Brain Injury & Crime

Question 1

Criminated Behaviour

Answer 1

• ROSS & FABIANO (1985); “offenders cope poorly w/life via ‘cognitive deficit’ exhibition”; 1/4 UK inmates between 15-24y
• IE. lack of impulse control; poor emotion control/problem solving; rigid/inflexible thinking; lack of consequence recognition; inability to shift perspectives via empathy/theory of mind)

Question 2

CB: Anti-Social Behaviour

Answer 2

• predicted by:
  1. LOW SELF CONTROL
  2. HYPERACTIVITY
  3. SENSATION SEEKING

Question 3

CB: Judicial Bias

Answer 3

• other than “criminal” behaviour, status offences (ie. begging/loitering/sexual exploitation/homeless curfew break) show justice system process as exacerbated by poverty
• causes lack of legal assistance/ID documentation access to impoverished

Question 4

CB: Young Re-offending

Answer 4

• FARRINGTON et al (2006); extremely high, particularly when vulnerable; prolific offenders usually “early starters”; later commit 77% of crime; 71.9% re-conviction chance within less than a year
• could be explained via MATURATION

Question 5

CB-YR: Maturation

Answer 5

• LENROOT & GIEDD (2006); grey/white matter subcomponents undergo dynamic adolescent changes
• axonal pruning = first 2 years post birth; synaptic pruning = adolescence
• wave peaks of pruning show complexity of underlying emotional/cognitive function changes
• neurochemical changes affect dopinergic systems

Question 6

CB-YR: Maturation (Teenagers)

Answer 6

• morphological changes affect mesolimbic structures; ie. nucleus accumbens maturity = heightened reward sensitivity/act for reward; dorsolateral prefrontal cortex can hardly keep up; axonal systems rewired (ie. circuitry impulse/judgement control)
• social brain also evolves; re-salience of sensory stimuli to sexual motivation/copulatory behaviour via phylogenetically programmed recreational procreation (aka. romance) = x4 more likely to engage in risks w/other teens/”crush” present
• so adult reasoning + heightened reward demand = poor consequence consideration/low capacity of buffering immediate influences = RISKY DECISION MAKING

Question 7

Traumatic Brain Injury

Answer 7

• injury/violence 2 leading death causes in 10-24y
• TBI (ie. falls/assaults) largest cause of death/disability in children/young adults WORLDWIDE
• 12% adults MAY have TBI
• 5-5-5 = under 5y in poorest 5% areas x5 more likely to be injured to TBI point
• highest annual occurrence in USA/Canada region; highest severity/burden of TBIs in South-East Asian/Western Pacific region

Question 8

TBI: Paediatric

Answer 8

• road accidents; most common (39%); unspecified causes (25%); falls (25%)
• infant/child mortality related in low income countries
• males x1.8 times more likely than females
• 7.3/100 deaths in pTBI cases; 1/4 experienced normal function reduction on discharge
• pTBI more likely in formative years in LICs than teen

Question 9

TBI: Mild/Moderate-Severe

Answer 9

• 30min loss of consciousness
• external mechanical force w/rotational sheer force insults brain (ie. blow to the head aka. crash stop on pillow, assault, fall)
• frontal/temporal lobes most common injury sites
• MILD ONLY: requires more “dosage” (ie. repeated injury); problems more likely

Question 10

TBI: Paediatric Personality Change

Answer 10

• M-STBI = 20%; MTBI = 80%
• 4/10 occurrence chance (though often delayed)
• affects:
  COGNITION (attention/memory/sociability/execution)
  BEHAVIOUR (dis-inhibition/anger)
  MOOD (depression/anxiety)
• injury = impulsivity/poor social skills/externalising behaviour = disrupted prosocial life role/increased risk of crime involvement

Question 11

TBI: The Social Brain

Answer 11

• RYAN et al (2013); TBI involves anterior brain region pathology linked w/social cognition
• diffuse axonal injury (DAI) disrupts white matter formation/connectivity between “social-brain” network (ie. superior temporal sulcus/fusiform gyrus/temporal pole/medial prefrontal cortex/orbitofrontal cortex/amygdala/temporoparietal junction/inferior parietal cortex)

Question 12

TBI: Mental Health/Conduct Disorders Post Injury

Answer 12

• increased risk of: elevated psychological distress/attempted suicide/counsel seeking/prescribed psych medication/victimisation via (cyber) bullying/threat w/weapon/violent and nonviolent misconduct behaviour

Question 13

CB-TBI: Risk of Crime Post Injury

Answer 13

LICHTENSTEIN et al (2011); epilepsy + TBI w/violent crime (ie. assault/homicide) associations; huge 44k+ sample
- TBI = 8.8% committed violent offence post diagnosis; statsig increase when compared w/controls; attenuated when compared w/unaffected siblings

Question 14

CB-TBI: Paediatric Risk of Crime Post Injury

Answer 14

• MCKINLAY et al (2010); longitudinal birth cohort (1265) in urban New Zealand; hospitalised/non-hospitalised/no injury groups; 15-21y; self-reported crimes
• TBI statsig more likely to get arrested w/evidence of school problems/teenage expulsion within 2 years
• WILLIAMS & CORDEN et al (2010); 65% TBI history in UK youth offender; +3 TBI = more violence; related directly w/offence count too
• CHITSABESAN et al (2015); 93 male 15-18y UK offenders; 83% = TBI; 44% w/ ongoing symptoms; CHAT session revealed high ADHD/self-harm/suicide risk/care experience

