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Virginia Researchers Explore Link Between Brain Injury And Crime

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Active duty service members are at a heightened risk of traumatic brain injury, which researcers have linked to criminal behavior.
The U.S. Army
Active duty service members are at a heightened risk of traumatic brain injury, which researcers have linked to criminal behavior.

During the wars in Iraq and Afghanistan, many American troops have encountered improvised explosive devices that left them with a traumatic brain injury or TBI. As a result, experts say they could be left with lifelong problems of uncontrolled anger, frustration and in some cases criminal behavior. Now some researchers in Virginia are looking for ways to use a deeper understanding of TBI to prevent crime from happening.

Brain injuries underdiagnosed

Twenty percent of U.S. servicemen are involved in a blast, a fall or some kind of crash that leads to a brain injury, according to Dr. David Cifu, of the Virginia Commonwealth University's school of medicine. He says there's no medical test to confirm the problem, but victims of brain injury have as many as 22 common complaints.

"Headache is way up there," says Cifu. "Number two is sleep disorder: insomnia, usually difficulty sleeping. Third one, dizziness: inability to walk as easily or do physical activities, because you feel some subtle sense of imbalance. The fourth most common one acutely, and the third most common one long-term, is cognitive issues: thinking difficulties — specifically difficulty with attention and concentration. And the fifth most common symptom is difficulties with frustration tolerance and irritability."

Frustration and irritability can lead to violent, impulsive behavior, but Cifu, who serves as National Director for Physical Medicine and Rehabilitative Services at the Veterans Administration, says that's sometimes overlooked in soldiers.

"Often that's not seen for the first couple of days or a couple of weeks, because you've got a headache to worry about, or you're in a very structured military environment where you don't have a chance to be frustrated, or frustration and a little anger is not always a negative thing in a battle zone, says Cifu. "But trust me, when they yell at their superior or they explode at their wife or they have road rage above and beyond what they had before, it becomes noticed."

A connection between TBI and violence

One of those who noticed a connection between brain injury and violent behavior is Professor Jeffrey Kreutzer, Director of Virginia Commonwealth's Traumatic Brain Injury Model System of Care.

"Overall, about one in four people that we saw in our practice was somehow involved with the law, and so we began thinking about the relationship between brain injury and crime," says Kreutzer. "We talked with some folks from the department of juvenile justice. There was minimal assessment of the extent of traumatic brain injury. While there were tests being done, they were more focused on academics and intelligence, and those tests are not necessarily sensitive to the effects of brain injury."

So he helped to develop a new set of tests that could be used to detect brain injury in juveniles convicted of crimes.

"These are tests of memory, attention, concentration, vision," says Kreutzer. "We added a brain injury history taking interview that asked people what kind of medical treatment they had, what kind of symptoms they had, and we also adapted a more thorough chart review."

After studying about 600 young offenders in Virginia prisons, Kreutzer and his colleagues found evidence that 20 percent had sustained at least one traumatic brain injury.

"This is a life-long issue that will, undiagnosed, get worse and worse and worse," says Department for Aging and Rehabilitative Services Commissioner Jim Rothrock. "Friends of mine suffered a brain injury. Their ability to work and live is not totally compromised, but they still have moments where things don't connect as you or I, and they need to learn to compensate around that, which we can do."

Treating instead of punishing TBI sufferers

Given that Virginia spends about $30,000 a year to house, feed and provide medical care for prisoners, Rothrock believes we must find ways to keep those who are released from coming back.

"We see now that there are individuals that cycle in and out of our corrections system from the time they're late teenagers for the rest of their lives," says Rothrock.

There are about 89,000 Virginians coping with traumatic brain injury  many more if you count veterans, and 28,000 more join the ranks each year. As researchers learn how to better identify them, Rothrock hopes they will benefit from improvements in medical and psychological treatments.

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