84 Chapter 7
marrying a non-antisocial wife led to reductions in criminal behaviour,
as did service in the army.
Attitudes. Do delinquents have a consistently anti-establishment set of
values? Early studies suggested not, since when asked why they commit
offences, young delinquents commonly mention the thrill, the relief
from boredom and the satisfaction of demonstrating their prowess to
peers; material gain is often not the main objective. However, studies of
young offenders’ moral reasoning show more egoism and less altruism;
they are less able to take another person’s point of view into account
or think about the consequences of actions. They are also much more
likely to believe that use of violence will resolve a conflict situation,
and that fighting and antisocial behaviour (including heavy drug and
alcohol use) gain ‘respect’ among their peers. Affection and respect for
school, and identification with its values are less than in non-delinquent
controls.
Personality. There have been no consistent differences on personality
measures, but recent research has indicated a subgroup with increased
callousness and lack of emotional responsiveness to the plight of others.
The use of the term ‘personality disorder’ is controversial in childhood
and adolescence. Yet for all types seen in adulthood, the pattern is
evident by late adolescence in the vast majority of cases. DSM-IV
antisocial personality disorder (ASPD) is predominantly a behavioural
description of acts carried out, such as persistent aggression and ir-
responsibility; it has as a requirement that the person had conduct
disorder as a youth. Between 50–80% of repeat offenders meet DSM
criteria for ASPD, but only 15–30% meet criteria for psychopathy (not
currently categorised as a personality disorder), who may constitute a
subgroup of ASPD. Callousness, deceitfulness, shallow affect and lack
of remorse characterise psychopathy, where the core deficit may be
lack of interpersonal emotional responsiveness. While biological factors
may predispose towards this, psychopaths have worse, more abusive
childhoods than non-psychopathic offenders with ASPD.Risk assessment
When assessing a juvenile delinquent, a usual, full psychiatric assessment
should be supplemented by an assessment of the risk of dangerousness
to others and to the young person themselves. Traditionally, forensic
psychiatry has relied on a ‘clinical wisdom’ approach that has focused
more on the person than their environment, more on risk to others
rather than to self, and has lacked much scientific validation in terms
of reliability and validity. The adage ‘the pattern of past violence predicts
future violence’ remains true, and is indexed by the number and type of
offences. Unfortunately it is only a rough guide, or, to put it another way,
it predicts only a relatively small proportion of the variability of outcomes:
some youths with many previous offences and risk factors do not offend