SCreen & INtervene
Neurobiological assessments in screening and individual treatment decisions in the forensic youth setting.

Antisocial behavioral problems in youth, such as delinquency, have a major
societal impact, as most criminal violent behavior is committed by juveniles
and young adults. Forensic treatment institutions aim to diagnose, predict,
treat and reduce the risk of reoffending of delinquent youth. However, not all
youth in juvenile forensic psychiatry benefit sufficiently from current
intervention programs. Criminal recidivism rates and long-term mental health
problems remain substantial. Treatment and risk assessment are insufficiently
tailored to the specific individual developmental problems and dysfunctions.
The leading biopsychosocial model aims to explain the development and
persistence of antisocial and delinquent behavior from an interaction between
psychological, environmental, neurocognitive and neurobiological factors.
Neurobiological and neurocognitive development, specifically during
adolescence, play a pivotal role in the development of severe and persistent
delinquent behavior. Therefore, neurobiology and neurocognition could offer a
promising novel approach to complement assessment and treatment in forensic
clinical practice. However, fundamental knowledge on individual biopsychosocial
developmental profiles, how forensic treatment affects neurobiological
development, and how changes in neurobiology relate to treatment outcome, is
currently lacking.

Over the last decades, much fundamental knowledge has been obtained about the
neurobiology of antisocial behavior on group level. The main aim of the current
study is to translate this group-level knowledge to individualized,
developmental profiles of suspected and convicted juveniles and adolescents.
Using latent class regression techniques, we aim to identify subgroups in the
population with distinct biopsychosocial profiles.

The data collected from repeated screenings will provide input for the
development of biopsychosocially informed, statistical models to assess
neurodevelopment, biopsychosocial changes in relation to treatment and
treatment success as measured by societal functioning, quality of life and
reoffending. During the development of these models, statistical analyses will
be performed to explore the added predictive value of our target measures
besides the psychosocial measurements already used in clinical practice.

This study has a longitudinal, observational design, with neurophysiological,
neuroendocrinological, and neurocognitive assessments in combination with
standard psychosocial measurements during screening and assessment in forensic
clinical practice. To achieve this, a standardized neurobiological assessment
battery will be administered at multiple points in time, with the last
follow-up one year after release from prison.

Burden for participants consists of 2 to 4 3-monthly assessments with a
duration of 1 to 2 hours. These assessments consist of questionnaires,
neuropsychological tasks, as well as stress and emotion reactivity tasks with
non-invasive neurophysiological and neuroendocrinological measurements. We
expect a small burden from stress and emotion reactivity tasks (presentation
task, aversive noise anticipation task and emotional film clip). Measures are
taken to minimize this burden and successful use of the measurements has been
reported in studies with children and adolescents from our target population.
There are no risks regarding their criminal trial or treatment, since practice
as usual will not be interfered with. Participation in any part of the study is
completely voluntary. Although the participants do not receive direct benefits
from participation, there are greater benefits for society from knowledge that
could be gained from the proposed study.
This study will provide fundamental knowledge on the added value of
neurobiology in screenigs for treatment, on the changability of neurobiology
in reaction to treatment and the relationship between neurodevelopment and
antisociality during adolescence.This knowledge is needed to 1) improve the
prediction of reoffending risk, to 2) improve treatment success by tailoring
interventions to the specific needs and risks of individual youth and to 3) aid
in decision making for the application of Adolescent Criminal Law. It is
expected that these improvements will lead to an improvement in psychosocial
functioning and ultimately to a decrease in recidivism in this group of young
offenders, which not only benefit these youth, but also the society as a whole.