Forensic Issues in Child and Adolescent Psychiatry

Traditionally, forensic child and adolescent psychiatrists have dealt largely with custody evaluation and recommendations and with the ramifications of child abuse and neglect. Child and adolescent psychiatrists are increasingly being sought out by patients and attorneys for evaluations and expert opinions related to child sexual and physical abuse and criminal behaviors perpetrated by minors and to evaluate the relationships between traumatic life events and the emergence of psychiatric symptoms in children and adolescents. As more youth enter the juvenile justice system, an increasing need exists for forensic psychiatrists with expertise in evaluation and treatment for detainees and committed youths. The American Academy of Child and Adolescent Psychiatry (AACAP) provided Practice Parameters for the Forensic Evaluation of Children and Adolescents Who May Have Been Physically or Sexually Abused for custody evaluations and for children with posttraumatic stress disorder (PTSD).

Society’s view of children and their rights evolved dramatically in the 20th century. The institution of a juvenile court system about 100 years ago was an acknowledgment that children must be protected and provided for differently than adults. In 1980, the AACAP published a code of ethics that was developed to publicly endorse the ethical standards of this discipline. The code is based on the assumption that children are vulnerable and unable to take adequate care of themselves; as they mature, however, their capacity to make judgments of and choices about their well-being develop as well. The code has several caveats: From the standpoint of child and adolescent psychiatrists, issues of consent, confidentiality, and professional responsibility must be seen in the context of overlapping and potentially conflicting rights of children, parents, and society.

In general, no way exists to simplify the many difficult, complex confidentiality issues that may emerge in treating children and adolescents. Child and adolescent psychiatrists function as advocates for their patients and must always remain aware of minors’ vulnerabilities and of the importance of maintaining trust in the treatment relationship.

Students should study the questions and answers below for a useful review of basic issues.

Questions

Directions

The incomplete statement below is followed by five suggested completions. Select the one that is best.

54.1 According to the Children’s Bureau of the Department of Health and Human Services, which is the most common form of abuse suffered by children?

A. Emotional

B. Physical

C. Neglect

D. Sexual

E. Ritual

View Answer

54.1 The answer is C

According to the Children’s Bureau of the Department of Health and Human Services, of the 3.6 million child abuse cases reported each year, 78 percent are cases of neglect. The results are published in an annual document called Child Maltreatment. The agency estimated that approximately 3.6 million alleged victims were reported to child protective services. Of those reports, approximately 22.1 percent were substantiated. The substantiated cases were distributed as follows: 78 percent neglect, 18 percent physical abuse, 9.5 percent sexual abuse, and 7.6 percent emotional or psychological maltreatment. The Children’s Bureau estimated that 1,770 children died as the result of maltreatment in 2009. Approximately 46 percent of these deaths were children younger than 1 year of age. Approximately 12 percent of the fatalities had been identified as victims and received family preservation services in the prior 5 years, and 2 percent had been removed from foster care and reunited with their families in the prior 5 years.

Directions

Each set of lettered headings below is followed by a list of numbered statements. For each numbered statement, select

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