Trauma and young offenders - a review of the research and practice literature

Abstract

The report presents key findings from a review of the research and practice literature concerning trauma in the backgrounds of young people who offend. It aims to highlight what is currently known about trauma within the population of young offenders, and to identify the importance of this knowledge for effective resettlement practice. It focuses on:
• Definitions of trauma and the different ways in which trauma has been understood in the research and practice literature
• The prevalence of different types of traumatic childhood and adolescent experiences in the backgrounds of young offenders
• The effects that such trauma can have on young people in the short-term, and its longer term impacts on emotional, social, and neurological development
• The links between trauma and young people’s behaviour, including the extent of their capacity to comply with youth justice interventions
• The implications that an understanding of trauma and its effects might have for resettlement work undertaken with young custody-leavers

Full text

Trauma and young offenders – a review of the research and practice literature | 1
TRAUMA AND YOUNG
OFFENDERS
A REVIEW OF THE RESEARCH
AND PRACTICE LITERATURE

Trauma and young offenders – a review of the research and practice literature | 2
Contents
1 INTRODUCTION 3
1.1 Purpose and scope of the review 3
1.2 Methods 3
1.3 Some comments on the literature 4
1.4 Structure of the report 4
2 WHAT IS TRAUMA? 5
 2.1 Denitionalissues 5
2.2 Key developments and debates 6
2.2.1 Early research on trauma 6
2.2.2 Shell shock and combat stress 9
2.2.3 Disaster research 10
2.2.4 The evolution of post-traumatic stress disorder (PTSD) 11
2.2.5 Complextrauma 14
 2.2.6 Trauma,powerandvictimisation–radicalandcriticalapproaches 15
2.3 The link with brain injury 17
2.4 Summary 18
3 HOW COMMON IS TRAUMA? 19
 3.1 Traumaticexperienceinthegeneralpopulation 19
3.2 Theextentoftraumaamongtheyoungoffenderpopulation 21
3.3 Trauma and mental health conditions 24
3.3.1 Traumaandmentalhealthinadultprisonerscomparedwiththegeneralpopulation 25
3.3.2 Traumaandmentalhealthinyoungoffenderscomparedwiththegeneralpopulation 27
3.4 Trauma and neurodevelopmental disorder with particular reference to brain injury 29
3.5 Post-traumaticstressdisorder(PTSD)amongyoungoffenders 30
3.6 Traumawithintheoverlapbetweenyoungoffendersandlookedafterchildren 32
3.7 Trauma and women offenders 33
3.8 Summary 35
4 WHAT ARE THE IMPACTS OF TRAUMA? 37
 4.1 Keyfactorsaffectingimpact 37
4.2 Impacts on development 38
4.3 Attachment 39
4.4 Dissociation and memory 41
4.5 Impactsonbraindevelopment 42
4.6 The impact of trauma upon behaviour 42
4.6.1 Traumaand‘problematicbehaviours’ 45
 4.7 Impactsofcombinedandcumulativetraumas 45
4.8 Impacts related to brain injury 46
4.9 Summary 48
5 TRAUMA-INFORMED PRACTICE 49
 5.1 Whyistraumaanimportantconsiderationforresettlementpractice? 49
5.2 Traumaanddesistance 50
5.3 Whatistrauma-informedresettlement? 51
5.3.1 Staffawareness,trainingandsupport 52
5.3.2 Screeningandassessment 53
 5.3.3 Interventionswithyoungoffenders 54
5.3.4 Theuseofattachmenttheorytohelpunderstandandresolvetrauma 58
5.3.5 Theneedforpositivesocialsupport 59
 5.3.6 Considerationofthetherapeuticwindow 59
5.4 Summary 60
6 REFERENCES 62

Trauma and young offenders – a review of the research and practice literature | 3
1. INTRODUCTION
Thisreportpresentskeyndingsfromareviewoftheresearchandpracticeliteratureconcerningtraumain
thebackgroundsofyoungpeoplewhooffend.Ithasbeen producedaspartoftheBeyondYouthCustody
(BYC) programme, funded under the Big Lottery’s Youth in Focus (YIF) programme. It is linked to two
downloadableBYCpractitionerguidesontheprevalenceandimpactsoftraumaamongyoungpeoplewho
offend, and to trauma-informed resettlement practice (WrightandLiddle,2014a,2014b).
The YIF programme aims to engender positive change in the lives of vulnerable young people, with a
particular focus on three strands: young people leaving custody, young people leaving care and young
carers.BYCisoneofthreeEngland-widelearningandawarenessprojectsthatareworkingtodevelopbest
practiceinpolicyandservicedeliveryineachofthesethreeYIFstrands.Focusingontheyoungoffenders’
strand,BYCexiststoadvanceknowledgeandpromotebetterpolicyandpracticeforyoungpeoplemaking
the transition from custody to the community and beyond, in order to improve outcomes.
BYCisbeingdeliveredthroughapartnershipbetweenfourorganisations:Nacro,ARCS(UK)Ltd,theCentre
for Social Research at the Universityof Salford, and the Vauxhall Centre for the Study of Crime at the
UniversityofBedfordshire.
1.1 Purpose and scope of the review
Thisreviewaimstohighlightwhatiscurrentlyknownabouttraumawithinthepopulationofyoungoffenders,
andtoidentifytheimportanceofthisknowledgeforeffectiveresettlementpractice.Itfocuseson:
• Denitionsoftraumaandthedifferentwaysinwhichtraumahasbeenunderstoodintheresearchand
practice literature
• Theprevalenceofdifferenttypesoftraumaticchildhoodandadolescentexperiencesinthe
backgroundsofyoungoffenders
• Theeffectsthatsuchtraumacanhaveonyoungpeopleintheshortterm,anditslongertermimpacts
onemotional,social,andneurologicaldevelopment
• Thelinksbetweentraumaandyoungpeople’sbehaviour,includingtheextentoftheircapacityto
comply with youth justice interventions
• Theimplicationsthatanunderstandingoftraumaanditseffectsmighthaveforresettlementwork
undertakenwithyoungcustody-leavers
1.2 Methods
Members of the BYC research team canvassed a very wide range of academic, professional and grey
literature, generated by searches of internet and academic databases. The searches drew largely on
combinationsofthefollowingterms:
• Trauma,adversechildhoodexperience,childabuse,childneglect,abandonment,separation,violence
• Impact, effect(s), development
• Youngoffender,offending,youthjustice,criminaljustice
• Mentalhealth,problematicbehaviour,vulnerablegroup
Initialsearchesusing termssuchas ‘mental health’generatedvast numbers ofsources,but more nely
tunedBooleansearches(allowingthe combinationof keywordswithoperatorssuchas‘or’,‘and’or‘not’)
usingthreeormoreoftheabovetermshelpedtheteamtonarrowdownlistsofrelevantmaterial.

Trauma and young offenders – a review of the research and practice literature | 4
Materialprovidingamorespecicfocusontraumawasfoundbyutilisingsearchcombinationsfromtherst
groupofkeywordslistedabove.
SincetheYIFprogrammeworkswithyoungpeopleuptotheageof25,thereviewwasnotlimitedtomaterial
relatingtoyoungpeoplebelowtheageof18,althoughmuchofthepublishedmaterialdoesfocusonthis
youngeragerange.
Severalhundredkeydocuments–themajorityofwhichwerepublishedinthelast20years–werenally
selected for assessment, and it is upon this material that this review is based.
1.3 Some comments on the literature
Incomparisonwithpublishedmaterialonthewidereldofmentalhealth,theliteratureontraumaand
trauma-relatedissueshas been slow to develop. In recent years, however,it has grownrapidlywiththe
increasingrecognitionoftraumaanditseffects,suchaspost-traumaticstressdisorder(PTSD)arisingout
oflifeexperiencesasdiverseaswar,childabuse,braininjuryandnaturaldisaster,tocitebutafewexamples.
Duetoitsdiverseoriginsandeffects,traumadeesclassicationunderanyonedisciplinaryumbrella.Asa
result,soreferencetoitisfrequentlyfoundwithinarangeofdifferenttheoreticalparadigms,ofteninvolving
differentdenitionswhichcanoccasionallybemutuallyantagonistic.Innosense,therefore,can‘theliterature’
ontraumabeseenashomogeneous.
1.4 Structure of the report
Giventhewide-rangingdisciplinarysourceswhichinformthephenomenonoftraumaanditsrelatedissues,
there are many different ways in which this material could be synthesised and presented.
Forthepurposesofthisreportbothrelevantgenericandtrauma-specicsourceshavebeendrawnuponto
structurethematerialintofourmainsections.Section2coversdenitionalissuesandgivesanoverviewof
someofthebackgroundresearchontraumaandkeydebatessurroundingit.Section3providesanoverview
oftheevidenceconcerningtheprevalenceoftraumabothintheoffendingandgeneralpopulations;italso
presentsmaterialgeneratedbyresearchonarangeofmentalhealthissuesinbothpopulations.
Section4sets out a range of impacts of trauma thathavebeen focusedon intheliterature.Section5
discussessomeofthekeyimplicationsoftheevidencefortraumaanditsimpactsforthegeneraleldof
resettlementpracticewithyoungpeople.

