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UNEMOTIONAL TRAITS AND ASPERGER'S SYNDROME?
LETTERS TO THE EDITOR
PSYCHIATRIC DISORDERS IN INCARCERATED YOUTHS To the Editor: In the paper by Dolamanta et al. (2003), the authors state that of the few prevalence studies of incarcerated youths, “none, to date, [has used] DSM-IV criteria.” We would like to call the authors’ attention to two earlier studies of the prevalence of disorder in delinquent youths, published in this same journal, which used DSM-IV diagnostic criteria. Our own paper (Wasserman et al., 2002) considered diagnostic status in almost 300 boys incarcerated (postadjudication) in Illinois and New Jersey. Garland et al. (2001) did the same across service sectors, including the justice system (balanced regarding restrictiveness of setting). Both reported studies used a structured diagnostic interview (the DISC) with the youths; the Garland et al. (2001) study also included parent interview data from the DISC for certain diagnoses. We agree with the authors’ assertion that “greater accuracy” in their study would have been obtained “with diagnostic interviews.” We also agree with the authors that this remains a very much understudied population. The juvenile justice system is not monolithic: characteristics of youths will differ greatly across processing locations (detention, correctional, aftercare settings) and by jurisdiction (relating to demography, arrest and sentencing practices). For this reason, at the present time, comparisons deriving from single settings should probably provide some caveat regarding limitations to generalizability. These issues can cloud findings considerably. In our own work (Wasserman and McReynolds, 2003), for example, rates of internalizing disorder (including major depressive disorder) were significantly elevated in girls, relative to boys, passing through intake with the Texas Juvenile Probation Commission in Harris County. In the same county, after a month’s detention (and based on checklist data), Dolamanta et al. (2003) reported no gender differences in rate of major depressive disorder. Gail A. Wasserman, Ph.D. Larkin S. McReynolds, M.P.H. Center for the Promotion of Mental Health in Juvenile Justice Columbia University, New York Prudence Fisher, Ph.D. Chris Lucas, M.D. Child Assessment Technology Group Columbia University, New York
Dolamanta DD, Risser WL, Roberts RE, Risser JMH (2003), Prevalence of depression and other psychiatric disorders among incarcerated youths. J Am Acad Child Adolesc Psychiatry 42:477–484 Garland AF, Hough RL, McCabe KM, Yeh M, Wood PA, Aarons GA (2001), Prevalence of psychiatric disorders in youths across five sectors of care. J Am Acad Child Adolesc Psychiatry 40:409–418 Wasserman GA, McReynolds L, Lucas C, Fisher PW, Santos L (2002), The Voice DISC-IV with incarcerated male youth: prevalence of disorder. J Am Acad Child Adolesc Psychiatry 41:314–321 Wasserman GA, McReynolds LS (2003), Gender differences in psychiatric disorder in Texas juvenile probation. Presented at the Texas Juvenile Probation Commission Second Annual Juvenile Justice Research Forum, Austin, TX, February 25 DOI: 10.1097/01.CHI.0000070251.24125.16
CALLOUS/UNEMOTIONAL TRAITS AND ASPERGER’S SYNDROME? To the Editor: In their article “Callous/Unemotional Traits and Social Cognitive Processes in Adjudicated Youths,” Pardini et al. (2003) do not mention an important cause of these traits: high-functioning autism/Asperger’s syndrome. Indeed, problems with empathy are central to high-functioning autism/Asperger’s syndrome, and a small proportion of these persons do come into contact sometimes seriously with the law. They do correctly mention attentiondeficit/hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder, and high-functioning autism/ Asperger’s syndrome should be added to this list. It is not uncommon for persons with ADHD/conduct disorder to show evidence of pervasive developmental disorder not otherwise specified if not even Asperger’s syndrome. In the assessments carried out in this study, high-functioning autism/Asperger’s syndrome was not ruled out. If this had been done, I would not be surprised if some of their youths would not have met the criteria for pervasive developmental disorder not otherwise specified or Asperger’s syndrome/high-functioning autism where problems of social cognition loom very large and the small number show psychopathic traits. Indeed, Hans Asperger himself originally used the diagnosis autistic psychopathy to describe patients who would now be diagnosed as high-functioning autism/Asperger’s syndrome. Michael Fitzgerald, M.D. Department of Psychiatry Trinity College, Dublin Pardini DA, Lochman JE, Frick PJ (2003), Callous/unemotional traits and social cognitive processes in adjudicated youths. J Am Acad Child Adolesc Psychiatry 42:364–371 DOI: 10.1097/01.CHI.0000070252.24125.CD
J . A M . A C A D . C H I L D A D O L E S C . P S YC H I AT RY, 4 2 : 9 , S E P T E M B E R 2 0 0 3
