ADHD, Comorbidities, and Trauma Symptoms: Predictors of Functioning in Juvenile Justice Involved Youth

Background: This study will assess the impact that ADHD, mental health comorbidities, and trauma symptoms have on youth involved in the juvenile justice system.   The relationships among ADHD, juvenile offending, and lower levels of functioning have been supported by multiple studies.  However, it is difficult to discern if these negative outcomes are attributable to ADHD alone or other co-occurring factors like comorbid mental health issues, or symptoms associated with trauma exposure.

Method:  Data for this study were drawn from the Behavioral Health Juvenile Justice Initiative (BHJJ), which is a multi-county juvenile justice diversion program in Ohio.  Youth between 10 and 18 years old are screened for mental and behavioral health issues at intake and are diverted into community based mental health facilities for treatment.

Social workers’ perceptions of youth functioning, problem severity, and both parent and youth reports for satisfaction with services and hopefulness about life were measured using a validated instrument called the Ohio Scales. Risk for re-arrest was measured using the Ohio Youth Assessment System (OYAS), and trauma symptoms were assessed using the Trauma Symptom Checklist for Children.  Socio-demographic information, mental health diagnoses, substance use diagnoses, as well as medications prescribed youth were reported by the youth’s social worker.

Ordinary least squares (OLS) regression was used to assess the effect of predictors on youth functioning across three mental health classifications: youth with an internalizing disorder, externalizing disorder, and both internalizing and externalizing disorders.

Results:  The study sample consists of 1,061 youth with an average age at intake of 15.6 years.  The sample is slightly more male (57.5%) than female, and white (50.8%) than non-white.  Most of the sample was assessed as either being at moderate risk (52.3%) or high risk (29.9%) for recidivism.  24.3% of the sample was diagnosed with an internalizing disorder, 41.9% was diagnosed with an externalizing disorder, and 33.7% was diagnosed with both an internalizing and externalizing disorder.  Over one-third (38.6%) of the youth in the sample was diagnosed with ADHD.

The OLS regression shows that ADHD is a significant predictor of lower levels of functioning in youth with an externalizing disorder only.  Parent hopefulness is a significant predictor of higher functioning across all mental health classifications.  OYAS risk scores were a significant predictor of lower functioning across all mental health classifications.  In terms of trauma symptoms, clinical levels of anger and depression were predictors of lower functioning in youth with an externalizing disorder, and clinical levels of sexual concerns predicted lower functioning in youth with both an internalizing and externalizing disorder.

Conclusions:  Findings suggest that the effects of ADHD are more severe when it co-occurs with an externalizing disorder.  There is also a greater need for trauma informed care for youth with an externalizing disorder, or both an internalizing and externalizing disorder.  Parental engagement is also important when working with juvenile justice involved youth.  Further, the significance of the youth’s OYAS scores identifies a need for interventions that address youths’ risk for recidivism as well as their mental health needs.