Traumatic Brain Injury Among Juvenile Offenders: A Multi-Site Study

Background/purpose: Traumatic brain injury (TBI), defined as a head injury involving loss of consciousness/amnesia with ongoing cognitive or social impairment, is costly. There has been a growing awareness of traumatic brain injury (TBI) among client populations served by social workers. Due to their risk exposure one such population, juvenile delinquents, are significantly more likely than those in the general population to incur a traumatic brain injury. Unfortunately, extant studies of TBI in juvenile delinquents are hampered by methodological limitations (e.g., small sample sizes, non-control of confounding effects, and use of single sites that may lack representativeness). The present study surmounts these limitations. Further, we hypothesize that TBI will be associated with impulsivity and negative emotionality – two important risk factors for problem behaviors and poor social adjustment.   

Methods: The current study expands the generalizability of the study of TBI by employing data from two sites (Philadelphia, PA and Phoenix, AZ) and using a relatively large number (n =1354) of juvenile offenders. The mean age of the sample was 16.04 years old (SD = 1.14) and the sample was disproportionately male (male = 86.41%, female = 13.59%).  The racial/ethnic makeup of respondents was relatively well-distributed as 20.24% were non-Hispanic white, 41.43% were African American, 33.53% were Hispanic, and 4.80% were of an “other” racial/ethnic background. Respondents were queried (yes/no) as to whether they had ever experienced a head injury which caused unconsciousness for over twenty minutes or needed medical attention. Logistic regression analyses were conducted that specifically compared TBI youth with non-TBI youth across a range of demographic (age, gender, race, household income, father in the home) mental health/behavioral (psychological distress and negative emotions, substance use, moral disengagement, impulsivity), crimogenic (violent and non-violent delinquent behaviors, peer delinquency), and social (exposure to violence) measures.

Results: Approximately thirty percent (n = 411) of juvenile offenders had a TBI. The primary hypothesis that TBI would be associated with higher levels of impulsivity and negative emotionality was supported. Impulsivity and negative emotionality remained significant even after controlling for aforementioned demographic factors and confounds.  We also found that juvenile offenders with TBI were at increased odds of victimization and males were twice as likely to report a TBI compared with females.

Conclusions/implications: To our knowledge, the present study is the largest investigation undertaken of TBI among juvenile offenders. The prevalence of TBI found in this study (30%) is substantially higher than the 12% identified in the general population. Results suggest that greater attention be paid to screening of head injuries among juvenile offenders and stronger assessments be conducted to better facilitate treatment of TBI among this high-risk population. Screening, assessment, and treatment planning of TBI can be facilitated by social work practitioners who work in the juvenile justice system or in behavioral health settings designed for high-risk youth.