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2. WHAT IS TRAUMA?
2.1 Definitional issues
Trauma is a phenomenon that requires both a particular kind of event and a particular kind of reaction to
that event – as such, it dees simple denition. The wider disciplinary literature provides many such
denitions,mostofwhichfocusonthewayinwhichindividualsexperiencenegativeevents.Thefollowing
examplesdescribetraumaintermsofrelevantlinksbetweenevents,individualexperience,anditseffects
upon that individual:
 Traumaisanemotionalwound,resultingfromashockingeventormultipleandrepeatedlife-
threateningand/orextremelyfrighteningexperiencesthatmaycauselastingnegativeeffectsona
person,disruptingthepathofhealthyphysical,emotional,spiritualandintellectualdevelopment.
 (NationalCentreforChildTraumaticStressNetwork(NCTSN),2004)
 Individualtraumaresultsfromanevent,seriesofevents,orsetofcircumstancesthatisexperienced
byanindividualasphysicallyoremotionallyharmfulorthreateningandthathaslastingadverse
effectsontheindividual’sfunctioningandphysical,social,emotional,orspiritualwell-being…Inshort,
traumaisthesumoftheevent,theexperience,andtheeffect.
(Substance Abuse and Mental Health Services Administration (SAMHSA), 2014)
Underthesedenitions,traumacanbegeneratedbyawiderangeofevents,whethertheseareinterpersonal
orimpersonal, immediateorone-off, chronicorongoing. Theeventsbelowaretypicallyreferredtointhe
literatureashavingthepotentialtogeneratetrauma:
• Emotional,physical,andsexualabuse
• Neglect
• Assaults,bullying
• Witnessingfamily,school,orcommunityviolence
• War
• Racistvictimisation
• Acts of terrorism
• Disasters
• Serious accidents
• Serious injuries
• Lossoflovedones
• Abandonment
• Separation
Ifeventsofthiskindaredenedastraumatic,itisbecausetheyoverwhelmanindividual’scapacitytocope
andelicitpowerfulfeelingssuchasfear,terror,andhelplessness,lackofcontrol,hopelessnessordespair.
Thereisatensionintheliteraturebetween the formalapproachestodenitiontakenby the psychiatric
professioninparticularandthe lessboundaried,more inclusiveand contextualapproach takenbysome
otherhealthandsocialcareprofessionals.Forexample,thedenitionofatraumaforadiagnosisofPTSD
withinDSM-5–theAmericanPsychiatricAssociation’sDiagnosticandStatisticalManualofMentalDisorders
(2013)whichsetsoutthecriteriamostwidelyusedintheUnitedStatestoclassifymentaldisorders–isthat

Trauma and young offenders – a review of the research and practice literature | 6
theindividualwasdirectlyorindirectlyexposedto,orwitnessed,eitherdeath,threateneddeath,actualor
threatenedseriousinjury,oractualorthreatenedsexualviolence,andexperiencedspeciedsymptomsas
a result (see further discussion of PTSD at 2.2.4below).Although this mostrecentiterationof DSM has
widened its earlier denitions of trauma and traumatic stress, and has recognised the unique trauma
experiencesandresponsesofchildrenundertheageofseven,therelativerigidityofitsdenitionarguably
stillprovidessomescopeforoverlookingthoseclearlyexperiencingtraumaticdisorderbutwhodonotquite
meetthediagnosticthreshold,andtorobthenotionoftraumaofitssocial,politicalandothercontexts.
Somewritershavealsoclaimedthatusageofthetermwithintheliteraturehasledtoatrivialisationofthe
concept (Brandell,2012)ortoablurringofthedistinctionbetweentraumaticeventsandtraumaticresponse
to such events (Allen, 2001).Brandellconsidersthatcommondictionarydenitionsoftraumaareusually
“moreclinicallyuseful”,citingtheWebster’sNewCollegeDictionarydenitionoftraumaasanexample:
 Trauma–anemotionalshockthatcreatessubstantialandlastingdamagetothepsychological
developmentoftheindividual,generallyleadingtoneurosis;somethingthatseverelyjarsthemindor
emotions (Brandell,2012:42).
However,ratherthantrauma‘generallyleadingtoneurosis’,afurtherdenitionallowsforthepossibilitythat
some people will make a natural recovery:
Trauma is an emotional response to a terrible event like an accident, rape or natural disaster.
Immediatelyaftertheevent,shockanddenialaretypical.Longertermreactionsincludeunpredictable
emotions,ashbacks,strainedrelationshipsandevenphysicalsymptomslikeheadachesornausea.
Whilethesefeelingsarenormal,somepeoplehavedifcultymovingonwiththeirlives.
(AmericanPsychologicalAssociation,2015)
Someofthesedebateshavetheirrootsinearlierworkontrauma,conductedbykeyguresinpsychology
andpsychoanalysisinparticular.Theyhavealsohavetakenshapealongside majoreventssuchaslarge-
scaleconicts(withtwoworldwarsandthewarinVietnamhavingaparticularlystrongimpactontheoretical
development), research focusing on the impact of major disasters, and wider developments such as
feminism,communitytraumatheory,andtransgenerationaltheory.
In the following sub-sections, the key developments and debates which have led to contemporary
understandingsoftheissuessurroundingthemeaningandcontentoftraumaaresetout.
2.2 Key developments and debates
2.2.1 Early research on trauma
Interest in issues concerning trauma and its impacts has developedrelatively recently, although stress-
relatedconditionsmoregenerallyhaveattractedattentionwithinpsychology,psychiatry,healthandrelated
eldssinceatleastthemiddleofthe19th century.
Some of the earliest references to what would now be called psychological trauma were made during
debatesabouttheimpactofviolentrailwayaccidents.Railtravelexpandedrapidlyalongsidetechnological
advancesmadeinthewakeoftheIndustrialRevolutionandbythemid-19th century its use was widespread.
Railtravelatthattimewasnot,however,characterisedbyhighlevelsofsafety,andrailaccidentswereboth
commonandseriouswhentheydidhappen.Railaccidentsweresufcientlynumeroustohavegivenriseto
aliteraturefocusingonwhatcametobeknownas‘railwayspine’,whichreferredtoaclusterofsymptoms
that appeared to be generated by such accidents. These symptoms included sleep disturbances and
nightmares,tinnitus,andsometimeschronicpain(LasiukandHegadoren,2006a).Whilesomephysicians

