Huw WilliamsHuw Williams

School of PsychologySchool of PsychologyUniversity of ExeterUniversity of Exeter

& &

**Emergency DepartmentEmergency DepartmentRoyal Devon & Exeter Hospital Royal Devon & Exeter Hospital

w.h.williams@exeter.ac.ukw.h.williams@exeter.ac.uk

NHS

Centre for Clinical Neuropsychological Research (CCNR)

Brain Injury & Crime:Brain Injury & Crime:Social emotional processing Social emotional processing deficits in childhood and deficits in childhood and

risk of offendingrisk of offending

Anti-social Personality and brain Anti-social Personality and brain activation…activation…

Birbaumer and colleagues Birbaumer and colleagues (2005) –fMRI & (2005) –fMRI & clips of clips of emotive film of facial emotive film of facial expression (eg fear). expression (eg fear). ““psychopathic criminals” psychopathic criminals”

lacked activation in limbic lacked activation in limbic structuresstructures

less less amygdala activity amygdala activity == the higher score for the higher score for “psychopathy” “psychopathy”

? a lack registering fear ? a lack registering fear linked to lack of inhibition linked to lack of inhibition

seeing fear inhibits one seeing fear inhibits one from acting violently (see from acting violently (see Mobbs et al, 2008). Mobbs et al, 2008).

PFC (Pre-Frontal Cortex) & Amygdala

Raine et al. (1998) - using (PET) Raine et al. (1998) - using (PET) normal functioning in the Pre normal functioning in the Pre Frontal Cortex of “predatory” Frontal Cortex of “predatory” murderers BUT “impulsive” had murderers BUT “impulsive” had reduced activation in the PFC & reduced activation in the PFC & enhanced activity in limbic enhanced activity in limbic structures. structures. reductions in pre-frontal cortex reductions in pre-frontal cortex & angular gyrus & corpus callosum & angular gyrus & corpus callosum in violent murderers –in violent murderers – ? poor inter-regulation of ? poor inter-regulation of cognition and emotion (eg cognition and emotion (eg inhibitory systems of left hem inhibitory systems of left hem not affecting right etc.)not affecting right etc.)

Cautions…against primacy of Cautions…against primacy of biologybiology

What might cause these differential patterns of What might cause these differential patterns of activation is not knownactivation is not known Anti-social Personality Disorder (APD) often occur in the Anti-social Personality Disorder (APD) often occur in the context of a range of issues - history of childhood context of a range of issues - history of childhood maltreatment or trauma may be common.maltreatment or trauma may be common.

““There are no concrete biological markers – genetic or There are no concrete biological markers – genetic or physiological – that can predict [ASP] behaviour” (Mobbs et physiological – that can predict [ASP] behaviour” (Mobbs et al, 2008)al, 2008)

ANDAND

When there is a When there is a biological riskbiological risk eg from eg from Birth complications Birth complications Minor physical anomalies*Minor physical anomalies* Environmental Poisoning (e.g. lead)Environmental Poisoning (e.g. lead) Mal-nutrition (leading to brain mal-development)Mal-nutrition (leading to brain mal-development)

Such issue is Such issue is not usually significant unless there is a not usually significant unless there is a “evocative environment” “evocative environment” “presence of negative psychosocial “presence of negative psychosocial factor” (Raine, 2002) (esp. maternal rejection*)factor” (Raine, 2002) (esp. maternal rejection*)

frontal-tempo-limbic systemsfrontal-tempo-limbic systems are crucial for are crucial for Monitoring arousal Monitoring arousal level & control of behaviour level & control of behaviour towards “goal states”towards “goal states”

Injury often leads to:Injury often leads to:

impulsivity, poor planning, impulsivity, poor planning, inadequate response inhibition inadequate response inhibition and inflexibility (Milders, and inflexibility (Milders, Fuchs & Crawford, 2003).Fuchs & Crawford, 2003).