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PSYCHIATRIC DISORDERS IN INCARCERATED YOUTHS To the Editor: In the paper by Dolamanta et al. (2003), the authors state that of the few prevalence studies of incarcerated youths, “none, to date, [has used] DSM-IV criteria.” We would like to call the authors’ attention to two earlier studies of the prevalence of disorder in delinquent youths, published in this same journal, which used DSM-IV diagnostic criteria. Our own paper (Wasserman et al., 2002) considered diagnostic status in almost 300 boys incarcerated (postadjudication) in Illinois and New Jersey. Garland et al. (2001) did the same across service sectors, including the justice system (balanced regarding restrictiveness of setting). Both reported studies used a structured diagnostic interview (the DISC) with the youths; the Garland et al. (2001) study also included parent interview data from the DISC for certain diagnoses. We agree with the authors’ assertion that “greater accuracy” in their study would have been obtained “with diagnostic interviews.” We also agree with the authors that this remains a very much understudied population. The juvenile justice system is not monolithic: characteristics of youths will differ greatly across processing locations (detention, correctional, aftercare settings) and by jurisdiction (relating to demography, arrest and sentencing practices). For this reason, at the present time, comparisons deriving from single settings should probably provide some caveat regarding limitations to generalizability. These issues can cloud findings considerably. In our own work (Wasserman and McReynolds, 2003), for example, rates of internalizing disorder (including major depressive disorder) were significantly elevated in girls, relative to boys, passing through intake with the Texas Juvenile Probation Commission in Harris County. In the same county, after a month’s detention (and based on checklist data), Dolamanta et al. (2003) reported no gender differences in rate of major depressive disorder. Gail A. Wasserman, Ph.D. Larkin S. McReynolds, M.P.H. Center for the Promotion of Mental Health in Juvenile Justice Columbia University, New York Prudence Fisher, Ph.D. Chris Lucas, M.D. Child Assessment Technology Group Columbia University, New York
Dolamanta DD, Risser WL, Roberts RE, Risser JMH (2003), Prevalence of depression and other psychiatric disorders among incarcerated youths. J Am Acad Child Adolesc Psychiatry 42:477–484 Garland AF, Hough RL, McCabe KM, Yeh M, Wood PA, Aarons GA (2001), Prevalence of psychiatric disorders in youths across five sectors of care. J Am Acad Child Adolesc Psychiatry 40:409–418 Wasserman GA, McReynolds L, Lucas C, Fisher PW, Santos L (2002), The Voice DISC-IV with incarcerated male youth: prevalence of disorder. J Am Acad Child Adolesc Psychiatry 41:314–321 Wasserman GA, McReynolds LS (2003), Gender differences in psychiatric disorder in Texas juvenile probation. Presented at the Texas Juvenile Probation Commission Second Annual Juvenile Justice Research Forum, Austin, TX, February 25 DOI: 10.1097/01.CHI.0000070251.24125.16
CALLOUS/UNEMOTIONAL TRAITS AND ASPERGER’S SYNDROME? To the Editor: In their article “Callous/Unemotional Traits and Social Cognitive Processes in Adjudicated Youths,” Pardini et al. (2003) do not mention an important cause of these traits: high-functioning autism/Asperger’s syndrome. Indeed, problems with empathy are central to high-functioning autism/Asperger’s syndrome, and a small proportion of these persons do come into contact sometimes seriously with the law. They do correctly mention attentiondeficit/hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder, and high-functioning autism/ Asperger’s syndrome should be added to this list. It is not uncommon for persons with ADHD/conduct disorder to show evidence of pervasive developmental disorder not otherwise specified if not even Asperger’s syndrome. In the assessments carried out in this study, high-functioning autism/Asperger’s syndrome was not ruled out. If this had been done, I would not be surprised if some of their youths would not have met the criteria for pervasive developmental disorder not otherwise specified or Asperger’s syndrome/high-functioning autism where problems of social cognition loom very large and the small number show psychopathic traits. Indeed, Hans Asperger himself originally used the diagnosis autistic psychopathy to describe patients who would now be diagnosed as high-functioning autism/Asperger’s syndrome. Michael Fitzgerald, M.D. Department of Psychiatry Trinity College, Dublin Pardini DA, Lochman JE, Frick PJ (2003), Callous/unemotional traits and social cognitive processes in adjudicated youths. J Am Acad Child Adolesc Psychiatry 42:364–371 DOI: 10.1097/01.CHI.0000070252.24125.CD
J . A M . A C A D . C H I L D A D O L E S C . P S YC H I AT RY, 4 2 : 9 , S E P T E M B E R 2 0 0 3
1011