Traumatic brain injuries (TBIs) are wounds to the scalp, skull, or brain caused by penetration, blunt contact, or acceleration-deceleration forces. These injuries are heterogeneous and multifaceted, vary in the presence and severity of symptoms, devastate individuals in all socio-demographic backgrounds, and are commonly misdiagnosed or under-identified. Consequences of TBIs are many and varied and can contribute to poor cognitive, psychological, social, and behavioral outcomes (for an overview, see Table 1). TBIs are an important, complex, and often overlooked topic that afflicts a high percentage of individuals involved with the criminal justice system. In fact, the prevalence of TBIs among criminal justice-involved populations is significantly higher than in the general population. As such, criminal justice professionals are likely to encounter suspects, defendants, and witnesses with TBIs on a regular basis. Unfortunately, many of these professionals have not received advanced education or training on TBIs. When TBIs go unrecognized within the criminal justice system, the impacted individual will likely struggle to navigate the various stages and processes of this complex system (see Table 2).

Interviewing individuals with TBIs in criminal justice settings can be a challenging, confusing, and complicated process. As mentioned earlier, individuals with TBI may be at a significant disadvantage as they navigate through the various stages of the criminal justice system (i.e., arrest, trial, sentencing, confinement, probation, court-ordered treatment, etc.). The serious short- and long-term consequences associated with TBI necessitate that criminal justice professionals acquire additional training and resources on this topic. Such investments offer the potential for increased awareness and better understanding of TBIs among criminal justice professionals. Benefits could include improvements in how suspects, defendants, and witnesses are both interviewed and treated. To address these shortcomings in the literature, this article highlights and summarizes several key points about TBI that all criminal justice professionals need to know. This includes cognitive, sensory, psychiatric, social, behavioral, and other concerns.

I. Cognitive

Cognitive Impairments

TBIs can result in cognitive deficits in areas such as executive functions, short- and long-term memory, information processing speed, attentional control, and emotion regulation. It is imperative that professionals consider these possible impairments when interacting with suspects, defendants, and witnesses who may have a TBI. If unrecognized, these factors can significantly undermine a person’s ability to navigate through the various stages of the criminal justice system.

Altered Neurological Function

Changes in neurological function like confusion or loss of consciousness are primary consequences of TBIs. The experience of these and other alterations of neurological function during the interview process can place the person at a significant disadvantage. Consequences can include poor decision-making and false confessions.

Processing Speed Weaknesses

One of the most common consequences of serious TBIs is information processing deficits. In general, processing speed is the amount of time required to perform a given cognitive task. This ability plays a critical role in several other processes including intellectual development, cognitive reasoning, and learning.  Slow processing speeds can interfere with a person’s capacity to process information during an interview, listen and take notes, or hold a conversation. Slow processing speed may also impact the ability to plan, set goals, make decisions, start a particular task, and pay attention.

Sluggish Cognitive Tempo

It is not uncommon for some individuals with TBIs to experience sluggish cognitive tempo (SCT). This is a cluster of symptoms that may include absentmindedness, apathy, confusion, distractibility, hypoactivity, and deficits in information processing speed and accuracy. Other symptoms may include easily getting lost in one’s thoughts, excessive daydreaming, lack of motivation, and the need for constant stimulation. People with SCT might appear slow moving and generally disengaged.

Metacognition

Individuals with TBIs often exhibit deficits in metacognition. This can be defined as the capacity to contemplate one’s own thoughts and learning processes. Deficits in this ability may contribute to difficulties with insight, decision-making, organization, and treatment engagement. When an interviewee has metacognitive deficits, this can impact thinking, awareness, self-regulation, and learning capabilities.

Executive Dysfunction

Individuals with TBIs often present with impairments in executive functions. These abilities are critical for performing goal-directed behavior. Deficits in executive functions can result in problems at school and work, social settings, emotion regulation, and behavior (e.g., aggression and violence). Further, executive function impairments undermine a person’s ability to live independently. These problems may be due to injuries to the prefrontal cortex. During this interviewing process, interviewees with executive functioning impairments may experience comprehension, decision-making, and processing deficits, among other challenges.

