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Most secure juvenile treatment facilities address certain problems linked to perpetration, such as substance abuse, anger management, development of pro-social skills and empathy, and relapse prevention, but they fail to address post-traumatic stress disorder.

This is a major omission since criminally involved adolescents are exposed to numerous risk factors for PTSD. This article reviews preliminary results regarding the prevalence of PTSD among incarcerated youth and outlines the utility of addressing PTSD symptoms in juvenile prisons.

In a collaborative study between the National Center for PTSD Behavioral Sciences Division and the Massachusetts Department of Youth Services, we are assessing the prevalence of potentially traumatic life events, criterion A events and PTSD. Among 42 adolescents interviewed thus far, 14 percent met DSM-IV criteria for current PTSD, and 21 percent met criteria for past PTSD. In addition, on a self-report instrument, 72 percent met current criteria for PTSD. These results indicate that a significant group of incarcerated adolescents are affected by trauma-related symptoms and require interventions.

These adolescents' PTSD symptoms may be misdiagnosed, and associated trauma-related problems may not be addressed in the context of trauma.

Symptoms of conduct disorder, attention deficit disorder and major affective disorder may reflect trauma-related symptoms and require trauma-specific interventions. For example, the high incidence of substance abuse disorders in incarcerated adolescents may represent the youth's attempt to self medicate against traumatic intrusive thoughts and feelings, numbness and psychological distress. Directly addressing trauma-related symptoms would help incarcerated youth take responsibility for their crimes, increase empathy and perspective-taking capacity, and facilitate anger management.

For example, denying responsibility for a crime may be associated with trauma-related avoidant coping styles and intrusions that prevent perpetrators from examining the negative affect associated with violent and abusive life experiences. Additionally, the capacity for empathy and perspective taking among youth with PTSD can be hampered by numbing symptoms.

Effective PTSD treatment paradigms have not been integrated into the rehabilitation of incarcerated juveniles. Direct exposure therapies such as flooding may prove useful in extinguishing arousal, maladaptive beliefs and negative affect associated with traumatic experiences. Cognitive-behavioral and psychoeducational group formats could be readily integrated into juvenile treatment programs in a cost-effective manner. Tailoring inpatient PTSD programs in the Veterans Administration system to younger clientele may serve as a useful model for helping these youth reduce their violent behavior.