U.S. Department of Justice

Office of Justice Programs

Office of Juvenile Justice and Delinquency Prevention 

Office of Juvenile Justice and Delinquency Prevention ojjdp.gov

Melodee Hanes, Acting Administrator Robert L. Listenbee, Administrator

 

September 2015 

Beyond Detention 

Even though research indicates that 

the majority of youth in the juvenile 

justice system have been diagnosed with 

psychiatric disorders, reports issued by 

the Surgeon General and the President’s 

New Freedom Commission on Mental 

Health show that juvenile detainees 

often do not receive the treatment and 

services they need. 

This bulletin series presents the results of 

the Northwestern Juvenile Project, the 

first large-scale, prospective longitudinal 

study of drug, alcohol, and psychiatric 

disorders in a diverse sample of juvenile 

detainees. Individual bulletins examine 

topics such as suicidal behaviors in 

youth in detention, posttraumatic 

stress disorder and trauma among this 

population, functional impairment in 

youth after detention, and barriers for 

youth who need to receive mental health 

services. 

Nearly all detained youth eventually 

return to their communities and the 

findings presented in this series provide 

empirical evidence that can be used 

to better understand how to meet 

youth’s mental health needs and provide 

appropriate services while in detention 

and after their release. The Office 

of Juvenile Justice and Delinquency 

Prevention hopes this knowledge will 

help guide innovative juvenile justice 

policy and create a better future for 

youth with psychiatric disorders in the 

justice system. 

Detained Youth Processed in Juvenile 

and Adult Court: Psychiatric Disorders 

and Mental Health Needs 

Jason J. Washburn, Linda A. Teplin, Laurie S. Voss, Clarissa D. Simon, Karen M. Abram, 

Gary M. McClelland, and Nichole D. Olson 

Highlights 

This bulletin presents results of a study of the prevalence of psychiatric disorders 

among youth transferred to adult criminal court compared with those processed 

in juvenile court. Key observations, findings, and recommendations include: 

•	 Many youth are being transferred to adult criminal court, with males, 

African Americans, Hispanics, and older youth significantly more likely 

to be processed in adult criminal court than females, non-Hispanic 

whites, and younger youth (even after controlling for the current 

charge). 

•	 The prevalence of one or more disorders among youth transferred 

to adult criminal court does not significantly differ from that among 

youth processed in juvenile court. 

•	 Among youth processed in adult criminal court, those sentenced to 

prison had significantly greater odds than those who received a less 

severe sentence of having a disruptive behavior disorder, a substance 

use disorder, or co-occurring affective and anxiety disorders. 

•	 Community and correctional systems must collaborate to identify and 

treat youth with psychiatric disorders who are transferred to adult 

criminal court. Youth who are transferred to adult criminal court and 

receive prison sentences should be considered a particularly highrisk group who are likely to require additional services. 
2 Juvenile Justice Bulletin 

SEPTEMBER 2015

 

Detained Youth Processed in Juvenile and Adult Court: 

Psychiatric Disorders and Mental Health Needs 

Jason J. Washburn, Linda A. Teplin, Laurie S. Voss, Clarissa D. Simon, Karen M. Abram, Gary M. McClelland, and Nichole D. Olson 

All 50 states and the District of Columbia have legal 

mechanisms for trying juveniles as adults in criminal 

court (General Accounting Office, 1995; Griffin, 2003; 

OJJDP, 2012; Puzzanchera et al., 2003). Historically, 

most states transferred juveniles to adult criminal court 

primarily through judicial waiver. Juvenile court judges 

waived youth to criminal court on a case-by-case basis, 

considering both the charge and the characteristics of the 

individual youth (Griffin, 2003; Salekin, 2002; Snyder, 

Sickmund, and Poe-Yamagata, 2000). The number of 

youth transferred to the adult court through a judicial 

ABOUT THIS SERIES 

Studies in this series describe the results of statistical 

analyses of the Northwestern Juvenile Project, a 

longitudinal study of youth detained at the Cook County 

Juvenile Temporary Detention Center in Chicago, IL, 

between 1995 and 1998. The sample included 1,829 male 

and female detainees between ages 10 and 18. The data 

come from structured interviews with the youth. 

Topics covered in the series include the prevalence of 

suicidal thoughts and behaviors among juvenile detainees, 

posttraumatic stress disorder and trauma within this 

population, functional impairment after detention (at work, 

at school, at home, or in the community), psychiatric 

disorders in youth processed in juvenile or adult court, 

barriers to mental health services, violent death among 

delinquent youth, and the prevalence of psychiatric 

disorders in youth after detention. The bulletins can 

be accessed from the Office of Juvenile Justice and 

Delinquency Prevention’s (OJJDP’s) website, ojjdp.gov. 

waiver nearly doubled from 1985 to 1994 (Puzzanchera 

and Kang, 2012), contributing to the 128-percent 

increase in the number of juveniles held in adult jails 

during that time period (Adams and Addie, 2010). 

Today, more juveniles are transferred to the adult criminal 

court, using automatic transfers and prosecutorial directfile procedures, than by judicial waiver (Griffin et al., 

2011). Automatic transfers exclude juveniles from the 

jurisdiction of the juvenile court solely on the basis of the 

type of offense, criminal history, and age of the youth. 

