Neurocognitive deficits, academic difficulties and substance dependence among Finnish offenders : connections to recidivism and implications for rehabilitation

Neurocognitive and academic deficits are frequent among male offenders and the prevalence of these disorders is known to be higher than in the general population. Also psychiatric disorders and substance dependence are overrepresented among offenders. Neurocognitive and academic deficits, psychiatric disorders and substance dependence are all known to be risk factors for offending and a criminal career. Studies on recidivism have mainly focused on the associations between ADHD (Attention Deficit Hyperactivity Disorder), psychiatric disorders, and violent crime, but have ignored connections to various psychiatric disorders and neurocognitive deficits and academic difficulties. The aim of this thesis is to examine the neurocognitive and academic performance in a sample of sentenced male prisoners in Finland. The frequency of reading, spelling, and mathematical difficulties was also analyzed. I also examined how neurocognitive deficits and academic difficulties are associated with psychiatric diagnoses, especially with substance dependence. If a specific profile of neurocognitive, academic and psychiatric factors among offenders could be found that is related to recidivism and criminal career, this could be more effectively targeted by intervention procedures. In a health survey of Finnish prisoners, 72 sentenced male prisoners were examined in Turku prison using a neurocognitive test battery and psychiatric assessment including a standardized psychiatric interview (SCID-I, II). First, a range of neurocognitive deficits was common, especially in motor dexterity, visual construction, verbal comprehension, verbal and visual memory, and shifting attention. Furthermore, recidivist men had problems indicating impulsivity. Second, the comprehensive neurocognitive deficits and illiteracy problems seemed to go together among prisoners. The results showed a high number of reading and spelling difficulties. Fifteen percent of those with medium to severe problems in academic skills had marked difficulties in mathematics. Third, major mental disorders (Axis I diagnosis) and substance dependence were connected with neurocognitive and academic deficits. Moreover, first- time offenders had fewer neurocognitive deficits and Axis I disorders, less substance dependence and fewer personality disorders than those with several convictions. Fourth, the combination of neurocognitive deficits and substance dependence was connected to recidivism. According to the thesis, the Finnish male offender could be described using four groups with different characteristics of neurocognitive, academic and psychiatric factors. Preventing the development of substance dependence, together with rehabilitation of neurocognitive deficits, seems to be important for reducing recidivism. We suggest that both selection and preparation for participation in offender programs might be more effective if specific neurocognitive deficits are identified and efforts first made to ameliorate them.Neurokognitiiviset häiriöt sekä lukemisen, kirjoittamisen ja matematiikan vaikeudet ovat yleisiä vangeilla ja näiden ongelmien esiintyvyys on suurempaa kuin yleisväestössä. Vangit kärsivät myös psykiatrisista häiriöistä ja päihderiippuvuudesta yleisväestöä enemmän. Neurokognitiiviset häiriöt, lukemisen, kirjoittamisen ja matematiikan vaikeudet sekä psykiatriset häiriöt ja päihderiippuvuus ovat tutkimusten mukaan riskitekijöitä rikolliselle käyttäytymiselle ja vankilaan joutumiselle. Rikoksen uusimista käsittelevissä tutkimuksissa on usein keskitytty yhteyksiin ADHD:n (keskittymisen ja tarkkaavuuden häiriö) ja muiden neuropsykiatristen ja psykiatristen häiriöiden sekä väkivaltarikollisuuden välillä. Muut psykiatriset häiriöt ja erityisesti niiden yhteydet neurokognitiivisiin ja lukemisen, kirjoittaminen ja matematiikan vaikeuksiin on jätetty vähemmälle huomiolle. Tässä väitöskirjassa tarkastellaan suomalaisten miesvankien neurokognitiivista suoriutumista, lukemisen, kirjoittamisen ja matematiikan ongelmia sekä niiden yhteyksiä psykiatrisiin häiriöihin. Tässä tutkimuksessa oli tavoitteena selvittää, miten neurokognitiiviset sekä lukemisen, kirjoittamisen ja matematiikan häiriöt ovat yhteydessä psykiatrisiin diagnooseihin, erityisesti päihderiippuvuuteen. Tarkoituksena on pyrkiä löytämään mahdollisia ongelmaprofiileja, jotka voisivat auttaa tarkoituksenmukaisten ja toimivien kuntoutusohjelmien suunnittelussa ja toteuttamisessa vangeille. Turun vankilasta kerättyä aineistoa varten tutkittiin neuropsykologisilla testimenetelmillä 72 miespuolista vankeusvankia. Aineisto liittyi laajempaan Suomessa tehtyyn vankien terveystutkimukseen. Psykiatrinen arvioi suoritettiin käyttäen standardoitua psykiatrista haastattelua (SCID-I,II). Ensimmäiseksi, vangeilla oli yleisesti laaja-alaisia neurokognitiivisia häiriöitä, erityisesti hienomotoriikassa, visuaalisessa hahmottamisessa, kielellisessä ymmärtämisessä, visuaalisessa sekä kielellisessä muistissa sekä tarkkaavuuden siirtämisessä. Rikoksen uusijoilla oli taipumusta impulsiiviseen reagointiin. Toiseksi, neurokognitiiviset häiriöt ja lukemisen, kirjoittamisen ja matematiikan ongelmat näyttivät olevan yhteydessä toisiinsa. Lukemisen ja kirjoittamisen ongelmat olivat vangeilla yleisiä. Viisitoista prosenttia niistä vangeista, joilla oli keskivakavia tai vakavia ongelmia lukemisessa ja kirjoittamisessa, oli myös merkittäviä vaikeuksia matematiikassa. Kolmanneksi, vakava mielenterveyden häiriö (Axis I) ja päihderiippuvuus olivat yhteydessä neurokognitiivisiin sekä lukemisen ja kirjoittamisen häiriöihin. Ensimmäistä vankeustuomiota suorittavilla vangeilla oli vähemmän neurokognitiivisia häiriöitä, vakavia mielenterveyden häiriöitä, päihderiippuvuutta ja persoonallisuushäiriöitä kuin moninkertaisilla tuomion uusijoilla. Neljänneksi, neurokognitiiviset häiriöt yhdessä päihderiippuvuuden kanssa olivat eniten yhteydessä uusintarikollisuuteen. Tämän väitöskirjan tulosten perusteella Suomalaisia miesvankeja voidaan kuvata neljänä erillisenä ongelmaryhmänä liittyen neurokognitiivisiin häiriöihin, lukemisen, kirjoittamisen ja matematiikan ongelmiin sekä psykiatrisiin häiriöihin. Päihderiippuvuuden ehkäisy sekä neurokognitiivisten ja lukemisen, kirjoittamisen ja matematiikan taitopuutosten harjoittaminen ja kuntoutus ovat tulosten valossa tärkeitä tekijöitä uusintarikollisuuden ehkäisyssä. Tulosten perusteella voidaan suositella, että vankien neurokognitiivisia, sekä lukemisen, kirjoittamisen ja matematiikan puutoksia arvioidaan ja kuntoutetaan jo ennen vangin ohjaamista laaja-alaisempiin käytössä oleviin kuntoutusohjelmiin. Tämä saattaa edesauttaa sijoittumista sopivaan kuntoutusohjelmaan sekä tehostaa vangin hyötymistä kuntoutuksesta

