Adolescent treatment and assessment is hard enough without factoring in the uncertainties of sex offender care and prognosticating. So the assessment of the psychopathology and personality of a group of juvenile sexual homicide offenders is helpful (J Am Acad Psychiatry Law, 25:4 pp. 497-508).

Fourteen incarcerated adolescents were evaluated using structured interviews, and correctional files reviewed. To assess Axis I disorders, the DSM-III-R Diagnostic Interview for Children and Adolescents (DICA-R) was administered. The Schedule for Nonadaptive and Adaptive Personality (SNAP) allowed for the diagnosis of the 13 DSM-III-R personality disorders and included normal personality scales. To measure psychopathy dimensionally, the Revised Psychopathy Checklist (PCL-R) was used.

Twelve youths manifested one or more Axis I diagnoses at the time of their crimes with the most common being conduct disorder (86%) and substance abuse disorders (43%i None of the youth were found to have a current or past psychotic disorder; however, a history of psychotic symptoms was found in 85% of the adolescents. They demonstrated more DSM-III-R cluster A symptomatology (the paranoid, schizoid, and schizotypal spectrum) than cluster B (antisocial, borderline) spectrum symptomatology.

The mean PCL-R score for the group was 22.4 (range, 7.1 to 30.6). Two of the youth had low psychopathy scores (7.1 and 7.1). In addition to not having conduct disorder, they were without a personality disorder diagnosis. They were also the only two in the sample who were functioning relatively well at school.

A chaotic family system was present in 13 members (93%) of the sample. This was defined as parental abandonment or neglect, child abuse, unstable living arrangements with frequent geographical moves, parental incarceration, parental substance abuse, and/or serious parental arguing/ fighting. Family violence was present in 86% of the youths' homes. This was defined as physical abuse of the child, physical abuse of one spouse by another, or physical fighting between parents or adult family members witnessed by the child.

In the 14 subjects, the two most prevalent antisocial behavior markers were fighting (86%) and prior arrests (86%). All had a history of truancy. Eleven (79%) had been officially employed one or more times in their lives. At the time of the crime, 43% of the juveniles were under the influence of mind-altering substances, either marijuana or alcohol alone or a combination of the two.

The subjects were assessed based on the FBI crime classification of organized or disorganized (planned versus spontaneous) crime. No relationship was found between the organized/disorganized classification and Axis I disorders, personality disorder diagnoses, psychopathy scores, presence of sexual fantasies, and sexual assault patterns.

Most of the young men reported themselves as being relatively inhibited in their expression of emotions. Contrary to the expectation that many of the young men would have been sexually abused, this was not the case. In contrast to previous studies, only 55% of the juveniles in the current assessment were white.

Expanding the study of adolescent sex murderers will do more than distinguish them from those with major diagnoses. We still have much to learn about risk for recidivism in a group with a variety of backgrounds and problems.