&&

““poor anger managementpoor anger management (reactive), (reactive), irritability and irritability and impulse controlimpulse control are common” are common” (Hawley et al. 2003).(Hawley et al. 2003).

personality and emotional personality and emotional deficits – due to deficits – due to de-coupling of de-coupling of cognition and emotioncognition and emotion has been has been described by Damasio (1994), as described by Damasio (1994), as “acquired sociopathy”” - “acquired sociopathy”” -

Brain Areas that typically Injured…

Brain Injury: Scale Brain Injury: Scale of problemof problem

““TBI is an epidemicTBI is an epidemic … yet it is silent … … yet it is silent …the public largely seem unaware of it… …”the public largely seem unaware of it… …”

Thurman, 2002Thurman, 2002

Head Injury is Head Injury is the leading cause of death and disability in the leading cause of death and disability in children & working age adultschildren & working age adults

(Leurssen et al, 1988; Graham, 2001; Maas et al, 2006)(Leurssen et al, 1988; Graham, 2001; Maas et al, 2006)

Prevalence rate of Prevalence rate of 8%8% (Silver et al, 2001) to (Silver et al, 2001) to 30%30% (McKinley et al, (McKinley et al,

2008)2008) in population studies in population studies

0

20

40

60

80

100

120

140

160

180

200

00-0405-0910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+

Age Group

Rate per 100,000 popn

MIXED RURAL - Female URBAN - Female MIXED RURAL - Male URBAN - Male

Yates, Williams et al. 2006, JNNP

Differences in socio-economic status Differences in socio-economic status (SES) between attendees with MHI and (SES) between attendees with MHI and Orthopdedic (OI) comparison group.Orthopdedic (OI) comparison group.

Percentages of attendees in the deprivation (IMD) quintiles compared to the local population

0%

20%

40%

60%

80%

100%

Population total MHI total OI total

5 (afluent)

4

3

2

1 (deprived)

SES determined by the “Index of Multiple Deprivation” and put into quintiles.A greater proportion of those with MHI are in the 2 most deprived quintiles than in the comparison group with upper-limb orthopaedic injuries (OI).Chi-square = 36.4, p < 0.001.

Poverty puts children at higher Poverty puts children at higher risk of accidentsrisk of accidents

WHO REPORT Guardian – 10.12.08WHO REPORT Guardian – 10.12.08"Over the last 20 years, there have been very dramatic decreases in child injury deaths," said Prof. Elizabeth Towner…but "The figures mask a very deep social divide, a strong and persistent social divide," she said. "The poorer children have not shared equally in the progress of the last 20 years."

What are the rates for TBI What are the rates for TBI in prison populations?in prison populations?

mental health & drug/alcohol problems identified mental health & drug/alcohol problems identified ““relative to general population, [prisoners]…relative to general population, [prisoners]…experience poorer physical, mental, and social experience poorer physical, mental, and social health…[more] mental illness and disability, health…[more] mental illness and disability, drug, alcohol…suicide, self harm…lower life drug, alcohol…suicide, self harm…lower life expectance [etc.]…” Orme et al. BMJ editorial, expectance [etc.]…” Orme et al. BMJ editorial, 2005, 330. p 9182005, 330. p 918

and see Fazel & Danesh (and see Fazel & Danesh (2002a2002a (Lancet)) (Lancet))

Studies Studies seldom examine the serious physical seldom examine the serious physical illnesses OR intellectual disability prevalent in illnesses OR intellectual disability prevalent in prisonsprisons

“…“…..delivery of servicesdelivery of services to prisoners with anxiety to prisoners with anxiety and affective disorders, drugs and alcohol and affective disorders, drugs and alcohol problems, problems, brain injurybrain injury, learning disability, , learning disability, challenging behaviour and repetitive self-harm challenging behaviour and repetitive self-harm has has changed little or worsenedchanged little or worsened.” Dearbhla Duffy, et .” Dearbhla Duffy, et al. (2003) p. 242 (our emphasis)al. (2003) p. 242 (our emphasis)

Report of the New South Wales Chief Health Report of the New South Wales Chief Health OfficerOfficer

- - 45%45% male and male and 39%39% female reported at least female reported at least one head injury…one head injury…

www.health.nsw.gov.au/public-health/chorep/prs/prs_chronic_type.htmwww.health.nsw.gov.au/public-health/chorep/prs/prs_chronic_type.htm

TBI in Prison TBI in Prison PopulationsPopulations

Barnfield & Leathem (98) NZ study:Barnfield & Leathem (98) NZ study: 118 respondents to questionnaire 118 respondents to questionnaire surveysurvey

86.4%86.4% reported some form of head reported some form of head injury (56.7% MORE than 1).injury (56.7% MORE than 1).