Prosecutorial direct-file mechanisms allow prosecutors 

In addition to the funding that OJJDP provided, the 

research also was supported by the National Institute 

on Drug Abuse, the National Institute of Mental Health, 

the National Institute on Alcohol Abuse and Alcoholism, 

the Substance Abuse and Mental Health Services 

Administration (Center for Mental Health Services, Center 

for Substance Abuse Prevention, and Center for Substance 

Abuse Treatment), the Centers for Disease Control and 

Prevention (National Center for Injury Prevention and 

Control and National Center for HIV/AIDS, Viral Hepatitis, 

STD, and TB Prevention), the National Institutes of Health 

Office of Research on Women’s Health, the National 

Institute on Minority Health and Health Disparities, the 

Office of Rare Diseases, the Office of Behavioral and Social 

Sciences Research, the U.S. Departments of Labor and 

Housing and Urban Development, the William T. Grant 

Foundation, and the Robert Wood Johnson Foundation. 

The John D. and Catherine T. MacArthur Foundation, the 

Open Society Foundations, and The Chicago Community 

Trust provided additional funds. 
Juvenile Justice Bulletin 3 

to determine when to file certain juvenile cases directly 

in criminal court. Juvenile court judges are precluded 

from exercising their discretion in both of these forms 

of transfer. By 2011, automatic transfers were available 

in 29 states and prosecutorial direct-file procedures were 

available in 15 states, accounting for 78.4 percent of 

transfers to adult criminal court (Griffin et al., 2011). 

The expansion of automatic transfers and prosecutorial 

direct-file mechanisms likely contributed to the 39-percent 

decline in the proportion of youth transferred to the adult 

court through the use of judicial waiver since its peak in 

1994 (Adams and Addie, 2012). Given the substantial 

number of youth whose cases are filed in adult criminal 

court annually, accurate information on the prevalence of 

psychiatric disorders in this population is critical because 

youth with serious psychiatric disorders who are processed 

in adult criminal court have the right to receive treatment. 

Recent studies indicate that a substantial proportion of 

juvenile detainees need mental health services (Cauffman, 

2004) and that between one-half and two-thirds of these 

juveniles have one or more psychiatric disorders (Teplin et 

al., 2002; Wasserman et al., 2002). Another study using a 

screening instrument for mental health problems indicates 

that youth who are transferred to adult prison have higher 

rates of psychiatric symptoms than youth housed in 

juvenile facilities (Murrie et al., 2009). Yet, no study has 

examined how prevalent psychiatric disorders are among 

youth transferred to adult criminal court (referred to in 

this bulletin as “transferred youth”). Data on this topic is 

needed for several reasons. 

Historically, transferred youth have disproportionately 

come from underserved sociodemographic groups, and 

numerous studies indicate that they are disproportionately 

male and from racial/ethnic minority groups (Austin, 

Johnson, and Gregoriou, 2000; Barnes and Franz, 

1989; Bishop, 2000; Fagan, Forst, and Vivona, 1987; 

Hamparian et al., 1982; Kinder et al., 1995; Olson, 2005; 

Snyder, Sickmund, and Poe-Yamagata, 2000). Although 

these disparities have declined in the past decade, they 

persist (Adams and Addie, 2010). They are a significant 

concern because young men and adolescent youth from 

racial/ethnic minority groups are significantly less likely 

than female and non-Hispanic white youth to receive the 

mental health treatment they need, once they are detained 

(Teplin et al., 2005). Little is known, however, about 

racial/ethnic disparities in mental health needs among 

transferred youth. 

A further disadvantage for transferred youth is that 

they often wait substantially longer for their cases to 

be adjudicated (that is, to receive a finding of guilt or 

innocence) than youth who remain in the juvenile system 

(Fagan, 1996; Myers, 2003; Rudman et al., 1986). They 

are also less likely to be released before adjudication than 

adults in the criminal court system (Rainville and Smith, 

2003). Because they are incarcerated longer, transferred 

youth may be at greater risk for developing psychiatric 

problems than those held in juvenile detention for shorter 

periods. In particular, the conditions often associated 

with extended detention—separation from loved ones, 

crowding, and solitary confinement—may increase the risk 

of suicidal behavior among transferred youth (Gallagher 

and Dobrin, 2006; Marcus and Alcabes, 1993; Parent et 

al., 1994; Pogrebin, 1985). 

In addition, findings from an experimental study suggest 

that, once in court, transferred youth face jurors who may 

be biased against them simply because they are being tried 

in an adult court. Where it exists, this bias increases the 

likelihood of a guilty verdict, boosts the jurors’ confidence 

in the youth’s guilt, and lowers the standard of proof for 

guilt (Tang and Nunez, 2003). Transferred youth are 

more likely to be convicted and to receive more stringent 

sentences than those processed in juvenile court (Myers, 

2003; Podkopacz and Feld, 1996; Rainville and Smith, 

2003; Strom, Smith, and Snyder, 1998). They are also 

more likely to receive more severe punishments than 

young adults facing similar charges in adult criminal court 

(Kurlychek and Johnson, 2004, 2010). Nearly 60 percent 

of all transferred youth charged with violent offenses 

are adjudicated to prison, compared with 26 percent 

of similarly charged young adults (Rainville and Smith, 

2003). As a result, approximately 2,639 youth are housed 

in adult state prison facilities (Sabol and Couture, 2008), 

where they may not receive age-appropriate interventions 

(Woolard et al., 2005). Before age-appropriate 

interventions for youth in the adult correctional system 

can be developed and implemented, corrections personnel 

and treatment providers need to know which psychiatric 

disorders are most prevalent among these youth. 

