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There has been substantial discussion in the research literature and public press over the past decade about the growing body of knowledge concerning brain development across childhood and adolescence, and its impact on our thinking about responsibility, judgment, and choice. Of note has been the range of television, newspaper and magazine articles, and commentaries and opinion pieces that have attempted to wrestle with concerns of judgment, decision making, and culpability for juveniles and young adults in the criminal and civil justice arenas. The Supreme Court of the United States has grappled with this issue – particularly with regard to whether youth (with typical or atypical development) are capable of understanding the intentions and outcomes of their choices and actions, and how we as a society can address this concern through prevention and intervention (cf., Atkins v. Virginia, the 2002 decision regarding the diminished culpability of the intellectually disabled, ruling that the death penalty is inappropriate for such individuals; and Roper v. Simmons, the 2005 decision ruling that the death penalty for youth under 18 years of age is “cruel and unusual punishment”). This discussion is intimately intertwined with the unfolding body of research about EdF. It is within the area of EF perhaps more than anywhere else that we have been asked to provide guidance and direction to the legal, political, educational, and public safety systems to help them better understand the underlying neuropsychology of such concerns as “bad behavior” and “poor decision making” and how they impact broader society.
Niranjan S. Karnik, Division of Child and Adolescent Psychiatry Stanford University 401 Quarry Road Stanford, CA 94305 USA,
Marie V. Soller, Resident in Psychiatry San Mateo Medical Center San Mateo, CA USA,
Hans Steiner, Professor of Psychiatry and Behavioral Sciences, Director of Education, Division of Child and Adolescent Psychiatry Co-Director, Center for Psychiatry and the Law Stanford University School of Medicine 401 Quarry Road Stanford, CA 94305 USA
Several controlled clinical trials of medications in youth make it clear that psychopharmacology can significantly contribute to rehabilitation and possibly recovery. This chapter summarizes the clinical indications for pharmacological interventions that may help in reducing pathology in this population. The combined knowledge of clinical care, clinical trials, and the recommendations generated by consensus in practice guidelines suggests that the most appropriate approach to using medications in juvenile offenders requires employing a cautious and supportive attitude, and always weighing risks and benefits. The chapter proposes that clinicians should use the integrated provision of services, including medication, to attempt to target the subtype of aggression that may be underpinning the delinquent behaviors of the juvenile. It summarizes the trials where the primary recruitment target was a disorder of aggression, conduct disorder (CD), oppositional-defiant disorder (ODD), and intermittent explosive disorder (IED). In all cases, clinicians should strive to use evidenced-based principles for treatment.
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