Essential Psychiatric Assessment for Sex Offenders or Victims with ADHD: Study
By Ruwan Laknath Jayakody
Since neurodevelopmental disorders such as Attention Deficit Hyperactivity Disorder (ADHD) are in turn associated with sexual abuse and related offenses in the Sri Lankan context, it is recommended that children and children adolescent victims or perpetrators of sexual abuse, undergo a psychiatric evaluation, noted a local study.
This point was raised by M. Chandradasa and R. Fernando (teachers in the Department of Psychiatry at Kelaniya University), D. Hettiarachchi and S. Wijetunge (Senior Registrar in Child and Adolescent Psychiatry and Consultant Psychiatrist for Children and Adolescents at Lady Ridgeway Hospital for Children, respectively), M. Gunathilake (Senior Registrar of Psychiatry at the National Institute of Mental Health) and A. Tennakoon (Chief Forensic Officer and Chief of the Institute of Forensic Medicine and Toxicology, Colombo) in an article on “A Sex Offender with ADHD” which was published in the Clinical and Nursing Research Journal First issue of the second volume in 2018.
ADHD has its onset in early childhood with more boys than girls, according to A. Thapar and M. Cooper. It is characterized by, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Revised Fifth Edition (DSM-5), inattention, hyperactivity and impulsivity. By the time the child reaches adolescence, while hyperactivity generally decreases, inattention persists, as A. Koumoula notes in “The evolution of ADHD over the course of life”.
ADHD is associated with school impairment in children, as reported in “A Longitudinal Study of Neuropsychological Functioning and School Achievement in Children with and Without Signs of ADHD” by B. Rennie, M. Beebe-Frankenberger and HL Swanson . Therefore, when parents and teachers of children with symptoms fail to identify the manifestations of this disease, especially the early detection of symptoms, its diagnosis and treatment are missed, and the resulting impact on school performance can be detrimental due to the serious consequences that ensue. .
In “The Knowledge and Attitude of Primary School Teachers in Sri Lanka Towards ADHD in Children,” MD Rodrigo, D. Perera, VP Eranga, SS Williams and KA Kuruppuarachchi found that the majority of teachers believed the symptoms of ADHD were the fault of the parents. In turn, as M. Blachno, U. Szamanska, A. Kolakowski and A. Pisula noted in “Parental corporal punishment in children with ADHD”, such behavior can be characterized as delinquent behavior and the child may be subject to disciplinary action rather than appropriate care.
In addition, K. Sayal observed in “Epidemiology of ADHD in the community”, a significant proportion of children with ADHD may not be referred to psychiatric services even when the child has, according to CK Berenson “Diagnoses frequently missed in adolescent psychiatry ”, a characteristic of inattention and minimal symptoms associated with hyperactivity are presented.
Another problem that delays diagnosis is the ratio of psychiatrists to population. R. Jenkins, R. Kydd, P. Mullen, K. Thomson, J. Sculley, S. Kuper, J. Carroll, O. Gureje, S. Hatcher, S. Brownie, C. Carroll, S. Hollins and ML L Wong’s book “International physician migration and its impact on the availability of psychiatrists in low- and middle-income countries” noted that the psychiatrist-to-population ratio in the country is low in non-Western countries. As a result, the mental health gap is large and the majority of major psychiatric disorders present themselves to health services after many years of illness, as noted by M. Chandradasa, L. Champika, K. Gunathillaka and J. Mendis in “Association of Duration of Untreated Psychosis and Functional Level in First Episode of Schizophrenia Attending Outpatient Clinic in Sri Lanka”. Exacerbating this problem is the fact that the availability of child and adolescent mental health professionals is even less numerous, according to Mr Chandradasa and KALA Kuruppuarachchi “Child and adolescent mental health in post-war Sri Lanka” .
Lady Ridgeway Hospital for Children (LRH) is the only hospital with inpatient psychiatric facilities, and Child and Adolescent Mental Health Services receives approximately 2,300 new registrations per year at the outpatient clinic.
Sexual abuse and related offenses have been recognized in children with ADHD (I. Tidefors and J. Strand’s “Life history interviews with 11 boys diabetes with ADHD who had sexual offensed” and MC Reinhardt and CA Reinhardt’s “ADHD, co -morbidities, and risk situations ”). As explained by Chandradasa et al., impulsivity in ADHD likely contributes to the lack of inhibition of sexual responses, which in turn can lead to being sexually abused due to dangerous and risky behavior On the other hand, children and adolescents with ADHD may seek sexual pleasure impulsively and be more likely to commit sexual offenses than other children (D. Blotcher, K. Henkel, W. Retz, P. Retz-Junginger, J. Thome, and M “Symptoms of the Ionic ADHD Sex Offender Spectrum”) by Rosler.