Despite the importance of this issue, the authors found 

only one study that examined psychiatric problems among 

transferred youth (Beyer, 2006). That study investigated 

only posttraumatic stress disorder (PTSD) and learning 

disorders, and it was based on one clinician’s coding of 

diagnoses from 50 of his case records. 

Therefore, the Northwestern Juvenile Project study 

reported here is the first large-scale investigation of 

psychiatric disorders among transferred youth. Using 

data from the Northwestern Juvenile Project (Teplin et 

al., 2002), the authors compared transferred youth with 

those processed in juvenile court, addressing the following 

questions: 

• Do the demographic characteristics of transferred youth 

differ from those of youth processed in juvenile court? 
 

• Do the psychiatric needs of transferred youth differ 

from those of youth processed in juvenile court? 

• Do the psychiatric needs of transferred youth who were 

sentenced to prison differ from those of transferred 

youth who received less severe sentences? 

Methods 

This section provides a brief overview of the authors’ 

methods. Additional detailed information on the 

methodology can be found in Abram et al. (2003) and 

Teplin et al. (2002). 

Participants and Sampling Procedures 

Participants were part of the Northwestern Juvenile 

Project (NJP), a longitudinal study of 1,829 youth (ages 

10–18) arrested and detained between November 20, 

1995, and June 14, 1998, at the Cook County Juvenile 

Temporary Detention Center (CCJTDC) in Chicago, 

IL. The random sample was stratified by gender, race/ 

ethnicity (African American, non-Hispanic white, 

Hispanic, or other), age (10–13 years or 14 years and 

older), and legal status (processed in juvenile or adult 

court) to obtain enough participants to examine key 

subgroups (e.g., females, Hispanics, younger children). 

The gender, age, and offense distributions of the CCJTDC 

detainees are similar to detained juveniles nationwide 

(Snyder and Sickmund, 2006). As in other urban facilities, 

most youth detained in the center belong to racial/ethnic 

minority groups. The CCJTDC population is 77.9 percent 

African American, 5.6 percent non-Hispanic white, 16 

percent Hispanic, and 0.5 percent other racial/ethnic 

groups. 

The authors chose the detention center in Cook County, 

which includes Chicago and surrounding suburbs, for 

three reasons: 

• Nationwide, most juvenile detainees live in and are 

detained in urban areas (Pastore and Maguire, 2000). 

• Cook County is ethnically diverse and has the third 

largest Hispanic population in the United States (U.S. 

Census Bureau, 2001). Studying this population is 

important because Hispanics are the largest minority 

group in the United States (U.S. Census Bureau, 

2000). 

• The detention center’s size (daily census of 

approximately 650 youth and intake of 20 youth per 

day) ensured that a large enough pool of participants 

would be available. 

Detainees were eligible to be sampled regardless of any 

psychiatric diagnoses, their state of drug or alcohol 

intoxication, or their fitness to stand trial. The youth were 

interviewed in a private area, almost always within 2 days 

of intake. Most interviews lasted 2 to 3 hours, depending 

on how many symptoms were reported. 

Transfer to Adult Criminal Court in Illinois 

In Illinois, the minimum age at which a juvenile can be 

transferred to adult criminal court is 13 years. At the 

time the data were collected, the juvenile court had 

jurisdiction over all youth 16 years and younger, unless 

they were transferred to an adult criminal court (Illinois 

Juvenile Justice Commission, 2010). The Illinois statute 

at that time specified six felony offenses for which youth 

were automatically transferred to adult criminal court for 

processing. Four of these offenses are violent offenses 

(first-degree murder, aggravated criminal sexual assault, 

armed robbery with a firearm, or aggravated vehicular 

hijacking with a firearm); the other two offenses are not 

(unlawful use of a weapon on or within 1,000 feet of 

school property, and delivery of a controlled substance in 

or within 1,000 feet of a school or public housing). 

Measures 

To determine diagnoses, the authors used the English- and 

Spanish-language versions of the Diagnostic Interview 

Schedule for Children Version 2.3 (DISC–2.3) (SchwabStone et al., 1996), which was the most recent version 

available at the time of the study. The DISC–2.3 assesses 

the presence of disorders from the Diagnostic and 

Statistical Manual of Mental Disorders, Third Edition, 

Revised (DSM–III–R) in interviewees within the past 

6 months. Data collection for PTSD began 13 months 

“Correctional systems cannot assume that assessment 

and treatment approaches used with youth in the general 

population will be effective with transferred youth.” 

4 Juvenile Justice Bulletin 
 

after the study began because PTSD was not included in 

the DISC–2.3. PTSD was measured with the DISC–4.0 

(Shaffer et al., 2000), which provided 12-month rates using 

DSM–IV criteria for PTSD. Data on PTSD diagnoses 

were examined by using a subsample of 898 participants. 

The subsample was composed of 532 males (59 percent) 

and 366 females (41 percent). It included 490 African 

American youth (55 percent), 154 non-Hispanic white 

youth (17 percent), 252 Hispanic youth (28 percent), 

and 2 youth of other racial/ethnic groups (less than 1 

percent). 

The authors included the following disorders: 

•	 Affective disorders (major depression, dysthymia, 

mania, and hypomania). 

•	 Anxiety disorders (generalized anxiety disorder, 

separation anxiety disorder, obsessive-compulsive 

disorder, overanxious disorder, PTSD, and panic 

disorder). 

•	 Psychotic disorders. 