Question 15

CB-TBI: Lack of Support

Answer 15

• KENT et al; poor parental supervision associated w/TBI reactive aggression in young offenders; parental interventions could reduce disabling effects of TBI in adolescents/contact w/law

Question 16

CB-TBI: Neurodevelopmental Disorders in Detained Adolescents

Answer 16

• BORSCHMANN et al (2020); young offender (YO) characteristics associated w/ amplification by pre-existing issues (ie. ADHD/ASD/Foetal Alcohol Spectrum Disorder (FASD)/intellectual disability/TBI)
• inattention/hyperactivity (12% YO; 2% NON) = ADHD/TBI
• speech/hearing/language impairment affecting academics (65% YO; 5% NON) = TBI/FASD/ADHD/ASD
• reduced height/weight/head/face or memory/cognition/mortor skill deficits (21% YO; 5% NON) = ASD/TBI
• IQ/adaptive functioning deficit (32%YO; 4% NON) = FASD/TBI/ASD
• disruption to normal brain functionality (50% YO; 15% NON) = TBI
• TBI by far most common factor

Question 17

CB-TBI: Female Offenders

Answer 17

• 65% show signs of brain injury; of these, 62% via domestic violence; 33% sustained prior to first offence
• vulnerable via abuse history/problematic substance misuse; TBI history must be included in justice policy to bring attention to interventions reducing mental health morbidity
• dose-response between TBI rate/loss of consciousness/deficit skill count
• female TBI offenders misjudge social situations/struggle in groups/heightened suicide risk

Question 18

CB-TBI: Female TBI Traits

Answer 18

• CUSIMAO et al; emotionally/physically traumatised foster kids w/TBI; behaviour involves:
  DANGEROUS COPING MECHANISMS (49%); ie. drugs/alcohol
  EMOTIONAL TRAUMA NORMALISATION (81%); ie. rape/sexual assault
  ADVERSE EXPERIENCE NORMALISATION (66%); ie. not having parents

Question 19

CB-TBI: Reduced Vulnerability

Answer 19

• kids most likely to experience TBI are least likely to receive support; problems are grown INTO, not out of
• importance of parental/carer support and preventative interagency working (ie. education/health/social justice/policing)
• improved inclusion necessary to reduce exclusion; kids must be worked with to deflect/divert experiences
• kids at risk of system entry must be found for via welfare law, where TBI is accounted for in regards to system entry; maturity must also be remembered; if in system, adopt trauma informed approach/programme

Question 20

CB-TBI: Young TBI Offender Upon Arrest

Answer 20

• HUGHES et al (2019)
• disorientated/stressed/overwhelmed/misunderstanding rights/falsely impulsive confessions/language difficulty w/questions/inappropriate body language/”rudeness”
• misinterpretation of attitude affects judge’s ruling
• police trained to recognise TBI signs via screening tools; new application of gatekeeping role

Question 21

CB-TBI: Police Awareness

Answer 21

• most severe TBI associated w/complex social needs linked w/ongoing symptoms
• BISI useful screening tool for police; increases awareness and confidence when working w/neurodivergent spectrum
• further support for TBI young offenders/police could reduce impulsive behaviour/improve rehabilitative outcomes/ensure proper assessment/necessary diagnosis

Question 22

CB-TBI: “Secure…”

Answer 22

STAFF w/appropriate intervention skills.
EMOTIONALLY resilient staff.
CARE FOR STAFF via supervision/support.
UNDERSTANDING establishment wide for child development/attachment/trauma/key theories.
REFLECTIVE SYSTEM of staff aware of trauma at all levels
EVERY INTERACTION MATTERS as the whole system must approach.

Question 23

CB-TBI: “Secure Stairs” Development

Answer 23

• behaviour = symptom; skewed development = cause
• development must be addressed to get rid of root issue; team formulation as powerful strategy for shifting cultures to psychosocial models/understanding of individual stories

Question 24

CB-TBI: “… Stairs”

Answer 24

SCOPING; situation assessed w/clarity around child’s life narrative.
TARGETS; staff, child and “home” agree on goals within establishment.
ACTIVATORS; children have psycho/bio/social developmentally informed multi-factorial formulation clarifying issues.
INTERVENTIONS; specialist/core; formulation/risk assessment driven; tailored to child’s risks/needs/content/intensity/timing.
REVIEW/REVISE; IRL outcome/goals monitored by home/establishment according to frequency/severity of behaviour; regular multi-disciplinary reviews.
SUSTAIN; sustainability planning from outset; maintenance of goals upon release and transition.

Question 25

CB-TBI: Key Takeaways

Answer 25

• sometimes young offenders don’t have TBI, but MOST DO; not specialist population, THE population
• staff must have qualities/qualifications/skills/support to work in a meaningful way to provide rehabilitation
• multi-agency working is vital for properly integrated judicial systems
• judicial TBI/neurodivergence screening is possible:
  PRE-CUSTODY (DEFLECT)
  CUSTODY (DIVERT)
  SENTENCING (COMMUNITY ORDERS)
  EXIT (SOCIAL RE-ENTRY)