Attention Problems Predict Risk of Violence and Rehabilitative Engagement in Mentally Disordered Offenders.

Ignazio Puzzo,Gisli Guðjónsson,Ben Greer,Rachel Kelly,Veena Kumari,Susan Young,Ottilie Sedgwick

doi:10.3389/fpsyt.2019.00279

Abstract

Mentally disordered offenders (MDOs) endorse difficulties with attention, impulsivity, and hyperactivity. Assessing these difficulties among MDOs may confer practical benefits for the management and provision of care for this population, by informing strategies to improve rehabilitative engagement and risk assessments for violence. However, there is a dearth of literature exploring these cognitive problems in MDOs in relation to outcome factors. Forty-eight MDOs from a high-security hospital completed the QbTest, which measures the domains of inattention, impulsivity, and hyperactivity. Comprehensive file review of clinical and occupational/vocational rehabilitative engagement and Historical Clinical Risk Management-20 (HCR-20) were used as outcome measures of interest. Participants displayed greater cognitive deficits in attention, impulsivity, and hyperactivity compared to the general population. The domain of inattention and omission errors was related to occupational/vocational therapy engagement as well as a higher risk of present and future violence as measured by the HCR-20. The findings suggest that QbTest is a helpful objective tool that could be incorporated into the assessment of MDOs. Specifically, inattention emerged as a strong predictor of patients’ risk of violence as well as patient’s vocational therapy engagement. Therefore, cognitive skills programs targeting attention problems should be introduced to improve outcomes for this population.

Highlights

Difficulties in the domains of attention, hyperactivity, and impulsivity are present across adult forensic and forensic psychiatric populations at both clinical and subclinical levels [1, 2]
Research utilizing continuous performance tasks (CPTs) has found that the traits of impulsivity and inattention are part of the clinical presentation of mental disorders that are prevalent in forensic psychiatric populations, such as schizophrenia and antisocial personality disorder (ASPD) [10]
The present study aims to answer three main questions: a) Are Mentally disordered offenders (MDOs) significantly impaired in the domains of attention, impulsivity, and hyperactivity as assessed by the Quantified Behavioural Test (QbTest) compared to the normative population? b) Are the QbTest domains of inattention, impulsivity, and hyperactivity individually related to a participant’s risk of violence, as measured by the HCR20, or rehabilitative engagement? c) Do omission and/or commission errors relate to risk of violence or rehabilitative engagement?

Summary

Introduction

Difficulties in the domains of attention, hyperactivity, and impulsivity are present across adult forensic and forensic psychiatric populations at both clinical (i.e., attention deficit hyperactivity disorder, ADHD) and subclinical levels [1, 2]. Within UK forensic mental health services, it is estimated that 6–12.9% of Attention Problems Predict Clinical Outcomes adult mentally disordered offenders (MDOs) endorse significant problems in these domains, based upon diagnostic screening measures for ADHD [4]. MDOs have demonstrated poorer performance than healthy controls in behavioral assessments of impulsivity and attention, including continuous performance tasks (CPTs) [7,8,9]. Research utilizing CPTs has found that the traits of impulsivity and inattention are part of the clinical presentation of mental disorders that are prevalent in forensic psychiatric populations, such as schizophrenia and antisocial personality disorder (ASPD) [10]. ASPD and schizophrenia are both characterized by impulsive and inattentive behavior [11]

Results

Discussion

Conclusion