1. SaVI colloquium 01 November 2013 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. SaVI colloquium 01 November 2013 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) 2

3. SaVI colloquium 01 November 2013 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 3

4. SaVI colloquium 01 November 2013 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 4

5. SaVI colloquium 01 November 2013 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. 5

6. SaVI colloquium 01 November 2013 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? 6

7. SaVI colloquium 01 November 2013 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 7

8. SaVI colloquium 01 November 2013 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 8

9. SaVI colloquium 01 November 2013 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) 9

10. SaVI colloquium 01 November 2013 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) 10

11. SaVI colloquium 01 November 2013 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). 11

12. SaVI colloquium 01 November 2013 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 12

13. SaVI colloquium 01 November 2013 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 13

14. SaVI colloquium 01 November 2013 Results (1) 14 Young offendersNon-offenders No TBI58 (50%)17 (63%) TBI (D&C + LOC)59 (50%)10 (37%)

15. SaVI colloquium 01 November 2013 Results (2) 15 Young offendersNon-offenders No TBI77 (66%)23 (85%) TBI only LOC40 (34%)4 (15%)

16. SaVI colloquium 01 November 2013 Results (3) Between group comparisons Young offenders that reported a TBI with LOC significantly higher scores for externalizing and internalizing difficulties. 16

17. SaVI colloquium 01 November 2013 Results (3) 17 TBI LOCNo TBIFpr Depressive symptoms M=31, SD=12 M=26, SD=12 3.80.03.17 Reactive and Proactive aggression M=23, SD=10 M=17, SD=10 4.75.02.26 Substance use M=1.9, SD=1.1 M=1.43, SD=1.1 4.36.02.22 Criminal activity M=1.08, SD=.9 M=.66, SD=.8 6.61.005.22 Socialising problems M=2.15, SD=.9 M=1.61, SD=.8 6.47.005.28 Psychologic al health problems M=11, SD=6M=9, SD=64.33.04.20

18. SaVI colloquium 01 November 2013 Discussion (1) The prevalence rates of TBI are higher for young offenders than non offenders, hypothesis one confirmed 18

19. SaVI colloquium 01 November 2013 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 19

20. SaVI colloquium 01 November 2013 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. 20

21. SaVI colloquium 01 November 2013 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%). 21

22. SaVI colloquium 01 November 2013 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 22

23. SaVI colloquium 01 November 2013 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 23

24. SaVI colloquium 01 November 2013 Acknowledgements Supervisor Leigh Schrieff Co-investigator Ju-Reyn Ockhuizen Statistics Collin Tredoux 24