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(e.g. Erichsen, 1875) attributed these symptoms to organic causes, others argued that they were
psychologicalinorigin,sincetheycouldbefoundinpeoplewhohadbeeninvolvedinsuchaccidentsbutnot
sufferedanyidentiableinjury(vanderKolketal.,1996;LamprechtandSack,2002).
In 1889, Hermann Oppenheim (Oppenheim, 1889) employed the term ‘traumatic neurosis’ to refer to the
condition(citedinWeisaethandEitinger,1991).Thisappearstobetherstuseoftheterm‘trauma’within
psychiatry, although it was of course already used widely in other elds such as surgery (Lasiuk and
Hegadoren,2006a).Oppenheimappearedtobelievethatthesymptomsofrailwayspineweregeneratedby
psychologicaltrauma,butthatthetraumaitselfledtoorganicchangesinthebrainwhichinturnallowedfor
continuing‘neuroses’.
The notion of ‘hysteria’ had also become a subject of interest around the middle of the 19th century, with the
publicationin1859ofPaulBriquet’s‘Traitédel’Hystérie’,inparticular.Thatworkpresentedndingsfrom
along-termstudyof430patientswithhysteria,aconditionwhichBriquetunderstoodasbeinga‘neurosis
ofthebrain’,butwhichwastriggeredbyenvironmentaleventswhichacteduponthe‘affectivepartofthe
brain’ (Briquet, 1859; Mai and Merskey, 1981; Mai, 1983). Symptoms identied by Briquetwere quite
similar to those which later came to be associated with post-traumatic stress disorder or dissociative
disorders whereby, in order to ward off the effects of intolerable pain, the individual may resort to dissociative
behaviours that represent distractions, or attempt to reassert control in place of helplessness. Self-
destructivebehavioursarealsocommon,asismemorylossrelatedtotraumaticincidents(Briere,2006).
Briquetrejectedthepreviousassociationofhysteriawithphysicaldiseasesofthefemalegenitalia.Healso
rejectedpreviousaccountswhichsoughttoexplainhysteriaintermsof‘frustratedsexualdesire’(Weckowicz
and Liebel-Weckowicz, 1990). Interestingly, a signicant portion of Briquet’s sample were (female)
prostitutes,and he noted that 53% of these women had the condition, whereas one third of the ‘house
servants’inhissamplewerethoughttohavehysteria(Lowenstein,1990).
Intermsofcausation,Briquetarguedthathysteriaresultedfromimpactonthenervoussystemoftraumatic
stressesorexperiences,suchasseveremaltreatmentinchildhood,rapeorsexualviolence,butalsoasa
resultofothereventssuchaswitnesseddeaths,seriousillness,orfamilyinstability(Lowenstein,1990).
FurtherexaminationoflinksbetweentraumaandmentalillnesswasundertakenbytheFrenchneurologist
JeanMartinCharcot,whoalsofocusedonhysteriainthelate1880s.Charcotdescribedtheconditionas
beingcharacterisedbysensoryloss,amnesiaand“hypnoticstates”insomepatients.Thedisorderwasfelt
tobesufferedalmostentirely bywomen,althoughCharcotsurmisedthattheconditionhadpsychological
ratherthanphysiologicalcauses.Infact,hewentsofarasto“describeboththeproblemsofsuggestibility
in these patients, and the fact that hystericalattacks are dissociative problems – the results of having
enduredunbearableexperiences”(vanderKolketal.,2007:49-50).Hemadethemorespeciclinkageof
hystericalsymptomswithexperiencesofviolence,rape,andsexualabuse(Charcot,1887),andhisstudent
PierreJanetalso wentontostudy the impactoftraumaticexperiences ofthiskindondevelopmentand
behaviour.Feministtheoristsandclinicianswouldlaterbuildontheseideasbyexaminingtheinuenceof
genderonpowerrelationsandraisingawarenessofthepervasivenessofviolenceandsexualvictimisation
in the lives of women and children (Herman, 1997).
Thefamouspsychiatrist,SigmundFreud,wasstronglyinuencedbyCharcot(whomhevisitedin1885),and
manyof Freud’s papers onhysteriaup until approximately1896drewsimilar links between dissociative
states and actual traumatic events. In his 1893 paper ‘On the Psychical Mechanism of Hysterical Phenomena:
ALecture’(Freud,1893/1962),henoted:
 Wemustpointoutthatweconsideritessentialfortheexplanationofhystericalphenomenatoassume
thepresenceofadissociation,asplittingofthecontentofconsciousness.[T]heregularandessential

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contentofahystericalattackistherecurrenceofaphysicalstatewhichthepatienthasexperienced
earlier(citedinvanderKolketal.,2007:54).
IntheirinuentialStudiesonHysteria(BreuerandFreud,1895),BreuerandFreudexpandedonthatcentral
connection,describinghow‘dissociativestates’ developedinresponsetooverwhelminglyunbearableor
traumatic experiences. Citing Janet, they argued that ‘hypnoid hysteria’ was in fact caused by external
traumaticexperiences,ratherthansolelybyinternalpsychologicalprocesses:
 Hystericssuffermainlyfromreminiscences…thetraumaticexperienceisconstantlyforcingitselfupon
thepatientandthisisproofofthestrengthofthatexperience:thepatientis,asonemightsay,xated
on his trauma (citedinvanderKolketal.,2007:54).1
Freud continued to develop this causal account of traumatic dissociation for the next several years.In
‘HeredityandtheAetiologyoftheNeuroses’(Freud,1896), he asserted that:
 Aprecociousexperienceofsexualrelations…resultingfromsexualabusecommittedbyanother
person…isthespeciccauseofhysteria…notmerelyanagentprovocateur(Freud,1896a/1962:152).
Controversially, however, Freud subsequently rejected what became known as his ‘seduction theory’ in
relationtotrauma-relatedsymptomsofthesortfocusedonbyCharcot,infavourof‘conicttheory’,which
focused on the perceivedunacceptability of sexual or aggressive desires. Under this view, the patient’s
‘hystericalsymptoms’arenotsomuchanchoredinveridicalrecollectionsofprevioussexualvictimisation,
asinconictsgeneratedby fantasies and desires thatarethemselvessounacceptablethatthe patient
strugglestoaccommodatethem.
Inotherwords,theviewthatsuchsymptomsweretriggeredbyactualeventsthatwerehighlyupsettingto
thosewhoexperiencedthem,gavewaytoaviewthatthesesymptomshadtheirrootsinfantasy.
Freud’s‘TheAetiologyofHysteria’(1896b/1962)seemedtomarkaturningpoint;itisinthispaperthathe
begantodevelopthenotionof‘defencehysteria’,andtomoveawayfromtheviewthathysteriahaditsroots
inactualtraumaticevents.AsFreudputitlateronin‘AnAutobiographicalStudy’(1925/1959):
 Ibelievedthesestories[ofchildhoodsexualtrauma]andconsequentlysupposedthatIhaddiscovered
therootsofthesubsequentneurosisintheseexperiencesofsexualseductioninchildhood.Ifthe
readerfeelsinclinedtoshakehisheadatmycredulity,Icannotaltogetherblamehim…Iwasatlast
obligedtorecognisethatthesescenesofseductionhadnevertakenplace,andthattheywereonly
fantasieswhichmypatientshadmadeup(Freud,1925/1959:34).
Thelatterpositionassumedakindofmainstreamorthodoxywithinpsychiatryforsometimeafter,although
a few psychoanalysts did continue to argue that actual traumatic events do have particular negative
sequelae.Sandor Ferencziinparticularcontinuedtomakesucharguments,although his workseemsto
havebeenregardedassomethingof anembarrassmentwithinthe mainstreamofpsychiatry atthetime
(andalsotoFreudhimself,whowasinmanyrespectsFerenczi’smentor).
Ferenczi’s1933 paper‘TheConfusionofTonguesBetweenAdults andtheChild’(Ferenczi, 1933/1955)
offersadetailedandimpressiveaccountofthepsychologyofchildsexualabuse,andoftheprocessesof
traumatisation,denial, guilt,fragmentationofmemory,and subsequent‘splitting’ ofpersonality.Ferenczi
1FreudandBreuer alsodrew comparisonsbetween hystericalsymptomsand ‘warneuroses’,whichreferredatthat time toa setof
symptomsexperiencedbysoldierswhohadbeensubjectedtooverwhelmingstressduringbattle.

