Investigating TBI prevalence rates in adolescent young offenders in Cape Town

1. Investigating TBI prevalence rates in adolescent young offenders in Cape Town Pieter E Erasmus University of Cape Town Psychology department p.erasmus@live.com

2. Introduction • TBI serious health concern worldwide, cost to society great • associated with various externalizing and internalizing difficulties that increase risk for offending the law • specific subgroups of the population more vulnerable to sustaining TBI and effects of TBI (especially male young offenders, LAMIC)

3. Defining TBI • TBI= blunt or penetrating blow, shearing and tearing of axons. • Assessment:GCS, LOC or PTA • Dose response relationship • Impact of TBI varies greatly

4. More on TBI • Measurement of TBI varies in research • For example: Williams et al., 2010 n uses CHAT to establish TBI in young offenders mostly use length of LOC, some use feeling D&C and rarely PTA. • Major causes of TBI = MVA, falls and interpersonal violence

5. TBI and young offenders • Adolescence high risk period for TBI and delinquency • Farrer et al., 2013- Meta analysis reports 30% TBI rate in young offenders in HIC. • However, limited information available on young offenders and TBI in LAMIC.

6. Situation in South Africa • 316 per 100 000 TBI (Nell & Brown,1993) • Badul (2012), 50% prevalence rate of TBI in 44 young offenders. • Uncertainty: Is this a function of the general population in South Africa or exclusive to young offenders?

7. Aims • 1 - expand on Badul’s sample of young offenders and compare to sample of non-offenders • 2 - investigate the association of TBI with LOC and various emotional and behavioural measures

8. Hypotheses • #1: The high prevalence rates of TBI in young offender population is not reflected in the broader non-offender population of Western Cape samples. • #2: TBI with LOC for young offenders associated with significantly higher rates of: • substance use, mood problems, difficulties with social relationships, and behaviour measures

9. Participants (1) • Investigating prevalence rates: • 117 Young offenders from institution • 27 non-offenders from school from same area as young offender institution • Investigating behavioural and emotional difficulties in young offenders with TBI • Group 1: Participants that have reported a TBI that included LOC (n=40) • Group 2: Participants that have not reported a TBI that included LOC (n=77)

10. Participants (2) • Inclusion criteria mixed race males, aged 13-17 years matched on age, sex, race, language and are from low socio-economic backgrounds • Exclusion criteria severe intellectual disability, mental disorders, diagnosed Attention Hyperactivity Disorder (ADHD), and medical conditions such as stroke, epilepsy or diabetes (Williams et al., 2010)

11. Measures • The Comprehensive Health Assessment Tool (CHAT). • Alcohol Use Disorders Identification Test (AUDIT). • Beck Depression Inventory (BDI-II). • Maudsley Addiction Profile (MAP). • Reactive-Proactive Aggression Questionnaire (RPQ). • The Inventory of Callous-Unemotional Traits youth version (ICU). • Child Behaviour Checklist (CBCL).

12. Procedure • Purposive and snowball sampling used for young offenders and non-offender samples. • For offenders- continue process… • For non offenders- getting in… • Keep things ethical- beneficence, autonomy, confidentiality, approval

13. Data Analysis • Used SPSS. • Prevalence rates from frequencies for young offenders and non offenders • ANOVA for between group comparisons for young offenders only. • significance level .05

14. Results (1)

15. Results (2)

16. Results (3) • Between group comparisons • Young offenders that reported a TBI with LOC significantly higher scores for externalizing and internalizing difficulties.

17. Results (3)

18. Discussion (1) • The prevalence rates of TBI are higher for young offenders than non offenders, hypothesis one confirmed

19. Discussion (2) • How do these prevalence rates compare to international findings? • Williams et al., 2010- 65% D&C + LOC, 46% LOC • Hux et al., 1998, 50% D&C + LOC • Perron & Howard, 2008, 18% LOC • Farrer et al., 2013. 30% LOC • My study 50% D&C + LOC, 40% LOC

20. Discussion (3) • Young offenders reporting a TBI with LOC had significantly higher emotional and behavioural problems than participants that did not report TBI with LOC. Hypothesis two confirmed.

21. Limitations • Self report measure of TBI, reverse causation, most international research uses this style of researching TBI • Only sampled from one institution and one high school, assists in keeping participants matched, makes generalisability low • Small sample size for non offenders and low response rates from parents (50%).

22. Recommendations • Corroborate with parents and verify using medical records • Increase sample sizes for non-offenders • Send out parent letters or arrange information sessions for all non-offender’s parents to potentially increase response rate

23. Significance of study • Research on prevalence rates of TBI in LAMIC • Access to large pools of offenders and non-offenders • Significant associations between TBI and emotional and behavioural difficulties that may lead to negative outcomes (e.g., crime) • Assist in early identification of adolescent TBI before age of maturity reached

24. Acknowledgements • Supervisor Leigh Schrieff • Co-investigator Ju-Reyn Ockhuizen • Statistics Collin Tredoux