Search

PurposeThis paper aims to examine the relationship between patterns of functioning in four domains (attention and concentration; social and communication; coordination and organisation; and literacy and numeracy) in women in prison. Also, to consider potential associations between functioning and previous Neurodevelopmental Disorder (NDD) diagnoses, previous mental health diagnoses and history of head injury, self-harm and attempted suicide.Design/methodology/approachWomen in one Scottish prison were invited to participate; 87 consented. Women were screened for functional difficulties and asked about their relevant educational and medical history.FindingsHalf of participants reported difficulties in one or more domains. All possible combinations of functional difficulties were found. Only eight women reported previous NDD diagnoses. Functional difficulties were significantly associated with history of self-harm, history of attempted suicide and mental health diagnoses. In total, 32% of women reported at least one head injury, but this was not significantly associated with functional difficulties.Research limitations/implicationsThe sample was comparatively small and questions were self-report. Analyses were based on within-cohort comparisons due to a lack of appropriate general population data.Practical implicationsThere is a clear need for timely, practical and comprehensive profiling of females in the Justice System. Current systems do not appear to adequately identify women with functional difficulties or other adversity. Greater use of interdisciplinary working and shared training is indicated, as is a move from categorical diagnostic systems towards dimensional approaches.Originality/valueThis study is the first to investigate associations between difficulties associated with NDDs, mental health difficulties and head injury in women in prison.

Traumatic brain injury (TBI) has the highest incidence of all common neurological disorders, and poses a substantial public health burden. TBI is increasingly documented not only as an acute condition but also as a chronic disease with long-term consequences, including an increased risk of late-onset neurodegeneration. The first Lancet Neurology Commission on TBI, published in 2017, called for a concerted effort to tackle the global health problem posed by TBI. Since then, funding agencies have supported research both in high-income countries (HICs) and in low-income and middle-income countries (LMICs). In November 2020, the World Health Assembly, the decision-making body of WHO, passed resolution WHA73.10 for global actions on epilepsy and other neurological disorders, and WHO launched the Decade for Action on Road Safety plan in 2021. New knowledge has been generated by large observational studies, including those conducted under the umbrella of the International Traumatic Brain Injury Research (InTBIR) initiative, established as a collaboration of funding agencies in 2011. InTBIR has also provided a huge stimulus to collaborative research in TBI and has facilitated participation of global partners. The return on investment has been high, but many needs of patients with TBI remain unaddressed. This update to the 2017 Commission presents advances and discusses persisting and new challenges in prevention, clinical care, and research.

OBJECTIVE To establish whether poor parental supervision is associated with head injury and self-reported reactive aggression (ie, aggression in response to perceived provocation or threat) in adolescents in a Young Offender's Institute, by examining correlations between these variables. Understanding this population is important, as they are at a key pivotal age for intervention to prevent lifelong reoffending. METHODS Ninety-six male participants aged 16 to 18 years were recruited from a UK Young Offender's Institute. Self-report measures of remembered parenting, reactive aggression, and head injury history were administered during individual interviews. RESULTS Seventy-four percent of participants reported having experienced a lifetime traumatic brain injury (TBI), and 46% of participants reported experiencing at least 1 TBI leading to a loss of consciousness (LOC). We found that poor parental supervision, length of LOC following TBI, and self-reported reactive aggression were all positively correlated. CONCLUSIONS Findings show that there are correlational relationships between poor parental supervision, length of LOC following lifetime TBI, and higher levels of self-reported reactive aggression. This suggests there may be pathways resulting from poor parental supervision leading to both TBI with LOC, and reactive aggression. We advocate for future research with longitudinal designs and larger samples to examine the nature of these interactions, and to establish whether poor parental supervision is a prospective risk factor for more TBIs leading to LOC, and reactive aggression. This is key to understanding whether parenting interventions could help to reduce the disabling effects of TBI in adolescents, and help to prevent contact with the law.

Highlights • ALE meta-analysis revealed functional activation differences in mTBI. • Reduced activation identified within the right middle frontal gyrus. • Suggests alteration of prefrontal region, associated with executive functioning. • Need for addressing subject- and task-specific variation in future studies., Task-based functional magnetic resonance imaging (fMRI) has been used to examine neuroanatomical and functional changes following mild traumatic brain injury (mTBI). Prior studies have lacked consistency in identifying common regions of altered neural activity during cognitive tasks. This may be partly due to differences in task paradigm, patient heterogeneity, and methods of fMRI analysis. We conducted a meta-analysis using an activation likelihood estimation (ALE) method to identify regions of differential brain activation in patients with mTBI compared to healthy controls. We included experiments that performed scans from acute to subacute time points post-injury. The seven included studies recruited a total sample of 174 patients with mTBIs and 139 control participants. The results of our coordinate based meta-analysis revealed a single cluster of reduced activation within the right middle frontal gyrus (MFG) that differentiated mTBI from healthy controls. We conclude that the cognitive impairments in memory and attention typically reported in mTBI patients may be associated with a deficit in the right MFG, which impacts the recruitment of neural networks important for attentional control.