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notedinrelationtothelatter,thateachsplitinthepersonalitybehavesasthough“itdoesnotknowofthe
existence of the others” (Ferenczi, 1933/1955: 165). His account is striking in its similarity to current
understandingofdissociativeprocesseswhicharenowregardedasbeingacentralfeatureofadaptationto
severe trauma.
2.2.2 Shell shock and combat stress
Earlier comparisons between trauma linkedto overwhelming interpersonal events and trauma linked to
large-scaleconict(asin BreuerandFreud’s1885descriptionsof‘warneuroses’,forexample)attracted
furtherattentioninthewakeoftheFirstWorldWar,atwhichpointthenotionof‘shellshock’alsoentered
commonusage.Althoughsimilarphenomenahadbeendescribedinrelationtootherconicts,theFirst
WorldWarwasunprecedentedbothintermsofitsscaleandtheindustrialisedwayinwhichitwasconducted.
Thehorrorsoftrenchwarfareinparticularwereseentomarkauniquedeparturefrompreviousconicts.
Thescaleandtypeofcasualtieswerealsounlikeanythingpreviouslyseen,anddidmuchtoacceleratethe
studyofwar-relatedpsychologicaltraumaasgraphicallydescribedhere:
 Underconditionsofunremittingexposuretothehorrorsoftrenchwarfare,menbegantobreakdown
inshockingnumbers.Connedandrenderedhelpless,subjectedtoconstantthreatofannihilation,
and forced to witness the mutilation and death of their comrades without any hope of reprieve, many
soldiersbegantoactlikehystericalwomen.Theyscreamedandweptuncontrollably.Theyfrozeand
could not move. They became mute and unresponsive. They lost their memory and the capacity to feel.
Thenumberofpsychiatriccasualtieswassogreatthathospitalshadtobehastilyrequisitionedto
housethem.Accordingtooneestimate,mentalbreakdownsrepresented40percentofBritishbattle
casualties.
(Herman, 1997:20)
CharlesMyers,a militarypsychiatristwhostudiedlargenumbersoftraumatisedsoldiersduringandafter
theFirstWorldWar,initiallyfeltthat sets of symptomsseeninsomesoldiersafterperiodsofprolonged
shellingwerea result of cerebral concussion and the rupture of bloodvesselsinthebrain.Inwhat was
probablytherstacademicpapertousetheterm‘shellshock,Myers(1915)alsonotedsimilaritiesbetween
war neuroses and hysteria. He subsequentlyargued, however, that not all cases that he sawcould be
regardedashavingneurologicalconditions,andhemadeadistinctionbetween‘shellconcussion’torefer
tocasesofthelattersort,and‘shellshock’torefertoapsychologicalconditionbroughtonbyextremewar
experience(LamprechtandSack,2002).
Abram Kardiner, an American anthropologist and psychoanalyst, also began his career working with
traumatised war veterans, and his research provided a detailed and rich account of the impact of traumatic
war-related events and subsequent ‘traumatic neuroses’. The key features of the latter as described by
Kardinerarehighlysimilartowhatarenowregardedintheeldasbeingthedeningcharacteristicsofpost-
traumaticstress disorder,whichinvolvehyper-sensitivity(bothphysiologicaland emotional),ghtor ight
reactionstoeverydaystimuli,dissociationandwithdrawal,cyclicalre-livingofthetraumaticevents,anxiety
and panic attacks, and shifts in conceptions of the self. Kardiner described the latter:
 Thesubjectactsasiftheoriginaltraumaticsituationwerestillinexistenceandengagesinprotective
deviceswhichfailedontheoriginaloccasion.Thismeansineffectthathisconceptionoftheouter
world and his conception of himself have been permanently altered (Kardiner, 1941: 82).
In effect, because the sufferer’s ego “dedicates itself to the specic job of ensuring the security of the
organism, and of trying to protect itself against recollection of the trauma” (Kardiner, 1941: 184), and

Trauma and young offenders – a review of the research and practice literature | 10
becausethelatteristoooverwhelmingfortheindividualtodealwithinthenormalmanner,(s)hebecomes
stuck in a spiral which Kardiner likened to the myth of Sisyphus.2Indescribingtheimpactoftraumainthis
way,Kardineralso highlightedafundamentaldilemmaof treatment in suchcases–howto balancethe
possiblebenetsofinterventionagainsttherisksinvolvedin disrupting mechanisms which are tosome
extentadaptivefortheindividualsufferingtheeffectsoftrauma.
2.2.3 Disaster research
Contemporarytraumatheorywasfurtherdevelopedbyarangeofstudiesfocusingontheimpactoflarge-
scale disasters. Research and enquiries into disasters well-known to current generations, such as the
terroristattackon theWorldTradeCenter(Koplewiczetal.,2002)andtheHillsboroughFootballStadium
disaster(HillsboroughIndependentPanel,2012)havebenetedfromtheseearlyanalysesandattentionto
theplaceoftraumaindisaster.Connectionsbetweentraumaandmorerecentmassviolenceeventssuch
as the Paris terrorist shootings in November 2015 have also attracted media and research attention,
althoughdetailedstudieshaveyettobepublished.
Oneoftheearlystudieswasofthe1942CocoanutGrovenightclubreinBoston,whensome493individuals
perished,withmanybeingtrampledtodeath.ErichLindemann,aBostonpsychiatrist,workedwithsurvivors
in the aftermath of the disaster, and conducted focused interviews with many of them, as part of his study
ofacutegriefandtraumaticloss.Lindemannfoundcommonsymptomsinthat groupofdisastervictims,
including disorganisation, somatic problems, profound guilt feelings, hostile reactions and behavioural
changes (Lindemann, 1944). He also noted, however, that interventions could be made which allowed
traumavictimstoavoidreactionsthatweremaladaptiveinthelongerterm.
GeraldCaplan,apsychiatristwhocametobeknownasthefatherofcrisisintervention,alsoworkedwith
CocoanutGrovesurvivors,anddrewontheexperiencetodescribekeycomponentsofsurvivors’effortsto
cometotermswithoverwhelminglystressfulevents.Thenotionof‘insurmountability’isofkeyimportance
in his account:
 Peopleareinastateofcrisiswhentheyfaceanobstacletoimportantlifegoals…anobstaclethatis,
foratime,insurmountablebytheuseofcustomarymethodsofproblemsolving.Aperiodof
disorganisationensues,aperiodofupset,duringwhichmanyabortiveattemptsatsolutionaremade.
 (Caplan,1961:18)
Howard Parad, another pioneering crisis theorist, worked with Caplan to identify ve components that
affectedatraumavictim’sabilitytocopewithoverwhelminglystressfulevents:
• Thestressfuleventposesaproblemwhichisbydenitioninsolubleintheimmediatefuture.
• Theproblemovertaxesthepsychologicalresourcesofthefamily,sinceitisbeyondtheirtraditional
problemsolvingmethods.
• Thesituationisperceivedasathreatordangertothelifegoalsofthefamilymembers.
• The crisis period is characterised by tension which mounts to a peak, then falls.
• Perhapsofthegreatestimportance,thecrisissituationawakensunresolvedkeyproblemsfromboth
thenearanddistantpast(ParadandCaplan,1960:11–12).
2SisyphusisagureofGreekmythology,whoiscondemnedtoaneternityofrollingalargerockupthesideofamountain,onlytohave
itrollbackdownagain oncehe reachesthe top.Kardinerdescribeshowsome ofthe sufferersof “pathologicaltraumatic syndrome”
had persistent ‘Sisyphus dreams’ in which the trauma is re-lived in a cyclical and utterly futile manner – futile because the dream simply
involvesxation,andnoresolutionorscopeforresolution.