Reported ++difficulties with Reported ++difficulties with memory and socializationmemory and socialization

Rates of Mild – Severe TBI in Rates of Mild – Severe TBI in Prisoners Prisoners

Mewse, Mills, Williams & Tonks et al (in prep)Mewse, Mills, Williams & Tonks et al (in prep)

Other

Murder/manslaughter

Robbery

Sexual offences

Drugs offences

Fraud/deception

Driving offences

Violent offences

Shoplif ting/theft

Burglary

Missing453 males held 453 males held in HMP Exeter in HMP Exeter

Pps:Pps:196 aged between 196 aged between 18 and 54 years 18 and 54 years (43% response (43% response rate)rate)

sentenced or sentenced or remandedremanded

Percentage of population Percentage of population reporting TBI & type of reporting TBI & type of

injuryinjury

Number of severe tbi

Number of moderate t

Number of mild tbi

“Any tbi?”No 39.6 %Yes 60.4%

we estimate that65% may have had a TBI.

• 10% Severe• 5.6 % Moderate • 49.4% Mild

Any tbi?

YesNoMissing

Count

140

120

100

80

60

40

20

0

Average age at 1st imprisonment:21 – Non-TBI16 - TBI

Mild TBIMild TBI

Number of mild tbisNumber of mild tbisNo %No %

0.00 = NO TBI and 0.00 = NO TBI and Mod-severe TBI)Mod-severe TBI)1.1. 1.001.00 19.519.52.2. 2.002.00 16.916.93.3. 3.003.00 6.76.74.4. 4.004.00 2.12.15.5. 5.005.00 3.13.16.6. 6.006.00 .5.57.7. 7.007.00 .5.58.8. 8.008.00 .5.5

8.00

7.00

6.00

5.00

4.00

3.00

2.00

1.00

.00

Missing

19.5

TBI a risk for Crime? TBI a risk for Crime?

- Population based - Population based studystudy Timonen et al (2002)Timonen et al (2002)

population based cohort study in Finland population based cohort study in Finland involving more than 12,000 subjectsinvolving more than 12,000 subjects

TBI during childhood or adolescence associated TBI during childhood or adolescence associated with with

fourfold increased risk of developing later fourfold increased risk of developing later mental disorder with coexisting offending in mental disorder with coexisting offending in adult (aged 31) male cohort members (OR 4.1)adult (aged 31) male cohort members (OR 4.1)

TBI might have been a result of TBI might have been a result of high novelty seekinghigh novelty seeking and and low harm avoidancelow harm avoidance in people susceptible (for issues of in people susceptible (for issues of genetics, family background, social forces etc.) to risky genetics, family background, social forces etc.) to risky behaviours – coincidental to crime….BUTbehaviours – coincidental to crime….BUT

TBI earlier than age 12 were found to have committed crimes TBI earlier than age 12 were found to have committed crimes significantly earlier than those who had a head injury later significantly earlier than those who had a head injury later

Therefore - temporal congruency suggests a causal linkTherefore - temporal congruency suggests a causal link

TBI in Prisoners: TBI in Prisoners:

crime profiles crime profiles and effectsand effects

Leon-Carrion J, Ramos FJ. (Leon-Carrion J, Ramos FJ. (2003) (BI)2003) (BI) Retrospective factor analytic study of links Retrospective factor analytic study of links between head injuries (in childhood and between head injuries (in childhood and adolescence) in adult violent and non-violent adolescence) in adult violent and non-violent prisoners. prisoners.

subjects in both groups had a history of academic subjects in both groups had a history of academic difficulties. difficulties.

