Persisting disability after head injury in juvenile prisoners and Clinical research portfolio

Background: The prevalence of head injury (HI) in juvenile offenders is estimated to be 30%, however no studies report disability after HI in prisoners. Furthermore, a recent Doctoral thesis found that adult offenders with a history of moderate-severe HI were more likely to experience disability, cognitive impairment, and anxiety than those with a mild HI history. Aims: To explore disability, health-related outcomes and offence characteristics associated with HI in juvenile prisoners in Scotland. Methods: HI, mental health, trauma, substance use, cognitive function and offending history were assessed in 78 male juvenile prisoners in HMYOI Polmont. Results: Compared with No/Mild HI, Multiple HI (as defined by the Ohio State University Traumatic Brain Injury Identification Method) was associated with greater substance use, poorer mental health, slower information processing, more violent convictions and prison incidents. Disability and self-report of dysexecutive functioning were associated with Multiple HI in univariate analysis. Regression indicated that a PTSD screening score and not HI group, ADHD, problematic alcohol/drug use, adverse childhood experiences, age or education predicted outcomes. Conclusions: Multiple HI was highly prevalent in juvenile prisoners and had associations with disability, dysexecutive difficulties and offence characteristics. A PTSD screening score was the only significant predictor of disability and dysexecutive difficulties. Those who score above the cut-off on the PTSD screening tool may not be referring to PTSD symptoms alone; clinical interview would be required for PTSD diagnosis. Staff working with juvenile prisoners should be aware of the impact of HI and trauma on their health and offending risk