Traumatic brain injury (TBI) is the biggest cause of death and disability in children and young people. TBI compromises important neurological functions for self-regulation and social behaviour and increases risk of behavioural disorder and psychiatric morbidity. Crime in young people is a major social issue. So-called early starters often continue for a lifetime. A substantial majority of young offenders are reconvicted soon after release. Multiple factors play a role in crime. We show how TBI is a risk factor for earlier, more violent, offending. TBI is linked to poor engagement in treatment, in-custody infractions, and reconviction. Schemes to assess and manage TBI are under development. These might improve engagement of offenders in forensic psychotherapeutic rehabilitation and reduce crime.

WHAT IS KNOWN ON THE SUBJECT?: Traumatic brain injury (TBI) has been linked to poor outcomes in terms of mental health, specifically, PTSD, depression and alcohol abuse. A lack of research evidence exists relevant to exploring the presence and implications of TBI in the police in the UK and globally, despite the elevated risk of physical and emotional trauma specific to policing. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The rate of traumatic brain injury is highly prevalent in a small sample of police officers. Traumatic brain injury is a major source of post-concussion symptoms (physical, cognitive and emotional deficits) in police officers, which, in general, are associated with greater mental health difficulties and drinking alcohol to cope. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Traditional mental health treatments should be supplemented with elements of concussion care to address any cognitive, emotional and physical issues due to head injury. Interventions should be made more accessible to those suffering from a mild brain injury. This can be done through regular reminders of appointments, pictograms and by providing a concrete follow-up. ABSTRACT: Introduction Police officers have a high risk of injury through assaults, road traffic incidents and attending domestic calls, with many officers developing post-traumatic stress disorder (PTSD) as a consequence. Traumatic brain injury (TBI) is a common injury in populations involved in conflict and has been extensively linked to mental health difficulties. However, current research has not explored the frequency and sequelae of TBI in police populations, despite the elevated risk of physical and emotional trauma specific to policing. Aim To explore self-reported TBI, PTSD, post-concussion symptoms, depression and drinking to cope in a small sample of UK police, to determine the frequency of these conditions and their relationships. Method Measures of TBI, mental health, and drinking alcohol to cope were administered to 54 police officers from a Midshire Police Constabulary. Results Mild TBI with loss of consciousness was reported by 38.9% of the sample. TBI was associated with increased post-concussion symptoms (PCS). PCS were associated with greater severity of PTSD, depression and drinking to cope. Discussion Exploring TBI in the police could identify a major factor contributing towards ongoing mental health difficulties in a population where, based on previous research, the implications of TBI should not be overlooked, highlighting the need for further research in this area. Implications for Practice This research spans to identify the importance of routine assessment and increasing awareness within mental health services. Mental health treatments should be made amenable to a population with potential memory, planning and impulse control deficits. Further work in mental health services is needed to understand the level of ongoing issues that are due to post-concussion symptoms and those that are due to other mental health difficulties, such as PTSD, thereby educating patients on the association between TBI and emotional difficulties. A graduated return-to-work plan should be developed to enable a safe transition back to work, whilst managing any ongoing symptoms.

Emotional processing is affected by childhood brain injury. Ineffective emotional processing and poor understanding of social cues affect the development of social relationships leading to social isolation and a poorer quality of life in the long-term. Facial expression recognition is a non-verbal social cue that is used to interpret the thoughts and feelings of others. Children with brain injury have shown deficits identifying even basic emotions from facial expression, yet few intervention studies have explored how to develop facial expression recognition in children with brain injury. Enhancing the ability to recognize and interpret facial expressions for these children would have implications for their emotional processing and social-emotional behavior. In this paper we report on a short single case study intervention to increase facial expression recognition using the Facial Affect Recognition training (FAR) for a 10-year-old-child with brain injury. Following intervention, there was not only an increase in facial expression recognition but also changes in social-emotional behavior indicating some generalization to other contexts. The results suggest that rehabilitation of emotional processing difficulties may indeed be possible, and further intervention studies aimed at developing these skills in children with brain injury are warranted.

A range of functions can be negatively affected by pre-frontal cortex (PFC) injury, but observed behavioural and social changes are commonly linked to post-injury changes in executive function. Executive functioning is a complex neuropsychological construct which is further complicated by neuro-developmental processes when applied to children. There is a substantial and continuing evidence base that supports the view that early childhood pre-frontal cortex (PFC) injury results in hidden, dormant, or sleeping effects. In contrast, recent and rapidly accruing contemporary studies provide preliminary evidence that challenge the view that PFC associated impairments are completely 'hidden'. Studies that examine the various functions of the PFC and differentiate these to provide preliminary evidence to indicate earlier EF development than that which develops upon reaching adolescence, are reviewed here, together with research that identifies early predictors of later EF impairments. It remains that studies of PFC function and/or structural brain-changes are substantially complicated by issues related to definition regarding functions of the PFC, measurement of EF and other PFC-related functions that may be better understood as meta-processes. These issues are discussed in the concluding sections of this paper.