•	 Disruptive behavior disorders (conduct disorder, 

attention-deficit/hyperactivity disorder [ADHD], and 

oppositional defiant disorder). 

•	 Substance use disorders (alcohol, marijuana, and drugs 

other than marijuana). 

Details of the special procedures implemented for 

determining psychotic disorders and ADHD have been 

reported previously (Teplin et al., 2002). 

Data on arrest charges were obtained from intake records at 

the Cook County Juvenile Temporary Detention Center. 

Final Sample for Analyses 

The final sample was restricted to participants 13 years 

and older (N = 1,715) because juveniles younger than 

13 are not eligible for processing in adult criminal 

court in Illinois (see “Transfer to Adult Criminal Court 

in Illinois”). The PTSD subsample consisted of 840 

participants 13 years and older. The final sample of 

transferred youth totaled 275; it included 21 females and 

254 males, 199 African Americans, 69 Hispanics, and 7 

non-Hispanic whites. The sample of youth processed in 

juvenile court totaled 1,440, including 616 females and 

824 males, 727 African Americans, 429 Hispanics, 280 

non-Hispanic whites, and 4 participants who self-identified 

as an “other” race or ethnicity. The unweighted M±SD 

(mean±standard deviation) age was 15.7±0.5 years for 

transferred youth and 15.0±1.2 years for youth processed 

in juvenile court. 

Findings 

Criminal Characteristics 

Among the 275 transferred youth, 117 (43 percent) were 

charged with a violent felony, 213 (78 percent) were 

found guilty, and 139 (51 percent) were sentenced to 

prison. Among the 1,440 youth processed in the juvenile 

court, 281 (20 percent) were charged with a violent 

felony, 945 (65 percent) were “adjudicated delinquent” 

(the juvenile justice equivalent to being found guilty), 

and 8 (1 percent) were sentenced to prison. Compared 

with youth processed in juvenile court, significantly more 

transferred youth were charged with a violent felony, 

found guilty, and sentenced to prison. 

Likelihood of Transfer to Criminal Court by 

Gender, Age, and Racial/Ethnic Subgroup 

Table 1 (page 6) presents the unweighted demographic 

characteristics of the sample and the weighted proportions 

of transferred youth compared with youth processed in 

juvenile court by gender, racial/ethnic subgroup, and 

specific age group. As shown in table 1, males, youth from 

Juvenile Justice Bulletin 5 
 

Table 1. Demographic Characteristics of Arrested and 

Detained Youth and Their Likelihood of Transfer to Adult 

Criminal Courta 

Characteristic Total N 

Youth 

Transferred to 

Adult Court 

(%) 

Significant 

Comparisons 

(p < .05) 

Gender Male > female 

Female 637 3 

Male 1,078 7 

Race/ethnicity African American > 

non-Hispanic white 

African 

American 926 7 African American > Hispanic 

Hispanic 498 5 Hispanic > 

non-Hispanic white 

Non-Hispanic 

white 287 2 

Other 4 0 

Age, yb Older > younger 

13 258 0 

14 217 <1 

15 498 8 

16 644 10 

17c 89 1 

18c 9 0 

a Percentages are weighted to reflect the demographic characteristics of 

the Cook County Juvenile Temporary Detention Center (CCJTDC). Ns are 

unweighted. 

b Each additional year of age (after age 13) corresponds to a 52-percent 

increase in the odds of being transferred to adult criminal court. 

c In Illinois, detainees 17 years and older are housed in adult detention 

facilities. Detainees ages 17 and 18 were in CCJTDC only if they committed 

the index crime before age 17 or misrepresented their age. 

6 Juvenile Justice Bulletin 

Table 2. Psychiatric Disorders Among Arrested and 

Detained Youth Processed in Adult or Juvenile Courta 

Court Where Processedb 

Disorder 

Adult 

(N = 275)

 % 

Juvenile 

(N = 1,440) 

% 

Any disorder 66 68 

Any disorder except conduct disorder 64 62 

Any affective disorder 22 20 

Major depression 16 14 

Dysthymia 12 13 

Mania 3 2 

Hypomania 1 2 

Any anxiety disorder 24 22 

Panic disorder 0 <1 

Separation anxiety disorder 16 13 

Overanxious disorder 9 7 

Generalized anxiety disorder 8 7 

Obsessive-compulsive disorder 10 8 

Posttraumatic stress disorderc 8 12 

Psychotic disorder 2 1 

Any disruptive behavior disorder 41 44 

Attention-deficit/hyperactivity 

disorder 

9 8 

Oppositional defiant disorder 15 15 

Conduct disorder 37 38 

Any substance use disorder 55 51 

Alcohol use disorder 29 26 

Marijuana use disorder 49 45 

Other substance use disorder 2 3 

Alcohol and drug use disorder 24 21 

a Percentages are weighted to reflect the demographic characteristics of the 

Cook County Juvenile Temporary Detention Center. Ns are unweighted. 

b There were no significant differences between groups in prevalence rates of 

any of the listed disorders. 

c Estimates for posttraumatic stress disorder were based on a subsample 

(n = 840). 

racial/ethnic minority groups, and older youth had greater 

odds of being transferred to adult court than females, nonHispanic whites, and younger youth. Furthermore, African 

American youth had greater odds of being transferred 

than Hispanic youth. When examining whether the results 

changed when the sample was controlled for those charged 

with a violent felony, the results did not change. Males, 

youth from racial/ethnic minority groups, and older youth 

still had significantly greater odds of being transferred to 

adult court than females, non-Hispanic whites, and younger 

youth. 
 