Trend for both groups to have had behavioural and academic Trend for both groups to have had behavioural and academic problems at schoolproblems at school

Head injury in addition to prior learning Head injury in addition to prior learning disability/school problems increases chances of having a disability/school problems increases chances of having a violent offending profileviolent offending profile

Violent offending (noted) to be “associated with non-Violent offending (noted) to be “associated with non-treated brain injury”treated brain injury”

? rehabilitation of head injury may be a ? rehabilitation of head injury may be a measure of crime preventionmeasure of crime prevention

TBI & Crime: Coincidence or TBI & Crime: Coincidence or causal?causal?

Turkstra et al. (2003)Turkstra et al. (2003) offenders with TBI against “true peers” without TBI offenders with TBI against “true peers” without TBI

20 individuals convicted of violent crime compared to 20 non 20 individuals convicted of violent crime compared to 20 non convicted controls (matched for convicted controls (matched for education, age and education, age and employmentemployment). ).

TBI NOT more common in the offender group BUT TBI NOT more common in the offender group BUT there was variance on there was variance on severityseverity of injury of injury non-offending group– typically – Milder TBI from non-offending group– typically – Milder TBI from (eg sports). (eg sports).

offending group injuries offending group injuries More assaults (with probable longer lasting changes in More assaults (with probable longer lasting changes in behaviour). behaviour).

had more issue related to anger control. had more issue related to anger control.

TBI is not necessary for crime, but that TBI TBI is not necessary for crime, but that TBI may contribute to “expression of violence” - may contribute to “expression of violence” - increase the risk “threshold” in vulnerable increase the risk “threshold” in vulnerable people. people.

TBI a contributory factor:TBI a contributory factor:Multiplicative ModelMultiplicative Model

Kenny et al (2007) Kenny et al (2007) juvenile detention juvenile detention

in Sydney- 242 in Sydney- 242 young offenders (76% young offenders (76% response rate) response rate) Alcohol, Alcohol, substance abuse, substance abuse, TBI and cultural TBI and cultural backgrounds backgrounds

offences rated as:offences rated as: low (common low (common

assault)assault) moderate (robbery moderate (robbery

with weapon) with weapon) serious (homicide). serious (homicide).

85 individuals had 85 individuals had experienced a head experienced a head injury injury

Violent offending Violent offending more common for more common for those with KO those with KO historyhistory

TBI a contributory factor:TBI a contributory factor:Multiplicative ModelMultiplicative Model

odds ratios:odds ratios: of 2.37 for having of 2.37 for having s serious violent s serious violent crime if the young crime if the young offender had had a offender had had a head injury. head injury.

2.82 if the YO had 2.82 if the YO had been unconscious. been unconscious.

hazardous alcohol hazardous alcohol drinking history drinking history increased risk of increased risk of severe violent severe violent offending. offending.

regression models regression models produced produced “multiplicative model” “multiplicative model” of how TBI is related of how TBI is related to crime. to crime.

Childhood Brain Injury & Social Childhood Brain Injury & Social impairmentsimpairments

Social behavioural problems:Social behavioural problems: may not be evident until may not be evident until

adolescenceadolescence (Lishman, 1998; (Lishman, 1998; Teichner & Golden, 2000) Teichner & Golden, 2000)

may occur in isolation from may occur in isolation from cognitive deficitscognitive deficits (Anderson, (Anderson, Northam, Hendy & Wrennall, Northam, Hendy & Wrennall, 2001) 2001)

the the most common and most common and disruptivedisruptive issue (Henry, issue (Henry, Phillips, Crawford, Theodorou Phillips, Crawford, Theodorou & Summers, 2006)& Summers, 2006)

Anger episodes more Anger episodes more “reactive” than “reactive” than “planned” in adolescence “planned” in adolescence (Dooley et al. BI, 2008)(Dooley et al. BI, 2008)

Symptoms persist long-term Symptoms persist long-term post-injurypost-injury. (Anderson 2003). (Anderson 2003)

Injury leads to Injury leads to (potentially) an array (potentially) an array of problems:of problems:

•Attention, working Attention, working memory, disinhibition memory, disinhibition etc. etc. See at Catroppa & See at Catroppa & Anderson, 2004Anderson, 2004

•Dose responseDose response•SelectiveSelective•Some recoverySome recovery

•lack of “moral” lack of “moral” reasoning.reasoning. ((Damasio 1996; Damasio 1996; Anderson, Anderson, Bechara, Damasio, Tranel, & Bechara, Damasio, Tranel, & Damasio, 1999; Damasio, 1999; Hanks, Temkin, Hanks, Temkin, Machamer & Dikmen 1999; Levin & Machamer & Dikmen 1999; Levin & Hanten, Powell, 2004).Hanten, Powell, 2004).

