TRAUMATIC
BRAIN INJURY AND YOUTH JUSTICE
Understanding the Intersection of Brain Injury & the Youth Criminal Justice System
TBI & Social Justice Lab, McMaster University
Every year, approximately 69 million people worldwide suffer a traumatic brain injury (TBI). The majority of these injuries—around 56 million—are mild (mTBI), while around 5.5 million are severe.1 Children and youth have the highest rates of TBI.
TBI is an ‘invisible’ injury, as most people with TBI do not have any obvious changes in their physical appearance. As a result, people with TBI are often misunderstood and can be met with disbelief that they’ve had an injury and may be struggling.
More than 61% of children who have a severe TBI will have a life-long disability. While most people make a full recovery from a first-time mTBI (also known as a concussion), even mild brain injuries can have long-lasting and devastating implications. When infants, children and young people suffer a TBI, this can affect how their brains develop and can affect their life trajectory. This is referred to as a neurodevelopmental injury and neurodisability.
Criminal Justice System Involvement
Many people with a TBI go on to lead full and meaningful lives. However, there are also many whose lives are changed with far-reaching negative consequences.
The prevalence of people with TBI in the criminal justice system (CJS) internationally is a significant public health issue and a social justice issue.
Prevalence of youth with TBI in the CJS
An estimated 50% of children and young people charged with an offense have suffered at least one TBI. Among youth who are incarcerated, the rates are higher and may be as high as 100%.2, 3, 4 Thirty percent of incarcerated youth had their TBI long before they became entangled with the CJS, and many have had more than one TBI.
There are many reasons for this, but we know that having a brain injury can make it more difficult for people to:
- Regulate emotions and behaviour
- Control impulses
- Think, communicate, and learn
- Form and maintain social relationships
Unless it was a moderate-severe injury with clear loss of consciousness and medical intervention, children and young people with TBI often get missed. As a result, they might not get access to the right interventions and supports leading to difficulties at school, and being more vulnerable to exploitation, including by criminal groups.
While TBI is the most prevalent type of ‘neurodisability’ among young people in the CJS, it is not the only one. See the infographic below for a summary of health conditions and their prevalence in the CJS compare to the general youth population.
The focus of this website is TBI; however, the general principles apply to other neurodisabilities among children and youth involved in the CJS.
Factors Influencing Rates of TBI and Risk Factors for Outcomes
Not every child, young person, or adult who has a TBI will become involved in criminal activity or the criminal justice system.
Outcomes are best when children and young people have:
- Access to a diagnosis (many are missed)
- Good medical and specialized rehabilitation and care
- Support for community and school reintegration
- Support for families and caregivers
Why is TBI a Risk Factor for Criminal Involvement?
Evidence suggests that having a TBI is a significant risk factor for becoming involved in the CJS, either as someone charged with an offense, a victim, or a witness. Impairments or challenges resulting from the TBI that are risk factors for criminal involvement include:
- Difficulty regulating emotion and behaviour
- Increased aggression
- Poor attention and memory
- Difficulty following rules
- Poor social communication.
- Vulnerability to exploitation and abuse by criminal groups
Young people who experience challenges with emotion recognition and social communication are vulnerable to people who may exploit them and direct them to do things that are illegal. They are also vulnerable to sexual abuse and
exploitation, especially females. They may also have difficulty verbally navigating situations and getting their needs met, resulting in aggression. They are more likely to incite anger in another person, putting them at increased risk of physical violence.
Without proper supports, children and young people with TBI will have difficulties in school and with new learning. This may lead to poor academic performance and early school leaving, as well as difficulty holding down a job. When these factors are combined with cognitive-communication challenges and social isolation, children and young people with TBI become targets for exploitation, abuse, and criminal activity.
Barriers to Reintegration
Having a TBI (or multiple TBIs) is also a barrier for successful community reintegration. TBI-related challenges such as poor memory and difficulty in understanding complex information may result in an inability to follow release, bail, or probation conditions. This is not willful; they lack the ability to comply without external supports. Young people with TBI may have difficulty in school or holding down a job, which increases the likelihood of recidivism.
It is critical to support justice-involved youth with TBI from a rehabilitative lens rather than a punitive lens. One way to do this is through the services of a speech language pathologist or speech language therapist.
Intersectionalities
We know that children, young people, and adults from socio-disadvantaged backgrounds are more likely to sustain a TBI and less likely to have access to proper care, if they have experienced things such as:
- Precarious housing,
- Food insecurity, and/or
- Self or parental mental health concerns5, 6
Children and youth from racialized communities are also less likely to have access to specialized care.6
Children and young people who have experienced adverse childhood events, such as war, domestic violence, gender-based violence, or intimate partner violence, also have a higher risk of TBI and of criminalization.7,8,9 Indigenous children and youth with experiences of intergenerational trauma and colonialization have higher rates of TBI,10,11 as well as disproportionately higher rates of incarceration.10-13 Issues such as stigma, racism, rural and remote locations, poverty, and lack of trust in medical systems can act as barriers to accessing proper care.