A 14-year-old boy was referred for an opinion on his psychological state. He was the author of a sexual abuse incident involving another boy from the same school. According to the perpetrator, he had penetrative anal sex as a passive partner on the school grounds. The 14-year-old boy claimed he persuaded the other boy to accompany him to a secluded area of the school where he forced the youngest teenager to commit the alleged act. He also disclosed such incidents in the past involving an adolescent male parent and the repeated insertion of foreign bodies by him into his anus. During the forensic physical examination of the alleged perpetrator, there was evidence of repetitive anal intercourse in the recent past.
Based on the assessment of the abuser’s mental state, he exhibited inattentive characteristics such as difficulty maintaining attention, not completing work, easily distracted by external stimuli, and being disorganized. in its activities. There were characteristics of impulsiveness such as difficulty taking turns and interfering with others. However, there were no features of hyperactivity.
The perpetrator met the criteria for ADHD according to the DSM-5. The diagnosis was made after a detailed evaluation by the child and adolescent psychiatrist.
The boy scored higher than normal on the inattention subscale, but not on the hyperactivity subscale. The assessment of non-verbal intelligence indicated average intelligence. However, school test scores were well below average. The boy’s inattention contributed to his inability to grasp the things he was being taught.
The boy began taking behavioral therapies and stimulant drugs (a central nervous system stimulant that affects chemicals in the brain and nerves that help with hyperactivity and impulse control). With treatment, there was a clinically significant improvement in ADHD symptoms.
According to Tidefors and Strand, Reinhardt and Reinhardt, and Blocher et al., Children and adolescents with ADHD are more likely to become sex offenders and to be victims of such abuse.
This case described a teenager who allegedly sexually assaulted another schoolboy in the context of previously undiagnosed ADHD. Child sexual abuse is the involvement of children and adolescents in sexual activities that they cannot fully understand and to which they cannot consent as fully equal participants.
Regarding the alleged offender, Chandradasa et al. observed that it is possible that his impulsiveness and inattention contributed to his academic failure despite normal intelligence, while these same psychological impairments may have led to risky sexual behavior.
As BB Muld, J. Bokinen, S. Bolte, and T. Hirvikoski have found “Long-term outcomes of pharmacologically treated adults versus untreated adults with ADHD and substance use disorders: a naturalistic study ‘effective treatment reduces risky behaviors such as substance use.
While the early detection and proper management of this disorder may have reduced the propensity for risky sexual behavior on the part of the offender, a better understanding of the disease by parents and greater vigilance on the part of school authorities could have been helpful. prevent the alleged incident at school. . Therefore, as highlighted by C. Kleemeier, C. Webb, A. Hazzard, J. Pohl’s “Child sexual abuse prevention: Evaluation of a teacher training model”, improving the awareness of parents and teachers of the disorders psychiatric care can be an effective way to prevent sexual abuse among schoolchildren.
A person who is insane or insane at the time of the offense (the English case of 1843 of Daniel McNaughton concerning the criminal defense of insanity or insanity) is incapable of forming “mens rea”. spirit). Thus, such a person is not punished by law. The Penal Code states that: “Nothing is an offense that is committed by a person who, at the time of doing so, due to his state of mind, is incapable of knowing the nature of the act, or that she is doing what is wrong or against the law. Mental illness is not defined in the Criminal Code.
Sri Lankan law, like Chandradasa et al. explained, considers the cognitive aspect of an offense for criminal liability and not the impairment of voluntary control. Insanity, however, does not provide for mitigation of the sentence in circumstances which result in impairment but not deprivation of legal capacity (A. de Alwis and N. Fernando “The defense against insanity and the Sri Lanka Criminal Responsibility Assessment ”).
Therefore, in the case of this alleged young offender, the question is whether the boy’s mental disorder contributed to the alleged act, which is to be determined by forensic and psychiatric specialists.
If you suspect that you or someone you know is suffering from mental health issues and / or sexual abuse, the following institutions will help you.
The National Institute of Mental Health: 1926
Sri Lanka Sumithrayo: 0112 682 535
Shanthi Maargam: 0717 639 898
Police Office for Children and Women: 011 2444444
MANAGERS: 011 495 4111