Do informal caregivers of people with dementia mirror the cognitive deficits of their demented patients?:A pilot study

Recent research suggests that informal caregivers of people with dementia (ICs) experience more cognitive deficits than noncaregivers. The reason for this is not yet clear. Objective: to test the hypothesis that ICs ‘mirror' the cognitive deficits of the demented people they care for. Participants and methods: 105 adult ICs were asked to complete three neuropsychological tests: letter fluency, category fluency, and the logical memory test from the WMS-III. The ICs were grouped according to the diagnosis of their demented patients. One-sample ttests were conducted to investigate if the standardized mean scores (t-scores) of the ICs were different from normative data. A Bonferroni correction was used to correct for multiple comparisons. Results: 82 ICs cared for people with Alzheimer's dementia and 23 ICs cared for people with vascular dementia. Mean letter fluency score of the ICs of people with Alzheimer's dementia was significantly lower than the normative mean letter fluency score, p = .002. The other tests yielded no significant results. Conclusion: our data shows that ICs of Alzheimer patients have cognitive deficits on the letter fluency test. This test primarily measures executive functioning and it has been found to be sensitive to mild cognitive impairment in recent research. Our data tentatively suggests that ICs who care for Alzheimer patients also show signs of cognitive impairment but that it is too early to tell if this is cause for concern or not

Is procedural memory enhanced in Tourette syndrome? evidence from a sequence learning task

