Traumatic brain injury and social competence among young male offenders.

Purpose: To investigate the prevalence of traumatic brain injury (TBI) among young incarcerated males and determine the extent of deficits in behavioural regulation, aggression, hopelessness, and perceived social support, compared to a control group of non-incarcerated males.Methods: Sixty-two young offenders and 58 university-based, gender-matched controls agreed to take part. We collected information on criminal history, risk taking behaviour, drug and alcohol abuse, and mental illness. In addition, we employed measures of brain injury, hopelessness, behavioural regulation, aggression, and perceived social support.Results: Just over 87% (n = 54) of offenders exhibited some level of TBI with over 31% (n = 17) reporting six or more injuries. Offenders with TBI exhibited poorer behavioural control (p < 0.001; M = 66.01 vs. M = 51.33; 95% CI -19.08 to -11.76), higher levels of aggression (p < 0.001; M = 101.19 vs. M = 69.39; 95% CI -38.31 to -27.17), and higher levels of hopelessness (p < 0.001; M = 5.65 vs. M = 2.55) when compared to controls with TBI. Severity of TBI correlated positively with behavioural regulation, aggression, and hopelessness.Conclusions: Greater recognition of the presence and consequences of TBI within the custodial estate is necessary if the needs of young offenders are to be adequately met. Young offenders with TBI experience heightened vulnerability and need rehabilitative input to support their time in prison and on their return to society.Implications for rehabilitationThe presence of TBI is under reported within offending populations, with many young offenders lacking awareness of their injury or its implications on their health and behaviour.Healthcare staff within the custodial estate should be trained to screen and assess cognitive, behavioural and emotional deficits which have arisen following TBI.Greater recognition of TBI within the custodial estate could improve the targeting of deficits and lead to rehabilitation programmes which address behavioural regulation difficulties.Rehabilitation of TBI deficits within, and on release from prison, has the potential to help reduce recidivism, leading to reduced costs for the criminal justice system and improved quality of life for young men.

Traumatic brain injury and abuse among female offenders compared to non-incarcerated controls.

OBJECTIVE: To examine the prevalence of traumatic brain injury (TBI) and past abuse experienced by adult female offenders. METHODS: Twenty-nine female offenders from a UK women's prison and twenty-nine age and gender matched university controls were recruited. In addition to demographic data, the Brain Injury Screening Index was utilized alongside the Childhood Trauma Questionnaire and the Abusive Behaviour Inventory. RESULTS: Approximately 79% (n = 21) of female offenders reported a history of TBI, with 38% (n = 8) reporting six or more injuries. However, only 28.5% of female offenders reporting injury (n = 6) believed they had sustained a brain injury. Prevalence of both childhood (n = 15, 51.7%), and partner (n = 19, 65.5%) abuse was also high among offenders. TBI Index scores correlated with past childhood and past partner physical abuse. Past mental illness, partner physical abuse, and number of convictions were predictive of greater TBI severity. CONCLUSION: This is the first European study to examine combined TBI and abuse among an exclusively female offender population. It suggests that TBI is as prevalent among incarcerated females as it is among males. The unique presentation of female offenders must be acknowledged if effective rehabilitation programs are to be implemented.

Misconceptions about traumatic brain injury among probation services.

PURPOSE: The prevalence of traumatic brain injury (TBI) among offender populations is significantly higher than among the general population. Despite this, no study has yet assessed the knowledge of members of the probation service surrounding TBI. METHOD: Knowledge was assessed among members of the Probation Board for Northern Ireland (PBNI) using a cross-sectional online version of the Common Misconceptions about TBI (CM-TBI) questionnaire. Mean total misconception scores, along with scores on four subdomains (recovery, sequelae, insight, and hidden injury) were calculated. Analysis of variance was used to explore differences in misconceptions based on the collected demographic information. RESULTS: The overall mean percentage of misconceptions for the group was 22.37%. The subdomain with the highest rate of misconceptions (38.21%) was insight into injury which covered misconceptions around offenders' self-awareness of injuries. Those who knew someone with a brain injury scored significantly higher in the CM-TBI total score, F(1,63) = 6.639, p = 0.012, the recovery subdomain, F(1,63) = 10.080, p = 0.002, and the insight subdomain, F(1,63) = 5.834, p = 0.019. Additionally, significant training deficits around TBI were observed among the probation service. CONCLUSIONS: This study is the first of its kind to examine the level of understanding around TBI within probation services. The findings reflect potential barriers to identification and rehabilitation of TBI for offenders coming into contact with the criminal justice system. A lack of identification coupled with misconceptions about TBI could lead to inaccurate court reporting with a subsequent impact on sentencing. Implications for Rehabilitation Despite being one of the first points of contact for offenders entering the criminal justice system, members of the probation service reported having no formal training on traumatic brain injury (TBI). The subdomain with the highest rate of misconceptions (insight into injury) revealed an over-reliance on survivors of brain injury to identify, understand, and communicate the extent and severity of their injuries. Probation service personnel require training on TBI to improve awareness of the potential outcomes of the condition, ensuring injuries are identified and referred to the appropriate care pathways.

Technological aids for the rehabilitation of memory and executive functioning in children and adolescents with acquired brain injury.