• Often there is Often there is inappropriate social inappropriate social behaviourbehaviour

The Role of Theory of Mind and The Role of Theory of Mind and EmpathyEmpathy Theory of Mind (ToM): Theory of Mind (ToM):

to attribute mental states to attribute mental states to others, to know they have to others, to know they have beliefs, desires and beliefs, desires and intentions that are intentions that are different from one's own different from one's own

Early components achieved by Early components achieved by 4yrs, later developments by 4yrs, later developments by 11yrs 11yrs

Empathy: Empathy: to recognise or understand to recognise or understand another's state of mind or another's state of mind or emotion & “co-experience” emotion & “co-experience” their outlook or emotions their outlook or emotions within oneselfwithin oneself "putting "putting oneself into another's oneself into another's shoes”shoes”

Sophisticated levels achieved Sophisticated levels achieved during early adolescenceduring early adolescence

Both skills are Both skills are fluidfluid during during childhood childhood →→ likely to be likely to be vulnerable to the effects of an vulnerable to the effects of an acquired brain injury (ABI)?acquired brain injury (ABI)?

ABI may impact on skills for emotional understanding of others (ToM and Empathy)

these deficits may these deficits may be a key issue in be a key issue in social situations…social situations…

e.g. e.g. misperceive misperceive elements of a elements of a situationsituation (not (not reading emotion of reading emotion of others & perceive others & perceive threat when there threat when there was none), was none), make make poor social poor social judgementsjudgements (and (and behave behave inappropriately) inappropriately) and and lack lack communication communication skills to skills to negotiate out of negotiate out of conflictconflict (Turkstra (Turkstra et al 2003)et al 2003)

Charles Robert Darwin (1809-1882) The Expressions of Emotions in Man and Animals. London:  John Murray, 1881.“Expression of emotion evolve from behaviours that indicate what an animal is likely to do next…If these expressions benefit the animal that displays them, they will evolve in ways that enhance their communicative function…”

Understanding others through non-verbal cues

Amygdala.Emotion Recognition.Eye gaze detection/reading

HippocampusExternal context information

Intrinsic emotional arousal/ control system.

Face expression analysis

Eye Configurationanalysis

Vocal Analysis

Sensory/ spatial analysis system.

Executive functioning

Emotion regulation controlAffect perception

Executive system synthesis.

Functional at birth. Enables association learning.

Develops rapidly during the 18 months following birth, with an identifiable further significant stage of improvement at around 11 years old

Develops throughout childhood and adolescence, assuming increasing executive control over emotions.

Emotional response

External stimuli

Thalamo amygdala pathway.

Tonks et al, 2007/2008: A HEURISTIC FOR SOCIO-EMOTIONAL PROCESSING

(Le Doux, 1999; Rolls, 1999; Hornack, Rolls & Wade 1996; Jackson& Moffat, 1987; Baron-Cohen, 2000; Evans, 2003)

Age groupAge group

Male or FemaleMale or Female

TotalTotal

Mean Time Mean Time Lapse Lapse Since Since Insult Insult (yrs)(yrs)

Mean Mean Injury Injury AgeAge(yrs)(yrs)

Nature/ Frequency Nature/ Frequency of Insult.of Insult.(M=Male, (M=Male, F=Female)F=Female)

malemale femalefemale

Nine to tenNine to ten22 11 33

2.172.175.35.3

M= 1 Severe TBI, M= 1 Severe TBI, 1 Stroke. F= 1 1 Stroke. F= 1 Severe TBISevere TBI

