ABSTRACT
Objective: This study explores the intricate relationship between cognitive functioning and aggression, with a specific focus on individuals prone to reactive or proactive aggression. The purpose of the study was to identify important neuropsychological constructs and suitable tests for comprehending and addressing aggression. Methods: An international panel of 32 forensic neuropsychology experts participated in this three-round Delphi study consisting of iterative online questionnaires. The experts rated the importance of constructs based on the Research Domain Criteria (RDoC) framework. Subsequently, they suggested tests that can be used to assess these constructs and rated their suitability. Results: The panel identified the RDoC domains Negative Valence Systems, Social Processes, Cognitive Systems and Positive Valence Systems as most important in understanding aggression. Notably, the results underscore the significance of Positive Valence Systems in proactive aggression and Negative Valence Systems in reactive aggression. The panel suggested a diverse array of 223 different tests, although they noted that not every RDoC construct can be effectively measured through a neuropsychological test. The added value of a multimodal assessment strategy is discussed. Conclusions: This research advances our understanding of the RDoC constructs related to aggression and provides valuable insights for assessment strategies. Rather than suggesting a fixed set of tests, our study takes a flexible approach by presenting a top-3 list for each construct. This approach allows for tailored assessment to meet specific clinical or research needs. An important limitation is the predominantly Dutch composition of the expert panel, despite extensive efforts to diversify.
ABSTRACT
BACKGROUND: Acquired brain injury (ABI) is a major health problem, often with negative effects on behaviour and mental health as well as cognition. Prevalence of ABI is exceptionally high among offenders and increases their re-offending risk. Information on risk factors for ABI and its outcomes among offenders that could guide effective treatment for them is, nevertheless, scarce and dispersed. However, there is a more substantial literature about the general population that could inform work with brain-injured offenders, especially when selecting for samples or subgroups with similar relevant characteristics, such as lower socio-economic status (SES), pre-injury lower tested intelligence score (<85) and pre-injury mental health problems. AIMS: To explore brain injury data from non-offender samples of otherwise similar socio-economic and mental health and ability characteristics to offenders then, first, to describe their untreated outcomes and, secondly, outcomes after frequently used interventions in these circumstances, noting factors associated with their effectiveness. METHOD: Three databases were systematically searched for the years 2010-2022; first, using terms for brain injury or damage and cognitive (dys)function, mental health or quality of life. Second, in a separate search, we used these terms and terms for interventions and rehabilitation. In the second review, studies were selected for clear, distinguishable data on age, sex, SES and lifestyle factors to facilitate inferences for offenders. A narrative analytical approach was adopted for both reviews. RESULTS: Samples with characteristics that are typical in offender groups, including lower SES, lower pre-injury intelligence quotient (<85), prior cognitive impairments and prior mental health problems, had poorer cognitive and behavioural outcomes following ABI than those without such additional problems, together with lower treatment adherence. With respect to treatment, adequate motivation and self-awareness were associated with better cognitive and behavioural outcomes than when these were low or absent, regardless of the outcome measured. CONCLUSIONS: More complex pre-injury mental health problems and social disadvantages typical of offenders are associated with poorer post-brain injury recovery. This paper adds to practical knowledge by bringing together work that follows specific outcome trajectories. Overall, succesful ABI-interventions in the general population that aim at pre-injury difficulties comparable to those seen among offenders, show that personalising injury-specific treatments and taking account of these difficulties, maximised positive outcomes.
ABSTRACT
Background and Aims: The prevalence of acquired brain injury (ABI) in offender populations appears much higher than in the general population, being estimated at 50% compared to 12%, respectively. Taking into account ABI-related cognitive and social impairments or behavioral changes in forensic treatments might be relevant and may improve treatment outcomes. The aim of the current review is to summarize and integrate the literature on psychological interventions or treatments for consequences of ABI in the forensic setting. Reviewing this literature could provide crucial information for improving treatment options for offenders with ABI, which may contribute to reducing recidivism. Methods: The PubMed/MEDLINE, PsychInfo, CINAHL, COCHRANE, and Web of Science databases were searched for studies in adult offenders with ABI that evaluated the effect of psychological interventions with a focus on ABI-related impairments and recidivism. Results: This review identified four intervention studies that met the inclusion criteria. These included an adult population (≥18-year-old) in a forensic setting (given the focus of the current review on treatment, defined here as an environment in which offenders are treated while being incarcerated or as outpatients), non-pharmacological treatments and were published in English or Dutch between 2005 and 2020. All studies reported some positive effects of the intervention on interpersonal behavior, cognition and recidivism. The aspects of the interventions that seemed most beneficial included personalized treatment and re-entry plans, support for the individual and their environment and psychoeducation about the effects of ABI. Discussion: Although positive effects were reported in the studies reviewed, all studies had methodological limitations in terms of sample size, study design and outcome measures which affects the strength of the evidence. This limits strong conclusions and generalizability to the entire offender population. Conclusion: Despite high prevalence of ABI in offender populations, interventions in forensic settings seldom address the effect of ABI. The few studies that did take ABI into account reported positive effects, but those results should be interpreted with caution. Future studies are warranted, since this does seem an important venue to improve treatment, which could eventually contribute to reducing recidivism.
