Criminality among Former Child and Adolescent Psychiatric Patients and Matched Controls

Background: Externalizing symptoms in children (aggression, oppositionality, prop- erty and status violations), and the Attention Deficit Hyperactivity Disorder (ADHD) triad of problems (inattention, hyperactivity, impulsivity) display a substantial co- morbidity. The “short temper” problem is common to these syndromes, which are predictive of a range of negative life outcomes including substance abuse and crimi- nality in adulthood. There is a gender gap for the syndromes (boys are more af- fected), for criminality (men are more criminal) and knowledge (we know less about girls’ criminal careers). Aims: The main aim was to compare crime rates and crime profiles among former Child and Adolescent Psychiatric (CAP) patients with cor- responding data for matched controls, focusing externalizing and internalizing psy- chiatric symptoms, sex and adverse social factors. Method: Data for 6055 former CAP-Stockholm outpatients were extracted from available treatment registers. For each CAP patient, two matched controls from the general population were randomly selected from the same area of residence, of the same sex and with the same year of birth (N approx. 12,000). Data on criminality for these individuals were obtained from a Swedish police register which also includes crimes committed prior to age 15. Results: Overall, twice as many former CAP patients were registered for crimes at a mean age of 21.4 compared to the controls. The over-representation was larger for crimes of violence. Females were registered for a much lower number of crimes, par- ticularly crimes of violence (gender gap). The gender gap among the CAP patients was smaller than among controls. Compared with controls, CAP patients character- ized by externalizing problems at referral had an odds ratio (OR) for crimes of 5 for males and 10 for females. Neglect was the only adverse social factor which was asso- ciated with a higher crime rate and affected boys more than girls. Compared to pre- vious Swedish CAP cohorts, the criminality of the current cohort was much higher. Conclusion: In-depth studies of female crime careers characterized by externalising problems are needed. Child psychiatric services must find new and more effective ways of identifying and treating children with such problems, regardless of sex. The findings can guide the choice of strategies which will reduce crime rate