1%; MDD: 5%; mania: 2% 

Age: 16.9 CD: 30% 

Gender: 74 females; 404 males Anxiety (any): 9%; generalized anxiety: 

Race/ethnicity: African American: 21%; 1%; obsessive-compulsive: 2%; panic: 0%; 

Asian/Pacific Islander: 6%; Hispanic: PTSD: 3%; separation anxiety: 4%; social 

26%; white: 39%; mixed: 5%; other: 3% phobia: 2% 

Other: Participants from a subsample Other: Any DBD: 48%; ADHD: 13%; ODD: 15% 

(n=1,618) of a larger study titled 

“Patterns of Care”; age and race based 

on total subsample 

Shelton, 2001 Participants: Youth in commitment and DISC; C–GAS Psychosis: 32% 

detention facilities Affective: 17% 

N: 312 SUD: 37% 

Age: 12–20 (mean or median N/R) Anxiety: 58% 

Gender: 60 females; 252 males Other: Any DBD: 40%; miscellaneous 

Race/ethnicity: African American: 57%; disorders: 18% 

Hispanic and other: 17%; white: 26% Comorbidity:§ 

McCabe et al., 2002 Participants: Adjudicated youth Computer-assisted Male (%) Female (%) 

N: 625 DISC–IV (selected Affective (any) 5 16 

Age: 16.2 modules); CIDI Sub- MDD 3 14 

Gender: 112 females; 513 males stance Abuse Module Mania 1 3 

Race/ethnicity: African American: SUD 37 28 

19%; Asian/Pacific Islander: 12%; CD 33 38 

Hispanic: 30%; white: 29%; biracial/ Anxiety (any) 8 15 

other: 9% PTSD 2 7 

Other: Participants from a larger study Separation 4 10 

titled “Patterns of Care” (n=1,715) Other 

Any DBD 49 64 

ADHD 15 21 

ODD 30 42 

Comorbidity 38 28 

Wasserman et al., 2002 Participants: Youth in secure facilities Voice DISC–IV Affective (any): 10%; dysthymic: 1%; 

N: 292 hypomanic: 1%; MDD: 8%; manic: 2% 

Age: 17 SUD (any): 50%; alcohol abuse: 17%; alcohol 

Gender: Male dependence: 13%; marijuana abuse: 15%; 

Race/ethnicity: African American: 54%; marijuana dependence: 26%; other substance 

Hispanic: 16%; white: 28%; other: 2% abuse: 4%; other substance dependence: 13% 

CD: 32% 

Anxiety (any): 20%; agoraphobia: 5%; generalized anxiety: 2%; obsessive-compulsive: 5%; 

panic: 5%; PTSD: 5%; specific phobia: 9%; 

social phobia: 2% 

Other: Any DBD: 33%; ADHD: 2% 

behavior disorders. More than one-fourth 

of females and almost one-fifth of males 

met the criteria for one or more affective 

disorders. 

Table 2 reports the female-to-male odds 

ratios. Females had significantly higher 

odds than males of having any disorder, 

any disorder except conduct disorder, 

any affective disorder, major depressive 

episode, any anxiety disorder, panic 

disorder, separation anxiety disorder, 

overanxious disorder, and substance use 

disorder other than alcohol or marijuana. 

Significantly more females (56.5 percent) 

than males (45.9 percent) met criteria for 

two or more of the following disorders: 

major depressive, dysthymic, manic, 

psychotic, panic, separation anxiety, overanxious, generalized anxiety, obsessivecompulsive, ADHD, conduct, oppositional 

defiant, alcohol, marijuana, and other substance use. Approximately one-fifth of 

(continued) 

females (17.3 percent) and males (20.4 

percent) had only one disorder (Abram 

et al., 2003). 

Figures 1 and 2 (page 8) indicate substantial comorbidity for females and males. 

(Psychoses were omitted from this analysis because there were so few cases.) 

Patterns of overlap differ somewhat by 

gender. Nearly one-third of females (29.5 

percent) and males (30.8 percent) had 

substance use disorders and ADHD or 

5 
Table 1—Continued 

Author(s)/Year Sample* Diagnostic Measures* Major Findings* 

Domalanta et al., 2003 Participants: Youth in a detention 

center 

N: 1,024 

Patient health 

questionnaire 

Male (%) Female (%) Total (%) 

Affective (any) 26 31 

MDD 10 10 

Age: 14.9 for females; 15.3 for males 

Gender: 274 females; 750 males 

Mood NOS 12 13 

Other mood 4 8 

Race/Ethnicity: 

Male (%) Female (%) 

African American 42 33 

Hispanic 35 37 

White 19 23 

SUD 43 36 

AUD 27 27 

Anxiety 

Other 8 12 

Panic 5 8 

Other 4 7 Somatoform 12 22 

Comorbidity** 38 

Notes: Treatment studies are not included; only diagnoses reported by each study are displayed. Percentages are rounded to the nearest whole number. 

Mean age in years is reported unless unavailable or otherwise indicated. 

