This Article  • Abstract  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (36)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Pediatrics  • Adolescent Psychiatry  • Post Traumatic Stress Disorder  • Alert me on articles by topic

Karen M. Abram, PhD; Linda A. Teplin, PhD; Devon R. Charles; Sandra L. Longworth, MS; Gary M. McClelland, PhD; Mina K. Dulcan, MD

Arch Gen Psychiatry. 2004;61:403-410.

ABSTRACT
Objective  To determine prevalence estimates of exposure to trauma and 12-month rates of posttraumatic stress disorder (PTSD) among juvenile detainees by demographic subgroups (sex, race/ethnicity, and age).

Design  Epidemiologic study of juvenile detainees. Master's level clinical research interviewers administered the PTSD module of the Diagnostic Interview Schedule for Children, version IV (DISC-IV), to randomly selected detainees.

Setting  A large, temporary detention center for juveniles in Cook County, Illinois (which includes Chicago and surrounding suburbs).

Participants  Randomly selected, stratified sample of 898 African American, non-Hispanic white, and Hispanic youth (532 males, 366 females, aged 10-18 years) arrested and newly detained.

Main Outcome Measures  Diagnostic Interview Schedule for Children, version IV.

Results  Most participants (92.5%) had experienced 1 or more traumas (mean, 14.6 incidents; median, 6 incidents). Significantly more males (93.2%) than females (84.0%) reported at least 1 traumatic experience; 11.2% of the sample met criteria for PTSD in the past year. More than half of the participants with PTSD reported witnessing violence as the precipitating trauma.

Conclusion  Trauma and PTSD seem to be more prevalent among juvenile detainees than in community samples. We recommend directions for research and discuss implications for mental health policy.

INTRODUCTION

Jump to Section  • Top  • Introduction  • Methods  • Results  • Comment  • Author information  • References

Each year, approximately 2.4 million youth are arrested, accounting for 17% of all arrests.¹ On a typical day, approximately 109 000 youth are detained.² The number of youth in the juvenile justice system with psychiatric disorders is a major public health problem. Two thirds of males and three quarters of females in juvenile detention have 1 or more psychiatric disorders.^3-4

The related literature suggests that posttraumatic stress disorder (PTSD) is more common in youth in the juvenile justice system than in community samples.^4-15 Lifetime diagnoses of PTSD in community samples of youth range from 6.3%¹⁶ to 7.8%¹⁰; current diagnoses are 3.5%.¹⁷ Prevalence of PTSD among youth in the juvenile justice system varies considerably, depending on the type of sample, the measure used, and the time frame assessed (within the past year, within the past month, or at the time of the interview).^{4, 13-15,18-20} For example, rates among males are 2.3% among American Indian detainees (past year)¹⁹; 4.8% among youth in secure placement (past month)⁴; 24.2% among felons in secure custody (at the time of the interview)¹⁴; and 32.3% among incarcerated youth (at the time of the interview).¹³ Far fewer data are available on females in the juvenile justice system. Duclos et al¹⁹ found 0 cases of PTSD within the past year among 64 female American Indian juvenile detainees. In contrast, Cauffman et al¹⁵ found 47 (48.9%) of 96 incarcerated females met criteria for PTSD in the past 3 months.

Unfortunately, most of these studies are too small,^13-15,19 too unique,¹⁹ or lack sufficiently standardized diagnostic assessments¹⁴ to generate reliable estimates. To date, no large-scale study has examined the prevalence of trauma and PTSD across demographic subgroups that make up increasing proportions of the juvenile justice population, that is, African Americans, Hispanics, females, and younger children. This omission is critical. Posttraumatic stress disorder is associated with severe functional impairment¹⁶ and other psychiatric problems.^{8, 10, 21} Left untreated, PTSD may become chronic,^{8, 10, 22-23} with enormous personal and societal costs.²⁴

In this article we present the prevalence of PTSD and trauma among juvenile detainees. This study has 2 advantages: (1) a stratified, random sample, large enough to compare sex, racial/ethnic, and age groups; and (2) a standardized measure of PTSD, the Diagnostic Interview Schedule for Children, version IV (DISC-IV).

