Forensic psychiatry encompasses broad fields of research and practice ─ from psychiatric evaluation, criminology, ethical issues related to involuntary admission, to protection of children's rights in the community, school, and home. This paper first introduces the significance of the Convention on the Rights of the Child. Second, Japan's childrelated laws including the Child Welfare Act, the Child Abuse Prevention Act, and the Juvenile Act are reviewed, extending to discussion of issues surrounding the Mental Health and Welfare Law, from the perspective of a child's capacity to consent.
Public recognition and acceptance of the concept of autism spectrum disorder (ASD) has been a development over the past thirty years, during which we have come to see growing media focus on possible ASD involvement in criminal cases. Criminal cases of ASD are also being reported in the medical journals. While these anecdotal reports underline the affinity between ASD and crime, scientific evidence upholding this association is rare. This paper reviews the findings available to date on the association between ASD and crime, alongside discussion on the understanding and management of the risks involved, the needs for support, and further study.
Forensic or investigative interviews are methods of eliciting as much accurate information as possible at minimum psychological burden from alleged victims and witnesses. The present paper describes the background and current situation regarding use of the forensic interview on children in Japan. Starting with a review on how the forensic interview was developed in the West, how it was brought into Japan, and how it is currently being used in our country, the aim, characteristics, and general procedure of the forensic interview were described. In particular, that (1) the aim of the forensic interview is to investigate what happened to a child, as opposed to psychological counseling or therapy, (2) emphasis is on the use of open-ended questions to elicit as much and as accurate information as possible, (3) the structured interview is designed to maximize extraction of free narrative, and (4) interviews are conducted by a multidisciplinary team and videotaped to reduce the number of interviews and minimize secondary trauma. Findings were presented from studies showing efficacy of open-ended questions compared to closed questions in eliciting more accurate information of greater credibility from children's testimonies. In closing, the recent collaboration between the Child Guidance Centers, Police, and Prosecutor's Office in Japan was described, alongside emphasis on the need for further collaboration with professionals in medical care as well as clinical psychology.
In Japan, the Family Court takes charge of criminal cases committed by juveniles. The criminal liability age is 14, and adolescents under 20 are initially processed according to the Juvenile Act (1948). Under this Act, “accountability”—an essential part of forensic psychiatry—is considered less critical than in adult cases.
Family Court probation officers are assigned to each Family Court, as specialists in the social sciences such as psychology, education, sociology, social welfare and law. Their primary function is to conduct interviews with the juveniles, parents, and other persons involved, to construct recommendations submitted to the judge regarding appropriate methods of reform for each case.
From the perspective of an ex-Family Court probation officer, characteristics of present-day juvenile delinquency in Japan are presented alongside discussion of the increasing relevance of the psychiatric perspective, the effective use of genograms, and importance of the forensic interview for correct and comprehensive understanding of juvenile cases.
It has come to be known that there exists a certain number of individuals with autism spectrum disorder (ASD) among the juvenile offenders. Requests for psychiatric evaluations by child psychiatrists are increasing as most delinquent behaviors conducted by such persons are difficult to understand in terms of existing forensic psychiatry.
In psychiatric evaluations for juveniles with ASD, the background and motivations behind delinquent behavior, and mental status of the individual should be evaluated and analyzed taking their autistic characteristics into adequate account. In addition, arrangements for additional explanations are necessary subsequent to witness examinations in order to ascertain accurate understanding by the judges, given the disparity between ASD and traditional psychiatric disorders, the diversity of clinical manifestation in ASD, the fact that even general psychiatrists have difficulty in understanding the mental states of individuals with ASD, in addition to the jury system in which laymen in both justice and psychiatry are required to determine guilt or innocence.
This article discusses some matters requiring consideration in conducting psychiatric evaluations and witness examination in juvenile cases involving ASD, from the perspectives of understanding the disorder, determining criminal liability, and deviation from the accepted conventions of forensic psychiatry.
The core symptoms of Attention-deficit/Hyperactivity Disorder (ADHD) are inattention, hyperactivity, and impulsivity. Among these, impulsivity has a particularly profound effect on daily life. The co-occurrence of Autism Spectrum Disorder (ASD) and ADHD was formally recognized as ADHD/ASD with the introduction of DSM-5. However, little is known on how the co-occurrence of ASD with ADHD affects impulsivity. Hence, in this study, we utilized near-infrared spectroscopy (NIRS) to assess the frontal lobe functions associated with impulsive behavior in patients with ADHD and ADHD/ASD. The study involved a group of 15 patients with ADHD (mean age, 8.93 years), a group of 15 patients with ADHD/ASD (mean age, 8.64 years), and a control group of 15 subjects of corresponding age, sex, and intelligence quotients. Utilizing the Stroop Color- Word Test as an activation task, we compared the ADHD and ADHD/ASD groups by measuring changes in prefrontal cortex oxyhemoglobin during task performance. As results, the ADHD and ADHD/ ASD groups showed significantly lower values compared to the control group for channels 5, 15, 16, and 23 among the 24 channels of the frontal region. Similarly, the ADHD group showed significantly lower values than the control group for channel 11, and the ADHD/ASD group showed significantly lower values than controls for channel 12. Furthermore, both the ADHD and ADHD/ASD groups provided significantly fewer correct responses and significantly more incorrect responses than the control group. These results suggest there is no difference between the ADHD and ADHD/ASD groups regarding executive function failure including impulsivity, based on hemodynamic responses in the prefrontal cortex and Stroop color-word task performance.
We report on the course of treatment of an 18-year-old girl with autism spectrum disorder (ASD) who presented with severe hyperacusis. The patient first visited our hospital at 13 years of age for school nonattendance, and was diagnosed with pervasive developmental disorder not otherwise specified. By 18, she had become hypersensitive to almost all sounds in daily life, appearing fearful and easily startled. Earplugs and earmuffs could not control her symptoms; therefore, the patient was re-examined. Examination by the Department of Otolaryngology revealed no abnormal findings following medical tests, brain magnetic resonance imaging, and electroencephalographic examination. As such, she was diagnosed with ASD-associated hyperacusis. Pharmacotherapy was attempted following provision of information regarding her condition with consent to off-label drug use. Dose-dependent remission of hyperacusis was noted with gradual increase of aripiprazole (ARP) dose up to 18mg/day, but administration was suspended due to side effects. Symptom relief was observed with 3 mg ARP/day, but the effect being inadequate, combination treatment was attempted with sound exposure starting 3 months after resumption of ARP. Sound exposure consisted of a task in which the patient used headphones over earplugs to listen to music of her own selection at a tolerable volume once each day for 15 min with gradual increments in volume. As a result, habituation and generalization to acoustic stimuli occurred, resulting in significant reduction of hearing hypersensitivity. Five months after ARP resumption, ARP treatment was terminated due to side effects, while sound exposure alone was continued for 3 months, during which symptomatic improvement continued. The course of treatment of this patient suggested efficacy of low dose ARP combined with sound exposure as a treatment modality for treating ASD-associated hyperacusis. Recent findings, including auditory characteristics of ASD and side effects of ARP in ASD treatment, the treatment of hyperacusis, and future prospects were discussed.