*ADD = attention-deficit disorder; ADHD = attention-deficit/hyperactivity disorder; AUD = alcohol use disorder; CD = conduct disorder; C–GAS = Children’s 

Global Assessment Scale; CIDI = Composite International Diagnostic Interview; DBD = disruptive behavior disorder; DICA–R = Diagnostic Interview for 

Children and Adolescents–Revised; DISC = Diagnostic Interview Schedule for Children; DSM = Diagnostic and Statistical Manual of Mental Disorders; 

K–SADS–PL= Kiddie-Schedule for Affective Disorders, Present and Lifetime Version; MDD = major depressive disorder; NOS = not otherwise specified; 

N/R = not reported; ODD = oppositional-defiant disorder; PD = personality disorder; PTSD = posttraumatic stress disorder; SCID = Structured Clinical 

Interview for DSM; SUD = substance use disorder 

† Of the 21% with two or more disorders, 83% had SUD and DBD. 

‡ Among those with mania, 82% had CD, 36% had alcohol dependence, 64% had marijuana dependence, and 45% had other substance dependence. 

Among those with MDD, 80% had CD, 20% had alcohol dependence, and 60% had marijuana dependence. 

§ Anxiety and DBD: 28%; anxiety and psychotic: 21%; anxiety and affective: 14%; anxiety and SUD: 25%; DBD and psychotic: 14%; DBD and affective: 

9%; DBD and SUD: 19%; psychotic and affective: 1%; psychotic and SUD: 15%; affective and SUD: 7%. 

** Among those with MDD, 49% had substance abuse and 39% had alcohol abuse. Among those with alcohol abuse, 14% had MDD and 83% had 

substance abuse. Among those with substance abuse, 12% had MDD and 55% had alcohol abuse. 

disruptive behavior disorders; approximately half of these also had anxiety 

disorders, affective disorders, or both. 

Significantly more females (47.8 percent) 

than males (41.6 percent) had two or 

more of the following types of disorders: 

affective, anxiety, substance use, and 

ADHD or disruptive behavior. Significantly 

more females (22.5 percent) than males 

(17.2 percent) had three or more types of 

disorders. Additional information is available in Abram et al., 2003. 

Prevalence by Race 

and Ethnicity 

Tables 3 and 4 (pages 9 and 10) show the 

prevalence rates of disorders for males 

and females by race and ethnicity. Table 3 

indicates that among males, non-Hispanic 

whites had the highest rates for many 

disorders and African Americans had the 

lowest. Compared with African Americans, 

non-Hispanic whites had significantly 

higher rates of any disorder, any disorder 

except conduct disorder, any disruptive 

behavior disorder, conduct disorder, any 

substance use disorder, and substance 

use disorder other than alcohol or marijuana. The only disorder for which African 

Americans had significantly higher rates 

than non-Hispanic whites was separation 

anxiety disorder. Hispanics had significantly higher rates than non-Hispanic whites of 

any anxiety disorder and separation anxiety disorder. Compared with African Americans, Hispanics had higher rates of panic 

disorder, obsessive-compulsive disorder, 

and substance use disorder other than 

alcohol or marijuana. Non-Hispanic whites 

had higher rates than Hispanics of any 

disorder, any disruptive behavior disorder, 

conduct disorder, and substance use disorder other than alcohol or marijuana. 

Table 4 compares prevalence rates among 

females by race and ethnicity. Compared 

with African American females, nonHispanic white females had significantly 

higher rates of any disorder, any disorder 

except conduct disorder, any disruptive 

behavior disorder, conduct disorder, and 

all substance use disorders. Compared 

with Hispanic females, non-Hispanic white 

females had higher rates of any disorder 

except conduct disorder. Hispanic females 

had higher rates of generalized anxiety 

disorder than either African American or 

non-Hispanic white females. Compared 

with African American females, Hispanic 

females had higher rates of all disruptive 

behavior disorders, alcohol use disorder, 

substance use disorder other than alcohol 

or marijuana, and alcohol and drug use 

disorders. 

Among females, significantly more nonHispanic whites (63.1 percent) had two or 

more types of disorders than African 

Americans (42.6 percent). Among males 

also, significantly more non-Hispanic 

whites (53.1 percent) had two or more 

types of disorders than African Americans 

(40.7 percent). The odds of having 

comorbid disorders were higher than 

expected for most racial and ethnic 

subgroups, except when base rates of 

disorders were already high or when there 

were few participants in a category 

(Abram et al., 2003). 

6 
Prevalence by Age 

Tables 5 and 6 (pages 11 and 12) show 

the prevalence of disorders for males and 

females by age. Table 5 indicates that 

among males, the youngest age group 

had the lowest rates of many disorders, including any disorder, any disorder except 

conduct disorder, generalized anxiety disorder, and all the substance use disorders. 