METHODS

Jump to Section  • Top  • Introduction  • Methods  • Results  • Comment  • Author information  • References

PARTICIPANTS AND SAMPLING PROCEDURES

Participants were part of the Northwestern Juvenile Project, a longitudinal study of 1829 youth (aged 10-18 years) arrested and detained between November 20, 1995, and June 14, 1998, at the Cook County (Illinois) Juvenile Temporary Detention Center (CCJTDC) in Chicago. The random sample was stratified by sex, race/ethnicity (African American, non-Hispanic white, Hispanic), age (10-13 years or 14 years), and legal status (processed as a juvenile or as an adult) to obtain enough participants to examine key subgroups (eg, females, Hispanics, and younger children).

The CCJTDC received approximately 8500 admissions each year during the time data were collected (John Howard Association, unpublished data, 1992). The CCJTDC is used solely for pretrial detention and for offenders sentenced for fewer than 30 days. All detainees younger than 17 years are held at the CCJTDC, including youth processed as adults (automatic transfers to adult court). Youth up to the age of 21 years may be detained in the CCJTDC if they are being prosecuted for an arrest that occurred when they were younger than 17 years.

Like juvenile detainees nationwide,²⁵ approximately 90% of the CCJTDC detainees are male; most are racial/ethnic minorities. The population of the CCJTDC is 77.9% African American, 5.6% non-Hispanic white, 16.0% Hispanic, and 0.5% other racial/ethnic groups. The age and offense distributions of the CCJTDC detainees are also similar to detained juveniles nationwide.²⁵

We chose the detention center in Cook County (which includes Chicago and surrounding suburbs) for 3 reasons. First, nationwide, most juvenile detainees live in and are detained in urban areas.²⁶ Second, Cook County is ethnically diverse and has the third largest Hispanic population in the United States.²⁷ Studying Hispanics is important because they are the largest minority group in the United States²⁸ and they are overrepresented in the justice systems.²⁵ Third, the detention center's size (daily census of approximately 650 youth and intake of 20 youth per day) ensured that enough participants would be available.

No single site can represent the entire country because jurisdictions may have different options for diversion.^29-30 Nevertheless, Illinois' criteria for detaining juveniles are similar to other states'.²⁹ All states allow pretrial detention if the juvenile needs protection, is likely to flee, or is considered a danger to the community.^29-30

Detainees were eligible to be sampled, regardless of their psychiatric morbidity, state of drug or alcohol intoxication, or fitness to stand trial. Within each stratum, we used a random numbers table to select names from the CCJTDC's intake log. Throughout the study, we tracked how many participants were still needed to fill each cell. Project staff sampled the rarest categories first. The final sampling fractions ranged from 0.018 to 0.689. (Additional information on the sample is available from us.)

Studying detained youth requires special procedures because they are minors, because they are detained, and because many do not have a parent or guardian who can provide appropriate consent.³¹ Project staff approached participants on their units, explained the project, and assured them that anything they told us (except acute suicidal or homicidal risk) would be confidential. Participants signed either an assent form (if they were <18 years) or a consent form (if they were 18 years). Federal regulations allow parental consent to be waived if the research involves minimal risk (45 CFR 46.116[c], 45 CFR 46.116[d], and 45 CFR 46.408[c]).^31-32 The Northwestern University Institutional Review Board, the Centers for Disease Control and Prevention Institutional Review Board, and the US Office of Protection from Research Risks waived parental consent. However, as ethicists recommend, we nevertheless tried to contact parents to provide them an opportunity to decline participation and to offer them additional information (45 CFR 46.116[d][4]).^33-34 Despite repeated attempts to contact the parent or guardian, for 43.8% of the participants, none could be found. In lieu of parental consent, youth assent was overseen by an independent participant advocate representing the interests of the participants. Federal regulations allow for a participant advocate if parental consent is not feasible (45 CFR 46.116[d]).³³