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Theirrstandthirdpointsaboutaperceiveddangerorthreattolifewhichappearsinsolubleintheimmediate
futureprovidesomeoftheingredientsofwhatwouldlaterbecomeknownasPTSD.Thenalpointaboutthe
extenttowhichthecurrent crisisresonateswithan individual’sprevioushistoryoftraumaticexperiences
feedsintomorerecentunderstandingsoftheeffectsofcumulativeandcomplextrauma(furtherdiscussed
in subsection 2.2.5).
Whilemuchoftheearlierdisasterresearchfocusedonspecicevents(andcanthereforeberegardedas
casestudies),anumberofwiderreviews(e.g.GreenandSolomon,1995)andmeta-analyses(e.g.Rubonis
andBickman,1991)havealsobeenproducedmorerecently,whichaimtosynthesiseandassessabroader
rangeofdisasterresearch.
Reviews of that kind now form a key part of the ‘trauma literature’ and the themes identied in them
resonatestronglywith contributions from other disciplines referred to throughout this report. The meta-
analysisundertakenbyFranNorrisandcolleagues,forexample,(Norrisetal.,2002a,2002b)canvassed
morethan250previouspublicationsfocusingon disasters and their impacts. They also undertookvery
detailedanalysis ofinformationconcerning160samplesofdisastervictims,in ordertoidentifykeylinks
between types of incident, trauma, psychosocial impacts and the characteristics and backgrounds of
victims.Findingsfromthatanalysissuggestthat:
• Disastersthatinvolvesomehumanintent(e.g.massshootings,bombings)aremorelikelytobe
experiencedastraumaticandoverwhelmingthanthosethatdonot.
• Massviolenceisthemostlikelytypeofdisastertoresultin‘severe’or‘verysevereimpairment’among
victimsorwitnessesintermsofadversepsychological/emotionalimpactsincludinganxiety,stress,
andarangeofPTSDsymptoms(describedinmoredetailinsection2.2.4).
• Individualswhohaveaprevioushistoryoftraumaticexperiencearemorelikelytobeaffected
adversely by new disasters or other stressors.
2.2.4 The evolution of post-traumatic stress disorder (PTSD)
One of the most commonly referred to conditions relating to traumatic experience is PTSD (previously
referred to in section 2.1). It was partly as a result of the traumatic stress being repor tedover time by
VietnamWarveterans(Kulkaetal.,1990)thatthetermcameintousageinthe1970s,andenteredofcial
psychiatric discourse with the addition of PTSD to the third iteration of the DSM (DSM-III, 1980).
TheInternationalClassicationofDiseases(ICD)istheclassicationusedbytheWorldHealthOrganisation
(WHO) since 1994. It has become the international standard diagnostic classication for most general
epidemiological purposes. The ICD-10 Classication of Mental and Behavioural Disorders: Clinical
DescriptionsandDiagnosticGuidelines also providesinternationalguidelinesforthe diagnosisofPTSD,
whichare broadly similartothose used bytheDSM. Arguably amodernversionof shell shock,theterm
PTSDservedtollatheoreticalgapbyspecifyingthatitsrootcausewasoutsidetheindividualratherthan
emanatingfromaninherentweaknessorneurosis.
TobecategorisedasPTSDwithinthetermsofitsrstinclusionintheDSM,thetraumaticeventassociated
withtheconditionhadtoconstituteactualorthreateneddeathorinjury“outsidetherangeofusualhuman
experience”,suchasmassviolence,theHolocaust,Hiroshima,earthquakes,aircrashesandsoon.Thisdid
not make allowance for the less visible, but potentially no less traumatic impact on the individual of such
eventsaschildabuse,loss,andseriousillness;in1980thesewouldhavebeencategorisedas‘adjustment
disorders’.

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Sincethattime,theDSMhasbeenrevisedfourtimes,makinggradualchangesinparalleltoitssectionson
PTSD.Inthe1987version(DSM-III-R),thedenitionofPTSDaddedthestressorof‘threatstopsychological
integrity’,whichmeantthateventscouldbecategorisedastraumatic iftheywerehighlyupsettingevenif
they did not involve any actual or threatened death or injury. However, this revision has not appeared in
subsequentversions,anditwasthereforearguedthatmorerecentversionswill“underestimatetheextent
ofactual traumainthegeneralpopulation” (BriereandScott,2013:4).Or,toputitmoreaccurately,the
narrowerdenitions will failtocovera range of peoplewhohavenotexperiencedevents involving such
‘threats’,butwhoareexperiencingnegativeimpactsorsymptomsthataresimilaroridenticaltothoseof
otherswhohaveexperiencedsuchevents.
Themostrecentrevision– theDSM-5(AmericanPsychiatricAssociation,2013)–hasmadeanumberof
evidence-basedrevisionstoPTSDdiagnosticcriteria.Asaresult,PTSD,whichhithertohadbeenclassied
asanAnxietyDisorderisnowclassiedwithinthenewcategoryofTrauma-andStressor-RelatedDisorders.
Theonsetof every disorderinthiscategoryhasbeenpreceded by exposuretoa traumatic or otherwise
adverse environmental event.
ItisworthsettingouttheDSM-5criteriaforPTSDinfull,sincethisistheversionthatiscurrentlyinoperation,
andsincethecriteriathemselveshaveverywidecurrencyandareusedbyalargenumberofmentalhealth
professionalsbothwithinandoutsidethepsychiatriceld.
Therstsetofcriteriaisspecictochildrenovertheageofsixyears,adolescentsandadults.CriteriaA-E
requireahistoryofexposuretoatraumaticeventthatmeetsspecicstipulationsandsymptomsfromeach
offoursymptomclusters:intrusion,avoidance,negativealterationsincognitionsandmood,andalterations
inarousalandreactivity.CriterionFconcernsdurationofsymptoms,criterionGassessesfunctioning,and
CriterionHclariessymptomsasnotattributabletoasubstanceorco-occurringmedicalcondition.Again,
basedonresearchevidence,DSM-5nowincludesthenewspecicationsofadissociativesub-typeofPTSD,
andofdelayedexpression.
TheDSM-5criteriaforPTSDareasfollows:
Criterion A: Stressor
The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or
threatenedsexualviolence,asfollows(onerequired):
• Directexposure
• Witnessinginperson
• Indirectly,bylearningthatacloserelativeorclosefriendwasexposedtotrauma.Iftheeventinvolved
actual or threatened death, it must have been violent or accidental
• Repeatedorextremeindirectexposuretoaversivedetailsoftheevent(s),usuallyinthecourseof
professionalduties(e.g.,rstresponders,collectingbodyparts;professionalsrepeatedlyexposedto
detailsofchildabuse);thisdoesnotincludeindirectnon-professionalexposurethroughelectronic
media, television, movies, or pictures
Criterion B: Intrusion symptoms
Thetraumaticeventispersistentlyre-experiencedinthefollowingway(s)(onerequired):
• Recurrent,involuntaryandintrusivememories(note:childrenolderthansixmayexpressthissymptom
in repetitive play)
• Traumaticnightmares(note:childrenmayhavefrighteningdreamswithoutcontentrelatedtothe
trauma(s))

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• Dissociativereactions(e.g.,ashbacks)whichmayoccuronacontinuumfrombriefepisodesto
complete loss of consciousness (note: children may re-enact the event in play)
• Intenseorprolongeddistressafterexposuretotraumaticreminders
• Markedphysiologicreactivityafterexposuretotrauma-relatedstimuli
Criterion C: Avoidance
Persistenteffortfulavoidanceofdistressingtrauma-relatedstimuliaftertheevent(onerequired):
• Trauma-relatedthoughtsorfeelings
• Trauma-relatedexternalreminders(e.g.,people,places,conversations,activities,objects,or
situations)
Criterion D: Negative alterations in cognitions and mood
Negativealterationsincognitionsandmoodthatbeganorworsenedafterthetraumaticevent(tworequired):
• Inability to recall key features of the traumatic event (usually dissociative amnesia not due to head
injury,alcoholordrugs)
• Persistent(andoftendistorted)negativebeliefsandexpectationsaboutoneselfortheworld(e.g.,“I
ambad”or“Theworldiscompletelydangerous”)
• Persistentdistortedblameofselforothersforcausingthetraumaticeventorforresulting
consequences
• Persistentnegativetrauma-relatedemotions(e.g.,fear,horror,anger,guiltorshame)
• Markedlydiminishedinterestin(pre-traumatic)signicantactivities
• Feelingalienatedfromothers(e.g.,detachmentorestrangement)
• Constrictedaffect–persistentinabilitytoexperiencepositiveemotions
Criterion E: Alterations in arousal and reactivity
Trauma-relatedalterationsinarousalandreactivitythatbeganorworsenedafterthetraumaticevent(two
required):
• Irritableoraggressivebehaviour
• Self-destructive or reckless behaviour
• Hypervigilance
• Exaggeratedstartleresponse
• Problems in concentration
• Sleep disturbance
Criterion F: Duration
Persistenceofsymptoms(inCriteriaB,C,D,andE)formorethanonemonth.
Criterion G: Functional significance
Signicantsymptom-relateddistressorfunctionalimpairment(e.g.social,occupational).
Criterion H: Exclusion
Disturbance is not due to medication, substance use, or other illness.

