Traumatic Brain Injury and Juvenile

Traumatic Brain Injury and Juvenile Offending: Complex Causal Links Offer Multiple Targets to Reduce Crime


TRAUMATIC BRAIN INJURY (TBI) is a leading cause of death and disability in children and young adults1 and is widely acknowledged to pose major global health and social challenges.2 This article deals with the accumulating evidence that TBI is associated with criminal behavior.3 This topical issue contains studies that demonstrate that children who survive TBI are likely to become adults with behavioral problems,4 that young people with TBI being adjudicated may have poor lev-els of communicative ability5 that could place them at a disadvantage in legal proceedings, that the rates of TBI are very high in offender groups,6 and that TBI is linked to psychiatric disturbance—particularly self-harm.7 These studies indicate that TBI is an en-demic chronic health condition in offender popula-tions and may well be a factor that contributes to the risk of criminal behavior. These studies raise the trou-bling possibility of a “double hazard” by which chil-dren who are socially disadvantaged and who experi-ence a TBI are at increased risk of worse outcomes.8 Furthermore, poor social-communication skills may in-crease the chances of externalizing behaviors that even-tuate in criminal acts such as aggression against others. In this article, we argue that screening for, and man-aging, the effects of TBI may improve the well-being of affected young offenders and—potentially—reduce

crime.

TBI AND CRIME

The links between TBI and criminal behavior are complex. Young people who offend likely do so for many reasons—genetics, disadvantage, abuse, antisocial personality, peer pressure, among others. It is difficult to

This work was partially funded by the Barrow Cadbury Trust. Dr Williams thanks Ms Katya Whitmarsh Williams for comments on action points

The authors declare no conflicts of interest.

DOI: 10.1097/HTR.0000000000000134


identify a clear causal link between TBI and offending. Adolescence is marked by increased “risk taking” and is thus a “life stage” during which risky behavior may foster a drift toward criminal action that may persist throughout a lifetime.9 Traumatic brain injury is more common among young people who take risks, especially in adolescence. Therefore, TBI may be coincidental to such risk taking, that is, those who offend may do so whether or not they sustain a TBI.

However, it does appear that TBI alters one’s life tra-jectory so as to increase the chances of offending. In a Finnish birth cohort study of approximately 12 000 sub-jects, a TBI during childhood or adolescence was associ-ated with a 4-fold increased risk of mental disorder, with coexisting offending in adult males.10 Crime histories tended to occur following TBI. Even more compelling evidence for links between TBI and crime come from a Swedish total population data linkage study. Fazel et al11 showed that 8.8% of those with TBI commit-ted violent crime compared with 3% of controls. Of note, risk was still greater among TBI cases than among siblings who presumably experienced the same social and environmental conditions as their related offender. Furthermore, a history of loss of consciousness among offending youth has been linked to persistent, rather than adolescent-limited, offending.12

Once a person’s life course is on a downward trajec-tory, with an increased likelihood of incarceration, does a TBI matter? It certainly matters in venues where jus-tice systems lack resources to recognize or manage TBIs. Studies from across the world have shown that the rate of TBI is much greater—3 to 8 times as high—in offender populations than in nonoffender groups.6 Studies have also shown that about half of young offenders have a history of loss of consciousness, with repeated injuries being very common.13 Traumatic brain injury in of-fenders has been associated with higher rates of infrac-tions while in custody, higher levels of reoffending, and engagement in violent crimes.9,14–18 It would therefore


appear that managing the effects of TBI may be impor-tant both for improving engagement in forensic rehabil-itation and for limiting recidivism.