We began collecting data on PTSD 13 months after the larger study began. Of the 1148 names selected, 34 detainees (3.0%) refused to participate in the study. There were no significant differences in refusal rates by sex, race/ethnicity, or age. Two youth were released before finishing the interview; 189 youth left the CCJTDC while we were locating their caretakers for consent or before we could schedule an interview; 25 youth were released after consent was obtained but before the interview commenced. The final sample size was 898 and comprised 532 males (59.2%) and 366 females (40.8%); 490 African Americans (54.6%), 154 non-Hispanic whites (17.1%), 252 Hispanic (28.1%), and 2 others (0.2%). Participants ranged in age from 10 to 18 years; the mean was 14.8 years; the median was 15 years.

Participants were interviewed in a private area, almost always within 2 days of intake. Most interviews lasted 2 to 3 hours, depending on how many symptoms were reported. We used both male and female interviewers. Female participants were always interviewed by female interviewers. Interviewers were trained for at least 1 month; most had a master's degree in psychology or an associated field and experience interviewing high-risk youth. One third of our interviewers were fluent in Spanish. We maintained consistency throughout the study by monitoring scripted interviews with mock participants. Additional information on our methods is published elsewhere.^{3, 35-36}

MEASURING PTSD

We used the DISC-IV, based on DSM-IV criteria, to assess PTSD. (Other disorders, presented elsewhere,^{3, 35} were assessed using the DISC, version 2.3.) Our data are based on the youth's self-report because it was not feasible to interview caretakers. Like other measures of PTSD in children,³⁷ there are still insufficient data on the DISC-IV's reliability and validity, in part, because the PTSD diagnosis is relatively new.³⁷ Studies documenting the module's reliability and validity are in progress (P. Fisher, PhD, e-mail, July 11, 2003). Despite the lack of psychometric data on the PTSD module of the DISC-IV, we chose it for several reasons. The DISC is the most widely used diagnostic instrument for child and adolescent research.³⁸ It is especially useful for large-scale epidemiologic studies because it is relatively brief; it can be administered by nonclinicians; it is designed to assess youth who have and have not been traumatized; and it generates DSM-IV disorders using computerized scoring.

The PTSD module assesses whether youth have ever experienced any of the 8 traumatic experiences listed in Table 1. Participants then identify the event that was "the most difficult for you in your entire life." The DISC-IV assesses PTSD diagnosis within the past year for this "worst" trauma.

View this table: [in this window] [in a new window] Table 1. Prevalence of Trauma by Sex and Race/Ethnicity*

Because we stratified our sample by sex, race/ethnicity, age, and legal status, we weighted all prevalence estimates to reflect the population of the CCJTDC. All reported standard errors and inferential tests have been corrected for design characteristics with Taylor series linearization^40-41 using the survey estimation procedures of Stata Statistical Software: Release 8.0.³⁹ Tests of prevalence use logit models, and tests of means of counts use Poisson regression models.³⁹ We used 2-tailed tests throughout. To reduce the probability of type I errors, we used layered Bonferroni corrections.⁴² Our level of significance for each group of tests was P<.05.

RESULTS

Jump to Section  • Top  • Introduction  • Methods  • Results  • Comment  • Author information  • References

TRAUMA

Overall Rates

Table 1 shows that 92.5% of the sample had experienced at least 1 trauma; 84.0% had experienced more than 1 trauma (not shown); the mean number of traumatic incidents equals 14.6 ; the median equals 6 incidents (not shown). Significantly more males (93.2%) than females (84.0%) reported a traumatic experience. There were no significant differences in overall prevalence of trauma across race/ethnicity for males and females. Among both male and female detainees, significantly more youth 14 years or older (94.2% males and 86.5% females) reported trauma than youth aged 10 to 13 years (82.4% males [F_1,523 = 7.20, P = .008] and 59.1% females [F_1,363 = 14.56, P<.001]); analyses of age are available from us.