Summary A recent UN general comment on criminal justice systems includes guidance to state parties regarding the implementation of the Convention on the Rights of the Child for children with developmental delays or neurodevelopmental disorders or disabilities. This guidance asserts that these children “should not be in the child justice system at all”, but when present “should be individually assessed” to enable appropriate safeguards and accommodations to ensure the protection of their rights without discrimination. In this Viewpoint, we examine the significant barriers faced by children who are affected by neurodevelopmental disabilities to the realisation of their rights under international law and standards. These barriers include systemic and cultural barriers created by a lack of awareness among justice professionals about how to identify and work with children who have neurodevelopmental disabilities, as well as procedural barriers, which arise from the complexity and rigidity of many criminal justice processes. The effect of these barriers is that the child is denied their rights on an equal basis with other children without such disabilities.

Neuropsychological assessments results have significant implications for pediatric populations, based upon the assumption that the young person has adopted an effortful approach and has engaged in assessment. There is a commonly-accepted risk to assuming the validity of neuropsychological assessment results with adults, and, therefore, performance validity testing (PVT) has become a major topic of research and investigation and has become an accepted part of routine assessment. The same approach has not been adopted in assessment with children and a paucity of studies has focused on PVT in children. We review studies that demonstrate that children are equal to adults in their ability to use deception and that clinicians cannot detect false-effort without use of validity tests. We explore how frequently such tests are used and how well they work in assessment with children, and the limits, complexities, and constraints of adapting adult tests. We advocate that adequate performance validity testing is essential in order to maximize confidence in the results and we hypothesize that assessment with pediatric populations should take into account a range of influences, such as neuro-developmental factors associated with age of the child and suitability of proposed measures according to the evidence-base.

Survivors of traumatic brain injury are often impaired in their recall of specific events. Depressed, suicidal, and post-traumatically stressed patients also tend to be over-general in autobiographical recall. In this study we examined the extent to which neurological damage and disturbed mood converge to lead to problems in autobiographical recall for survivors of traumatic brain injury. Eighteen participants completed measures of depression and anxiety (HAD), tests of general memory and immediate recall (Rivermead), and of current and premorbid verbal IQ (SCOLP). In addition they completed a 20 cue word autobiographical memory test and made causal attributions for their trauma events. Correlational analyses revealed that difficulty in autobiographical recall was related to reduced immediate recall ability and mood disturbance. Remedial implications are discussed.

Sports-related concussion (SRC) is typically associated with functional, as opposed to structural, injury. The results of traditional structural neuroimaging techniques used to assess SRC tend to be normal in many athletes, and are only clinically helpful in ruling out a more serious injury. Diffusion tensor imaging (DTI) has increasingly been touted as a method offering greater clinical potential in mild traumatic brain injury (mTBI). Despite this, the utility of DTI as a clinical tool for diagnosing and managing SRC has received considerably less attention than it has in the general TBI research literature. The aim of this article is to conduct a systematic review of DTI in SRC, and to provide a focus and overview of research findings using this MRI technique in SRC. A systematic review of articles published in the English language, up to February 2012, was retrieved via PsycINFO(®), MEDLINE(®), EMBASE, SPORTDiscus(™), Scopus, Web of Science, and Informit; using the key search terms: diffusion tensor imaging, diffusion magnetic resonance imaging, diffusion weighted MRI, diffusion MRI, fractional anisotropy, tractography, apparent diffusion coefficient, magnetic resonance imaging, mild traumatic brain injury, mTBI, traumatic brain injury, concussion, sport, athletic and athlete. Observational, cohort, correlation, cross-sectional and longitudinal studies were all included in the current review. Results of the review found eight articles that met inclusion criteria, which included data on 214 athletes and 96 controls. Seven of eight studies reported some type of DTI abnormality, although the neuroanatomical sites involved varied. Although considerable methodological variations exist across studies, the current review suggests that DTI may possess adequate diagnostic sensitivity to detect SRC in affected athletes. Further longitudinal studies are required to demonstrate its discriminate validity and prognostic capacity within this field.

Objectives. The costs associated with traumatic injury are often exacerbated by the development of post-traumatic stress symptoms. However, it is unclear what decreases the development of post-traumatic symptoms over time. The aim of the present research was to examine the role of psychological symptoms and social group memberships in reducing the development of post-traumatic stress symptoms after orthopaedic injuries (OIs) and acquired brain injuries (ABIs). Design and Methods. A longitudinal prospective study assessed self-reported general health symptoms, social group memberships, and post-traumatic stress symptoms among participants with mild or moderate ABI (n= 62) or upper limb OI (n= 31) at 2 weeks (T1) and 3 months (T2) after injury. Results. Hierarchical regressions revealed that having fewer T1 general health symptoms predicted lower levels of T2 post-traumatic stress symptoms after OI but forming more new group memberships at T1 predicted lower levels of T2 post-traumatic stress symptoms after ABI. Conclusion. A focus on acquiring group memberships may be particularly important in reducing the development of post-traumatic stress symptoms after injuries, such as ABI, which result in long-term life changes.

Acquired brain injury (ABI) during childhood can be associated with enduring difficulties related to impairments to executive functioning (EF). EF impairments may detrimentally affect outcome by restricting an individual's ability to access 'resiliency' resources after ABI.The purpose of this study was to explore whether there is deterioration in children's resilience compared with peers after ABI and whether EF is influential in mediating relationships between resilience and behaviour.Measures of resilience, depression and anxiety were administered with 21 children with ABI and 70 matched healthy children aged 9-15 years. Parents completed measures of behaviour and EF.Children with ABI were identified as less resilient and more depressed and anxious than controls. Resiliency measures were correlated with depression and anxiety in both groups. Relationships between resiliency and socio-emotional behaviour were mediated by EF.Assessment of resilience after ABI may be useful in supporting or defining the delivery of more individualized rehabilitation programmes according to the resources and vulnerabilities a young person has. However, an accurate understanding of the role of EF in the relationship between resilience and behavioural outcome after ABI is essential.

Children with traumatic brain injuries (TBI) commonly present with socioemotional difficulties, as well as accompanying multiple cognitive impairments. Often difficulties worsen at around 10 years old. This change is associated with frontal system changes, and tests of executive function (EF) predict outcome. However, children with TBI sometimes present with socioemotional difficulties despite apparent cognitive recovery. Our aims were to explore potential cognitive and socioemotional effects following childhood TBI, before and after the age of 10 years. We also wanted to identify cognitive correlates of psychosocial dysfunction. Measures of cognitive function and socioemotional disturbance administered to 14 children with TBI aged 8—10 years, and 14 children with TBI aged 10—16 years, were compared to control data from 22 non-injured 8- to 10 year-olds and 67 non-injured 10- to 16-year-olds. Results indicated that only the older group of children with TBI were impaired in tests of EF, but significant socioemotional difficulties were commonly evident in both groups. Processing speed (as well as EF) was found to correlate with socioemotional disturbance. We conclude that poor processing speed may also index the risk of socioemotional difficulties, but our general findings indicate that cognitive functions relevant to socioemotional functioning are not readily testable in younger children and are not strongly associated with such outcomes as they may be in adults.

This study examined the roles of personal and social changes on the relationship between injury severity and life satisfaction among individuals with acquired brain injury (ABI). Personal change (i.e. having developed a survivor identity, identity strength), social changes (i.e. improved social relationships, support from services), injury severity (i.e. length of time in coma) and well-being (i.e. life satisfaction) were assessed in a sample of 630 individuals with ABIs. A counterintuitive positive relationship was found between injury severity and life satisfaction. Bootstrapping analyses indicated that this relationship was mediated by personal and social changes. Although identity strength was the strongest individual mediator, both personal and social changes each explained unique variance in this relationship. These findings suggest that strategies that strengthen personal identity and social relationships may be beneficial for individuals recovering from ABIs.

Adolescence is a risk period for offending and for traumatic brain injury (TBI) and TBI is a risk factor for poor mental health and for offending. TBI has been largely neglected from guidance on managing the mental health needs of young offenders. We sought to determine the rate of self-reported TBI, of various severities, in a male, adolescent youth offending population. We also aimed to explore whether TBI was associated with number of convictions, violent offending, mental health problems and drug misuse. Young male offenders aged 11 to 19 years were recruited from a Young Offender Institute, a Youth Offending Team and a special needs school. A total of 197 participants were approached and 186 (94.4%) completed the study. They completed self-reports on TBI, crime history, mental health and drug use. TBI with loss of consciousness (LOC) was reported by 46% of the sample. LOC consistent with mild TBI was reported by 29.6%, and 16.6% reported LOC consistent with moderate to severe TBI. Possible TBI was reported by a further 19.1%. Repeat injury was common - with 32% reporting more than one LOC. Frequency of self-reported TBI was associated with more convictions. Three or more self-reported TBIs were associated with greater violence in offences. Those with self-reported TBI were also at risk of greater mental health problems and of misuse of cannabis. TBI may be associated with offending behaviour and worse mental health outcomes. Addressing TBI within adolescent offenders with neurorehabilitative input may be important for improving well-being and reducing re-offending.

Symptoms of mild traumatic brain injury typically resolve within days or weeks. However, a significant group of patients may report symptoms of Post-concussional Syndrome (PCS) weeks, months and years postinjury. This review presents an overview of the pathogenesis, diagnosis and treatment options for PCS. The authors review the evidence for factors that may predict such symptoms. At early phases, there are associations between neurological signs and symptoms, neurocognitive functions and self reports. Over time, such associations become less coherent, and psychological issues become particularly relevant. An accurate understanding of neurological and psychosocial factors at play in PCS is crucial for appropriate management of symptoms at various points postinjury.

Background: TBI can lead to cognitive, behavioural and emotional difficulties. Previous studies suggest that TBI is relatively elevated in offender populations. In this study the aims were to establish the rate of TBI of various severities in a representative sample of adult offenders and patterns of custody associated with TBI.Methods: A self-report survey of adult, male offenders within a prison. Of 453 offenders, 196 (43%) responded.Results: Over 60% reported ‘Head Injuries’. Reports consistent with TBI of various severities were given by 65%. Of the overall sample, 16% had experienced moderate-to-severe TBI and 48% mild TBI. Adults with TBI were younger at entry into custodial systems and reported higher rates of repeat offending. They also reported greater time, in the past 5 years, spent in prison.Conclusions: These findings indicate that there is a need to account for TBI in the assessment and management of offenders.

As children with acquired brain injuries (ABI) mature to become adolescents they develop a range of previously undetected social and emotional difficulties, which are commonly associated with executive dysfunctions. The authors wanted to determine whether visual-spatial performance is subject to age-related improvement, whether such skills can differentiate between children with ABI and healthy children and whether visual-spatial performance is a correlate of socioemotional functioning.The 'Cube analysis' and 'Dot discrimination' tests from the 'Visual Object Space Perception (VOSP)' battery and the Strengths and Difficulties Questionnaire (SDQ) were administered for 18 children, 9-15 years, with ABI and compared against 67 'healthy' children.Cube analysis scores improved significantly at approximately 10 years old in the control group. The ABI group performed the task significantly poorer than controls. Analysis indicated that visual discrimination skill did not account for performance difficulties. Visual-spatial performance was correlated with greater impact of reported difficulties on the SDQ.Visual-spatial tests are sensitive in differentiating between healthy children and children with ABI. Impairment of visuo-spatial skills may provide an index of psychosocial risk during later teenage years and adulthood.

A previous study has shown that children with brain injuries are worse than their same age peers at reading emotions. It has not clearly been established that cognitive impairments and emotion processing impairments are dissociable in children and the question of whether emotion-reading skills can be selectively impaired in children after brain injury is explored here.This study addresses this issue by testing a case series of seven children with brain injuries, who were identified as experiencing emotional or behavioural difficulties, according to a social-behavioural measure.A battery of tests of cognitive function and measures that assess ability in reading emotions from faces, voices and eyes was administered to each child.Some cases demonstrate broadly based deficits that affect both cognitive and emotion processing domains, whilst other cases demonstrate highly selective deficits in reading emotions.Based on the profile of results across the cases, this study reports that modality-specific, selective impairments in reading emotional expression can be found in children after brain injury. In addition, the data provide evidence of dissociation between cognitive abilities and emotional expression processing.

Previous research has considered the presence of grief reactions following traumatic brain injury, the way loss is perceived, and the strategies used in adjustment. A qualitative approach was employed to investigate the experiences of seven adults with a severe traumatic brain injury. An Interpretative Phenomenological Analysis yielded findings highlighting associations to an existing model of coping with bereavement. Consideration of the Dual Process Model indicates a coherent process of adjustment within the sample. Following an early, overwhelming confrontation with loss, the participants used a range of strategies to avoid thinking about the losses experienced. Participants also described a focus on continuing progress, unresolved issues, the importance of social support, and post-traumatic growth. The utility and limitations of the Dual Process Model are explored, and implications for clinical work, long-term adaptation, and the need for further research are noted.

Lasting emotional and social communication deficits are common among children who have suffered brain injury. Concerns have been raised that current assessment and treatment methods are inadequate in addressing the needs of such children in rehabilitation. We advocate that a proportion of reported deficits occur as a result of compromise to emotion processing systems in the brain. In this article we review adult brain injury research, which indicates that dissociable subsystems are involved in distinguishing the nuances of emotional expression. Findings previously reported in the literature have been integrated into a dissociable heuristic framework, which offers a novel representation of subcomponents of the emotion processing system. In considering the development of the subcomponents of emotion processing, evidence indicates that intrinsic arousal systems are operational from birth, systems associated with sensory/spatial skills that are essential in reading emotional expression develop rapidly from birth, and systems utilised in executive system synthesis become increasingly sophisticated with development, stemming across childhood and into adulthood. In conclusion, it is proposed that the heuristic is a useful tool on which assessment measures may be based when considering the primary effects of brain injury in children.

Acute encephalitis is an inflammation of brain tissue that can result from activity in the central nervous system (CNS) of a number of viruses. Although the neurological and psychiatric effects of encephalitis in the acute phase of the illness are well-known (Caroff, Mann, Gliatto, Sullivan, & Campbell, 2001), larger scale studies of the pattern of neuropsychological and psychiatric impairment following recovery from the acute inflammatory phase are less apparent. This paper reports the results of neuropsychological testing with a range of standardised cognitive measures in a case series of long-term post-acute participants. Psychiatric abnormality is examined using the SCL-90-R self-report scale of distress (Derogatis, 1983). We also examined the role of emerging insight in the aetiology of depression in this population. Two clusters of cognitive dysfunction were observed, one group of primarily herpes simplex cases showing a severe generalised deficit across a number of cognitive domains and a second cluster showing a variety of more isolated disorders of executive function. Abnormally high levels of distress were reported by participants, with depression, obsessive-compulsive symptoms, interpersonal sensitivity and phobic anxiety most significantly increased. Depression was found to be least severe in those with most accurate insight into their problems. Examining the correlations between cognitive and psychiatric test results demonstrates a relationship between depression and interpersonal anxiety and specific cognitive measures. Obsessive-compulsive behaviour and phobic anxiety, however, appear to exist independently of the assessed cognitive deficits.

Little is known about how emotion recognition abilities develop during childhood and adolescence, although adolescence is a time marked by significant changes in socio-emotional behaviour. The first aim of this study was to explore the range of emotion recognition skills that 9-15-year olds would normally display and whether emotion-reading skills are reliably measurable. Secondly, one wanted to determine whether adolescence is a period during which skills in recognizing emotions improve.Novel and adapted measures of emotion processing were used in tasks that required 67 9-15-year olds to read emotion from voices, eyes and faces.Findings indicate that emotion recognition abilities are reliably measurable skills. A stage of improvement in facial expression recognition and reading emotion from eyes was found to occur at approximately 11 years of age.The findings show that these skills can be measured and that it is possible to devise assessment tests which are sensitive to developmental improvements in emotion recognition skills in early adolescence, when screening for the effects of child brain injury.

