Program

CO51-006

Oral Communication

Childhood acquired brain injury and subsequent delinquent behavior: a retrospective study of demographic, injury-related, neurological and cognitive characteristics in a sample of 40 patients

Dr Clémence LEFÈVRE-DOGNINa, Dr Hanna TOUREb, Dr Dominique BRUGELb, Dr Anne LAURENT-VANNIERa, Mrs Valentine VERDIERb, Dr Mathilde CHEVIGNARDa

a Service de Rééducation des Pathologies Neurologiques de l'Enfant - Hôpitaux de Saint Maurice – 14, rue du Val d’Osne – 94410 Saint Maurice, b Centre de Suivi et d’Insertion pour Enfants et Adolescents victimes de Lésions Cérébrales Acquises - Hôpitaux de Saint Maurice – 14, rue du Val d’Osne – 94410 Saint Maurice

Introduction

Childhood acquired brain injury (ABI) is responsible for severe cognitive and behavioural disorders, sometimes leading to violent and/or offending behaviours. The aim of this study was to review the cases of patients treated in a rehabilitation unit dedicated to children with ABI, who subsequently demonstrated behaviors leading to an intervention of the police and/or the justice, and identify any common characteristics.

Methods

Retrospective inventory of patients with ABI treated in a single rehabilitation department, who subsequently had contact with the police/justice following offenses. We collected demographic factors, type and severity of ABI, initial neurological examination, first and last neuropsychological assessment, type of schooling pre- and post-injury, and data from their offenses.

Results

Searches retrieved 40 patients (36 boys): 34 traumatic brain injury (TBI; 27 severe), 4 brain tumours, 1 frontal hemorrhagic stroke and 1 anoxia; mean age at injury was 9,7 years [SD=4; (2.1-15.7)]. In 88 % of cases, none of the parents had graduated from high school. Half of the children had previous school difficulties and 30 % had repeated a grade. Overall, children sustained severe injuries, with impaired neurological function, major cognitive deficits [mean initial full-scale IQ 73.1 (SD=12.8)] without significant improvement [77.4 (SD=13.4) at the last assessment]. The processing speed index was particularly low [73.2 (+/-15.4)] and did not improve over time. 76% had behavioural disorders already evident during hospitalization. Upon discharge, 62% required adapted and/or specialized schooling. After an average follow-up of 8 and a half years, only 6 patients still followed an ordinary curriculum and 8 were not attending school anymore. Four girls were victims, and among 36 boys, all were perpetrators, but 3 had been victims previously. The offenses were mainly cases of violence (56 %), but also entailed thefts, traffic offences, sexual assaults, drug use and vandalism.

Discussion

Children with ABI who suffer or commit offenses are mainly boys, from very low socioeconomic background, with pre-injury academic and social difficulties, who sustained severe TBI. They suffer very severe and disabling cognitive deficits and behavioral disorders. Multidisciplinary care and follow-up of those children more at risk is essential in the long-term.

Keywords : acquired brain injury, child, cognitive disorders, behavioral disorders, youth offenders, violence, educational outcome