Ten to elevenTen to eleven11 11 22

.88.889.89.8

M= 1 Heamorrage M= 1 Heamorrage (AVM).(AVM). F= 1 MeningitisF= 1 Meningitis

Eleven to Eleven to twelvetwelve

33 11 44

5.45.4

5.175.17

M= 1 mild TBI, 2 M= 1 mild TBI, 2 Tumour.Tumour. F= 1 moderate F= 1 moderate TBITBI

Twelve to Twelve to thirteenthirteen 22 00 22

6.466.466.336.33 M= 2 Severe TBI.M= 2 Severe TBI.

Thirteen to Thirteen to fourteenfourteen 22 11 33

6.146.147.177.17

M= 1 Severe TBI, M= 1 Severe TBI, 1 mod TBI. F= 1 1 mod TBI. F= 1 Severe TBI.Severe TBI.

Fourteen to Fourteen to Fifteen Fifteen 44 00 44

2.892.8911.4211.42

M= 1 Severe TBI, M= 1 Severe TBI, 1 mod TBI. 1 mild 1 mod TBI. 1 mild TBI. 1 Stroke.TBI. 1 Stroke.

Fifteen Plus*Fifteen Plus*11 11 22

2.332.3313.7913.79 M= 1 Severe TBI.M= 1 Severe TBI.

F= 1 Severe TBIF= 1 Severe TBI

Group TotalGroup Total

1515 55 2020

TBI=14, TBI=14, Meningitis=1, Meningitis=1, Tumour=2, Tumour=2, Heamorrage=1, Heamorrage=1, Stroke=2.Stroke=2.

Table 5: Summary and injury profiles for the ABI participants in the study

Tonks, Williams et al - Emotion processing post ABI

Tonks, Williams et al - Emotion processing post

ABI controls controls67 (age matched) children were recruited from primary and secondary schools. These were given the batteries of tests.

How do ABI children How do ABI children compare to non-compare to non-

injured children? injured children?

Group

HealthyABI

Mean FAB expression naming

82

80

78

76

74

72

70

68

F(1,85)=14.227 p<.000

ANCOVA (FAS): F(1,84)=10.992 p<.001

How do ABI children How do ABI children compare to non-injured compare to non-injured children (“Mind in the children (“Mind in the

Eyes”)?Eyes”)?

Group

HealthyABI

Mean mind in the eyes test

70

60

50

PIAGROUP

12 Plus11 to 12up to 11

Mean mind in the eyes test

80

70

60

50

40

Group

ABI

Healthy

Face-emotion processing Face-emotion processing problems in children with ABI problems in children with ABI

(Tonks et al, 2007/2008/2009)(Tonks et al, 2007/2008/2009)

Group trends:Group trends:•those with those with difficulties with angry faces difficulties with angry faces experienced peer problemsexperienced peer problems

• poor at identifying expressions reported less poor at identifying expressions reported less pro-social.pro-social.

•Specific deficitsSpecific deficits

•KL - KL - not recognise sad facesnot recognise sad faces • MN – not “getting” emotional tone. He could MN – not “getting” emotional tone. He could not understand sarcastic remarksnot understand sarcastic remarks•OP- reads all “eyes” OP- reads all “eyes” as hostileas hostile. increasingly . increasingly violentviolent

[also see: Milders, Fuchs and Crawford 2003 re: adults with TBI; [also see: Milders, Fuchs and Crawford 2003 re: adults with TBI; Skye MacDonald & colleagues re: TASIT (awareness of social Skye MacDonald & colleagues re: TASIT (awareness of social inference)]inference)]

Static vs. Dynamic Static vs. Dynamic tasks.tasks.

dynamic cues- movement and interaction- dynamic cues- movement and interaction- have been shown to be dissociated from have been shown to be dissociated from static cues static cues (Adolphs, Tranel & Damasio, 2003; (Adolphs, Tranel & Damasio, 2003;

McDonald & Saunders, 2005).McDonald & Saunders, 2005).

dynamic cues are infrequently used in dynamic cues are infrequently used in research and clinical assessments research and clinical assessments (Atkinson & Adolph, 2005).(Atkinson & Adolph, 2005).

a gap between clinical assessments and a gap between clinical assessments and reported social behavioural problems?reported social behavioural problems?

