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Keeping Children in Society:
Youth offending and
aquired brain injury.
Dr James Tonks & Prof. Huw Williams.
*School of Psychology
University of Exeter
UK Brain Injury
Centre for Clinical Neuropsychological Research (CCNR)
Building the bridge between academic and clinical neuropsychology
Brain development in children and adolescents: Insights from anatomical magnetic resonance imaging
Rhoshel K. Lenroota and Jay N. Giedd (2006)
Yates, Williams et al. 2006, JNNP:
Attendance rates for moderate to severe head injury per
100 000 population for each 5 year age band by sex and area residence (GCS under 12).
Nb. Rates of TBI (across all severities) in males across severities are given as between 5% to 24%
250-450 per 100,000 across all severities (US/UK) - 80% approx are MILD
Brain Areas that typically Injured…
“poor anger management (irritability and impulse control are common” (Hawley et al. 2003)
Problems: Attention, working memory, executive control disinhibition etc.
lack of “moral” reasoning.
(Damasio 1996; Anderson, Bechara, Damasio, Tranel, & Damasio, 1999; Hanks, Temkin, Machamer & Dikmen 1999; Levin & Hanten, Powell, 2004).
Often there is inappropriate social behaviour
the most common and disruptive issue (Henry, Phillips, Crawford, Theodorou & Summers, 2006).
may not be evident until adolescence (Lishman, 1998; Teichner & Golden, 2000)
point at which ‘delayed costs’ of earlier ABI are expressed (see Anderson 2008 re: neuroplasticity & crowding effects)
may occur in isolation from cognitive deficits (Anderson, Northam, Hendy & Wrennall, 2001
persisting personality and emotional deficits – due to de-coupling of cognition and emotion - has been described by Damasio (1994), as “acquired sociopathy”” –
Max et al, 2001: prospective study of 94 children with TBI aged 9 at time of injury
OPC in 57% of severe TBI sample (22/37) & 5% mTBI (3/57)
labile and aggressive OPC subtypes most common - 3-4 x more
Problems MIGHT also occur post MTBI
Wrightson, McGinn and Gronwall (1995)
Limond et al. 2009
follow up of moderate-severe and (mostly) complicated MTBI showed persisting disabilities at 1 year –
>lack of pro-social behaviour and emotional symptoms
Hessen et al, 2007 (BI) – 23 year follow up study of MTBI –
role of (longer) PTA as a predictor of outcomes – SUBTLE neuropsych impairments (memory)
Long-term behavioural outcomes of pre-school mild traumatic brain injuryA. McKinlay1,*, R. C. Grace1, L. J. Horwood2, D. M. Fergusson2, M. R. MacFarlane (2010)
Theory of Mind (ToM):
Emotion reading skills are developed across the span of childhood into late adolesecence.
From birth Intrinsic bipolar emotional related to arousal - distress and pleasure (Schaffer, 2003).
6? months - primary emotions - surprise, interest, anger, sadness and fear
From 1 yr Girls ‘empathising’ , by 3 Theory of Mind - boys slightly later
By 7-9 Complex theory of mind (e.g. Detecting faux pas) (see Baron-Cohen et al, 1999).
Continues to develop in late adolescence (14-17 yrs (ToM) (Dumontheil et al in press)
Development is non-linear - rapid development associated with growth of the prefrontal cortex, (see Tonks et al. 2009)
We were both, in our own way, manipulators — good at grasping the feelings of others and instinctively playing on them.
Tony Blair, as reported in the Guardian, 1/9/10
Piaget’s Four Stages Of Cognitive Development.
Epstein’s Growth Spurts In Brain Growth.
Birth to 18-24 months. Sensorimotor Stage
30% increase in brain weight by 1 ½ years.
Approx 2 to 6 years. Preoperational Stage.
Approx 2 to 4 years, 5 to 10%
Approx 7 to 11 years Concrete Operational Stage.
Approx 6 to 8 years, 5 to 10%
12 years + Formal Operational Stage
12 to 14 years 5 to 10 % .
Between ten and eleven the difference was highly significant (F(1,61) = 9.573 p<.003). No other significant differences were found.
Brain injury will affect lots of social abilities.
Is she happy, sad, angry,
Frightened, or normal/ neutral?
ANCOVA (FAS): F(1,84)=10.992 p<.001
Peer relationships after ABI?
positive peer relationships are an essential component of well-being
social isolation from peers poses a considerable threat to children’s mental health in both the short and long-term (Guralnick, 2006).
absence of peer relationships undermines self-esteem and deprives children of important pleasurable experiences, contributing to depression Windle (1992)
137 Healthy Childen (controls), 27 children using the Child and Adolescent Mental Health Services (CAMHS), 40 children with ABI, (All children aged 8 to 17 years old).
Strengths and Difficulties Questionnaire (SDQ) Parent version (Goodman, 1999)
Mean SDQ parent scores for emotional distress for healthy age-matched controls, CAMHS children and children with ABI.
Impairment to social skills + Loss of peer relationships= Vulnerability.
Vulnerability and Resilience
James & Huw’s equation
Family disruption, Depression & Anxiety
McKinlay A., et al.“Are children who experience Traumatic Brain Injury more likely to engage in criminal behaviour during their adult lives?” 33rd ASSBI(Abstract) Brain Impairment. 2010
453 males held in HMP Exeter
196 aged between
18 and 54 years
(43% response rate)
sentenced or remanded
Average age at 1st
21 Years – Non-TBI
16 years - TBI
192 young male offenders ranging from 11 to 19 years of age (M = 16.63, SD = 1.07 years) (response rate of 98%).
The mean number of convictions 6.95 (SD 4.56).
Offences of violence accounted: 27.1%
shoplifting, theft, and robbery: 25.5%
drug offences: 11.6%
Williams, Cordan et al (in press, Neuropsychological Rehabilitation):
65% reported a history of “head injury”
main category of injury was violence (57.6%)
With falls “on drugs” being second most common “criminal cause”.
MTBI with a LOC of up to 10 minutes & Moderate - severe TBI made up 46% of the overall sample.
Repeated MTBI were also very frequent
nearly twice as many multiple MTBI compared to single MTBIs
Frequency of cannabis use – (once a month –to – everyday)
“particularly violent crime, is likely to result from complex interaction of factors such as genetic pre-disposition, emotional stress, poverty, substance abuse and child abuse”
Tom McMillan – Head Injury & Offending
children are most likely to be injured & least likely to get support
EVEN if TBI is a marker, it may be an important one to pick up!
Systematic neuro-rehabilitation MAY BE A MEASURE OF CRIME PREVENTION IN IN ITSELF…
“sleeper effects” (“crowding” as part of neurplasticity)– esp. relevant to socio-emotional functions at transition to adolescence – important to monitor
The delivery of services to such groups would therefore require close cooperation between health, social and educational systems.
Particularly focus on parenting of at risk children -
http://www.incredibleyearswales.co.uk/ & see Gardner, Hutchings, Bywater & Whitaker, 2010 J. Clin Child & Adol Psych. – use of <: in multi agency work
“pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty”