Conscience Relevance and Sensitivity in Psychiatric Evaluations in the Youth-span

Background: While practice parameters recommend assessment of conscienceand values, few resources are available to guide clinicians. Objective: To improve making moral inquiry in youth aged 15 to 24. Method: After documenting available resources for behavioral health clinicians who are inquiringabout their patient’s moral life, we consider our studies of conscience developmentand functioning in youth. We align descriptions of domains of conscience with neurobiology.We compare youth reared in relative advantage, who have fairly smooth functional progressionsacross domains, with youth reared in adverse circumstances. We offer the heuristicconscience developmental quotient to help mind the gap between conscience in adversity andconscience in advantage. Next, we consider severity of psychopathological interference asdistinct from delay. A case illustration is provided to support the distinction be Results: Our findings support the hypotheses that youth who experience adverse childhoodexperiences show evidence of fragmentation, unevenness and delay in their consciencestage-attainment. We demonstrate proof of concept for conscience sensitive psychiatric assessmentin the youth-span. Conscience sensitive inquiries improve upon merely consciencerelevant interpretations by affording better appreciation of moral wounding, in turn settingthe stage for moral-imaginative efforts that elicit and make the latent values of the youthmore explicit. Conclusions: A conscience sensitive approach should be part of both psychiatric and generalmedical education, supported explicitly by clinical guidelines recommending consciencesensitive interview techniques that aim to acquire information aligned with current neurobiologicalterminology.