The 14–15 age group had higher rates of 

psychotic disorders than the 16-and-older 

age group. Significantly more males age 16 

and older (41.2 percent) had two or more 

types of disorders than males age 13 and 

younger (27.0 percent). Similarly, more 

males age 14 and 15 (45.3 percent) had two 

or more types of disorders than males age 

13 and younger (Abram et al., 2003). 

Table 6 indicates that patterns of disorders are different for females than for 

males. The oldest female age group had 

significantly lower rates of oppositionaldefiant disorder than the younger age 

groups. Compared with the older age 

groups, the youngest age group had 

significantly lower rates of any substance 

use disorder and marijuana use disorder. 

Among females, there were no significant 

age differences in the prevalence of 

comorbid disorder types. 

Comorbidity of 

Substance Use 

Disorders and Major 

Mental Disorders 

More than one-tenth of males (10.8 percent) and 13.7 percent of females had a 

major mental disorder (psychosis, manic 

episode, or major depressive episode) and 

a substance use disorder (Abram et al., 

2003). These disorders were examined 

in depth because detention centers are 

mandated to treat major mental disorders 

and because comorbidity complicates 

treatment. 

Prevalence of Substance 

Use Disorders Among Youth 

With Major Mental Disorders 

Compared with participants with no major 

mental disorder,1 females and males with 

any major mental disorder had significantly greater odds of having substance 

use disorders. Two subcategories of 

major mental disorder were examined: 

psychosis or manic episode (combined 

1 Relevant analyses regarding major mental disorders 

are available from authors. 

Table 2: Six-Month Prevalence and Odds Ratios of DSM–III–R Diagnoses, by Gender 

Male (%) Female (%) Female-to-Male 

Disorder (n=1,170) (n=656) Odds Ratios 

Any of the listed disorders 66.3 73.8 1.43† 

Any except conduct disorder 60.9 70.0 1.49† 

Any affective disorder 18.7 27.6 1.66† 

Major depressive episode 13.0 21.6 1.85† 

Dysthymia 12.2 15.8 1.34 

Manic episode 2.2 1.8 0.81 

Psychotic disorders 1.0 1.0 0.98 

Any anxiety disorder 21.3 30.8 1.64† 

Panic disorder 0.3 1.5 5.65† 

Separation anxiety disorder 12.9 18.6 1.55† 

Overanxious disorder 6.7 12.3 1.95† 

Generalized anxiety disorder 7.1 7.3 1.03 

Obsessive-compulsive disorder 8.3 10.6 1.31 

Attention-deficit/ 

hyperactivity disorder* 16.6 21.4 1.37 

Any disruptive behavior disorder 41.4 45.6 1.19 

Oppositional-defiant disorder 14.5 17.5 1.25 

Conduct disorder 37.8 40.6 1.12 

Any substance use disorder 50.7 46.8 0.86 

Alcohol use disorder 25.9 26.5 1.03 

Marijuana use disorder 44.8 40.5 0.84 

Other substance use disorder 2.4 6.9 3.00† 

Alcohol and other drug 

use disorders 20.7 20.9 1.01 

Notes: The odds ratios show the relative likelihood of one group having a disorder compared with another group. For the female-to-male odds ratios, odds 

ratios greater than 1.0 indicate that females had higher odds of having a specific disorder than males; ratios less than 1.0 show that females had lower 

odds of having the disorder. 

*Attention-deficit/hyperactivity disorder is reported without the criterion of onset before age 7 because caretaker information is not available and 

self-reporting of symptoms before age 7 is unreliable. 

† Odds ratios are significant at p < .05. 

7 
9.6%

Substance Use 

44.5%

1.2%

3.9%

14.0% 7.6%

4.9%

2.9% 2.6% 6.0%

2.0%

4.8%

2.3%

ADHD*/

Disruptive

Behavior

46.3%

Affective

26.4%

Anxiety

31.5%

Substance use

Anxiety

Affective

ADHD/behavioral

None of the Listed 

Disorders

27.2%

6.7%

2.0%

2.2%

Key

Age differences. Among females with 

Figure 1: Comorbidity Among Females, by Disorder major mental disorders, no significant 

differences existed by age. Among males, 

nearly 90 percent of those age 16 and 

older with a major mental disorder also 

had a substance use disorder, significantly 

more than males ages 10–13 and 14–15 

(55.2 percent and 60.6 percent, 

respectively). 

Prevalence of Major Mental 

Disorders Among Youth With 

Substance Use Disorders 

Nearly 30 percent of females and more 

than 20 percent of males with any substance use disorder also had a major 

mental disorder. Among youth with drug 

and alcohol use disorders, more than 

one-third of females and more than onequarter of males had a major mental disorder. There were no significant differences by gender, race and ethnicity, or age. 

Compared with participants with no 

substance use disorder (the residual 

category), females and males with any 

substance use disorder had significantly 

Note: Detail may not total 100% due to rounding. greater odds of having any major mental 

*Attention-deficit/hyperactivity disorder. disorder and its subcategory, major

because there were too few cases to 

analyze separately and because these dis- Figure 2: Comorbidity Among Males, by Disorder

orders have similar symptoms) and major 

depressive episode. Most odds ratios for 

these subcategories were statistically 

significant, except when cell sizes were 

small. 

