Lecture 7 - Traumatic Brain Injury and Violence

Question 1

What is the function of the prefrontal cortex?

Answer 1

Decision making - it is emotion based and usually unconscious

Question 2

What is the function of the right hemisphere?

Answer 2

Fight or flight

Question 3

What is the function of the left hemisphere?

Answer 3

Conscious decisions

Question 4

What happens after a brain injury?

Answer 4

When brain injury happens you may lack understanding of your own and others actions and emotions. Further, you may misinterpret others emotions.

Question 5

What thinking problems do offenders have?

Answer 5

• poor impulse control
• poor at controlling emotions
• lack problem solving skills
• rigid and inflexible thinking
• don’t recognising consequences of behaviour
• can’t see another person’s perspective

Question 6

What is the crime risk period?

Answer 6

About a quarter of England & Wales inmates are 15-24 yrs of age

Question 7

Why is there a crime risk period in teens?

Answer 7

During age development, the brain is forming connections with other parts. Miolin sheath is being laid down to protect it from bumps around 15-17 years. Therefore, during this critical period, the brain is very fragile and likely to have long term problems after injury.

Limbic system (middle) connects to decision making system at around 10 years (matures at a young age of around 13/14). Prefrontal cortex to manage feelings is yet to be developed.

The teenage brain has an adult-like ability when it comes to reasoning however the need for reward is heightened (known as meso-limbic “reward sensitivity”). So it’s harder to show restraint or consideration of consequences of behaviour. This is especially the case when with peers.

Question 8

What does the Lancet Neurology 2022 Commissioned Review say about brain injury?

Answer 8

• Violence is the third most common cause of TBI (road accidents and falls being biggest cause of TBI)
• In the CENTERTBI Core study and in TRACK- TBI, 6··7% (293/4388 and 171/2537 respectively) of injuries were caused by violence.
• In the CENTER-TBI China Registry, which collected data only on hospitalised patients, 13% (1714/13138) suffered TBI from violence.

Question 9

What is the role of intimate partner violence on TBI in women?

Answer 9

• When compared to other causes of TBI due to interpersonal violence, intimate partner violence far more commonly affects women (75% vs 5%)
• more often results in severe TBI (27% vs 5%),
• is associated with nearly three times the mortality (14% vs 5%).

Question 10

How do children with acquired brain injury perform compared to non-injured children?

Answer 10

Children with ABI perform significantly worse on theory of min tasks compared to non-injured children.
- They find is more difficult to read other people and therefore fall behind their peers
- Often have problems with remembering things as well as fitting in with people - knowing who to and not to approach

Question 11

Mental health issues in youth post TBI…

Answer 11

Greater odds of:
- elevated psychological distress (AOR = 1.52)
- Attempting suicide (AOR = 3.39)
- being victimized through bullying at school (AOR = 1.70), being cyber-bullied (AOR = 2.05)
- being threatened with a weapon at school (AOR = 2.90)

Question 12

Are people who experienced TBI more like to be violent?

Answer 12

• traumatic brain injury cases, 2,011 individuals (8.8%) committed violent crime after diagnosis
• compared with population controls (n = 229,118 (5,504 controls – 2.5%)),

Question 13

What did Williams, Cordan et al, 2010 find in their study of TBI in young people incarcerated in the UK?

Answer 13

• 65% history of “head injury”
• MTBI with LOC up to 10 minutes & moderate-severe TBI = 46% of overall sample
• 16.6% moderate to severe injury

Question 14

What is the comorbidity of neurodevelopmental disabilities?

Answer 14

Neurodevelopmental disorder (NDD) – deficits in women in prison are far more common than the general population.

• Deficits in attention & concentration skills
• Deficits in social & communication very common among female offenders

Question 15

What is the Devon & Cornwall Police TBI screening project?

Answer 15

• Screening for traumatic brain injury in people in contact with the Devon & Cornwall police pathfinder & Offender Management teams
• Showed elevated levels of TBI, memory problems, and a role for “reminding” and support to engage in services to reduce offending

Question 16

What does TBI in offenders typically lead to?

Answer 16

• Poorer engagement in treatment
• Greater levels of infraction
• Higher level of re-conviction
• Often in areas of violence
• Links to mental health problems – trauma – especially e.g. PTSD in women

Question 17

What did Ray and Richardson find about TBI in offenders?

Answer 17

• 151 inmates
• Post release 1.6 higher rate of recidivism