Article: Silver, Ian A., & Nedelec, Joseph L. (2020). “Traumatic brain injury and adverse psychological effects: Examining a potential pathway to aggressive offending.” Aggressive Behavior, 46(3), 254–265. https://doi.org/10.1002/ab.21886
A Traumatic Brain Injury (TBI) is defined as an injury that occurs when an external physical force to the head, neck, or body region results in the movement of the brain within the skull, compressing the gray and white matter. TBI has become a public health concern, as the severity and frequency of TBIs could lead to significant neurocognitive and psychosocial impairments, including impulsivity, irritability, emotional dysregulation, and aggression. Additionally, research suggests that TBI is associated with criminal legal system involvement and aggressive offending. However, prior research had not identified the mechanism that linked TBI to criminal legal system involvement and aggressive offending. The current article sought to explain this by arguing that TBI directly influences adverse psychological effects which, in turn, increases the likelihood of an individual engaging in aggressive offending. Adverse psychological effects is defined as the co-occurrence of symptoms such as impulsivity, anxiety, moral disengagement, and depression.
This study added to the growing body of literature that treats TBI as an environmental mechanism increasing psychological dysregulation and engagement in behaviors that could be classified as criminal. The authors assessed if TBI influences adverse psychological effects and indirectly aggressive behavior during early adulthood.
Notes: The dashed line indicates the theoretical expectation that other mechanism could mediate the association between TBI and aggressive offending, as well as the theoretical expectation of a direct path between TBI and aggressive offending. “+” indicates the theoretical expectation that a higher number of traumatic brain injuries is associated with higher levels of adverse psychological effects. In turn, higher levels of adverse psychological effects are hypothesized to be associated with higher levels of aggressive offending.
2. Summary of Findings
Three findings from the current study should be highlighted:
First, TBI during adolescence (Wave 2, average age 17) was significantly associated with increased adverse psychological effects one year later (Wave 3). The measure of adverse psychological effects included symptoms of impulsivity, moral disengagement, and internalizing symptoms like anxiety and depression. However, TBI at baseline or at Wave 3 was not significantly associated with adverse psychological effects.
Second, adverse psychological effects was significantly associated with increased aggressive offending in young adulthood (Wave 4, average age 19).
Third, a significant indirect pathway was found from adolescent TBI to aggressive offending through adverse psychological effects. No direct association between TBI and aggressive offending was observed, suggesting that the co-occurrence of symptoms such as impulsivity, anxiety, moral disengagement, anxiety, and depression may be the primary mechanism through which TBI exerts its criminogenic effects.
Overall, the findings provide preliminary evidence suggesting that psychological disruptions – adverse psychological effects – could serve as the mediator between TBI and future aggressive offending.
3. Implications
This research has important implications for public health, criminal justice, and youth service systems:
- Prevention: Reducing exposure to TBI during adolescence—especially among at-risk youth—may prevent downstream psychological and behavioral consequences. This can include investments in violence prevention, safer sports protocols, and trauma-informed care.
- Screening and Assessment: Juvenile justice and clinical systems should systematically screen for TBI history and current psychological symptoms. Early identification of TBI-related deficits may allow for targeted intervention before aggressive offending becomes a recurring behavioral pattern.
- Intervention: Since TBI was linked to aggression through modifiable psychological constructs, interventions that target internalizing symptoms, impulsivity, moral reasoning, anxiety, and aggression (e.g., CBT) may reduce aggressive offending.
- Policy and System Reform: Adjudicated youth—like those in the Pathways to Desistance study—often face multiple and compounding risks, including violence exposure, head injuries, and psychological distress. Policymakers should prioritize multi-system coordination (e.g., between schools, healthcare providers, and juvenile criminal legal system) to ensure continuity of care and service access for youth with TBI histories.
In sum, this study suggests that treating the psychological aftermath of TBI can serve as a lever to prevent future aggression and justice system involvement.
4. Data and Methods
The study uses data from the Pathways to Desistance project, a longitudinal study of 1,354 serious adolescent offenders recruited from Phoenix, AZ, and Philadelphia, PA. The analytic sample (n = 416) was limited to participants with complete data across four time points.
- Measures:
- TBI was assessed at three waves using self-reported total number of head injuries (e.g., loss of consciousness or need for medical treatment).
- Adverse psychological effects were measured as a latent construct using data from the Brief Symptom Inventory, a moral disengagement scale, and an impulsivity questionnaire.
- Aggressive offending was assessed via the Self-Reported Offending scale, focusing on frequency of aggressive acts at Wave 4.
- Controls included, but was not limited to, prior aggressive behavior, demographics, psychopathy, exposure to violence, and time spent in the community (“street time”).
- Analytical Strategy:
Structural Equation Modeling (SEM) with diagonally weighted least squares (DWLS) estimation was employed to assess both direct and indirect effects. The final model demonstrated good fit (CFI = 0.927; RMSEA = 0.046). Importantly, only the indirect path from TBI → psychological effects → aggression was statistically significant.
5. Conclusion
Silver and Nedelec (2020) provide evidence that traumatic brain injury during adolescence can lead to aggressive offending—but largely through psychological consequences rather than direct behavioral changes. The study advances the field by isolating adverse psychological effects as a key explanatory mechanism.
The findings underscore the need for integrated interventions that address both the neurological and psychological dimensions of youth trauma. Reducing adolescent exposure to TBI and treating its psychological aftermath may be crucial steps toward preventing chronic patterns of aggression and involvement in the criminal legal system.
Disclosure: This research brief was prepared by ChatGPT and reviewed/edited by Ian A. Silver.
ianasilver.com 