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Specify if: With dissociative symptoms
If,inadditiontomeetingcriteriafordiagnosis,anindividualexperienceshighlevelsofeitherofthefollowing
in reaction to trauma-related stimuli:
• Depersonalisation:experienceofbeinganoutsideobserverofordetachedfromoneself(e.g.,feeling
asif“Thisisnothappeningtome”oronewereinadream)
• Derealisation:experienceofunreality,distance,ordistortion(i.e.,“Thingsarenotreal”)
Specify if: With delayed expression
Fulldiagnosis is not met until at least six months afterthe trauma(s), although onset of symptoms may
occur immediately.
ForthersttimeDSM-5hasalsospeciedcriteriaforthediagnosisofPTSDinchildrenundersevenyears.
Althoughprofessionalsworkingwithyoungoffendersarenotlikelytobeworkingdirectlywithchildrenofthis
age,itisnotimpossiblethattheiryoungclientswillresideinfamilieswithsuchchildren,whichmayinclude
theirown.Itisalsopossiblethattheseyoungpeople may haveexperiencedPTSDinthesetermsasan
infant,andthatpossiblecomplextrauma(seesubsection2.2.5) could have ensued. It is therefore important
tobeawareofthesignsandsymptoms.
TheDSM-5criteriaforPTSDinchildrenundersevenyearsareasfollows:
• Exposuretoactualorthreateneddeath,seriousinjury,orsexualviolation
• Presenceofoneormorespeciedintrusionsymptomsinassociationwiththetraumaticevent(s)
• Symptomsindicatingeitherpersistentavoidanceofstimuliassociatedwiththetraumaticevent(s)or
negativealterationsincognitionsandmoodassociatedwiththeevent(s)
• Marked alterations in arousal and reactivity associated with the traumatic events(s)
• Durationofthedisturbanceexceedingonemonth
• Clinicallysignicantdistressorimpairmentinrelationshipswithparents,siblings,peers,orother
caregiversorinschoolbehaviour
• Inabilitytoattributethedisturbancetothephysiologiceffectsofasubstanceoranothermedical
condition
While there have been no specic laboratory studies that establish the diagnosis of PTSD, a range of
psychologicaltests,scalesandcheckliststhatfollowtheformatofthePTSDcriteriahavebeendeveloped.
MeasuresfollowingthemostrecentDSM(DSM-5,2013)notablyincludetheClinician-AdministeredPTSD
ScaleforDSM-5(CAPS-5),thePTSDChecklistforDSM-5(PCL-5),andtheLifeEventsChecklistforDSM-5
(LEC-5)(NationalCenterforPTSD,2014).Theapplicationofsuchmeasuresisfurtherdiscussedinsection
3.5inrelationtoPTSDamongyoungoffenders.
2.2.5 Complex trauma
Whilemanyaspectsoftraumaoutlinedintheforegoingsubsectionsinvolveafocusonspeciceventsand
theirimpacts,somewritersarguethatafocusonmultipleorchronicformsofadverseexperienceisperhaps
ofgreatervalue,notleastbecauseincaseswheretraumaisanchoredinsetsofeventsorexperiences,the
scopefordamagingimpactsisbroader.
Theterm‘complextrauma’describestheearly-lifeexperience of multipleand/orchronicand prolonged,
developmentally adverse traumatic events (HermanJ., 1997;van derKolk,2005). Suchexperiencesare
usually of an interpersonal nature and, in particular, the term is often used in reference to multiple traumatic

Trauma and young offenders – a review of the research and practice literature | 15
eventsthatbeginatayoungageandareperpetratedbyadultsresponsibleforcareofthechild(Cooketal.,
2005;vanderKolkandCourtois,2005).
However, Friedman(2014) suggests that scientic evidence in support of this notion is insufcient and
inconsistent, hence not being included in DSM-5 as subtype of PTSD. Rather, he considers that the
dissociative sub-type of PTSD, referred to in section 2.2.4,will prove to be the diagnostic sub-type that
incorporatesmanyorallofthesymptomsoriginallysetoutbyHerman.
Theterm,however,continuestobewidelyusedintheliterature,alongwithseveralsimilartermswhichalso
focusonmultipleeventsortypesofevent.Forexample,thenotionof‘polyvictimisation’isusedbyanumber
ofresearchers(e.g. Finkelhor etal.,2007;Finkelhoretal.,2011)toreferto multiple formsoftraumatic
experienceorvictimisationexperiencedbyindividuals,sometimesoverlongperiodsoftime.Thenotionof
‘cumulativetrauma’isalsomuchusedintheliteraturetorefertosimilarhistoriesorexperiencesofmulti-
facetedtraumaticexperiences.
Conceptsofthiskindareusefulbecause,aswillbeshowninsection3,theevidencesuggeststhatthose
who suffer from particular childhood and adolescent traumas are also more likely to suffer from other
traumatic events than those who do not.
Therelevanceofsuchnotionsisthattheyalsohighlightaneedforprofessionalawareness,asexpressedby
vanderKolkinthefollowingcomments:
 Researchhasshownthattraumaticchildhoodexperiencesarenotonlyextremelycommonbutalso
haveaprofoundimpactonmanydifferentareasoffunctioning.Forexample,childrenexposedto
alcoholicparentsordomesticviolencerarelyhavesecurechildhoods;theirsymptomatologytendsto
be pervasive and multifaceted, and is likely to include depression, various medical illnesses, as well as
avarietyofimpulsiveandself-destructivebehaviours.Approachingeachoftheseproblemspiecemeal,
ratherthanasexpressionsofavastsystemofinternaldisorganisationrunstheriskoflosingsightof
the forest in favour of one tree.
(vanderKolk,2005:402)
2.2.6 Trauma, power and victimisation – radical and critical approaches
Theidea that traumaticexperienceforsomeindividualsis multi-facetedandchronic isalsoarguedfrom
other perspectives which place much more emphasis on the systemic and power-related features of trauma.
Some of these perspectives involve a distancing from mainstream psychiatric approaches which, it is
argued,havetendedto dominatedebatesabout trauma anditsimpacts.WriterssuchasDanieli (1998)
haveprovidedaccountsof ‘transgenerational trauma’forexample,wheretraumais described asarising
throughrelationshipswithotherswhohavedirectlyexperiencedtraumaticeventssuchaswar,genocide,or
other forms of mass violence. A number of studies have focused on the families of Holocaust survivors from
thatperspective,andhavehighlightedtheextenttowhichtheimpactsoftrauma(includingthedevelopment
ofPTSD)canbetransmittedacrossgenerations(AuerhahnandLaub,1998;Felsen,1998;Solomon,1998).
Similar accounts have been offered of transgenerational trauma relating topar ticular social or cultural
groups,suchasIndigenouspeoplewhohavesuffered colonial oppression or slavery (Duran and Duran,
1998;Gagne,1998).Thenotionof‘insidioustrauma’hasalsobeenusedtodescribetherealityoftrauma
experiencedbyindividualswholiveunder constantoppressiveconditions,suchas thosewhoexperience
dailyracism,forexample(Brown,1995).Indeed,BrownhasarguedforachangetoCriterionAintheDSM,
since the kind of stressor which can be covered by the notion of insidious trauma may not involve the (direct
orindirect)experiencing of an eventinvolving actualorthreatenedviolence, death or injury (as required
underthecurrentCriterionAintheDSM,foradiagnosisofPTSD).