Table 3. Co-occurring Psychiatric Disorders Among 

Arrested and Detained Youth Processed in Adult or 

Juvenile Courta 

Court Where Processedb 

Co-occurring Disorder 

Adult 

(N = 275) 

% 

Juvenile 

(N = 1,440)

 % 

Affective disorderc and indicated co-occurring disorder 

Anxiety disorderc 15 12 

Disruptive behavior disorderc 17 15 

Substance use disorderc 19 13 

Anxiety and disruptive behavior 

disordersc 

11 10 

Anxiety and substance use 

disorders 

13 8 

Disruptive behavior and 

substance use disorders 

15 11 

Anxiety disorder and indicated co-occurring disorder 

Disruptive behavior disorder 17 15 

Substance use disorder 19 15 

Disruptive behavior and 

substance use disorders 

14 12 

Disruptive behavior and substance 

use disorders 

32 32 

Total number of types of disorder 

≥2 43 43 

≥3 22 19 

4 10 7 

a Percentages are weighted to reflect the demographic characteristics of the 

Cook County Juvenile Temporary Detention Center. Ns are unweighted. 

b There were no significant differences in prevalence rates of any of the listed 

co-occurring disorders between youth processed in juvenile court and youth 

transferred to adult court. 

c Affective disorders include major depression, dysthymia, mania, and 

hypomania. Anxiety disorders include generalized anxiety disorder, separation 

anxiety disorder, obsessive-compulsive disorder, overanxious disorder, 

panic disorder, and posttraumatic stress disorder. Disruptive behavior 

disorders include conduct disorder, attention-deficit/hyperactivity disorder, 

and oppositional defiant disorder. Substance use disorders include alcohol 

use disorder, marijuana use disorder, and drug use disorders other than 

marijuana. 

Psychiatric Disorders Among Youth 

Processed in Juvenile Versus Criminal Court 

Next, the study compared the prevalence of specific 

psychiatric disorders (table 2) and co-occurring psychiatric 

disorders (table 3) among transferred youth and youth 

processed in juvenile court. No significant differences in 

the prevalence of specific disorders were found between 

the two groups; both had high rates of disorders. 

As shown in table 3, no differences were found for 

any combination of co-occurring psychiatric disorders. 

Furthermore, the authors found no differences between 

transferred youth and youth processed in juvenile court in 

the number of specific disorders or the number of types of 

psychiatric disorders. 

Table 4. Psychiatric Disorders Among Youth Processed 

in Adult Court Receiving a Prison Sentence or a 

Sentence Other Than Prisona 

Sentence 

Disorder 

Prison 

(N = 139) 

% 

Other 

(N = 132) 

% 

Significant 

Comparisons 

(p < .05) 

Any disorder 74 57 Prison > Other 

Any disorder except 

conduct disorder 

74 55 Prison > Other 

Any affective disorder 26 17 

Major depression 18 14 

Dysthymia 15 8 

Mania 4 2 

Hypomania 2 0 

Any anxiety disorderb 28 19 

Separation anxiety 

disorder 

19 13 

Overanxious disorder 10 9 

Generalized anxiety 

disorder 

8 8 

Obsessive-compulsive 

disorder 

14 6 

Posttraumatic stress 

disorderc 

3 14 

Psychotic disorder 3 1 

Any disruptive behavior 

disorder 

50 32 Prison > Other 

Attention-deficit/ 

hyperactivity disorder 

8 10 

Oppositional defiant 

disorder 

20 9 Prison > Other 

Conduct disorder 46 28 Prison > Other 

Any substance use 

disorder 

65 45 Prison > Other 

Alcohol use disorder 39 19 Prison > Other 

Marijuana use disorder 60 39 Prison > Other 

Other substance use 

disorder 

2 2 

Alcohol and drug use 

disorders 

34 14 Prison > Other 

a Percentages are weighted to reflect the demographic characteristics of 

the Cook County Juvenile Temporary Detention Center. Ns are unweighted. 

Sentencing data were missing for four participants, and they were excluded 

from these analyses. 

b Panic disorder was excluded because no youth processed in adult court 

had this disorder. 

c Estimates for posttraumatic stress disorder were based on a subsample 

(n = 142). 

Psychiatric Disorders Among Youth 

Processed in Adult Court Receiving a 

Prison Sentence or a Sentence Other 

Than Prison 

Prevalence rates of psychiatric disorders among those who 

did and did not receive a prison sentence were compared 

Juvenile Justice Bulletin 7 
 

among the 275 youth who were transferred. Table 4 

shows the prevalence rates of specific psychiatric disorders. 

Transferred youth who received a prison sentence had 

significantly greater odds of having any disorder, any 

disorder except conduct disorder, any disruptive behavior 

disorder, oppositional defiant disorder, conduct disorder, 

any substance use disorder, alcohol use disorder, marijuana 

use disorder, and co-occurring alcohol and drug use 

disorders. 

Table 5 shows the prevalence rates of co-occurring 

disorders among transferred youth by prison status 

(sentenced to prison or not). Transferred youth who 

received a prison sentence had significantly greater 

odds for having nearly all combinations of co-occurring 

disorders. Compared with transferred youth who did not 

receive a prison sentence, those who received a sentence 

had significantly greater odds of having two or more, three 

or more, and all four types of disorders. Finally, transferred 

youth who received a prison sentence had significantly 

greater numbers of specific disorders and significantly 

more types of disorders than those who did not receive a 

prison sentence. 