Abstract Reasoning Deficits

Abstract reasoning is the capacity to analyze information, identify underlying patterns, and solve problems through the use of creativity. Sustaining a TBI can contribute to deficits in abstract reasoning abilities. As such, individuals with TBIs may struggle to process information, solve problems, recognize cause-and-effect, generalize knowledge across situations, make long-term plans, and complete complex tasks. Further, these individuals may present with social skill and self-esteem issues and appear stubborn or frustrated..

Confabulation

TBIs may increase the risk of confabulations or false memories. The nature of confabulations could range from alterations of real memories or the creation of an entirely fictional memory of an event that never took place. If the risk of confabulation among individuals with TBIs goes unrecognized, the consequences may include false confessions and wrongful convictions. Complicating matters, individuals with TBIs are prone to victimization in correctional facilities. As such, increased awareness of confabulation among criminal justice professionals is strongly encouraged.

Suggestibility

Although research on this particular effect is still limited, TBIs may increase the risk of suggestibility. This is a grave concern in the context of police interviews, interrogations, and cross-examinations. A suspect, defendant, or witness may be vulnerable to providing the response that they believe the authority figure wants to hear rather than stating the truth. As such, professionals should be careful to avoid using manipulative tactics, repetitive questions, and other forms of interpersonal pressure. Failure to avoid these practices may increase the likelihood of false confessions and wrongful convictions. Nonetheless, more research is needed to better understand the role of TBIs in the phenomenon of suggestibility.

II. Sensory

Sensory Impairment

Individuals with TBI commonly experience sensory impairment. During the interviewing process, the interviewee can become overwhelmed by bright lights, loud noises, and certain smells. These and other sensory experiences can elicit sensitivity to stimulation and even sensory overload. Table 3 summarizes several consequences that may result from sensory impairment.

Auditory Processing Deficits

Individuals with TBI commonly experience auditory processing deficits. When this occurs, several consequences may result, including distraction, confusion, and difficulties following directions. For instance, a person with TBI may struggle to understand speech or distinguish between similar sounds. Other consequences could include disorganization and forgetfulness. As such, professionals should adopt a slow pace when communicating with a person who may have TBI to maximize the likelihood of comprehension.

III. Psychiatric

Depression

Traumatic brain injuries frequently co-occur with symptoms of depression. In fact, depression commonly emerges at different stages throughout the recovery process from TBIs. Depression can undermine a person’s recovery and quality of life while increasing the likelihood of long-term cognitive deficits. Professionals should keep in mind that depression can impact an interviewee’s mood, behavior, energy, and cognitive abilities.

Alexithymia

Individuals with TBIs are at an increased risk of experiencing alexithymia. This is characterized by difficulties with recognizing, understanding, and communicating about emotions. Individuals with alexithymia also frequently experience depression, anxiety, anger, and substance abuse. Other problems include poor recognition of others’ emotions, lack of empathy, and poor coping skills to name a few.

Anosognosia

Potentially related to TBIs, anosognosia is a condition where a person struggles to recognize and comprehend their own deficits, dysfunctions, and condition. This can manifest in a person failing to acknowledge his or her condition or being distressed by its nature. When learning about anosognosia, it is also important to consider related topics including lack of insight, denial, and reduced awareness of deficits. Possible consequences associated with anosognosia can include poor decision-making, homelessness, legal problems, victimization, mental illness, treatment noncompliance, and the need for inpatient psychiatric care.

IV. Social

Communication and Language Problems

People suffering from a head injury often experience communication and language problems. For instance, the person may be excessively talkative, and his or her conversations may appear egocentric, tactless, repetitive, or tangential in nature. Further, the person may struggle to stay on topic or comprehend meaning during conversations with other people. Humor, sarcasm, and deceit are common areas of difficulties. The communication problems outlined here could be attributed, at least in part, to cognitive deficits (e.g., information processing speed, working memory, and metacognition).

Social Cognition

A growing body of research suggests that social cognition deficits could underlie behavioral problems in individuals with TBIs. Here, social cognition can be defined as the capacity to comprehend different pieces of social information, understand how this information influences the actions of other people, and react in accordance with social norms. Deficits in social cognition can play a role in confusion, affective dysregulation, low self-esteem, and different forms of social maladjustment (e.g., loneliness and social isolation).