Gender differences. Among youth with 

major mental disorders (n=305), more 

than half of females and nearly threequarters of males had any substance use 

disorder. Differences between females 

and males (and the corresponding odds 

ratios) were not statistically significant. 

Racial and ethnic differences. Among 

females with major mental disorders, 

significantly more non-Hispanic whites 

and Hispanics had drug and alcohol use 

disorders than did African Americans 

(50.0 percent and 43.4 percent, respec­


tively, versus 21.3 percent). Significantly


more Hispanic females had alcohol use


disorders than did African Americans


(52.5 percent versus 26.6 percent).


Among males with major mental disor­


ders, no significant differences existed Note: Detail may not total 100% due to rounding.

relative to race and ethnicity. *Attention-deficit/hyperactivity disorder.

14.6%

1.4%

3.2%

16.4% 6.7%

4.3%

2.1%

1.0%

2.1%

1.1%

1.2%

2.0%

0.7%

1.6%

Substance Use

49.8%

ADHD*/

Disruptive

Behavior

41.7%

Anxiety

21.1%

Affective

17.9%

None of the Listed 

Disorders

34.8%

Substance use

Anxiety

Affective

ADHD/behavioral

Key

6.9%

8 
Table 3: Six-Month Prevalence of DSM–III–R Diagnoses for Males, by Race and Ethnicity 

African 

American (%) 

Disorder (n=574) 

Non-Hispanic 

White (%) Hispanic (%) Overall 

(n=207) (n=386) Significance Specific Tests* 

Any of the listed disorders 64.6 82.0 70.4 < .001 White > African American; 

white > Hispanic 

Any except conduct disorder 59.4 72.9 65.3 .009 White > African American 

Any affective disorder 18.6 13.8 21.5 .19 

Major depressive episode 12.5 9.5 16.6 .20 

Dysthymia 12.2 9.5 13.3 .53 

Manic episode 2.5 0.5 1.4 .27 

Psychotic disorders 1.0 2.6 0.7 .19 

Any anxiety disorder 20.9 14.4 25.5 .05 Hispanic > white 

Panic disorder 0.1 0.5 1.0 .04 Hispanic > African American 

Separation anxiety disorder 12.7 5.9 15.5 .02 African American > white; 

Hispanic > white 

Overanxious disorder 6.9 2.9 7.0 .16 

Generalized anxiety disorder 7.5 2.5 7.2 .08 

Obsessive-compulsive disorder 6.5 9.3 17.0 .01 Hispanic > African American 

Attention-deficit/ 

hyperactivity disorder† 17.0 20.9 13.7 .18 

Any disruptive behavior disorder 39.8 60.3 43.3 < .001 White > African American; 

white > Hispanic 

Oppositional-defiant disorder 14.4 19.4 13.6 .23 

Conduct disorder 35.6 59.9 41.7 < .001 White > African American; 

white > Hispanic 

Any substance use disorder 49.1 62.6 55.4 .01 White > African American 

Alcohol use disorder 24.6 30.1 30.8 .28 

Marijuana use disorder 44.4 53.8 45.4 .11 

Other substance use disorder 0.5 21.1 6.0 < .001 White > African American; 

white > Hispanic; Hispanic > 

African American 

Alcohol and other 

drug use disorders 20.4 24.0 21.7 .65 

* Specific tests are performed only if the alpha for the overall test is less than .05. 

† Attention-deficit/hyperactivity disorder is reported without the criterion of onset before age 7 because caretaker information is not available and 

self-reporting of symptoms before age 7 is unreliable. 

depressive episode. Among males, odds 

ratios for psychosis or a manic episode 

were significant for alcohol use disorder 

and comorbid drug and alcohol use 

disorders. 

Relative Onset of Major 

Mental Disorders and 

Substance Use Disorders 

One-quarter of females (27.2 percent) and 

males (25.0 percent) reported that their 

major mental disorder preceded their substance use disorder by more than 1 year. 

One-tenth of females (9.8 percent) and 

20.7 percent of males reported that their 

substance use disorder preceded their 

major mental disorder by more than 1 

year. Nearly two-thirds of females (63.0 

percent) and 54.3 percent of males developed their disorders within the same year. 

Findings were similar for subcategories of 

disorders. 

Analysis 

Data gathered by the Northwestern 

Juvenile Project indicate that youth with 

psychiatric and substance use disorders 

pose a challenge for the juvenile justice 

system. Even when conduct disorder was 

excluded, 60 percent of male and 70 

percent of female juvenile detainees met 

diagnostic criteria for one or more psychiatric disorders. Comorbidity was 

common. To the extent that Cook County 

is typical, the findings suggest that on an 

average day, as many as 72,000 detained 

youth have at least one psychiatric disorder; 47,000 detained youth have two or 

more types of psychiatric disorders; and 

more than 12,000 detained youth have 

both a major mental disorder and a substance use disorder. 