Discussion of Findings 

Diagnoses and Need for Psychiatric 

Treatment Among Transferred Youth 

Compared With Youth Processed in 

Juvenile Court and Adults in Detention 

The study’s findings indicate that the prevalence of one or 

more psychiatric disorders is as high for transferred youth 

as for youth processed in juvenile court. These findings 

are consistent with the clinical data reported by Beyer 

(2006), who found no differences on a clinical assessment 

between transferred youth and youth processed in juvenile 

court. The study reported in this bulletin provides the first 

systematic empirical evidence that many transferred youth, 

like their peers processed in juvenile court, have a substantial 

need for psychiatric and substance abuse services. 

Table 5. Co-occurring Psychiatric Disorders Among 

Youth Processed in Adult Court Receiving a Prison 

Sentence or a Sentence Other Than Prisona 

Sentence 

Co-occurring Disorder 

Prison 

(N = 139) 

% 

Other 

(N = 132)

 % 

Significant 

Comparisons 

(p < .05) 

Affective disorderb and indicated comorbid disorder 

Anxiety disorderb 21 9 Prison > Other 

Disruptive behavior 

disorderb 

22 13 

Substance use 

disorderb 

24 14 Prison > Other 

Anxiety and disruptive 

behavior disorders 

16 7 Prison > Other 

Anxiety and substance 

use disorders 

19 7 Prison > Other 

Disruptive behavior 

and substance use 

disorders 

19 11 

Anxiety disorder and indicated comorbid disorder 

Disruptive behavior 

disorder 

21 13 

Substance use disorder 24 13 Prison > Other 

Disruptive behavior 

and substance use 

disorders 

17 9 

Disruptive behavior and 

substance use disorders 

42 22 Prison > Other 

Total number of types of disorder 

≥2 52 33 Prison > Other 

≥3 28 16 Prison > Other 

4 15 6 Prison > Other 

a Percentages are weighted to reflect the demographic characteristics of 

the Cook County Juvenile Temporary Detention Center. Ns are unweighted. 

Sentencing data were missing for four participants, and they were excluded 

from these analyses. 

b Affective disorders include major depression, dysthymia, mania, and 

hypomania. Anxiety disorders include generalized anxiety disorder, separation 

anxiety disorder, obsessive-compulsive disorder, overanxious disorder, 

panic disorder, and posttraumatic stress disorder. Disruptive behavior 

disorders include conduct disorder, attention-deficit/hyperactivity disorder, 

and oppositional defiant disorder. Substance use disorders include alcohol 

use disorder, marijuana use disorder, and drug use disorders other than 

marijuana. 

“Transferred youth may have a greater need for 

psychiatric services than detained adults.” 

8 Juvenile Justice Bulletin 
These findings also suggest that transferred youth may 

have a greater need for psychiatric services than detained 

adults. Previous research indicates that less than 35 

percent of detained adult males have a psychiatric disorder 

(excluding antisocial personality disorder) (Teplin, 

1994); in contrast, 64 percent of transferred youth have 

a psychiatric disorder, even when conduct disorder is 

excluded. This study found that the 6-month prevalence 

rate of major depression for transferred youth (16 percent) 

was three times greater than the rate of depression over 

a lifetime as reported by adult male detainees (5 percent) 

(Teplin, 1994). 

This study replicates previous findings that transferred 

youth are disproportionately male, African American, 

Hispanic, and older. Although these findings underscore 

the importance of addressing disproportionate 

confinement of individuals from minority groups (Hsia, 

Bridges, and McHale, 2004), the findings also have 

implications for psychiatric services. The sociodemographic 

factors associated with greater odds of being processed in 

adult criminal court are the same factors associated with 

lower odds of receiving psychiatric services, regardless of 

need (Teplin et al., 2005). This finding suggests that an 

urgent situation exists within the prison system; that is, the 

largest numbers of transferred youth who need psychiatric 

services are also the least likely to receive them. 

The study also found that the odds of having a psychiatric 

disorder were greater among transferred youth sentenced 

to prison than those who received less severe sentences. 

The specific disorders associated with increased odds for 

a prison sentence were disruptive behavior and substance 

use disorders. Higher rates of disruptive behavior and 

substance use disorders may reasonably be expected 

among youth with more antisocial traits, assuming that 

a prison sentence is a proxy for more antisocial behavior. 

In other words, disruptive behavior and substance use 

disorders may reflect underlying antisocial traits. A parallel 

result has been found among adult male prisoners, of 

whom approximately half meet criteria for antisocial 

personality disorder (Fazel and Danesh, 2002). 

The higher prevalence of co-occurring disorders found 

among prison-bound youth, however, is less easily 

explained by underlying antisocial traits. On average, 

transferred youth who were sentenced to prison had 

more than one psychiatric disorder, and 15 percent had 

all four major types of psychiatric disorders. Furthermore, 

the types of disorders were not limited to behavioral or 

substance use disorders; receiving a prison sentence was 

also associated with greater odds of having co-occurring 

affective and anxiety disorders. These findings suggest 

that transferred youth sentenced to prison have not only 

greater needs for behavioral rehabilitation to address 

disruptive behavior and substance use disorders than 

transferred youth who receive less severe sentences but 

also greater needs for psychiatric treatment of major 

affective and anxiety disorders. 