Facial Affect Recognition Deficits

The ability to recognize the emotions displayed on the faces of others is facial affect recognition. This is a critical aspect of social cognition. Research has consistently observed an association between TBIs and difficulties in facial affect recognition. The co-occurrence of these issues predicts subsequent behavioral problems such as aggression.

Poor Perspective-Taking

Individuals with TBIs often struggle to recognize and comprehend the perspectives of other people. Deficits in perspective-taking can contribute to problems in a wide range of areas. For instance, individuals with poor perspective taking may appear to be disinterested in interpersonal and social interactions. They could seem bored, distracted, selfish, or even callous. Further, perspective-taking deficits are associated with interpersonal relationship struggles, peer problems, social maladjustment, and difficulties in school and work settings.

V. Behavioral

Personality and Behavioral Changes

It is not uncommon for individuals with TBIs to exhibit changes in personality and behavior. Common changes include impulsivity, irritability, and aggressiveness along with apathy and loss of motivation. These changes can negatively impact the individual’s functioning in family, social, and vocational settings and lead to deterioration in overall quality of life.

Self-Regulation Deficits

Self-regulation is the ability to recognize, comprehend, and control one’s thoughts, feelings, and actions. This includes states of excitement, frustration, and distress. Deficits in self-regulation are common among individuals with TBI. Further, self-regulation issues are associated with problems in self-awareness, judgment, observation, reflection, and regulation. Interventions that improve the person’s abilities to monitor, evaluate, and take control could be beneficial.

Impulsivity

Another common symptom presented by individuals with TBIs is impulsivity. This can be defined as the propensity to act without considering consequences. Examples of impulsive criminal behaviors could range from less severe actions (e.g., shoplifting items of trivial value) to very severe actions (e.g., sexual assault). Impulsivity could contribute to a range of problematic behaviors during the interview including poor decision-making, impatience, irritability, emotion dysregulation, and acts of aggression (verbal and physical).

VI. Other Concerns

Fatigue

Chronic fatigue frequently co-occurs with TBIs. Fatigue can even persist for several years after the initial injury. The presence of chronic fatigue can undermine a person’s cognitive, psychological, and social functioning. Individuals with TBIs and fatigue may exhibit issues with information processing, attentional control, psychiatric symptoms (e.g., anxiety and depression), and pain.

Sleep Disturbances

Sleep disturbances are a common consequence of TBIs. For instance, insomnia and hypersomnolence disorder are sleep disturbances often observed in individuals with TBIs. The co-occurrence of sleep disturbances and TBIs place people at an elevated risk for worse clinical symptoms, work problems, safety issues, and struggles in rehabilitation. Relative to the general population, other sleep disturbances that may be elevated in individuals with TBIs include nightmares, nocturnal enuresis, rapid eye movement sleep behavior disorder, sleep apnea, sleep paralysis, sleep-wake rhythm irregularities, and sleepwalking.

Adverse Childhood Experiences (ACEs)

Exposure to adverse childhood experiences (ACEs) may increase the risk of TBIs. ACEs can include various forms of adversity like household dysfunction (e.g., exposure to high conflict divorce, parental incarceration, witnessing a parent being abuse by the other parent); neglect (e.g., physical and emotional); and abuse (e.g., verbal, sexual, physical, and emotional) before the age of 18. Other ACEs could involve peer victimization, exposure to community violence, and racism, to name a few. Research has found that individuals who have experienced higher rates of trauma during childhood are at an elevated risk of dealing with more social, emotional, behavioral, and physical health issues in adulthood.

Miranda Warnings

Individuals with TBIs may struggle to comprehend their Miranda rights. This is due, at least in part, to information processing and communication deficits. In fact, a person with a TBI may appear distracted, distressed, or indifferent.  Table 4 presents several correlates of issues with Miranda rights comprehension.

Conclusion

Professionals should carefully consider a wide range of factors prior to any interview, interrogation, or testimony with an individual who has a TBI. Table 5 provides an overview of several factors that may impact the accuracy of any information provided by a person with a TBI. The successful identification and referral of someone with a TBI has the potential to minimize the risk of miscarriages of justice (e.g., false confessions and wrongful convictions). 🛡

Please cite as

Jerrod Brown, “Interview Considerations – Traumatic Brain Injury: A Beginner’s Guide for Criminal Justice Professionals,” Police Chief Online, November 9, 2022.