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Theideathatwholecommunitiescanberegardedassufferingtraumaanditsimpactsisalsodevelopedby
writerssuch as Erikson (1995), who usethenotionof‘communitytrauma’ to highlight the wayinwhich
traumasexperiencedbyentirecommunities(e.g.inthewakeofsignicantdisasters)canhaveimpactsthat
are wider than the individual:
 Sometimesthetissuesofcommunitycanbedamagedinmuchthesamewayasthetissuesofmind
andbody,asIshallsuggestshortly,butevenwhenthatdoesnothappen,traumaticwoundsinicted
onindividualscancombinetocreateamood,anethos–agroupculture,almost–thatisdifferent
from (and more than) the sum of the private wounds that make it up. Trauma, that is, has a social
dimension.
 Erikson(1995)
Whatshouldalreadybeclearfromsuchaccountsistheextenttowhichtheydeviatefromwhatislaiddown
intheDSMconcerningthewayinwhichtraumashouldbeunderstood,andthewayinwhichconditionssuch
asPTSDshouldbediagnosedandtreated.
Ifthereisaconsensusamongthewritersreferredtoaboveitisthat‘mainstream’approachestotraumatend
tode-contextualisethephenomenonand,inparticular,tostripitofitsessentiallysocialandpoliticaldimensions.
Writersassociatedwiththe‘anti-psychiatry’movement(e.g.DavidCooper,1967)havemadesuchobjections
evenmoreexplicit,andhavealsobeenoutspokenaboutwhattheyregardastheshortcomingsofmainstream
accountsoftrauma.ThomasSzaszfamouslyarguedagainstthecoerciveaspectsoftraditionalpsychiatry
anddeniedthattheDSMprovidedanyobjectiveandreliablewayofidentifyingmentaldisorder;infact,he
suggestedthatmentalillnessitselfwasamythandthattheDSMshouldbeseenaspartofawidereffortto
medicalisewhathecalled“problemsinliving”.
Other critics of mainstream psychiatry have also noted that, historically, some efforts to medicalise human
experience appear decidedly oppressive and atheoretical in retrospect. Gary Greenberg (2013), in his
critiqueoftheDSM(whichhereferstoas‘TheBookofWoe’)describesinsomedetailamedicalcondition
calleddrapetomania.‘Discovered’byaphysiciannamedSamuelCartwrightin1850,drapetomaniawasa
disorder that “caused Negroes [slaves] to run away”. Cartwright’s account of this new disease came
completewithanaetiology,symptomatologyandrecommendedtreatments.
Greenbergnotesthatsuchanexampleisperhapsan‘easytarget’forthosewhowishtocriticisemainstream
medicineorpsychiatry,butotherwritersalsopointoutthathomosexualitywasitselfregardedasamental
disorderevenintheDSMasrecentlyas1973(KutchinsandKirk,1997).Thefactthathomosexualityisnow
notregardedasadisordersuggests,attheveryleast,thattherangeofphenomenawhichtheDSMseeks
tonameandunderstandscienticallyisbothhistoricallyvariableandhighlypoliticised.
Feministwritershavealsobeenattheforefrontofcriticalresponsesbothtomainstreampsychiatryandthe
DSM.It waswriterssuch asJudithHerman whoexertedpressure ontheAPAtomakechangesto earlier
versionsoftheDSMand,inparticular,tomakechangeswhichwouldallowittoberecognisedthatwomen
whoexperiencedomesticorsexualviolence candeveloppreciselythe kindsoftrauma-relatedsymptoms
relatedtoadiagnosisofPTSD.
Other feminist theorists have continued in their criticisms of the DSM, with some arguing that radical
approachestotraumaanditstreatment–outsideoftraditionalpsychiatricframeworksaltogether–need
tobedeveloped.BonnieBurstowhasarguedthatthePTSDdiagnosiswithintheDSMisessentiallybeyond
redemptionandthat, forexample,theaccountofPTSDisinadequate“…asadiagnosis,asaframework,
andasanaccount.Itiscontradictory,impractical,presumptuous,pathologizing,arbitrary,evasive,confused,
insensitive,andreductionistic”Burstow(2005:442).

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LikeSzasz,BurstowarguesthatthewayinwhichtheDSMapproachestraumaanditsimpactsisinsensitive
“to the complexities of human existence”because it seeks to medicalise “problems in living” (Burstow,
2005:444).Shehighlightswhatsheseesasafundamentaltensionbetweentherealityoftraumaandthe
motivationtoprovideaconsistentdiagnosisforitasamedicalcondition:
 ThemoresensitivePTSDistothecomplexandvariegatedrealitiesoftraumaandsotheless
distastefulitistoprogressivepractitioners,thelessdefensibleitisasamedicaldiagnosis,andthus
thelesslikelyitistocontinuetobeofuseforlegalandforinsurancepurposes;thatis,themoreroom
allowedfordifferencesinexperiences,includingexperiencessuchasinsidioustraumatisation,the
greaterthevarietyofexperiencesthatqualify.Thegreaterthevarietyofexperiencesthatqualify,the
morereadilypeoplewithalmostnoallegedsymptomsincommoncouldbegiventhediagnosis.And
themorereadilypeoplewithalmostnoallegedsymptomsincommoncanbegiventhediagnosis,the
lesslikelythediagnosiswillbeacceptedinlawsuitsorbyinsurancerms.Inaddition,themore
inclusivethedenitionisandsothemoresensitiveitistothedifferentwaysinwhichhumanbeings
are‘wounded’,thegreaterthenumberofpeoplewhowillbesolabelled;andthegreaterthenumber
ofpeoplesolabelled,thegreaterthenumberinvalidatedandplacedinjeopardyoffurtherpsychiatric
intrusion. I see no way around these conundrums.
 Burstow(2005:444)
In short, critical theorists argue that ‘trauma’ needs to be extricated from the medical and psychiatric
mainstreamwhich hasclaimedthe notionforscience, andplaceit backrmlyon aterrainof powerand
victimisation.
Suchviewsarealsolinkedtocriticismof‘decitmodels’oftraumaanditsimpacts(Burstow,2003)within
whichindividuals’attemptstocopewithtraumaaredescribedas‘dysfunctional’.Hyperarousal,forexample,
isdeemedtobedysfunctionalbecauseithighlightsamismatchbetweenindividualresponsetotheworld
andtheactualoflevelofdangerthatispresentforthetraumatisedindividual.Burstowarguesinsteadthat
some of the symptoms of PTSD are effective survival mechanisms which, in fact, involve perceptions of the
worldanditsdangersthataremoreveridicalthanmainstreamaccountsseemtosuggest(i.e.theexperiences
ofthetraumasufferermayinfacthavegiventheman accurateperceptionthattheworldisadangerous
place–inwhichcasetheirdefensivestrategiesareaptratherthandysfunctional).Wewillexpanduponthis
issue in section 4.
2.3 The link with brain injury
Indiscussingkeyapproachestounderstandinganddeningtrauma,itisalsoimportanttohighlightrecent
developments in relation to the study of brain injury.
This is important because there are clear overlaps between the impacts of brain injury and those of traumatic
experiencemoregenerallyandtherearealsooverlapsintermsofindividualexperienceofeach(andthe
circumstancesinwhichthoseexperiencestakeshape).
Anacquiredbraininjury(ABI)isbraindamagecausedatanypointafterbirth.Itmayoccurformanyreasons
butmostcommonlyitisaresultoftrauma,infectionorstroke.TraumaticBrainInjury(TBI)isalsoinjurythat
iscausedatsomepointafterbirth,butiscausedbyanexternalforceofsomekind,suchasbeinginaroad
accident,sustaininggunshotinjuriestothehead,beingphysicallyassaulted,strikingtheheadinafallorin
asportsaccident,andsoon(Williams,2012).
AgeisakeyriskfactorforTBI,withtheveryyoungbeingmostatrisk,particularlyfromfalls.Adolescentsand
youngeradultsarethenthemostatriskgroupforTBIresultingfromroadaccidentsandassaults(Williams
et al., 2010). Males and females are at equal risk in childhoodbutinteenageyearsandthroughoutmostof

