Pediatric traumatic brain injury and antisocial behavior: are they linked? A systematic review.

Purpose: Despite growing evidence supporting a link between pediatric traumatic brain injury (TBI) and antisocial behavior, little work has rigorously evaluated this. This review aimed to explore systematically previous literature on the association between TBI before the age of 19 and severe behavioral problems such as violence, aggression and assault. Methods: All articles published from 1990 to 2018 were searched using four major databases, alongside manual searching and cross-referencing. Results: Sixteen articles met the eligibility criteria. Overall, they supported an association between pediatric TBI and antisocial behavior. Factors were identified that might influence this link, such as, for example, TBI severity and substance use. Conclusions: The review identified several issues in the current literature, highlighting key areas for improvement. It is imperative that more attention is paid to gathering detailed information regarding the temporal sequencing of events and TBI severity; evaluating the contribution of biopsychosocial variables co-occurring with TBI and antisocial behavior; disentangling which outcomes are specific to TBI versus any injury. The review has implications for the health and justice systems; regardless of whether TBI is the cause versus a contributing factor to antisocial behavior, increased awareness of their association could lead to more comprehensive assessments, tailored interventions and effective sentencing.