Specific Traumas

Table 1 also shows that, among both males and females, the 3 most frequently reported traumas were having "seen or heard someone get hurt very badly or be killed" (reported by 74.9% of males and 63.5% of females), having been "threatened with a weapon" (reported by 59.3% of males and 47.3% of females), and being in a situation where "you thought you or someone close to you was going to be hurt very badly or die" (reported by 53.5% of males and 49.1% of females). Significantly more males than females reported having "been in a bad accident." On the other hand, significantly more females than males reported being "forced to do something sexual that you did not want to do." Among males, non-Hispanic whites were more likely to have "been attacked physically or beaten badly" than were African Americans. Among females, Hispanics were more likely to have been attacked physically or beaten badly than were African Americans.

POSTTRAUMATIC STRESS DISORDER

Table 2 reports PTSD diagnoses in the past year for the entire sample (11.2%). There were no significant differences in PTSD diagnosis by sex or across race/ethnicity for males and females.

View this table: [in this window] [in a new window] Table 2. Prevalence of DSM-IV Posttraumatic Stress Disorder by Sex and Race/Ethnicity* for 892 Study Participants

We examined precipitating traumas for persons diagnosed as having PTSD. Among male participants "having seen or heard someone get hurt very badly or be killed" was the most frequent precipitating trauma for PTSD, significantly higher among males (58.9%) than females (23.5%) (F_1,98 = 6.46, P = .01). Among female participants, thinking "you or someone close to you was going to be hurt very badly or die" was the most frequent precipitating trauma, significantly higher among females (27.8%) than males (9.5%) (F_1,98 = 6.31, P = .01). (These analyses are available from us.) Other precipitating traumas were too rare to analyze further.

We also examined the age at which the participants had experienced their worst, precipitating trauma. Most participants (88.7%) reported that their worst traumas occurred within 2 years prior to the interview. However, being forced to do something sexual—when that was identified as the worst trauma—occurred 5 years before the interview for most participants. (These analyses are available from us.)

COMMENT

Jump to Section  • Top  • Introduction  • Methods  • Results  • Comment  • Author information  • References

TRAUMA

Exposure to trauma is a fact of life for delinquent youth. More than 90% of our sample experienced at least 1 traumatic event; more than half (56.8%) were exposed 6 or more times. These findings are comparable to reports from smaller studies of youth in correction facilities.^{7, 13, 15, 18}

It is difficult to compare our findings to community studies because published findings vary, depending on the sample (eg, urban, suburban, minority) and which traumas were assessed. Yet, our overall prevalence of trauma is substantially higher than most studies of youth and young adults (ages 15-24 years), especially for severe and violent trauma.^{5-6,16-17,43-45}

Witnessing violence, the most common trauma, is far more common in our sample (63.5% of the females and 74.9% of the males) than in most community studies of youth and young adults (4.9%-40.1%)^{5-6,10, 16, 43, 46} Our findings are most comparable to studies of urban teenagers.^44-45,47-49 Living with widespread or chronic community violence in the inner city has been compared with living in a war zone.⁴⁷

TRAUMA AND PTSD

More than 1 (11.2%) of 10 detainees had PTSD during the year prior to the interview. These estimates are lower than those reported by Burton et al¹⁴ (24%, current disorder), Cauffman et al¹⁵ (48.9% of females, past 3 months), and Steiner et al¹³ (31.7% of males, current disorder), perhaps because our instruments and methods are different. Burton et al¹⁴ used a symptom checklist administered to small groups. Cauffman et al¹⁵ and Steiner et al¹³ used the PTSD module of the Revised Psychiatric Diagnostic Interview.⁵⁰ The Revised Psychiatric Diagnostic Interview assesses symptoms of PTSD independent of a particular trauma. In contrast, the DISC, like most instruments, assesses PTSD based on the participant's perceived worst trauma.