The prevalence of psychiatric disorders 

among youth entering the juvenile justice 

system may be greater than that of detainees, as reflected in this study. The 

9 
Table 4: Six-Month Prevalence of DSM–III–R Diagnoses for Females, by Race and Ethnicity 

African 

American (%) 

Disorder (n=430) 

Non-Hispanic 

White (%) Hispanic (%) Overall 

(n=89) (n=136) Significance Specific Tests* 

Any of the listed disorders 70.9 86.1 75.9 .01 White > African American 

Any except conduct disorder 67.4 83.9 69.5 .01 White > African American; 

white > Hispanic 

Any affective disorder 26.2 23.4 28.7 .68 

Major depressive episode 19.7 19.0 22.8 .70 

Dysthymia 15.5 17.9 17.2 .80 

Manic episode 1.9 1.1 2.1 .85 

Psychotic disorders 0.9 0.0 2.1 .29† 

Any anxiety disorder 31.2 30.0 32.6 .92 

Panic disorder 0.9 3.4 2.8 .17 

Separation anxiety disorder 18.9 14.5 21.7 .41 

Overanxious disorder 12.5 11.1 13.2 .90 

Generalized anxiety disorder 6.6 4.4 13.1 .03 Hispanic > African American; 

Hispanic > White 

Obsessive-compulsive 

disorder 10.3 12.4 10.6 .84 

Attention-deficit/ 

hyperactivity disorder‡ 20.0 22.2 29.3 .08 

Any disruptive behavior disorder 39.4 61.6 56.5 <.001 White > African American; 

Hispanic > African American 

Oppositional-defiant disorder 15.8 17.8 26.2 .03 Hispanic > African American 

Conduct disorder 34.3 58.9 50.2 <.001 White > African American; 

Hispanic > African American 

Any substance use disorder 42.3 61.9 51.7 .002 White > African American 

Alcohol use disorder 21.2 39.2 34.0 <.001 White > African American; 

Hispanic > African American 

Marijuana use disorder 37.8 53.4 44.7 .02 White > African American 

Other substance use disorder 0.9 20.0 14.7 <.001 White > African American; 

Hispanic > African American 

Alcohol and other 

drug use disorders 17.2 35.1 28.3 <.001 White > African American; 

Hispanic > African American 

* Specific tests are performed only if the alpha for the overall test is less than .05. 

† Test computed with one degree of freedom because of empty cells. 

‡ Attention-deficit/hyperactivity disorder is reported without the criterion of onset before age 7 because caretaker information is not available and 

self-reporting of symptoms before age 7 is unreliable. 

sample included only detainees; it excluded 

youth who were not detained because 

their charges were less serious, because 

they were immediately released, or because they were referred directly to the 

mental health system. Moreover, under 

reporting of symptoms and impairments 

by youth is common, especially for disruptive behavior disorders (Schwab-Stone 

et al., 1996). 

Comparing these findings with studies of 

youth in the general population is difficult 

because published estimates for the latter 

vary widely depending on the sample, the 

method, the source of data, and whether 

functional impairment was required for 

diagnosis (Roberts, Attkisson, and Rosenblatt, 1998). Despite these differences, the 

overall rates presented here are substantially higher than the median rate (15 percent) reported by Roberts, Attkisson, and 

Rosenblatt (1998) and the rates of other 

recent investigations (Costello et al., 1996b; 

Simonoff et al., 1997; Shaffer et al., 1996; 

and Turner and Gil, 2002). The rates of 

comorbidity reported here are also substantially higher than those reported in 

community samples (Angold, Costello, and 

Erkanli, 1999; Costello et al., 1996a; Costello et al., 1999; Kessler and Walters, 1998; 

Lewinsohn, Gotlib, and Seeley, 1995). 

Of particular concern are the high rates 

of depression and dysthymia among detained youth,2 which are also higher than 

rates in the general population (Costello 

et al., 1996a; Costello et al., 1996b; Garrison et al., 1997; Kessler and Walters, 1998; 

McGee et al., 1992; Simonoff et al., 1997; 

Turner and Gil, 2002). Depressive disorders, which are a risk factor for suicide 

and attempted suicide, are difficult to 

detect and treat in the corrections milieu. 

Overall, the prevalence rates presented 

2 Although not included in table 2, combined prevalence rates of major depressive episode and dysthymia 

were 17 percent for males and 24 percent for females. 