We investigated the relationship between the reporting of symptoms of posttraumatic stress disorder (PTSD) in a community sample of 66 survivors of severe traumatic brain injury (TBI) and measures of injury severity, memory, insight, and index-event attributions. Correlational analyses revealed that reporting of PTSD symptoms was related to level of insight and not associated with the severity of survivors' injury, educational background, premorbid or current IQ, or memory impairment. The severity of PTSD symptoms was also associated with external attributions to others of causality for the event.

Rugby Union, a popular full-contact sport played throughout the world, has one of the highest rates of concussion of all full-contact sports. The aim of the current review was to systematically evaluate the available evidence on concussion in Rugby Union and to conduct a meta-analysis of findings regarding the incidence of concussion. Articles were retrieved via a number of online databases. The current review examined all articles published in English up to May 2014 pertaining to concussion in Rugby Union players. The key search terms included ‘Rugby Union’, ‘rugby’, ‘union’, and ‘football’, in combination with the injury terms ‘athletic injuries’, ‘concussion’, ‘sports concussion’, ‘sports-related concussion’, ‘brain concussion’, ‘brain injury’, ‘brain injuries’, ‘mild traumatic brain injury’, ‘mTBI’, ‘traumatic brain injury’, ‘TBI’, ‘craniocerebral trauma’, ‘head injury’, and ‘brain damage’. The final search outcome following the eligibility screening process resulted in the inclusion of 96 articles for this review. The meta-analysis included a total of 37 studies. The results of the meta-analysis revealed an overall incidence of match-play concussion in men’s rugby-15s of 4.73 per 1,000 player match hours. The incidence of concussion during training was 0.07 per 1,000 practice hours. The incidence of concussion in women’s rugby-15s was 0.55 per 1,000 player match hours. In men’s rugby-7s match-play, concussion incidence was 3.01 per 1,000 player match hours. The incidence of concussion varied considerably between levels of play, with elite level play recording a rate of 0.40 concussions per 1,000 player match hours, schoolboy level 0.62 concussions per 1,000 player match hours, and the community or sub-elite level recording a rate of 2.08 concussions per 1,000 player match hours. The incidence of concussion in men’s rugby-15s as a function of playing position (forwards vs. backs) was 4.02 and 4.85 concussions per 1,000 player match hours, respectively. Concussion is a common injury sustained and reported in match play and to a lesser extent during practice by Rugby Union players. Based on the available published data, there appears to be a variation in risk of concussion across level of play, with the sub-elite level having the greatest incidence of injury. Future research focused on studying the acute consequences and best management strategies in current players, and the potential longer term outcomes of concussion in retired players, is needed. A focus on the areas of prevention, injury identification, and medical management, and risk for long-term outcomes will be of benefit to current athletes.

OBJECTIVES:: As provenance of postconcussion symptoms after mild traumatic brain injury (mTBI) is controversial, with similar rates found in other populations, we aimed to identify postconcussion symptoms specific to mTBI compared with controls. We also compared differences between complicated and uncomplicated mTBIs. SETTING:: Hospital emergency department. PARTICIPANTS:: Adult individuals (34 individuals with complicated mTBI, 76 individuals with uncomplicated mTBI, and 47 orthopedic controls) who sought care in the emergency department and were consecutively recruited by post at 2 weeks postinjury. MAIN MEASURES:: Rivermead Postconcussion Symptom Questionnaire. Preinjury factors were used as covariates. RESULTS:: Compared with orthopedic controls, complicated mTBI group reported greater severity of headaches, dizziness, and nausea, as well as concentration difficulties, suggesting that these are neurogenic. Severity of other symptoms measured on the Rivermead Postconcussion Symptom Questionnaire was not significantly different between these groups, suggesting that these are psychogenic. Differences were evident between the 2 mTBI samples on the items of dizziness, nausea, fatigue, sleep disturbance, and concentration difficulties. CONCLUSIONS:: Neurogenic and psychogenic postconcussion symptoms were identified at the acute-phase postinjury. Findings suggest that treating persons with mTBI as a homogenous sample is not prudent. This should inform prognostic models and follow-up support offered after leaving the emergency department. Language: en

The costs associated with traumatic injury are often exacerbated by the development of post-traumatic stress symptoms. However, it is unclear what decreases the development of post-traumatic symptoms over time. The aim of the present research was to examine the role of psychological symptoms and social group memberships in reducing the development of post-traumatic stress symptoms after orthopaedic injuries (OIs) and acquired brain injuries (ABIs).A longitudinal prospective study assessed self-reported general health symptoms, social group memberships, and post-traumatic stress symptoms among participants with mild or moderate ABI (n= 62) or upper limb OI (n= 31) at 2 weeks (T1) and 3 months (T2) after injury.Hierarchical regressions revealed that having fewer T1 general health symptoms predicted lower levels of T2 post-traumatic stress symptoms after OI but forming more new group memberships at T1 predicted lower levels of T2 post-traumatic stress symptoms after ABI.A focus on acquiring group memberships may be particularly important in reducing the development of post-traumatic stress symptoms after injuries, such as ABI, which result in long-term life changes.