The prevalence of PTSD in our sample was higher than reported by Garland et al²⁰ (3.1%, past year) and Wasserman et al⁴ (4.8%, males only, past month), who used the DISC, and Duclos et al¹⁹ (1.3%, past year), who used a modified version of the Composite International Diagnostic Interview (CIDI); the CIDI is similar in structure to the DISC. Our findings and those of prior studies may differ because of the point at which the sample was drawn. We sampled youth right after they were detained, and before their adjudication hearings. Garland et al²⁰ and Wasserman et al⁴ sampled convicted juveniles in secure placement. The findings of Duclos et al¹⁹ may be different from ours because their sample was composed only of American Indian detainees.

The prevalence of PTSD in our sample (during the 12 months prior to the interview) exceeds lifetime estimates of PTSD reported in community samples of youth and young adults (3.5%-9.2%).^{5-6,10, 16} More than half of our participants with PTSD had reported witnessing violence as the precipitant. Our findings might reflect that our participants, like most juvenile detainees nationwide, live in urban areas that have high rates of violence.^51-52 Alternatively, our findings are consistent with research linking traumatic victimization in childhood and subsequent psychosocial problems, such as delinquency, perpetration of violence, and drug use.^{13, 16-17,47-48,53-58}

Why were rates of PTSD not higher, given the extent of exposure to trauma in our sample? There are several possibilities. First, the types and patterns of traumas reported by youth in community samples and our sample differ. We do not know the conditional risk of specific traumas in our sample because the DISC-IV, like most instruments, assesses PTSD only for the worst trauma.⁶ Second, traumatic experiences can precipitate other conditions besides PTSD, for example, disruptive behavior disorders, other internalizing disorders, some personality disorders, and physical illnesses.³⁷ These disorders are common in our sample.^{3, 35} Third, prevalence of PTSD may have been higher had we asked about a wider range of traumas, used more than 1 screen question to ask about sexual abuse or other types of intimate violence, or conducted interviews using techniques that allow for anonymity (eg, the Voice DISC).^{4, 59-60}

Most demographic differences corroborated prior investigations of community samples.^{6, 10, 16, 46, 61} Although male detainees were significantly more likely than female detainees to have experienced trauma, female detainees were as likely to have PTSD as were male detainees. In community samples, females are twice as likely as males to develop PTSD following exposure to trauma.⁶

Like prior studies in the community, we found few racial/ethnic differences in rates of trauma or PTSD.^{5, 10} Those few differences pertained to the type of trauma reported most frequently. In our sample, African American males were more likely to have witnessed violence than were non-Hispanic whites, consistent with the high levels of violence exposure among inner-city, minority youth.⁶² Non-Hispanic white males were more likely to have experienced actual and threatened violence than other males. Among females, Hispanics were most likely to have experienced violent victimization.

LIMITATIONS

Our findings are drawn from 1 site and may pertain only to youth in urban detention centers with similar demographic composition. Moreover, our findings are based on a sample of pretrial detainees and may not be generalizable to adjudicated juveniles serving sentences.

Because it was not feasible to interview caretakers, our data are subject to the reliability and validity of the youths' self-report. However, youth and their caretakers are comparable reporters of youths' anxiety disorders.⁶³ Recall of traumas may be affected by arrest and detention; yet, recall of events by youth may be less subject to the distortions of time than recall by adults.⁵ Moreover, the DISC—like most measures—probes for PTSD for the single-worst trauma; hence, we are unable to estimate the age of onset of PTSD or the vulnerability to PTSD by type of trauma.⁶ Despite these limitations, our study has implications for research on PTSD and for mental health policy.

FUTURE RESEARCH

We suggest 3 directions for future research.

