Traumatic brain injury prevalent among prisoners

In the past week I’ve run across an unexpected convergence between my roles as a trial lawyer handling brain injury cases and as president-elect of the State Bar of Georgia.

Last Friday, I attended a program on criminal justice reform at the American Bar Association office in Washington, along with state government representatives. Among the dizzying array of statistics cited in the program was data on the huge percentage of state prisoners who have alcohol and drug addictions and/or mental illness.

The program presenters did not drill down in the data to focus on the prevalence of traumatic brain injury among convicts.  However, in a study on "Traumatic Brain Injury Among Prisoners," the authors summarize a body of research finding that from 76% to 88% of prisoners have a history of traumatic brain injury, and that from 36% to 58% have had traumatic brain injury with loss of consciousness.

The article also reports that Individuals with a history of TBI are much more likely to have problems with alcohol and drug abuse than people without TBI, as well as irritability or aggressiveness, including explosive outbursts, which can be set off by minimal provocation.

In efforts to divert a portion of prison populations to less expensive, community based correction and rehabilitation options, the prevalence of TBI is an important factor to recognize. If individuals are too dangerous to set free, they must still be locked up notwithstanding TBI history. However, there are probably many who could with some treatment do well in a less restrictive (and less expensive) form of correctional supervision. For sake of public safety, an individualized risk assessment should be used.

Parents of kids who have traumatic brain injuries should be aware that it is important to recognize the risk factors affecting the child’s long-term quality of life, and build in to a life care plan funds for psychological and tutoring services to prevent them from falling into behaviors that may lead to prison.

For example, in one recent case involving a preschool child who suffered a head injury when a large truck overturned on the family vehicle, we built into the settlement funds to flexibly provide psychological, tutoring and other services that would address learning disabilities and behavioral problems that could get him on the wrong path in life.



Ken Shigley is a trial attorney in Atlanta, Georgia whose practices focuses on representation of plaintiffs in high end personal injury and wrongful death cases. He is  listed among the "Legal Elite" (Georgia Trend Magazine), as a "Super Lawyer" (Atlanta Magazine), and in the Bar Register of Preeminent Lawyers (Martindale).  A Certified Civil Trial Advocate of the National Board of Trial Advocacy, Mr. Shigley has extensive experience representing parties in trucking and bus accidents, products liability, catastrophic personal injury, wrongful death, brain injury, spinal cord injury and burn injury cases.  Currently he is President-elect of the 42,200 member State Bar of Georgia.


  • Anonymous

    As a volunteer visitor at prison facilities in my state, I’ve been coming to the conclusion that a lot of these people I see who have “behavior problems” and ensuing abuse by prison staff, are related to some very severe head injuries sustained when they were children. Both from abusive adults and accidents. However, they are viewed as if they are just acting up to get their own way. How absurd. Anyone in their right mind would know that’s not how to “get your own way”. A lot of these inmates are otherwise very intelligent, talented, creative. What a tragedy and waste to keep these guys locked in solitary confinement for years on end. At best, they are stuffed with a cocktail of psychotropic drugs to keep them zoned out and less of a bother to the psych and guard staffers. Those who still have their intelligence sense there is something more to their condition and refuse the drugs and are fighting an uphill battle for proper treatment even though they don’t know exactly what the problem is. If brain scans are used for the purpose of marketing goods and services out their in “the real world” (watching how ads or commercials cause changes in peoples’ brain functions), surely some kind of study can be done on inmates to see what parts of their brains are damaged and causing aggressiveness, lack of impulse control and the like. Too many people “on the outside” have the attitude that “these people committed crimes, so they should be beaten, abused, or just execute them. Why should my taxes pay for these people in jail.” and so on and so on. How did our society become so deplorable?