The effects of Mild Traumatic Brain Injury (mTBI) typically resolve within days or weeks. However, a significant group of patients can report Persistent Concussional Symptoms (PCS). They may report a range of symptoms weeks, months and years post-injury. This review presents an overview of the pathogenesis, diagnosis and treatment options for mTBI and PCS, in adults and children. At early phases, post-injury, there are associations between neurological signs and symptoms, and neuropsychological functions and self-reported symptoms. However, over time, such associations become less coherent, and psychological issues become particularly relevant. Post-traumatic stress factors appear particularly important. We provide a biopsychosocial framework within which factors that predict such symptoms can be understood. An accurate diagnosis is critical for appropriate management of symptoms at various points post-injury.

Survivors of acquired brain injury (ABI) are at risk of a range of neuropsychiatric and behavioural disorders. Emotional disturbance, with reactive elements of mood disorder, such as depression and anxiety, appear particularly common. Specific anxiety disorders, such as post-traumatic stress disorder (PTSD) have also been identified. Pain syndromes are also common-particularly in those who have suffered Traumatic Brain Injuries (TBI). Survivors of ABI are often atrisk of substance misuse and of irritability states. Their relationships may suffer from the stresses triggered by the aftermath of injury. Intimate, in particular, sexual relationships may be particularly affected. These effects are not, necessarily, only consequent of severe injuries, as mild TBI can also have, for some, significant neuropsychiatric effects. Assessment and management of such conditions are compromised by survivors of injury often having a limited insight into the sequelae of their injuries. Interventions for such disorders and forms of distress are increasingly available. This paper introduces the special issue of Neuropsychological Rehabilitation on biopsychosocial approaches in neurorehabilitation. A range of papers provide overviews for assessing and managing such neuropsychiatric, mood and behavioural (health and habit) disorders.

In this paper we explore the evidence for post-traumatic stress disorder (PTSD) after traumatic brain injury (TBI). We examine its possible mediating mechanisms after brain injury, the evidence for its occurrence, risk, and protective factors, and the implications for intervention and service demands. In the first section we review the current literature relevant to cause, maintenance, and treatment of PTSD in general, before addressing issues associated with the assessment and management of PTSD after TBI. It is argued that PTSD may occur after a brain injury, and can be, relatively, a common disorder. However, explanatory mechanisms for its occurrence may be speculative. In this context, we argue, assessment and treatment need to be carefully considered, and comprehensive.

Social and emotional impairments are frequently reported following acquired brain injury, including an inability to adopt another’s perspective, empathize, and display guilt, and inappropriate social conduct. Case studies suggest that these problems are particularly apparent when the injury is sustained in childhood, with deficits increasing with age and persisting throughout adulthood. In addition to these deficits, individuals may have limited insight into their cognitive or social-emotional deficits, which in turn may also affect social functioning and have implications for the success of rehabilitation. Despite the frequency of these problems, there is a dearth of suitable measures for detecting them in children or adolescents. The purpose of the current study was to develop one such measure from a measure initially intended for adults. Normative data were collected from 109 typically-developing 11- to 14-year-olds and their parent/guardian on the Social-Emotional Questionnaire for Children (SEQ-C). Factor and reliability analyses were conducted and the subscales were then explored in association with key demographic information. Social-emotional development showed a fluctuating course across early adolescence, alongside some gender differences. This measure, with its normative data, will be of value to neuropsychologists wishing to explore such functioning in their clinical practice.

Positive peer relationships are essential in healthy development. The prevalence of peer-relationship problems in children after acquired brain injury (ABI) has yet to be explored, although ABI does inevitably impact upon peer interactions. We aimed to explore how peer-relationships and emotional distress after ABI may differ from the levels reported by healthy children or mental health controls. Parents of 214 children (137 "healthy" children, 27 children using mental health services and 40 children with ABI) aged 9-15 years participated. A questionnaire measure of peer-relationship functioning and emotional distress was completed. Children with ABI experienced a greater degree of peer-relationship difficulties and emotional distress than healthy controls. No difference was found in reported peer relationship difficulties or emotional distress between ABI children and the children accessing mental health services. We conclude that emotional distress and co-occurring peer-relationship difficulties are as prevalent in a population of children after ABI as may be expected in a population of children under the care of mental health services, yet, unlike the latter group, appropriate intervention services are not commonly available. Interventions that aim to enhance peer relationships after childhood ABI may provide an essential resource to the benefit of outcome.

Introduction Most people who suffer serious traumatic brain injury (TBI) have a period of loss of consciousness and post-traumatic amnesia that typically means that they do not recall the moment of injury itself. They may also have a gap in memory stretching from some time prior to injury to some time after the injury. Therefore despite going through the traumatic experience of a motor vehicle accident or assault or fall the individual may have no recollection of the incident itself. Post-traumatic stress disorder (PTSD) is a mood disorder characterized by re-experiencing (flashbacks, nightmares), avoidance and arousal symptoms (e.g. hypervigilance) in relation to having experienced, witnessed or been confronted by an event involving death or serious injury that results in feelings of fear, helplessness or horror (American Psychiatric Association, 2000). In the context of amnesia for the traumatic event, the question as to whether PTSD can occur after TBI, has been the subject of some debate (Sbordone and Liter 1995; Bryant et al . 2000; Williams et al . 2002; Sumpter and McMillan 2006). However, it is generally accepted now that, through various different mechanisms, PTSD can occur after TBI (Bryant, 2001). Some people who suffer a closed head injury have partial recall of the incident (Creamer et al . 2005) with some experiencing specific ‘islands’ of memory for traumatic events (King, 1997).

