The Georgia Cold Case Project
Mental health presenting problems were also measured using a variety of intelligence and functioning scales. The measured IQs of cold case children ranged from 43 to 136, with an average of 84. Thus the sample is functioning below the IQ average of 100 in the general population. Approximately one in five (18%) of cold case children would, on the basis of their IQ score, fall in or below the borderline range of intellectual functioning. Children ranged from 5 to 85 on the DSM-IV Global Assessment of Functioning (GAF) Scale of 1-100; the average was 54. A score of 54 would reflect moderate symptoms or moderate difficulty in social, occupational, or school functioning. Forty percent (40%) of children had a GAF of 50 or below, indicating serious symptoms or serious impairment in functioning.
Table 8. Most Frequent Mental Health Medications
% of Children with Prescription
Prescription treatment patterns emerge as well. On average, at the early assessment, children were taking one prescribed medication ostensibly diagnosed to treat one or more mental health issues. On the latest assessment, children averaged two medications. One in three children were never prescribed any medications. The most frequent medications prescribed were Risperdal, Seroquel and Adderall. Risperdal is most commonly prescribed for schizophrenia and bipolar disorders (it stabilizes moods and restores more orderly thinking). Seroquel is most commonly prescribed for bipolar and depressive issues (it works to stabilize moods), and Adderall and Ritalin are commonly prescribed for ADHD.
A Method to Summarize Mental Health
The research team devised a method of summarizing the state of mental health of cold cases. A rating system was devised in an attempt to quantify the degree of trauma, psychopathology, and behavioral issues presented by each child. The rating system, which utilized a six-point scale ranging from no discernable issues to profound issues, is described in Table 9 on the next page.
All children experienced some degree of trauma, not surprising given the fact that the children had been removed from their homes due to abuse and neglect. However, 81% of the cold case children experienced ongoing or profound trauma.
As noted above, the children in our sample presented with a host of diagnoses. About one half of the children (51%) had multiple DSM-IV Axis I disorders or both Axis I and Axis II disorders. One in five (19%) had chronic, serious, treatment resistant mental illness and/or cognitive issues. This latter level of pathology often requires fairly long-term inpatient care to stabilize and treat the child. A small number of children had suffered such insults in their early lives that they were profoundly cognitively impaired, incapable of speech or self-care.
Behavior issues were also prominent. One in three children (34%) exhibited behavior that was an issue in multiple settings with violence or serious criminality. An additional 16% of children exhibited behavior that was unmanageable in all but secure settings, with violence or serious criminality. These children often spent long periods of time in therapeutic settings and institutions as a result.