Procedural memory, which is rooted in the basal ganglia, underlies the learning and processing of numerous automatized motor and cognitive skills, including in language. Not surprisingly, disorders with basal ganglia abnormalities have been found to show impairments of procedural memory. However, brain abnormalities could also lead to atypically enhanced function. Tourette syndrome (TS) is a candidate for enhanced procedural memory, given previous findings of enhanced TS processing of grammar, which likely depends on procedural memory. We comprehensively examined procedural learning, from memory formation to retention, in children with TS and typically developing (TD) children, who performed an implicit sequence learning task over two days. The children with TS showed sequence learning advantages on both days, despite a regression of sequence knowledge overnight to the level of the TD children. This is the first demonstration of procedural learning advantages in any disorder. The findings may further our understanding of procedural memory and its enhancement. The evidence presented here, together with previous findings suggesting enhanced grammar processing in TS, underscore the dependence of language on a system that also subserves visuomotor sequencing

Neurocognition and behaviour:diagnostic work-up and interventions in Duchenne and Becker muscular dystrophy

Duchenne (DMD) and Becker (BMD) Muscular Dystrophy are hereditary, progressive muscle diseases caused by changes or mutations in the Duchenne Muscular Dystrophy (DMD) gene. This gene is part of the hereditary material, the DNA. These muscle diseases occur almost exclusively in boys. The dystrophin gene is responsible for the production of multiple dystrophin isoforms that occur in different body tissues, namely in the muscles, kidneys, eye and brain. Scientific research in recent years has focused on investigating the link between the disrupted production of dystrophin in the brain and the more frequent occurrence of neurocognitive (i.e. learning and thinking problems) and behavioural problems. The exact role of dystrophin in cognition and behaviour remains unclear. The aim of this thesis was to further describe the relationship between dystrophin in the brain and the common behavioural and neurocognitive problems. In addition, a literature review was used to identify the psychological measurement instruments used in the scientific literature. Finally, little research has been done on treatments to reduce the consequences of behavioural and neurocognitive problems. This dissertation studied two treatments in boys with DMD, namely a psychological intervention (cognitive working memory training) and a medication-based treatment to improve attention (methylphenidate)

The Use of Virtual Reality in the Science of Psychology

With the evolution of technology, digital gaming became a more holistic and realistic experience that engages all senses. This novel capacity was seized by Psychological Science. The aim of this literature review was to describe some of the usages of Virtual Reality (VR), specifically in the domains of Developmental, Clinical, Social, Organizational, Athletic Psychology and Neuropsychology. Some of the findings were that VR can promote children’s socialization and self-control in the case of Developmental Psychology. Research on Clinical Psychology has shown that VRT contributes to phobia treatment and can help analyze negative self-image in individuals with eating disorders. In the area of Social Psychology, it can reduce prejudice and enhance prosocial behavior, by providing the ability to manipulate variables and achieving high experimental control and ecological validity. Furthermore, it can enhance employees’ productivity and help them cope with stress in Organizational Psychology and boost athletes’ motivation and decision making in Athletic Psychology. In Neuropsychology, VR gives the potential of early diagnosis and rehabilitation of neuropsychological complications of Traumatic Brain Injury, Brain Stroke, Parkinson’s Disease and facilitates the reduction of Autism Index. Overall, psychological research, diagnosis and treatment via VR seems so far to be a rich and promising field for further investigation that will possibly improve different people’s quality of life

Effects of Diversity and Neuropsychological Performance in an NFL Cohort

Objective: The aim of this study was to examine the effect of ethnicity on neuropsychological test performance by comparing scores of white and black former NFL athletes on each subtest of the WMS. Participants and Methods: Data was derived from a de-identified database in South Florida consisting of 63 former NFL white (n=28, 44.4%) and black (n=35, 55.6%) athletes (Mage= 50.38; SD= 11.57). Participants completed the following subtests of the WMS: Logical Memory I and II, Verbal Paired Associates I and II, and Visual Reproduction I and II. Results: A One-Way ANOVA yielded significant effect between ethnicity and performance on several subtests from the WMS-IV. Black athletes had significantly lower scores compared to white athletes on Logical Memory II: F(1,61) = 4.667, p= .035, Verbal Paired Associates I: F(1,61) = 4.536, p = .037, Verbal Paired Associates: II F(1,61) = 4.677, p = .034, and Visual Reproduction I: F(1,61) = 6.562, p = .013. Conclusions: Results suggest significant differences exist between white and black athletes on neuropsychological test performance, necessitating the need for proper normative samples for each ethnic group. It is possible the differences found can be explained by the psychometric properties of the assessment and possibility of a non-representative sample for minorities, or simply individual differences. Previous literature has found white individuals to outperform African-Americans on verbal and non-verbal cognitive tasks after controlling for socioeconomic and other demographic variables (Manly & Jacobs, 2002). This highlights the need for future investigators to identify cultural factors and evaluate how ethnicity specifically plays a role on neuropsychological test performance. Notably, differences between ethnic groups can have significant implications when evaluating a sample of former athletes for cognitive impairment, as these results suggest retired NFL minorities may be more impaired compared to retired NFL white athletes