Study Limitations 

This study has several limitations. Because the findings 

are drawn from a single site, they may pertain only to 

detention centers with a demographic composition and 

legal mechanisms for transfer to adult criminal court 

that are similar to those at CCJTDC. For example, these 

findings may be generalized only to states that limit the 

juvenile court’s jurisdiction to youth ages 16 and younger; 

most states extend their juvenile court’s jurisdiction to age 

18. Differences in the prevalence of disorders by transfer 

status may vary if diagnoses are based on later editions of 

the DSM than the DSM–III–R. Because it was not feasible 

to interview caretakers (few would have been available), 

the diagnostic data are also limited by the reliability and 

validity of youth’s reports of their own behavior. This 

may result in underreporting of some disorders, such as 

disruptive behavior disorders. In addition, the sample 

size for specific sociodemographic groups, such as nonHispanic white females, may be too small for reliable 

Juvenile Justice Bulletin 9 
 

comparisons with other states. The findings may apply 

less to areas with different mechanisms for transferring 

juveniles to adult criminal court. 

Directions for Future Research 

The following directions are suggested for future research. 

Conduct Studies of Long-Term Functioning 

and Outcomes for Transferred Youth 

Although several studies have examined recidivism among 

transferred youth (Bishop et al., 1996; Fagan, 1996; 

Myers, 2001; Podkopacz and Feld, 1996; Redding, 

2010; Winner et al., 1997), little is known about the 

long-term effects for broader indications of functioning 

on individuals who have been processed in adult criminal 

court. Findings from this study suggest that youth 

processed in adult criminal court may experience worse 

long-term psychiatric outcomes than youth processed in 

juvenile court; however, few empirical studies are available. 

Longer stays in preadjudication detention and the stressors 

associated with processing in adult criminal court may 

increase the risk of psychiatric disorders and other adverse 

developmental, social, and functional consequences for 

transferred youth (Bishop and Frazier, 2000; Forst, Fagan, 

and Vivona, 1989; Penney and Moretti, 2005; Redding, 

2003). Furthermore, previous studies have found 

that even within the juvenile court system, few youth 

receive the psychiatric services they need before they are 

adjudicated (Teplin et al., 2005), and the likelihood that 

transferred youth will receive the services they need after 

their adjudication is slim (Mulvey, Schubert, and Chung, 

2007). With most transferred youth likely to complete 

their sentences and be released or to be returned to their 

communities on parole, data on the long-term psychiatric 

and overall functioning of this population are especially 

needed. 

Conduct Studies of Competency 

To Stand Trial 

Future studies should investigate the influence of 

psychiatric disorders on competency to stand trial among 

youth transferred to adult criminal court. Some states 

are beginning to recognize cognitive and developmental 

immaturity as a basis for incompetence similar to mental 

illness and mental retardation (Poythress et al., 2006). 

Although research indicates that adolescents as young as 

16 years have, on average, abilities for judicial competency 

that are similar to those of adults (Bishop and Frazier, 

2000; Poythress et al., 2006), more research is needed 

to understand how psychiatric disorders interact with the 

developmental stages that youth progress through and 

how they affect a youth’s ability to participate in adult 

legal proceedings. 

Implications for the Juvenile 

Justice System 

Provide Diagnosis and Treatment for 

Transferred Youth 

Psychiatric services within correctional systems must 

address the needs and characteristics of transferred youth; 

however, correctional systems are not yet prepared to 

identify and treat transferred youth who have psychiatric 

disorders (Woolard et al., 2005). Assessment and 

treatment approaches developed for use with adults 

cannot be applied automatically to transferred youth 

(Woolard et al., 2005), so correctional psychiatric systems 

must use developmentally, culturally, and contextually 

appropriate assessment and treatment approaches 

(Penney and Moretti, 2005). Because little is known 

about the effectiveness of treatments delivered to youth 

in correctional facilities (Grisso, 2004), correctional 

systems cannot assume that assessment and treatment 

approaches used with youth in the general population will 

be effective with transferred youth (Woolard et al., 2005). 

It is essential to correctly identify and treat psychiatric 

disorders in correctional settings to better serve not only 

the transferred youth themselves but also the communities 

to which they will return after serving their sentences. 

Determine Whether Psychiatric Disorders 

Should Play a Mitigating Role in Transfer 

Decisions 

Judicial processing, particularly the decision to process 

youth as adults or juveniles, provides a critical opportunity 

to intervene in a juvenile’s life (Skowyra and Cocozza, 

2007). Clinicians can advise the court about which youth 

may benefit from alternative sentencing options and which 

youth may be more likely or less likely to benefit from 

rehabilitation (Grisso, 2000). If alternative sentencing 

options are made available, prison sentences may become 

less common (Steiner, 2005). Clinicians and researchers 

must continue to refine juvenile assessment technology to 

help courts weigh mitigating psychiatric factors in transfer 

decisions (Brannen et al., 2006; Penney and Moretti, 

2005). Unfortunately, although public opinion generally 

supports considering mitigating factors when making 

transfer decisions (Nunez et al., 2007), jurisdictions that 

have automatic transfer systems make this impossible. 

10 Juvenile Justice Bulletin 
Address Racial and Ethnic Disparities 

in the Transfer Process 

The field must continue to address ongoing racial/ 

ethnic disproportionality associated with the transfer 

process. According to the study’s findings and national 

statistics, more than 60 percent of transferred youth with 

psychiatric problems are from racial/ethnic minority 

groups (Sickmund, Sladky, and Kang, 2008); these youth 

are most likely to be underserved in detention and in the 

community (Teplin et al., 2005). The disproportionate 

transfer of African American youth to adult court is of 

particular concern. 