    • Freddi,

      Thank you for your comment, letter and volunteer advocacy for survivors of childhood TBI. You may find more material through a Google Scholar search for “child brain injury incarceration” or similar search terms. There is a good deal of research on the correlation between a history of TBI and a pattern of antisocial behavior, substance abuse, hypersexual behavior and resulting incarceration. Unfortunately, courts and corrections agencies often lack the resources to take such a comprehensive view of what makes folks tick. Society must protect itself from violent conduct, whatever the underlying causes, but understanding of what leads people to such conduct may help in dealing with them more effectively.

      Here are some web links and literature references I have in my research files, but I have not systematically updated this in a couple of years.

      “Blows to the head during development can predispose to violent criminal behaviour: rehabilitation of consequences of head injury is a measure for crime prevention,”

      “Interrelationships between crime, substance abuse, and aggressive behaviours among persons with traumatic brain injury,” 1995, Brain Injury, Vol. 9, No. 8 , Pages 757-768
      J. S.

      “The Epidemiology and Impact of Traumatic Brain Injury: A Brief Overview,” JA Langlois, W Rutland-Brown… – The Journal of head …, 2006 – (As many as 87% of persons incarcerated in prisons have history of TBI)

      “Incidence and outcomes of traumatic brain injury and substance abuse in a New Zealand prison population,” 1998, Vol. 12, No. 6 , Pages 455-466 (doi:10.1080/026990598122421) The present study investigated the rates and perceived effects of past traumatic brain injury (TBI) and substance use in a prison population. Responses to a questionnaire indicated that 86.4% of the 118 respondents had sustained a TBI, with 56.7% reporting more than one, and rates of illicit substance use were higher than the general population.

      “Advances in Postacute Rehabilitation after Childhood-acquired Brain Injury a Focus on Cognitive, Behavioral, and Social Domains,” 85:9 American Journal of Physical Medicine & Rehabilitation 767-778 O1-9 (September 2006). Children with early TBI “may experience persisting disability across a range of domains, including cognition, behavior, and social function. These deficits may impact on a child s capacity to interact with the environment, resulting in impairments in skill acquisition and increasing gaps between the abilities of injured children and those of their age peers. . . . [C]hildren are particularly vulnerable to persisting impairments after acquired brain injury. . . . [W]hen skills are undeveloped or immature at the time of injury, resultant deficits may be more global and devastating for children. . . . [M]ore than one third of the children who had sustained severe TBI continued to exhibit significant impairments across two or more of the domains examined with further evidence that such functional problems may increase over time as a result of disruption of normal developmental processes. . . . [B]y 2 yrs postinjury, 70% of children with severe injuries and 40% of those with moderate injuries require special educational assistance.

      “Long-term executive function deficits in children with traumatic brain injuries: assessment using the Behavior Rating Inventory of Executive Function (Brief),” Child Neuropsychology : a Journal on Normal and Abnormal Development in Childhood and Adolescence 84 271-84 (December 2002). “TBI results in long-term deficits in executive functions that are related to children’s psychosocial outcomes, as well as to parent and family functioning.”

      “Neuropsychological Function 23 Years after Mild Traumatic Brain Injury: a Comparison of Outcome after Paediatric and Adult Head Injuries,” Brain Injury : [BI] 219 963-79 (August 2007). “In the paediatric group significant relationships were found between head injury severity and current neuropsychological function. . . . The findings indicate that children sustaining complicated mild TBI may be more vulnerable to development of chronic mild neuropsychological dysfunction than adults sustaining similar head injuries.”

      “Planning, Problem-solving and Organizational Abilities in Children Following Traumatic Brain Injury: Intervention Techniques,” Pediatric Rehabilitation 92 89-97 (2006 April-June). “As the frontal regions of the brain are believed to subsume executive functioning, then it follows that post-TBI deficits may be seen in this domain. Executive functioning broadly refers to a set of inter-related skills necessary to maintain an appropriate problem-solving set for the attainment of a future goal and may include areas such as attentional control, planning, problem-solving, cognitive flexibility, abstraction and information processing.”

      Ken Shigley