BACKGROUND: The use of technology in healthcare settings is on the increase and may represent a cost-effective means of delivering rehabilitation. Reductions in treatment time, and delivery in the home, are also thought to be benefits of this approach. Children and adolescents with brain injury often experience deficits in memory and executive functioning that can negatively affect their school work, social lives, and future occupations. Effective interventions that can be delivered at home, without the need for high-cost clinical involvement, could provide a means to address a current lack of provision.We have systematically reviewed studies examining the effects of technology-based interventions for the rehabilitation of deficits in memory and executive functioning in children and adolescents with acquired brain injury. OBJECTIVES: To assess the effects of technology-based interventions compared to placebo intervention, no treatment, or other types of intervention, on the executive functioning and memory of children and adolescents with acquired brain injury. SEARCH METHODS: We ran the search on the 30 September 2015. We searched the Cochrane Injuries Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), EMBASE Classic + EMBASE (OvidSP), ISI Web of Science (SCI-EXPANDED, SSCI, CPCI-S, and CPSI-SSH), CINAHL Plus (EBSCO), two other databases, and clinical trials registers. We also searched the internet, screened reference lists, and contacted authors of included studies. SELECTION CRITERIA: Randomised controlled trials comparing the use of a technological aid for the rehabilitation of children and adolescents with memory or executive-functioning deficits with placebo, no treatment, or another intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed titles and abstracts identified by the search strategy. Following retrieval of full-text manuscripts, two review authors independently performed data extraction and assessed the risk of bias. MAIN RESULTS: Four studies (involving 206 participants) met the inclusion criteria for this review.Three studies, involving 194 participants, assessed the effects of online interventions to target executive functioning (that is monitoring and changing behaviour, problem solving, planning, etc.). These studies, which were all conducted by the same research team, compared online interventions against a 'placebo' (participants were given internet resources on brain injury). The interventions were delivered in the family home with additional support or training, or both, from a psychologist or doctoral student. The fourth study investigated the use of a computer program to target memory in addition to components of executive functioning (that is attention, organisation, and problem solving). No information on the study setting was provided, however a speech-language pathologist, teacher, or occupational therapist accompanied participants.Two studies assessed adolescents and young adults with mild to severe traumatic brain injury (TBI), while the remaining two studies assessed children and adolescents with moderate to severe TBI. Risk of biasWe assessed the risk of selection bias as low for three studies and unclear for one study. Allocation bias was high in two studies, unclear in one study, and low in one study. Only one study (n = 120) was able to conceal allocation from participants, therefore overall selection bias was assessed as high.One study took steps to conceal assessors from allocation (low risk of detection bias), while the other three did not do so (high risk of detection bias). Primary outcome 1: Executive functioning: Technology-based intervention versus placeboResults from meta-analysis of three studies (n = 194) comparing online interventions with a placebo for children and adolescents with TBI, favoured the intervention immediately post-treatment (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.66 to -0.09; P = 0.62; I(2) = 0%). (As there is no 'gold standard' measure in the field, we have not translated the SMD back to any particular scale.) This result is thought to represent only a small to medium effect size (using Cohen's rule of thumb, where 0.2 is a small effect, 0.5 a medium one, and 0.8 or above is a large effect); this is unlikely to have a clinically important effect on the participant.The fourth study (n = 12) reported differences between the intervention and control groups on problem solving (an important component of executive functioning). No means or standard deviations were presented for this outcome, therefore an effect size could not be calculated.The quality of evidence for this outcome according to GRADE was very low. This means future research is highly likely to change the estimate of effect. Primary outcome 2: MemoryOne small study (n = 12) reported a statistically significant difference in improvement in sentence recall between the intervention and control group following an eight-week remediation programme. No means or standard deviations were presented for this outcome, therefore an effect size could not be calculated. Secondary outcomesTwo studies (n = 158) reported on anxiety/depression as measured by the Child Behavior Checklist (CBCL) and were included in a meta-analysis. We found no evidence of an effect with the intervention (mean difference -5.59, 95% CI -11.46 to 0.28; I(2) = 53%). The GRADE quality of evidence for this outcome was very low, meaning future research is likely to change the estimate of effect.A single study sought to record adverse events and reported none. Two studies reported on use of the intervention (range 0 to 13 and 1 to 24 sessions). One study reported on social functioning/social competence and found no effect. The included studies reported no data for other secondary outcomes (that is quality of life and academic achievement). AUTHORS' CONCLUSIONS: This review provides low-quality evidence for the use of technology-based interventions in the rehabilitation of executive functions and memory for children and adolescents with TBI. As all of the included studies contained relatively small numbers of participants (12 to 120), our findings should be interpreted with caution. The involvement of a clinician or therapist, rather than use of the technology, may have led to the success of these interventions. Future research should seek to replicate these findings with larger samples, in other regions, using ecologically valid outcome measures, and reduced clinician involvement.

Traumatic brain injury and co-occurring problems in prison populations: A systematic review.

BACKGROUND: A growing body of epidemiological research suggests high rates of traumatic brain injury (TBI) in prisoners. The aim of this review is to systematically explore the literature surrounding the rates of TBI and their co-occurrences in a prison population. METHODS: Six electronic databases were systematically searched for articles published between 1980-2014. Studies were screened for inclusion based on pre-determined criteria by two researchers who independently performed data extraction. Study quality was appraised based on a modified quality assessment tool. RESULTS: Twenty-six studies were included in this review. Quality assessment ranged from 20% (poor) to 80% (good), with an overall average of 60%. Twenty-four papers included TBI prevalence rates, which ranged from 5.69-88%. Seventeen studies explored co-occurring factors including rates of aggression (n = 7), substance abuse (n = 9), anxiety and depression (n = 5), neurocognitive deficits (n = 4) and psychiatric conditions (n = 3). CONCLUSIONS: The high degree of variation in TBI rates may be attributed to the inconsistent way in which TBI was measured, with only seven studies using valid and reliable screening tools. Additionally, gaps in the literature surrounding personality outcomes in prisoners with TBI, female prisoners with TBI and qualitative outcomes were found.