In everyday adolescent communication, the ability to empathise with the mental state of others, recognise or infer intentions, or make judgements about emotional state, is a non-conscious but vital prerequisite of relating. Execution of these skills in social interactions supports both the exchange of social knowledge and also the development and maintenance of personal relationships. Thus, adolescents with impairments in these skills are at risk for a variety of negative outcomes. In this paper, we present data to illustrate that adolescents with traumatic brain injury (TBI) are likely to have impairments in processes such as emotion recognition and mental state attribution, and that these might not be identified on standardised tests. This is considered from the perspective of clinical assessment and intervention in school contexts.

Lasting socio-emotional behaviour difficulties are common among children who have suffered brain injuries. A proportion of difficulties may be attributed to impaired cognitive and/or executive skills after injury. A recent and rapidly accruing body of literature indicates that deficits in recognizing and responding to the emotions of others are also common. Little is known about the development of these skills after brain injury. In this paper we summarize emotion-processing systems, and review the development of these systems across the span of childhood and adolescence. We describe critical phases in the development of emotion recognition skills and the potential for delayed effects after brain injury in earlier childhood. We argue that it is important to identify the specific nature of deficits in reading and responding to emotions after brain injury, so that assessments and early intervention strategies can be devised.

A survey study of patients recovering from stroke (N = 53) examined the extent to which belonging to multiple groups prior to stroke and the maintenance of those group memberships (as measured by the Exeter Identity Transitions Scales, EXITS) predicted well-being after stroke. Results of correlation analysis showed that life satisfaction was associated both with multiple group memberships prior to stroke and with the maintenance of group memberships. Path analysis indicated that belonging to multiple groups was associated with maintained well-being because there was a greater likelihood that some of those memberships would be preserved after stroke-related life transition. Furthermore, it was found that cognitive failures compromised well-being in part because they made it hard for individuals to maintain group memberships post-stroke. These findings highlight the importance of social identity continuity in facilitating well-being following stroke and, more broadly, show the theoretical contribution that a social identity approach to mental health can make in the context of neuropsychological rehabilitation.

This study presents an exploration of the impact of childhood encephalitis on parental mood, coping and disciplinary strategies. Thirty six parents of children aged between 10 and 17 years were recruited. They were split into groups of recent and remote cases (within or beyond 7 years). Group comparison revealed that neurobehavioural consequences of childhood encephalitis appear to persist over time. Higher levels of behavioural symptoms consistent with dysexecutive disorder were associated with greater parental distress. Parents remain distressed despite reporting proactive profiles of coping. There was an indication that severity of dysexecutive disorder was asscociated with less use of proactive parental management strategies. Support for parents, in particular focused on effective management of dysexecutive problems, is recommended.

Child brain injury can have a lasting, detrimental effect upon socio-emotional behaviour, but little is known about underlying impairments that cause behavioural disturbance. This study explored the possibility that a proportion of difficulties result from compromise to systems in the brain which function in reading emotion in others from eyes, face expression or vocal tone.Measures of ability in reading emotion from faces, voices and eyes were used in conjunction with a battery of tests of cognitive function, in gathering data from 18 children aged between 9-17 with acquired brain injuries (ABI). Performance levels were compared against the normative data from 67 matched 'healthy' children. Questionnaires were used as a measure of socio-emotional behaviour.The ABI children in the sample were worse than their same age peers at reading emotions. Regression analyses revealed that emotion recognition skills and cognitive abilities were generally unrelated. Some relationships between emotion reading difficulties and behaviour disturbance were found, however there were limitations associated with this particular finding.Emotion-recognition skills, which are not routinely assessed following child brain injury, can be adversely affected as a consequence of brain injury in childhood.

Spousal relationships following brain injury are particularly vulnerable to strain and breakdown. Changes in personality and socio-emotional processing and behaviour have been implicated as causal factors. We examined spousal relationship satisfaction following an acquired brain injury to one partner. Couples affected by chronic pain and a group of healthy couples were used for comparison and control. Compared to healthy controls current satisfaction was poorer in the brain injury couples, and satisfaction with the relationship had reduced from pre to post-injury. We found an especially important role for empathy, which differentiated between the groups in terms of functioning and insight.

In everyday adolescent communication, the ability to empathise with the mental state of others, recognise or infer intentions, or make judgements about emotional state, is a non-conscious but vital prerequisite of relating. Execution of these skills in social interactions supports both the exchange of social knowledge and also the development and maintenance of personal relationships. Thus, adolescents with impairments in these skills are at risk for a variety of negative outcomes. In this paper, we present data to illustrate that adolescents with traumatic brain injury (TBI) are likely to have impairments in processes such as emotion recognition and mental state attribution, and that these might not be identified on standardised tests. This is considered from the perspective of clinical assessment and intervention in school contexts.