10 
Table 5: Six-Month Prevalence of DSM–III–R Diagnoses for Males, by Age 

13 and Younger 14–15 Years Old 16 and Older 

(%) (%) (%) Overall 

Disorder (n=315) (n=361) (n=494) Significance Specific Tests* 

Any of the listed disorders 52.7 68.0 67.3 .001 14 and 15 years > 13 and 

younger; 16 and older > 13 

and younger 

Any except conduct disorder 44.9 63.4 61.8 < .001 14 and 15 years > 13 and 

younger; 16 and older > 

13 and younger 

Any affective disorder 13.0 21.2 17.7 .09 

Major depressive episode 7.5 14.8 12.4 .06 

Dysthymia 7.3 14.5 11.2 .08 

Manic episode 1.6 2.6 2.0 .80 

Psychotic disorders 0.0 2.1 0.3 .01† 14 and 15 years > 16 

and older 

Any anxiety disorder 17.7 23.0 20.6 .42 

Panic disorder 0.8 0.1 0.3 .25 

Separation anxiety disorder 10.0 14.5 12.0 .40 

Overanxious disorder 4.8 5.1 8.4 .25 

Generalized anxiety disorder 1.3 5.9 9.2 .001 14 and 15 years > 13 and 

younger; 16 and older > 

13 and younger 

Obsessive-compulsive disorder 6.0 9.4 7.8 .43 

Attention-deficit/ 

hyperactivity disorder‡ 12.5 20.9 13.8 .06 

Any disruptive behavior disorder 32.9 43.5 41.2 .06 

Oppositional-defiant disorder 10.7 18.2 12.1 .08 

Conduct disorder 30.8 41.1 36.4 .10 

Any substance use disorder 28.3 51.3 54.4 < .001 14 and 15 years > 13 and 

younger; 16 and older > 

13 and younger 

Alcohol use disorder 12.9 25.6 28.7 < .001 14 and 15 years > 13 and 

younger; 16 and older > 

13 and younger 

Marijuana use disorder 25.1 46.9 46.8 < .001 14 and 15 years > 13 and 

younger; 16 and older > 

13 and younger 

Other substance use disorder 0.8 2.5 2.6 .01 14 and 15 years > 13 and 

younger; 16 and older > 

13 and younger 

Alcohol and other drug use 10.2 21.5 22.0 < .001 14 and 15 years > 13 and 

disorders younger; 16 and older > 

13 and younger 

* Specific tests are performed only if the alpha for the overall test is less than .05. 

† Test computed with one degree of freedom because of empty cells. 

‡ Attention-deficit/hyperactivity disorder is reported without the criterion of onset before age 7 because caretaker information is not available and 

self-reporting of symptoms before age 7 is unreliable. 

here are comparable to rates in other 

high-risk populations, such as maltreated 

or runaway youth (Famularo, Kinscherff, 

and Fenton, 1992; Feitel et al., 1992). 

The comorbidity of substance use disorders is also of particular concern. Among 

the disorders assessed, detainees are 

more likely to have substance use plus 

ADHD or disruptive behavior disorders 

than any other combination. Half of these 

detainees also have an affective or anxiety 

disorder. Among adolescent substance 

users, these internalizing disorders are 

associated with more severe substance 

use (Riggs et al., 1999; Whitmore et al., 

1997) but better treatment outcomes 

(Randall et al., 1999). 

The data highlight an important paradox 

regarding race and ethnicity. More than 

11 
Table 6: Six-Month Prevalence of DSM–III–R Diagnoses for Females, by Age 

13 and Younger 14–15 Years Old 16 and Older 

(%) (%) (%) Overall 

Disorder (n=56) (n=353) (n=247) Significance Specific Tests* 

Any of the listed disorders 66.7 72.2 77.6 .18 

Any except conduct disorder 64.7 67.4 74.8 .13 

Any affective disorder 20.7 27.9 28.8 .50 

Major depressive episode 13.0 21.6 23.4 .27 

Dysthymia 10.4 15.6 17.2 .46 

Manic episode 3.9 1.4 1.9 .45 

Psychotic disorders 0.0 0.6 1.8 .21† 

Any anxiety disorder 26.6 32.6 29.2 .55 

Panic disorder 1.9 1.7 1.0 .75 

Separation anxiety disorder 18.1 19.7 17.2 .77 

Overanxious disorder 7.1 13.8 11.4 .34 

Generalized anxiety disorder 3.8 7.1 8.4 .51 

Obsessive-compulsive disorder 10.4 11.8 8.8 .51 

Attention-deficit/hyperactivity 

disorder‡ 26.6 22.7 18.5 .30 

Any disruptive behavior disorder 44.7 50.0 39.6 .11 

Oppositional-defiant disorder 30.5 20.2 10.7 <.001 13 years and younger > 16 

and older; 14 and 15 > 

16 and older 

Conduct disorder 33.0 45.3 35.7 .06 

Any substance use disorder 30.5 45.8 52.0 .02 14 and 15 years > 13 and 

younger; 16 and older > 

13 and younger 

Alcohol use disorder 16.7 25.4 30.3 .16 

Marijuana use disorder 24.8 41.3 43.3 .04 14 and 15 years > 13 and 

younger; 16 and older > 

13 and younger 

Other substance use disorder 5.9 5.3 9.5 .52 

Alcohol and other drug use 

disorders 11.5 21.8 22.0 .20 

* Specific tests are performed only if the alpha for the overall test is less than .05. 

†Test computed with one degree of freedom because of empty cells. 