Communicating social emotions Communicating social emotions skillsskills

Tonks, Williams, Frampton, Yates, Slater (in prep)Tonks, Williams, Frampton, Yates, Slater (in prep) 20 ABI children aged 9 to 15 yrs (M 20 ABI children aged 9 to 15 yrs (M 2.5, SD 2.1) were compared to closely 2.5, SD 2.1) were compared to closely age matched controls (M 11.6, SD 2.2). age matched controls (M 11.6, SD 2.2).

Parents of all participants completed Parents of all participants completed the Parent SDQ as a measure of socio-the Parent SDQ as a measure of socio-emotional behaviour.emotional behaviour.

THEN, all participants watched the THEN, all participants watched the following Movie…following Movie…

“So they are having a game and he pushes that stick down and he is trapped. and sad. and they have gone off together. They made friends. so he is left out and is sad nowso he is left out and is sad now” (C, aged 5)

MOVIE CLIP:Inspired by Heider and Simmel

Comparisons: ABI vs. Comparisons: ABI vs. controls:controls:

Differences in Differences in MotionMotion (“moved to”) and (“moved to”) and EmotionEmotion

(“sad”) words used(“sad”) words used.. ABI children and controls ABI children and controls did did not significantly differ in not significantly differ in terms of % ofterms of % of Motion Motion words words used to describe the film.used to describe the film.

Neither did they differ Neither did they differ significantly in the % of significantly in the % of EmotionEmotion words used. words used.

Comparisons: ABI vs. controls:Comparisons: ABI vs. controls:Differences in Social communication Differences in Social communication

words used.words used.ABI ABI

childrenchildrenControlsControls

ConditionCondition MM SDSD MM SDSD

Free description Free description ****

2.192.19 3.43.4 3.133.13 .3.3

Guided Guided QuestionsQuestions****

.86.86 1.61.6 3.973.97 4.64.6

Combined mean Combined mean scorescore**

.5.5 .08.08 3.083.08 3.33.3**p<.01, *p<.05

BUT - they did differ in terms of the number of social communication words used to describe the movie.

Peer problems (on SDQ) correlated with lack of ‘Social communication’ words (r=-0.47, p=0.037)

Theory of Mind & Empathy in Theory of Mind & Empathy in adolesenceadolesence

Sarah Wall, Huw Williams, & Ian FramptonSarah Wall, Huw Williams, & Ian Frampton

ToM ToM A Test of Social Processing (Turkstra et A Test of Social Processing (Turkstra et al., 2001)al., 2001)

Faux Pas test (Baron-Cohen et al., 1999) Faux Pas test (Baron-Cohen et al., 1999) EmpathisingEmpathising

Socio-Emotional Questionnaire for ChildrenSocio-Emotional Questionnaire for Children ““I (he/she) notice(s) when other people I (he/she) notice(s) when other people are happy”are happy”

““I (he/she) prefer(s) being alone than I (he/she) prefer(s) being alone than with others”with others”

+ Strengths and Difficulties Q & DEX-C + Strengths and Difficulties Q & DEX-C (Dysexecutive)(Dysexecutive)

35

36

37

38

39

40

41

42

11 12 13 14

Age

SEQ Emot Recog & Emp (I)

subscale score

Girls

Boys

Empathy in non-injured children in early adolesence (100+ boys and girls) (Wall et al. in press)

boys tended to show a decrease in positive social-emotional functioning, alongside self-reports of increased anti-social behaviour. Those with a history of MTBI rated particularly low

25 young adolescents (10 25 young adolescents (10 to 15yrs) with a history to 15yrs) with a history of ABI, 50 typically-of ABI, 50 typically-developing (TD) matched developing (TD) matched controlscontrols

Global impairmentsGlobal impairments Poorer empathic respondingPoorer empathic responding Less accurate ToMLess accurate ToM

Faux pasFaux pas SEQ-KidsSEQ-Kids

Parental reports of poor Parental reports of poor emotion recognition and emotion recognition and empathyempathy

Self-reports of poor Self-reports of poor emotion recognition and emotion recognition and empathyempathy

