Lead Authors: Dr Nathan Hughes (Senior Lecturer in Social Policy, University of Birmingham)

1. Lead Authors: Dr Nathan Hughes(Senior Lecturer in Social Policy, University of Birmingham) Prof Huw Williams (Director of the Centre for Clinical Neuropsychology Research, University of Exeter) Dr Prathiba Chitsabesan (Consultant Child and Adolescent Psychiatrist, Pennine Care NHS Foundation Trust, and member of the Offender Health Research Network, University of Manchester)

2. The Children's Commissioner • The Children’s Commissioner has a duty to promote the views and interests of all children in England • “I think I must have been born bad” argued for improvements in services designed to meet the mental health needs of young people in the secure estate • Evidence suggested that considerable numbers of young people in custody may have undiagnosed neurodevelopmental disabilities which contributed to the behaviours that led them to offend

3. Aims and focus of the report (1) • Childhood neurodisability is occasioned when there is a compromise of the central or peripheral nervous system due to genetic, pre-birth or birth trauma, and/or injury or illness in childhood. • This incorporates a wide range of specific neurodevelopmental disorders or conditions, with common symptoms including: muscle weakness; communication difficulties; cognitive delays; specific learning difficulties; emotional and behavioural problems; and a lack of inhibition regarding inappropriate behaviour.

4. Aims and focus of the report (2) • What is the prevalence of various neurodevelopmental disorders amongst young people within the youth justice system secure estate? • What are the key issues for policy and practice associated with these levels of prevalence? • An extensive, structured literature review of research from a variety of relevant academic disciplines • An advisory group of relevant academics and professionals • Consultation with young people and staff in one young offender institution

5. The prevalence of neurodevelopmental disorders

6. Neurodisability as ‘risk’ • Criminogenic risk factors associated with neurodisability include: - hyperactivity and impulsivity; - alienation; - cognitive and language impairment; - poor emotional regulation. • Secondary association with other risk factors such as: - truancy and peer delinquency; - illicit drug use; - poor educational attendance and attainment. • Systemic factors may increase risk further, such as: - detachment from education; - challenges in parenting; - failure of services to recognise and meet specialist needs.

7. Implications for the youth justice system (1) • Identifying neurodisability • Extending the Comprehensive Health Assessment Tool to neurodisability • Considering the use of the Comprehensive Health Assessment Tool in community settings • Greater integration between the yjs and key partner agencies to highlight indicators of prominent neurodevelopmental disorders • Using this data to commission specialist services

8. Implications for the youth justice system (2) • Appropriate support and services • Improve understandings of the implications of neurodisability for engagement and behaviour • Responsivity to specific needs and learning styles • Addressing the multiple risk factors contributing to offending behaviour • Continuity of care between community and custody and between child and adult services • Sentencing that supports desistence by taking account of maturation

9. Implications for further research Specific areas of further research should include: • the development of a health economics model of early intervention for young people with neurodisability who are at risk of offending, in order to evaluate long-term cost-benefits of an investment to save model; • improved understandings of developmental pathways and processes of desistence for young people with specific neurodevelopmental disorders, so as to support an evaluation of the effectiveness of interventions to enable rehabilitation and prevent re-offending

10. Find out more • Go to: tinyurl.com/llzdrm6 • Search for: ‘Nobody made the connection’ • Email: n.j.hughes@bham.ac.uk