1. Vadan, I., and Ilut, S. (2022, November 15) Estimating the global incidence of TBI. Academy for Multidisciplinary Neurotraumatology. https://brain-amn.org/global-incidence-of-tbi/
2. Hughes N., Ungar, M., Fagan, A., Murray. J., Atilola, O., Nichols, K., Garcia, J., Kinner, S. (2020) Health determinants of adolescent criminalisation. Lancet Child Adolesc Health, 4(2), 151-162. https://pubmed.ncbi.nlm.nih.gov/31956016/
3. Hughes, N., Williams, H., Chitsabesan, P. (2012) Nobody made the connection: The prevalence of neurodisability in young people who offend. University of Exeter. http://psychology.exeter.ac.uk/documents/Nobody_made_the_connection_Neurodevelopment%20Report_OCC_October2012.pdf
4. McKinlay, A., & Albicini, M. (2016). Prevalence of traumatic brain injury and mental health problems among individuals within the criminal justice system. Concussion (London, England), 1(4), CNC25. https://doi.org/10.2217/cnc-2016-0011
5. Haines, K. L., Nguyen, B. P., Vatsaas, C., Alger, A., Brooks, K., & Agarwal, S. K. (2019). Socioeconomic Status Affects Outcomes After Severity-Stratified Traumatic Brain Injury. The Journal of surgical research, 235, 131–140. https://doi.org/10.1016/j.jss.2018.09.072
6. Stubbs, J. L., Thornton, A. E., Sevick, J. M., Silverberg, N. D., Barr, A. M., Honer, W. G., & Panenka, W. J. (2020). Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis. The Lancet. Public health, 5(1), e19–e32. https://doi.org/10.1016/S2468-2667(19)30188-4
7. Brenner, E. K., Grossner, E. C., Johnson, B. N., Bernier, R. A., Soto, J., & Hillary, F. G. (2020). Race and ethnicity considerations in traumatic brain injury research: Incidence, reporting, and outcome. Brain injury, 34(6), 799–808. https://doi.org/10.1080/02699052.2020.1741033
8. Dewan, M. C., Rattani, A., Gupta, S., Baticulon, R. E., Hung, Y. C., Punchak, M., Agrawal, A., Adeleye, A. O., Shrime, M. G., Rubiano, A. M., Rosenfeld, J. V., & Park, K. B. (2018). Estimating the global incidence of traumatic brain injury. Journal of neurosurgery, 130(4), 1080–1097. https://doi.org/10.3171/2017.10.JNS17352
9. McKee, S. A., & Hilton, N. Z. (2019). Co-Occurring Substance Use, PTSD, and IPV Victimization: Implications for Female Offender Services. Trauma, violence & abuse, 20(3), 303–314. https://doi.org/10.1177/1524838017708782
10. Testa, A., Jackson, D. B., Ganson, K. T., & Nagata, J. M. (2022). Adverse Childhood Experiences and Criminal Justice Contact in Adulthood. Academic pediatrics, 22(6), 972–980. https://doi.org/10.1016/j.acap.2021.10.011
11. Fitts, M. S., Cullen, J., Kingston, G., Wills, E., & Soldatic, K. (2022). “I Don’t Think It’s on Anyone’s Radar”: The Workforce and System Barriers to Healthcare for Indigenous Women Following a Traumatic Brain Injury Acquired through Violence in Remote Australia. International journal of environmental research and public health, 19(22), 14744. https://doi.org/10.3390/ijerph192214744
12. Lasry, O., Dudley, R. W., Fuhrer, R., Torrie, J., Carlin, R., & Marcoux, J. (2016). Traumatic brain injury in a rural indigenous population in Canada: a community-based approach to surveillance. CMAJ open, 4(2), E249–E259. https://doi.org/10.9778/cmajo.20150105
13. Zeiler, K. J., & Zeiler, F. A. (2017). Social Determinants of Traumatic Brain Injury in the North American Indigenous Population: A Review. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques, 44(5), 525–531. https://doi.org/10.1017/cjn.2017.49
14. Macdonald, J., Scholes, T., & Powell, K. (2016). Listening to Australian Indigenous men: stories of incarceration and hope. Primary health care research & development, 17(6), 568–577. https://doi.org/10.1017/S1463423616000256
15. Muir, N. M., & Viljoen, J. L. (2022). Adverse childhood experiences and recidivism in Indigenous and white female and male adolescents on probation. Child abuse & neglect, 126, 105512. https://doi.org/10.1016/j.chiabu.2022.105512