+ executive impairments + executive impairments (DEX-C + EF measures), (DEX-C + EF measures), increased daily increased daily difficulties and impact difficulties and impact (SDQ)(SDQ)

8

9

10

11

12

13

14

15

16

17

18

BI TD

Theory of Mind mean score

Boys

Girls

Theory of Mind (complex) & Critical age Theory of Mind (complex) & Critical age of injuryof injury

Wall, Williams, Frampton (in prep)Wall, Williams, Frampton (in prep)

0

10

20

30

40

50

60

70

80

90

100

Birth to 2 2 to 6 6 to 12 +

Age at injury (years)

%

Average

Borderline/impaired

TBI and Crime – TBI and Crime – causal or co-incidental?causal or co-incidental?

The evidence The evidence is not clear cut there are many there are many confounding factors within the within the relationships between injury and later offendingrelationships between injury and later offending

the link between crime and TBI may be an the link between crime and TBI may be an epiphenomenonepiphenomenon whereby criminal behaviour “particularly violent crime, whereby criminal behaviour “particularly violent crime, is likely to result from complex interaction of factors is likely to result from complex interaction of factors such as genetic pre-disposition, emotional stress, such as genetic pre-disposition, emotional stress, poverty, substance abuse and child abuse” poverty, substance abuse and child abuse”

Turkstra, 2004 (P 40). Turkstra, 2004 (P 40). BUT: TBI may be an important factor in offending BUT: TBI may be an important factor in offending behaviour. behaviour.

““poor prefrontal function [may be associated with] poor prefrontal function [may be associated with] impulsive violence, [but] this brain dysfunction may be… impulsive violence, [but] this brain dysfunction may be… a predisposition only” p.54 Raine, 2002a predisposition only” p.54 Raine, 2002

MOREOVER: catch 22…MOREOVER: catch 22… ““The person at risk of violence needs to recognise his The person at risk of violence needs to recognise his risk and take preventative steps…but [those with]…damage risk and take preventative steps…but [those with]…damage to…prefrontal cortex…may not be able to reflect on their to…prefrontal cortex…may not be able to reflect on their behaviour and take responsibility…[as their] behaviour and take responsibility…[as their] internal internal soul-searching [is] damagedsoul-searching [is] damaged…” Raine (2002)…” Raine (2002)

So we need:So we need: better screening for head injury at better screening for head injury at pre-sentencing and on admission to pre-sentencing and on admission to prison/custodial services –prison/custodial services –

for better understanding of risk, for better understanding of risk, and for rehabilitative purposesand for rehabilitative purposes

Esp. those with executive (& socio-Esp. those with executive (& socio-affective) difficulties who may have affective) difficulties who may have difficulty in changing behaviour difficulty in changing behaviour patterns in response to patterns in response to contingencies. contingencies.

Screening…for sentencing & Screening…for sentencing & rehabilitation*rehabilitation*

……Developmental issues…Developmental issues… Developmental factors may be particularly Developmental factors may be particularly important:important:

There may be sleeper effects – esp. relevant to There may be sleeper effects – esp. relevant to socio-emote functions at transition to adolescencesocio-emote functions at transition to adolescence

public safety and long term economic advantage public safety and long term economic advantage could be gained by better, earlier, targeted could be gained by better, earlier, targeted interventions to interventions to prevent injury, prevent injury, reduce impact of injury reduce impact of injury

Systematic neuro-rehabilitation - Systematic neuro-rehabilitation - Targetted at ?socio-emotional processing (esp. Targetted at ?socio-emotional processing (esp. ToM/Empathy etc.):ToM/Empathy etc.):

eg “Mind Reading: An Interactive Guide to Emotions” eg “Mind Reading: An Interactive Guide to Emotions” (Baron-Cohen, 2004)(Baron-Cohen, 2004)

Impulse control? (Stop, (breathe!!) Think, Do! (or Impulse control? (Stop, (breathe!!) Think, Do! (or DON’T Do))DON’T Do))

"Brains become minds when they "Brains become minds when they learn to dance with other learn to dance with other brains”brains” W.J. Freeman W.J. Freeman