1. Studies of vulnerability to PTSD in high-risk youth. Although more than 90% of our sample were exposed to 1 or more traumas, only 11.2% of the sample met criteria for PTSD in the past year. We need to determine the relative risk of PTSD for types of trauma (eg, witnessing murder, being shot, witnessing ongoing domestic violence, sudden loss of a loved one) among youth who are frequently exposed to trauma and violence, such as our participants. Such studies could document factors that increase resilience to PTSD among high-risk youth and guide prevention strategies.^64-65
   
2. Studies of chronic community violence and its relationship to PTSD. Community violence is epidemic in inner cities.⁶² Research suggests that chronic exposure to violence may have more deleterious effects on children than acute violence.⁶² We must study the effects of chronic community violence on high-risk youth as they become adults.¹⁷ Longitudinal studies should examine the role that witnessing violence plays in perpetuating the cycle of violence.
   
3. Definition of trauma and diagnosis of PTSD. There is a scarcity of research on the validity and reliability of diagnostic measures of PTSD, in part because the diagnosis is relatively new.³⁷ Moreover, the definitions of trauma in DSM-IV are somewhat ambiguous⁶⁶; hence, there is little consistency among diagnostic instruments that measure traumas. For example, most measures assess violent victimization (DISC-IV, CIDI 2.1)⁶⁷; others also assess trauma from perpetration of violence (R. C. Kessler, PhD, National Comorbidity Study—Replication, unpublished data, 2001-2002). Some measures assess sexual victimization by any perpetrator (DISC-IV, CIDI 2.1); others specifically ask about victimization by family members (DIS-IV,⁶⁸ National Comorbidity Study—Replication). These differences reduce the validity and reliability of diagnoses. We need a consensually understood and empirically validated framework to define and measure traumatic events.^{24, 69-71}
   

AUTHOR INFORMATION

Jump to Section  • Top  • Introduction  • Methods  • Results  • Comment  • Author information  • References

Corresponding author and reprints: Linda A. Teplin, PhD, Psycho-Legal Studies Program, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 710 N Lake Shore Dr, Suite 900, Chicago, IL 60611 (e-mail: psycho-legal{at}northwestern.edu).

Submitted for publication May 9, 2003; final revision received November 4, 2003; accepted November 18, 2003.

This study was supported by grants R01MH54197 and R01MH59463 from the National Institute of Mental Health, Bethesda, Md; and grant 1999-JE-FX-1001 from the Office of Juvenile Justice and Delinquency Prevention. Major funding was also provided by the National Institute on Drug Abuse, Bethesda; the Center for Mental Health Services, Rockville, Md; the Centers for Disease Control and Prevention (CDC) National Center for HIV, STD, and TB Prevention, Atlanta, Ga; CDC National Center on Injury Prevention and Control, Atlanta; the National Institute on Alcohol Abuse and Alcoholism, Bethesda; the Center for Substance Abuse Prevention, Rockville; the Center for Substance Abuse Treatment, Rockville; the National Institutes of Health's (NIH) Center on Minority Health and Health Disparities, Bethesda; the NIH Office of Research on Women's Health, Bethesda; the NIH Office of Rare Diseases, Bethesda; the William T. Grant Foundation, New York, NY; and the Robert Wood Johnson Foundation, Princeton, NJ. Additional funds were provided by The John D. and Catherine T. MacArthur Foundation, Chicago, Ill; the Open Society Institute, New York, NY; and the Chicago Community Trust, Chicago, Ill. We thank all our agencies for their collaborative spirit and steadfast support.

Many more people than the authors contributed to this project. Ann Hohmann, PhD, and Kimberly Hoagwood, PhD, provided technical support in the design; Heather Ringeisen, PhD, provided helpful advice. Grayson Norquist, MD, and Delores Parron, PhD, provided steadfast support throughout. Celia Fisher, PhD, guided our human subjects procedures. We thank Gail Wasserman, PhD, and the reviewers of the ARCHIVES for their insightful comments on earlier versions of the manuscript, and Prudence Fisher, PhD, for her helpful advice on the DISC-IV PTSD module. We thank all project staff, especially Amy M. Lansing, PhD, for supervising the data collection, and Laura Coats, our expert editor and research assistant. We greatly appreciate the cooperation of everyone working in the Cook County justice systems, especially David H. Lux, our project liaison. Without the county's cooperation, this study would not have been possible. Finally, we thank our participants for their time and willingness to participate.