More locally, this study revealed metrics for CCJTDC 

that clearly show that minority youth in Cook County are 

disproportionately transferred to adult criminal court—84 

percent of transferred youth were African American, but 

only 26 percent of Cook County’s population is African 

American. Some states have already begun to address 

the influence of transfer processing on racial/ethnic 

disproportionality, and considerable gains have been made 

(Adams and Addie, 2010). For example, Illinois repealed 

two laws enacted in 1989 that required automatic transfer 

of youth older than 14 years to adult criminal court if 

they were charged with selling drugs within 1,000 feet 

of a designated “safe zone,” typically schools and public 

housing. Because of the dense concentration of both 

schools and public housing in urban areas where racial/ 

ethnic minority groups make up a large portion of the 

population, 99 percent of the youth transferred to adult 

criminal court for a drug crime were from racial/ethnic 

minority groups (Kooy, 2001). 

Conclusion 

Male, African American, Hispanic, and older youth had 

greater odds of being processed in adult criminal court 

than female, non-Hispanic white, and younger youth, even 

after adjusting for felony-level violent crime. Among youth 

processed in adult criminal court, 66 percent had at least 

one psychiatric disorder and 43 percent had two or more 

disorders. The prevalence and number of co-occurring 

disorders for youth processed in adult criminal court were 

similar to those processed in juvenile court. Among youth 

processed in adult criminal court, those sentenced to 

prison had significantly greater odds than those receiving 

a less severe sentence of having a disruptive behavior 

disorder, a substance use disorder, or co-occurring 

affective and anxiety disorders. 

The transfer of youth to adult criminal court should 

be reserved for the most serious, chronic, and violent 

offenders (Penney and Moretti, 2005). Clinicians can help 

to ensure this outcome by determining when and how 

mitigating psychiatric factors should be considered and 

which transferred youth may respond best to alternative 

sentencing. Correctional systems as well must provide 

psychiatric services to transferred youth, especially 

to youth sentenced to prison, and community health 

systems must continue services for these youth when 

they are released into the community. Whether part of 

the corrections or community systems, psychiatric service 

providers need to consider the disproportionate number 

of individuals from racial/ethnic minority groups who 

are transferred to adult criminal court when they are 

developing and implementing services. 

For More Information 

This bulletin was adapted from Washburn, J.J., Teplin, 

L.A., Voss, L.S., Simon, C.D., Abram, K.M., and 

McClelland, G.M. 2008. Psychiatric disorders among 

detained youths: A comparison of youths processed in 

juvenile court and adult criminal court. Psychiatric Services 

59:965–973. 

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14 Juvenile Justice Bulletin 
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; the Office for Victims 

of Crime; and the Office of Sex Offender 

Sentencing, Monitoring, Apprehending, 

Registering, and Tracking. 

 

Acknowledgments 

Jason J. Washburn, Ph.D., ABPP, is Assistant Professor and Director of Education and Clinical Training in the Division of 

Psychology, Department of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine, Northwestern University, 

Chicago, IL. He is also Director of the Center for Evidence-Based Practice at Alexian Brothers Behavioral Health Hospital, 

Hoffman Estates, IL. 

Linda A. Teplin, Ph.D., is the Owen L. Coon Professor and Vice Chair for Research in the Department of Psychiatry and 

Behavioral Sciences at the Feinberg School of Medicine, Northwestern University, Chicago, IL, as well as Director of the 

Department’s Program in Health Disparities and Public Policy. 

Laurie S. Voss, Ph.D., is Managing Principal and Global Lead Executive Coaching, Korn/Ferry International, Durango, CO. 

Clarissa D. Simon, Ph.D., is an Adjunct Professor in the School of Education and Social Policy, Northwestern University, 

Evanston, IL. She is also a Research Consultant in the Department of Medical and Social Sciences at the Feinberg School of 

Medicine, Northwestern University, Chicago, IL. 

Karen M. Abram, Ph.D., is Associate Professor and Associate Director, Health Disparities and Public Policy, in the Department 

of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine, Northwestern University, Chicago, IL. 

Gary M. McClelland, Ph.D., is Research Assistant Professor in Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 

Northwestern University, Chicago, IL. 

Nichole D. Olson, Ph.D., is a postdoctoral fellow in the Department of Psychiatry, Stanford School of Medicine, Stanford, CA. 

The study on which this bulletin is based could not have been accomplished without the advice of Ann Hohmann, Ph.D., 

Kimberly Hoagwood, Ph.D., Heather Ringeisen, Ph.D., Grayson Norquist, M.D., and Delores Parron, Ph.D. The procedures 

used with the study’s participants were guided by Celia Fisher, Ph.D. Leah Welty, Ph.D., provided assistance on analytic issues. 

She is an Associate Professor in the Department of Preventive Medicine and the Department of Psychiatry and Behavioral 

Sciences and a biostatistician in the Biostatistics Collaboration Center, all at the Feinberg School of Medicine, Northwestern 

University. The authors also thank Eugene Griffin, Ph.D., for reviewing an earlier version of this article. 

The research described in this bulletin was supported under grant numbers 1999–JE–FX–1001, 2005–JL–FX–0288, and 

2008–JF–FX–0068 from the Office of Juvenile Justice and Delinquency Prevention (OJJDP), 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. 

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