‡ Attention-deficit/hyperactivity disorder is reported without the criterion of onset before age 7 because caretaker information is not available and 

self-reporting of symptoms before age 7 is unreliable. 

one-half of the youth in the juvenile justice system are African American or Hispanic. Therefore, most delinquent youth 

with psychiatric disorders are minorities. 

The prevalence of many single and comorbid disorders, however, is highest among 

non-Hispanic whites. Thus, non-Hispanic 

white youth in the juvenile justice system 

may, on average, be more dysfunctional 

(have greater psychiatric morbidity) than 

minorities. 

Females had higher rates than males of 

many single and comorbid psychiatric 

disorders, including major depressive 

episodes, some anxiety disorders, and 

substance use disorders other than 

alcohol and marijuana (e.g., cocaine and 

hallucinogens). These findings confirm 

those of earlier studies of adult female 

detainees and females with conduct disorder (Lewis et al., 1991; Teplin, Abram, and 

McClelland, 1996; Wasserman et al., 2005). 

In contrast to the general population, 

males did not have significantly higher 

odds of ADHD than females. This may 

reflect a greater prevalence of attentional 

problems among females in detention 

compared with those in the general 

population, or a possible unreliability of 

the ADHD diagnosis. 

The youngest age group (13 and younger) 

had the lowest prevalence rates of most 

disorders, consistent with studies of youth 

in the general population (Cohen, Cohen, 

and Brook, 1993; Kandel et al., 1997; Newman et al., 1996; Simonoff et al., 1997). 

Many youth in the juvenile justice system 

may develop new or additional disorders 

as they grow older. Although comorbidity 

of major mental and substance use disorders is more prevalent among older 

detainees, this study found no dominant 

sequence of onset, suggesting that multiple pathways to disorders exist. 

Limitations 

This study provides a snapshot of the subjects’ psychopathology immediately after 

12 
arrest and detention. It cannot show 

whether mental disorder causes delinquency, increases the likelihood of arrest 

and detention, or is merely a frequent trait 

among delinquent youth. Some symptoms 

may be a reaction to detention. Moreover, 

the rates might differ somewhat using 

DSM–IV rather than DSM–III–R criteria. 

The findings are drawn from one site only 

and may pertain only to youth in urban 

detention centers with a similar demographic composition. Finally, because 

interviewing caretakers was not feasible, 

the data are subject to the limitations of 

self-reporting. Despite these constraints, 

the study has implications for future 

research on delinquent youth and for 

the juvenile justice system. 

Future Research 

Further research is needed to determine 

the most common pathways to comorbidity, critical periods of vulnerability, and 

how these factors differ by gender, race 

and ethnicity, and age. Longitudinal studies that identify the most common developmental sequences would demonstrate 

when primary and secondary preventive 

interventions might prove most beneficial 

(Nottlemann and Jensen, 1995). 

Females are increasingly arrested for violent crimes, and they make up a growing 

proportion of delinquent youth (Office of 

Juvenile Justice and Delinquency Prevention, 2001; Snyder and Sickmund, 1999). 

Understanding psychiatric morbidity and 

associated risk factors among delinquent 

females could help improve treatment and 

reduce the cycle of disorder and dysfunction. Earlier studies of conduct-disordered 

youth (many of whom become delinquent) 

suggest that females have a greater 

persistence of emotional disorder and 

worse outcomes than males (Loeber and 

Stouthamer-Loeber, 1998; Zoccolillo, 1992). 

Moreover, problem behaviors among 

females often persist beyond adolescence. 

As they grow older, delinquent females 

may become suicidal, addicted to alcohol 

or drugs, enmeshed in violent relationships, and unable to care for their children 

(Lewis et al., 1991; Zoccolillo, 1992). Delinquent females also engage in sexual activity at an earlier age than nonoffenders, placing them at greater risk for unintended 

pregnancy and the human immunodeficiency virus (Gender-Specific Programming for 

Girls Advisory Committee, 1998). 

Longitudinal studies are needed to examine why some delinquent youth develop 

new psychopathology and others do not, 

to investigate protective factors, and to 

determine how vulnerability and risk differ by key variables such as gender and 

race and ethnicity. Many youth in the 

juvenile justice population will develop 

new disorders as they grow older. Risk 

factors for the development of disorders 

are common among delinquent youth 

(Werner, 1989). These factors include 

physical and sexual abuse, a troubled 

family environment, parental substance 

abuse, poverty, poor education, neighborhood disintegration, and neglect. 

Delinquent youth have few protective factors to offset these risks (Cocozza, 1992). 

Thus, most youth in the juvenile justice 

system are at great risk for psychopathology, problem behaviors, and even early 

death (Lattimore, Linster, and MacDonald, 

1997; Loeber et al., 1999; Teplin et al., 

2005). Longitudinal data on the subjects 

described in this Bulletin are being collected. Future papers will address persistence and change in psychiatric disorders 

(including onset, remission, and recurrence), comorbidity, associated functional 

impairments, and how these disorders affect 

risk behaviors that may lead to rearrest. 

