Acquired brain injury, violence, and anti-social behaviour: Disentangling cause and effect
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- intimate partner violence, sexual assault, choking, neurobehavioral, Hypoxia, causal inference, interrupted time series, concussion, child, adolescent, brain injury, strangulation, DClinPsy, School of Psychology
Research areas
Abstract
Abstract
Since Cain killed Abel with a rock to the skull, brain injury, violence, and anti-social behaviour have been entangled. This thesis attempts to disentangle them.
Chapter One systematically reviews the clinical outcomes of non-fatal strangulation in domestic and sexual violence. 27 studies met inclusion criteria. Together they evidence potentially severe medical consequences: loss of consciousness, seizures, motor and speech disorders. Psychological outcomes include suicidality, dissociation, and PTSD. There was less evidence for cognitive and behavioural sequelae, but memory deficits and compliance were reported. We propose further research, using standardised neuropsychological assessment to build cognitive and behavioural profiles. We also discuss broader implications: the ‘rough sex’ defence, issues of consent, and chokeholds within mixed martial arts.
Chapter Two explores the temporal sequencing of childhood brain injury and anti-social behaviour, using prospective sampling. We hypothesised that brain injury would come first and, controlling for confounds, causation could be inferred. 476 members of the Millennium Cohort Study (CLS, 2019) have had accidents resulting in loss of consciousness; we compare them to 3,964 children with orthopaedic injuries. Using interrupted time series regression, we explore post-injury changes to behavioural trajectories, measured by the SDQ (Goodman, 2001). Modelling did not demonstrate any significant alteration in the short or long term, and thus we could not infer causation. Moreover, there was neither a significant effect of age at injury, nor a dose response. We discuss study limitations which may have obscured effects, but highlight the difference made by using prospective sampling, and injured control groups, in a field used to clinical samples, cross-sectional analysis, and retrospective report.
The final chapter suggests theoretical development for both papers, further research, and clinical implications, before concluding with personal reflections on the research process.
Since Cain killed Abel with a rock to the skull, brain injury, violence, and anti-social behaviour have been entangled. This thesis attempts to disentangle them.
Chapter One systematically reviews the clinical outcomes of non-fatal strangulation in domestic and sexual violence. 27 studies met inclusion criteria. Together they evidence potentially severe medical consequences: loss of consciousness, seizures, motor and speech disorders. Psychological outcomes include suicidality, dissociation, and PTSD. There was less evidence for cognitive and behavioural sequelae, but memory deficits and compliance were reported. We propose further research, using standardised neuropsychological assessment to build cognitive and behavioural profiles. We also discuss broader implications: the ‘rough sex’ defence, issues of consent, and chokeholds within mixed martial arts.
Chapter Two explores the temporal sequencing of childhood brain injury and anti-social behaviour, using prospective sampling. We hypothesised that brain injury would come first and, controlling for confounds, causation could be inferred. 476 members of the Millennium Cohort Study (CLS, 2019) have had accidents resulting in loss of consciousness; we compare them to 3,964 children with orthopaedic injuries. Using interrupted time series regression, we explore post-injury changes to behavioural trajectories, measured by the SDQ (Goodman, 2001). Modelling did not demonstrate any significant alteration in the short or long term, and thus we could not infer causation. Moreover, there was neither a significant effect of age at injury, nor a dose response. We discuss study limitations which may have obscured effects, but highlight the difference made by using prospective sampling, and injured control groups, in a field used to clinical samples, cross-sectional analysis, and retrospective report.
The final chapter suggests theoretical development for both papers, further research, and clinical implications, before concluding with personal reflections on the research process.
Details
| Original language | English |
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| Award date | 2020 |