From the Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University (Drs Abram, Teplin, McClelland, and Dulcan and Mss Charles and Longworth); and Children's Memorial Hospital (Dr Dulcan), Chicago, Ill.

REFERENCES

Jump to Section  • Top  • Introduction  • Methods  • Results  • Comment  • Author information  • References

1. Snyder HN. Juvenile Arrests 2000. Washington, DC: US Dept of Justice, Office of Juvenile Justice and Delinquency Prevention; 2002. Publication NCJ 191729. 2. Sickmund M, Wan Y. Census of Juveniles in Residential Placement Databook. Available at: http://www.ojjdp.ncjrs.org/ojstatbb/cjrp. Accessed March 26, 2002. 3. Teplin LA, Abram KM, McClelland GM, Dulcan MK, Mericle AA. Psychiatric disorders in youth in juvenile detention. Arch Gen Psychiatry. 2002;59:1133-1143. FREE FULL TEXT 4. Wasserman GA, McReynolds LS, Lucas CP, Fisher P, Santos L. The Voice DISC-IV with incarcerated male youths: prevalence of disorder. J Am Acad Child Adolesc Psychiatry. 2002;41:314-321. FULL TEXT | ISI | PUBMED 5. Breslau N, Davis GC, Andreski P, Peterson E. Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry. 1991;48:216-222. ISI | PUBMED 6. Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P. Trauma and posttraumatic stress disorder in the community: the 1996 Detroit area survey of trauma. Arch Gen Psychiatry. 1998;55:626-632. FREE FULL TEXT 7. Carrion VG, Steiner H. Trauma and dissociation in delinquent adolescents. J Am Acad Child Adolesc Psychiatry. 2000;39:353-359. FULL TEXT | ISI | PUBMED 8. Davidson JR, Hughes D, Blazer DG, George LK. Post-traumatic stress disorder in the community: an epidemiological study. Psychol Med. 1991;21:713-721. ISI | PUBMED 9. Helzer JE, Robins LN, McEvoy L. Post-traumatic stress disorder in the general population: findings of the Epidemiologic Catchment Area survey. N Engl J Med. 1987;317:1630-1634. ABSTRACT 10. Kessler RC, Sonnega A, Bromet J, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52:1048-1060. ISI | PUBMED 11. Norris FH. Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. J Consult Clin Psychol. 1992;60:409-418. FULL TEXT | ISI | PUBMED 12. Olfson M, Fireman B, Weissman MM, Leon AC, Sheehan DV, Kathol RG, Hoven C, Farber L. Mental disorders and disability among patients in a primary care group practice. Am J Psychiatry. 1997;154:1734-1740. FREE FULL TEXT 13. Steiner H, Garcia IG, Mathews Z. Posttraumatic stress disorder in incarcerated juvenile delinquents. J Am Acad Child Adolesc Psychiatry. 1997;36:357-365. FULL TEXT | ISI | PUBMED 14. Burton D, Foy D, Bwanausi C, Johnson J, Moore L. The relationship between traumatic exposure, family dysfunction, and post-traumatic stress symptoms in male juvenile offenders. J Trauma Stress. 1994;7:83-93. FULL TEXT | ISI | PUBMED 15. Cauffman E, Feldman S, Waterman J, Steiner H. Posttraumatic stress disorder among female juvenile offenders. J Am Acad Child Adolesc Psychiatry. 1998;37:1209-1216. FULL TEXT | ISI | PUBMED 16. Giaconia RM, Reinherz HZ, Silverman AB, Pakiz B, Frost AK, Cohen E. Traumas and posttraumatic stress disorder in a community population of older adolescents. J Am Acad Child Adolesc Psychiatry. 1995;34:1369-1380. FULL TEXT | ISI | PUBMED 17. Cuffe SP, Addy CL, Garrison CZ, Waller JL, Jackson KL, McKeown RE, Chilappagari S. Prevalence of PTSD in a community sample of older adolescents. J Am Acad Child Adolesc Psychiatry. 