The development of decision-making capacities in children and adolescents has been a topic of interest for hundreds, if not thousands, of years. Questions regarding the development of decision-making capacities (and moral reasoning) of youth frequently arise in juvenile justice settings, other forensic settings, and sometimes in treatment settings. This article attempts to review the latest and most relevant research on the development of decision-making capacities likely to be relevant in children and adolescents who are defendants. We distinguish cognition versus judgment in decision-making and briefly review adolescent decision-making in laboratory and real world conditions. We review a theoretical framework of two different systems, a cognitive-control system and socio-emotional system, and potentially correlated neurobiological and psychological findings. Implications for selected aspects of the juvenile adjudicative process are discussed.

IntroductionThere are increasing concerns regarding long-term psychotropic polypharmacy prescribed for foster care youth 3.5 to 5 times more often than in at-home youth (Kreider et al., 2014). Polypharmacy risks include weight gain, glucose intolerance and type 2 diabetes. (De Hert et al., 2011). In view of these risks, novel interventions are essential to safeguard foster care youth from overmedication.ObjectivesTo present guidelines for identification and management of polypharmacy in foster care youth.AimsTo demonstrate a novel intervention to monitor and diminish polypharmacy and enhance psychiatric care in foster care children.MethodsPolypharmacy is identified using LA County Juvenile Court Mental Health Service (JCMHS) Psychotropic Parameters* to review medication consent forms from treating psychiatrists. Polypharmacy triggers an in-person JCHMS consultation. *(Parameters 3.9 for JCMHS PMAF Review, Revised May 2015).JCMHS Psychotropic Parameters (summary):– age 0–5 years:– 2 or > psychotropic medications,– Any antipsychotic (*except Risperidone in ASD);– age 6–8 years:– 3 or > psychotropic medications;– age 9–17 years:– 4 or > psychotropic medications;– All age youth:– 2 or > psychotropic medications in the same class (antipsychotics, antidepressants, stimulants, mood stabilizers, alpha agonists).Psychotropic medication doses in excess of recommended (*LA County Department of Mental Health Parameters 3.8 for use of Psychotropic Medications for Children and Adolescents).ResultsApproximately 25% of JCMHS annual psychiatric consultations were initiated by JCMHS parameters for polypharmacy. Corresponding consultations included education and recommendations discussed with treating psychiatrists regarding polypharmacy and optimal psychiatric management.ConclusionsJCMHS Psychotropic Parameters is a useful tool to identify polypharmacy and enhance psychiatric care of foster care youth.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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IntroductionIt is well known that youth in foster care are at high risk for psychiatric disorders, recently reported in up to 89%, with over 55% exhibiting ADHD in one sample (Linares et al., 2013). Psychotropic medication use was reported in 59% of foster care youth within a 2-month period (Brenner et al., 2013). The psychotropic medication consent process in Los Angeles for dependent children is multidisciplinary, starting with the treating psychiatrist's written authorization request to Children's Dependency Court. Once received, it is distributed to the child's attorney, social worker, and Juvenile Court Mental Health Service (JCMHS). JCMHS reviews and provides recommendations to the judicial officer who ultimately approves, modifies, or denies consent.ObjectivesTo present the steps and reasoning in the process of review, consultation, recommendations and decisions in psychotropic medication consent for dependent youth.AimsTo provide an understanding of the multidisciplinary review process involved in determining psychotropic medication consent in foster care youth.MethodPresentation of a timeline, forms and guidelines used in the process including the “Psychotropic Medication Authorization Form” (PMA) (Judicial Council of California, 2008).ResultsCategories of recommendations and approvals provided to the judicial officer will be presented and rationales for in-person consultations.ConclusionThe psychotropic medication consent process for foster care youth is a complex multidisciplinary process which includes a clinically significant set of recommendations from JCMHS to the judicial officer to aid in making informed decisions regarding psychotropic medication.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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