Distinguishing Performance on Tests of Executive Functions Between Those with Depression and Anxiety

Objective: To see if there are differences in executive functions between those diagnosed with Major Depressive Disorder (MDD) and those with Generalized Anxiety Disorder (GAD).Participants and Methods: The data were chosen from a de-identified database at a neuropsychological clinic in South Florida. The sample used was adults diagnosed with MDD (n=75) and GAD (n=71) and who had taken the Halstead Category Test, Trail Making Test, Stroop Test, and the Wisconsin Card Sorting Test. Age (M=32.97, SD=11.75), gender (56.7% female), and race (52.7% White) did not differ between groups. IQ did not differ but education did (MDD=13.41 years, SD=2.45; GAD=15.11 years, SD=2.40), so it was ran as a covariate in the analyses. Six ANCOVAs were run separately with diagnosis being held as the fixed factor and executive function test scores held as dependent variables. Results: The MDD group only performed worse on the Category Test than the GAD group ([1,132]=4.022, p\u3c .05). Even though both WCST scores used were significantly different between the two groups, both analyses failed Levene’s test of Equality of Error Variances, so the data were not interpreted. Conclusions: Due to previous findings that those diagnosed with MDD perform worse on tests of executive function than normal controls (Veiel, 1997), this study wanted to compare executive function performance between those diagnosed with MDD and those with another common psychological disorder. The fact that these two groups only differed on the Category Test shows that there may not be much of a difference in executive function deficits between those with MDD and GAD. That being said, not being able to interpret the scores on the WCST test due to a lack of homogeneity of variance indicates that a larger sample size is needed to compare these two types of patients, as significant differences may be found. The results of this specific study, however, could mean that the Category Test could be used in assisting the diagnosis of a MDD patient

The Effect of Ethnicity on Neuropsychological Test Performance of Former NFL Athletes

Objective: To investigate the effect of ethnicity on neuropsychological test performance by specifically exploring differences between white and black former NFL athletes on subtests of the WAIS-IV. Participants and Methods: Data was derived from a de-identified database in Florida consisting of 63 former NFL athletes (Mage=50.38; SD=11.57); 28 white and 35 black. Participants completed the following subtests of the WAIS-IV: Block Design, Similarities, Digit Span, Matrix Reasoning, Arithmetic, Symbol Search, Visual Puzzles, Coding, and Cancellation. Results: One-Way ANOVA yielded a significant effect between ethnicity and performance on several subtests. Black athletes had significantly lower scaled scores than white athletes on Block Design F(1,61)=14.266, p\u3c.001, Similarities F(1,61)=5.904, p=.018, Digit Span F(1,61)=8.985, p=.004, Arithmetic F(1,61)=16.07, p\u3c.001 and Visual Puzzles F(1,61)=16.682, p\u3c .001. No effect of ethnicity was seen on performance of Matrix Reasoning F(1,61)=2.937, p=.092, Symbol Search F(1,61)=3.619, p=.062, Coding F(1,61)=3.032, p=.087 or Cancellation F(1,61)=2.289, p=.136. Conclusions: Results reveal significant differences between white and black athletes on all subtests of the WAIS-IV but those from the Processing Speed Scale and Matrix Reasoning. These findings align with previous literature that found white individuals to outperform African-Americans on verbal and non-verbal tasks after controlling for socioeconomic and demographic variables (Manly & Jacobs, 2002). These differences may also be a reflection of the WAIS-IV’s psychometric properties and it is significant to consider the normative sample used may not be appropriate for African-Americans. This study highlights the need for future research to identify how ethnicity specifically influences performance, sheds light on the importance of considering cultural factors when interpreting test results, and serves as a call to action to further understand how and why minorities may not be accurately represented in neuropsychological testing