1998;37:147-154. FULL TEXT | ISI | PUBMED 18. Crimmins SM. Child Maltreatment, Drugs and Crime Among Male Offenders: Final Report to the National Institute on Drug Abuse, Grant No. R01 DA08893. New York, NY: National Development and Research Institutes Inc; 1999. 19. Duclos CW, Beals J, Novins DK, Martin C, Jewett CS, Manson SM. Prevalence of common psychiatric disorders among American Indian adolescent detainees. J Am Acad Child Adolesc Psychiatry. 1998;37:866-873. FULL TEXT | ISI | PUBMED 20. Garland AF, Hough RL, McCabe KM, Yeh M, Wood PA, Aarons GA. Prevalence of psychiatric disorders in youths across five sectors of care. J Am Acad Child Adolesc Psychiatry. 2001;40:409-418. FULL TEXT | ISI | PUBMED 21. Breslau N, Davis G, Peterson EL, Schultz L. Psychiatric sequelae of posttraumatic stress disorder in women. Arch Gen Psychiatry. 1997;54:81-87. ISI | PUBMED 22. Burger FL, Lang CM. Diagnoses commonly missed in childhood: long-term outcomes and implications for treatment. Psychiatr Clin North Am. 1998;21:927-940. FULL TEXT | ISI | PUBMED 23. Terr LC. Childhood traumas: an outline and overview. Am J Psychiatry. 1991;148:10-20. FREE FULL TEXT 24. Kessler RC. Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry. 2000;61:4-12. 25. Snyder HN, Sickmund M. Juvenile Offenders and Victims: 1999 National Report. Washington, DC: Office of Juvenile Justice and Delinquency Prevention; 1999. 26. Pastore AL, Maguire K. Sourcebook of Criminal Justice Statistics—1999. Washington, DC: US Dept of Justice; 2000. 27. US Bureau of the Census. The Hispanic Population. Washington, DC: US Dept of Commerce; 2001. 28. US Bureau of the Census. Profile of demographic characteristics: 2000. Available at: http://factfinder.census.gov. Accessed January 13, 2004. 29. Grisso T, Tomkins A, Casey P. Psychosocial concepts in juvenile law. Law Hum Behav. 1988;12:403-437. FULL TEXT 30. Illinois Criminal Justice Information Authority. Trends and Issues 1997. Chicago: Illinois Criminal Justice Information Authority; 1997:151-176. 31. Federal Policy for the Protection of Human Subjects: notices and rules. 56 Federal Register. Part 2, No. 117 (June 18, 1991): 28002-32 (56 FR 28002). 32. Shaffer D. Use of passive consent in child/adolescent mental health research—effect of letter from Dr Charles R. McCarthy, Director of the Office for Protection from Research Risks, NIH. Res Notes Child Adolesc Psychiatry. Summer 1992:10. 33. Fisher CB. Integrating science and ethics in research with high-risk children and youth. Soc Policy Rep. 1993;7:1-27. PUBMED 34. Nolan K. Ethical issues: assent, consent, and behavioral research with adolescents. Res Notes Child Adolesc Psychiatry. Summer 1992:7-10. 35. Abram KM, Teplin LA, McClelland GM, Dulcan MK. Comorbid psychiatric disorders in youth in juvenile detention. Arch Gen Psychiatry. 2003;60:1097-1108. FREE FULL TEXT 36. Teplin LA, Mericle AA, McClelland GM, Abram KM. HIV and AIDS risk behaviors in juvenile detainees: implications for public health policy. Am J Public Health. 2003;93:906-912. FREE FULL TEXT 37. Ohan JE, Myers K, Collett BR. Ten-year review of rating scales, IV: scales assessing trauma and its effects. J Am Acad Child Adolesc Psychiatry. 2002;41:1401-1422. FULL TEXT | ISI | PUBMED