Implications for 

Juvenile Justice 

Research findings indicate that a substantial number of youth in detention need 

mental health services. Youth with serious mental disorders have a constitutional right to receive treatment while 

detained. Providing mental health services to youth in detention and redirecting them to the mental health system 

after release may help prevent their return to the correctional system (Dembo 

et al., 1997; National Research Council 

and Institute of Medicine, 2001). However, providing services within the juvenile justice system poses a number of 

challenges. 

Mental health screening. Identifying 

youth who need mental health services 

is a significant first step. Experts recommend that youth be screened for psychiatric problems within 24 hours of admission to a juvenile facility. At a minimum, 

screening should address acute mental 

health problems (including psychosis), 

the risk for suicide or harm to self, the 

use of psychiatric medications, substance 

abuse, and the risk for assaultive behavior. Youth who disclose such information 

should have appropriate legal protections 

(Wasserman et al., 2003). 

Many detention centers do not routinely 

screen for psychiatric problems (Goldstrom et al., 2001). Only recently have 

specialized screening tools been developed to assess the mental health needs 

of youth entering the juvenile justice system (Dembo et al., 1996; Grisso, 1999; 

Grisso et al., 2001); these instruments 

need further testing and evaluation. 

Mental health services. Youth in need of 

mental health services require access to 

them while in detention (Costello and 

Jameson, 1987; Wasserman et al., 2003). 

Detention centers should train personnel 

to detect mental disorders that are overlooked at intake or that arise during incarceration (Dembo et al., 1997; Hayes, 2000; 

Ulzen and Hamilton, 1998). Furthermore, 

personnel need to know how to make 

appropriate referrals once they suspect 

a disorder may be present. 

Although fewer in number, females in detention have greater service needs than 

males. Earlier studies indicate that females with problem behaviors may have 

worse outcomes than males (Lewis et al., 

1991; Loeber and Stouthamer-Loeber, 

1998; Zoccolillo, 1992). Services should 

be developed to address the unique 

needs of this growing population. 

Community services. Youth typically do 

not remain in detention for long. Most 

detainees return to their communities 

within 2 weeks (Snyder and Sickmund, 

1999). Ideally, those with mental disorders 

should be linked to community mental 

health services prior to their release 

(Cocozza and Skowyra, 2000; Faenza, 

Siegfried, and Wood, 2000). However, 

youth in the juvenile justice system are 

disproportionately minority, impoverished, and poorly educated, and many 

lack social networks—characteristics 

known to limit the type and scope of 

mental health services provided to youth 

(Kataoka, Zhang, and Wells, 2002; McKay, 

McCadam, and Gonzales, 1996). Juvenile 

justice administrators need to form collaborative relationships with education, 

child welfare, mental health, and substance abuse service systems to ensure 

that youth have adequate access to care 

after their release. 

Because many youth in detention suffer 

from psychiatric disorders and pose a 

challenge to the juvenile justice system, 

research is needed to better understand 

the comorbidity of psychiatric disorders, 

psychiatric disorders among females 

involved in the juvenile justice system, 

13 
and the long-term outcomes of detained 

youth with mental disorders. These youth 

will continue to overburden the juvenile 

justice system, and eventually the adult 

justice system, until it is better able to 

detect them and respond with an integrated system of appropriate services 

during detention and after release. 

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years. American Journal of Orthopsychiatry 

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31:547–556. 

This Bulletin was prepared under grant number 

1999–JE–FX–1001 from the Office of Juvenile 

Justice and Delinquency Prevention, U.S. 

Department of Justice. 

Points of view or opinions expressed in this 

document are those of the authors and do not 

necessarily represent the official position or 

policies of OJJDP or the U.S. Department 

of Justice. 

The Office of Juvenile Justice and Delinquency 

Prevention is a component of the Office of 

Justice Programs, which also includes the 

Bureau of Justice Assistance, the Bureau of 

Justice Statistics, the National Institute of Justice, 

and the Office for Victims of Crime. 

Acknowledgments 

Linda A. Teplin, Ph.D., is the Owen L. 

Coon Professor of Psychiatry and Behavioral Sciences and Director, Psycho-Legal 

Studies Program, Feinberg School of 

Medicine, Northwestern University, Chicago. Karen M. Abram, Ph.D., is Assistant 

Professor, Feinberg School of Medicine, 

Northwestern University. Gary M. McClelland is Research Assistant Professor, 

Feinberg School of Medicine, Northwestern University. Amy A. Mericle, Ph.D., is 

Postdoctoral Fellow, School of Medicine, 

Department of Psychiatry, University of 

California, San Francisco. Mina K. Dulcan, 

Ph.D., is Professor of Psychiatry and 

Behavioral Sciences and Pediatrics, Feinberg School of Medicine, Northwestern 

University, and Head of Child and Adolescent Psychiatry, Children’s Memorial Hospital. Jason J. Washburn, Ph.D., is Assistant Professor, Feinberg School of 

Medicine, Northwestern University.