Hasil (Bahasa Indonesia) 1:

Cedera otak traumatis dan menyinggung remaja: link kausal kompleks menawarkan beberapa target untuk mengurangi kejahatan CEDERA OTAK TRAUMATIK (TBI) adalah penyebab utama kematian dan Cacat dalam adults1 anak dan remaja dan secara luas diakui untuk berpose utama kesehatan global dan sosial challenges.2 artikel ini berkaitan dengan mengumpulkan bukti bahwa TBI dikaitkan dengan pidana behavior.3 masalah ini topikal berisi studi yang menunjukkan bahwa anak-anak yang bertahan TBI cenderung menjadi dewasa dengan masalah perilaku , 4 bahwa orang-orang muda dengan TBI sedang diadili mungkin memiliki lev-els miskin dari komunikatif ability5 yang bisa menempatkan mereka pada kerugian dalam proses hukum, bahwa tingkat TBI sangat tinggi dalam kelompok pelaku, 6 dan TBI yang terkait dengan gangguan kejiwaan — terutama diri-harm.7 studi ini menunjukkan bahwa TBI adalah kondisi kesehatan kronis en-demik dalam pelaku men-tions dan mungkin menjadi faktor yang berkontribusi terhadap risiko perilaku kriminal. Studi ini meningkatkan kemungkinan trou-bling "bahaya ganda" oleh yang anak yang sosial kurang beruntung dan yang experi-masa kemerdekaan TBI berada pada peningkatan risiko buruk outcomes.8 Selanjutnya, miskin keterampilan sosial-komunikasi dapat di-lipatan kemungkinan externalizing perilaku yang bahkan-tuate dalam tindak pidana seperti agresi terhadap orang lain. Dalam artikel ini, kami berpendapat bahwa skrining untuk, dan manusia-penuaan, efek TBI dapat meningkatkan kesejahteraan pelanggar muda yang terkena dan — berpotensi — mengurangikejahatan.TBI DAN KEJAHATANHubungan antara TBI dan perilaku kriminal kompleks. Orang-orang muda yang menyinggung mungkin melakukannya untuk alasan-genetika, kerugian, pelecehan, antisosial kepribadian, tekanan, antara lain. Sulit untukKarya ini adalah sebagian didanai oleh Barrow Cadbury Trust. Dr Williams Ms Katya Whitmarsh Williams terima kasih atas komentar pada poin-poin aksiPara penulis menyatakan tidak ada konflik kepentingan.DOI: 10.1097/HTR.0000000000000134 mengidentifikasi hubungan kausal jelas antara TBI dan menyinggung. Remaja ditandai dengan peningkatan "risiko mengambil" dan dengan demikian "tahap kehidupan" di mana perilaku berisiko mungkin mendorong melayang ke arah tindakan kriminal yang bisa bertahan sepanjang lifetime.9 cedera otak traumatis lebih umum di antara orang-orang muda yang mengambil risiko, terutama pada masa remaja. Oleh karena itu, TBI mungkin kebetulan untuk pengambilan risiko tersebut, yaitu mereka yang menyinggung mungkin melakukannya apakah atau tidak mereka mempertahankan TBI.However, it does appear that TBI alters one’s life tra-jectory so as to increase the chances of offending. In a Finnish birth cohort study of approximately 12 000 sub-jects, a TBI during childhood or adolescence was associ-ated with a 4-fold increased risk of mental disorder, with coexisting offending in adult males.10 Crime histories tended to occur following TBI. Even more compelling evidence for links between TBI and crime come from a Swedish total population data linkage study. Fazel et al11 showed that 8.8% of those with TBI commit-ted violent crime compared with 3% of controls. Of note, risk was still greater among TBI cases than among siblings who presumably experienced the same social and environmental conditions as their related offender. Furthermore, a history of loss of consciousness among offending youth has been linked to persistent, rather than adolescent-limited, offending.12Once a person’s life course is on a downward trajec-tory, with an increased likelihood of incarceration, does a TBI matter? It certainly matters in venues where jus-tice systems lack resources to recognize or manage TBIs. Studies from across the world have shown that the rate of TBI is much greater—3 to 8 times as high—in offender populations than in nonoffender groups.6 Studies have also shown that about half of young offenders have a history of loss of consciousness, with repeated injuries being very common.13 Traumatic brain injury in of-fenders has been associated with higher rates of infrac-tions while in custody, higher levels of reoffending, and engagement in violent crimes.9,14–18 It would thereforeappear that managing the effects of TBI may be impor-tant both for improving engagement in forensic rehabil-itation and for limiting recidivism.