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adultlifemalesareatmuchhigherriskthanfemales.Otherfactorsassociatedwithincreasedriskinclude
beingfromadeprivedsocio-economicgroup;geographicallocation,withurbandwellingyouthbeingmore
atrisk (Yatesetal.,2006);anduseofalcohol and/orotherdrugs,particularlyinadolescenceandyoung
adulthood (Kolakowsky-Hayner, 2001).
Braininjuryoftenoccursinasocio-economicandfamilycontextthatisalsosometimeslinkedtoparticular
kindsoftraumaticexperienceinchildhoodandadolescence(suchasviolence,physicalorsexualabuse,or
neglect;Williamsetal.,2010),andsuchinjurycanalsohaveimpactsthataresimilarto(andoverlapwith)
thosegeneratedbytraumaticexperiencethatdoesnotinvolveimmediatebraininjury.Wereturntosomeof
these issues in section 3.2.
Theimportantadvancesinthepastfewyearsinourunderstandingofbrainsystems,theirdevelopmentand
whatmayhappenafterinjury,asnotedbyWilliamsetal.(2010),willbeconsideredinsection4.
2.4 Summary
Traumaiscurrentlyunderstoodasaphenomenonwhichrequiresforitsexistenceaparticularcategoryof
eventwhichhasgenerated aparticularcategoryof humanreaction.Itisaphenomenonwhich hasbeen
formallyidentied–though in earlier times differentlynamed –since at least the mid-1880s. Hysteria,
neurosis,shell shock and combat stress haveallheldakey place in theevolvingconceptualisation and
denitionbycliniciansandresearchers.Morerecently,thenotionsoftraumaasalegacyofcolonialismand
intergenerationaltransmissionhavebeguntoreceivecriticalattention.
Overthelasthalf-century,inthewakeofhighly-publicisednaturaldisastersandterroristattacks,andwith
increasedmediaattentiontophenomenasuchaschildabuseandneglect,domesticviolence,bullyingand
racismandtheireffectsuponindividuals,PTSDhascometobearecognisedterminbothpsychiatricand
widerclinicalandpopulardiscourse.TheofcialcriteriaforitsdiagnosisrstappearedintheDSMofthe
AmericanPsychiatricAssociation(1980)underthecategoryof‘AnxietyDisorder’.Thosecriteriahavebeen
widenedafterseveraliterationsofthatManual,andPTSDnowappearsunderthecategoryofTrauma-and
Stressor-RelatedDisorder.TestsdirectlyrelatedtotheManualcriteriahavealsobeendevelopedduringthat
period,andcanbeemployedasassessmenttoolsbyanyrecognisedprofessionalintheeld.
The notion of ‘complex trauma’ (Herman, 1997) refers to multiple traumatic effects that begin in early
childhood, continue sometimes via a chain reaction into early adulthood, and potentially across the lifespan,
withaparticularlypoorprognosisforthosewhoenterthecriminaljusticesystem.Thenomenclatureremains
contentiousand mayyet cometobeclassiedunderthe umbrellaofdissociative disorder.Althoughofa
differentorder,traumaticbraininjuryhasalsobecomerecognisedasafactorinthelifehistoriesofyoung
offenders. In these cases and in all the situations referred to above, it is crucial that professionals are
equippedwiththeknowledgeandskillstoaskthequestionsthatwouldleadtotheuncoveringofinformation
about trauma so that accurate assessment and tailored interventions or support may follow.
Finally,wehavenotedinthissectionthatdebatesconcerninghowtraumashouldbedenedandunderstood
arebothcontinuingandheated,withsomearguingthatmainstreamdenitionsignorecontextualfactorswhich
giverisetotraumaandevensustainit,andothersarguingagainstthemedicalisationoftraumaandthe‘decit
models’usedbythepsychiatricprofessioninparticular.Wereturntosomeofthelatterissuesinsection4.

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3. HOW COMMON IS TRAUMA?
Asnotedinearliersections,althoughdenitionsoftraumadovaryintheliteraturecanvassedbythe
researchteam,allofthemeffectivelydescribeitasconstitutingindividualshort-orlong-termreactionsto
particularkindsofadverseeventsorexperiences.
Thissectionwillthereforefocusontheprevalenceofkeytypesofadverseexperiencesandpresentndings
about the prevalence of particular sets of symptoms and/or trauma-related conditions. Materialwill be
examinedfromwithinthegeneralpopulation,andwithinthementalhealthandoffendingpopulations,with
particularfocusonprevalenceintheyoungoffendergroup.
3.1 Traumatic experience in the general population
Evidencefromadultandchild/youngpeoplesurveysabouttheprevalenceoftraumaticexperiences–such
as those listed in section 2.1–iswide-ranging,especiallyinrelationtochildabuseandviolencewithinthe
family.WhilemuchoftheevidenceisfromstudiesconductedinNorthAmericathereisalsoagrowingbody
of UK material and, when taken together, that evidence suggests that traumatic experiences are very
commonacrossallpopulationgroups.
IntheUnitedStates,surveysofthegeneralpopulationsuggestthatatleasthalfofalladultshaveexperienced
at least one major traumatic stressor (Elliott, 1997; Kessler et al., 1995). However, it is important to
remember that while such stressors are common, their ability to produce signicant psychological
disturbancevariesaccordingtoawidevarietyofothervariables(BriereandScott,2013).
Studies suggest that childhood sexual and physical abuse are both quite prevalent in North American
society,withestimatesrangingfrom25–35%ofwomenand10–20%ofmenhavingbeensexuallyabused
aschildren,and10–20%ofmenandwomenreportingexperiencesconsistentwithdenitionsofphysical
abuse(BriereandElliott,2003;Finkelhoretal.,1990).Theevidencealsosuggeststhatmanychildrenare
psychologicallyabusedand/orneglected,although theseformsofmaltreatmentarehardertoquantifyin
termsofincidenceorprevalence(EricksonandEgeland,2011;Hartetal.,2011).
Much higher prevalence rateshave been suggested in studies that also include experiences of indirect
victimisation–whereindividualshavewitnessedseriousviolence,forexample.TheUSA’sNationalSurvey
ofChildren’sExposure toViolence (NatSCEV) gathered feedback about their experience of violence and
maltreatmentviadirectinterviewswith4,549childrenandadolescentsaged17andyounger(Finkelhoret
al.,2009a,2009b).Thesurveycoveredarangeoftypesofviolencewithinthefamily,inschool,andinthe
community,andcaptureddetailsconcerningbothdirectexperiences(i.e.wheretherespondentwasdirectly
victimised) and cases where respondents witnessed violent events (primarily in the family or the community).
PercentagesuncoveredbyNatSCEVrelatingtokeyformsofviolencearesummarisedbelow,inFigure1.

Trauma and young offenders – a review of the research and practice literature | 20
Figure 1– National Survey of Children’s Exposure to Violence: exposure to selected categories of violence
in the past year3, for all children surveyed (% by type of violence)
More than one-third (38.7%) of the children surveyed reported more than one direct experience of
victimisationwithinthepreviousyear,andnearlytwo-thirds(64.5%)ofthosereportedmorethanone.High
levelsofexposuretoviolencewererevealed:10.9%reportedveormoredirectexposurestoviolenceinthe
pastyear,and1.4%reported10ormoredirectvictimisations.4
In the UK, a study conducted in 2000 by the National Society for the Prevention of Cruelty to Children
(NSPCC)focusedontheprevalenceofarangeofformsofchildmaltreatmentandbullying,usingarandom
probabilitysampleof2,869youngpeopleagedfrom18-24years.Intermsofparentalphysicalviolencethe
study found that 7% of the sample were seriously abused by parents or carers, 14% had experienced
‘intermediateabuse’and3%reected‘causeforconcern’(Cawsonetal.,2000).
AfurtherstudywasconductedbytheNSPCC in2009(Radford,etal.,2011).Itusedacomputer-assisted
self-interviewing(CASI)approach,withalarge,three-bandedsample:2,160parentsorguardiansofchildren
andyoungpeopleunder11yearsofage,2,275youngpeoplebetweentheagesof11and17(withadditional
informationprovidedbytheirparentsorguardians)and1,761youngadultsbetweentheagesof18and24.
Theresearchfoundsignicantlevelsofreportedchildmaltreatment–4%ofyoungadultsaged18–24years
reportedchildhoodexperiencesofbeingbeaten up or hit overandoveragain and 5% reportedcoerced
sexualactsunder the age of 16.Moregenerally,the researchalsofoundthat a substantial minority of
children and young people reported having been severely maltreated. Percentages by age band are
summarised below:
• 6%ofchildrenagedunder11yearshadexperiencedseveremaltreatment
• 19%ofyoungpeopleaged11-17yearshadexperiencedseveremaltreatment
• 25%ofyoungadultsaged18-24hadexperiencedseveremaltreatmentinchildhood
Thestudy also examinedtheco-occurrence of maltreatmentandfoundthat children and young people who
weremaltreatedbyaparent/guardianweremorelikelytosufferotherformsofabusefromotherperpetrators.
Inparticular,thoseaged11–17yearswhohadexperiencedseveremaltreatmentbyaparentorguardian
were three times more likely to witness family violence than those who were not severely maltreated.
Figure2providesadetailedbreakdownoftheprevalenceofdifferenttypesofabuseamongthedifferentage
rangesandgendersunderstudy.
3 The survey was conducted between January and May, 2008.
4Victimisationsthatcouldbecountedinmorethanonecategory,suchasphysicalabusebyaparentor caregiverthatcouldalsobe
consideredanassault,werenotincludedinthecountingofmultiplevictimisations.
Anyexposure
Assault with no weapon or
Assaultwithweaponand/or
Sexualvictimisation
Childmaltreatment
Datingviolence
Witnessingfamilyassault
Witnessingcommunityassault
010% 20% 30% 40% 50% 60% 70%
60.6%
36.7%
14.9%
6.1%
10.2%
1.4%
9.8%
19.2%

Trauma and young offenders – a review of the research and practice literature | 21
Figure 2 – NSPCC child abuse and neglect study: breakdown of prevalence by age and gender*
*FiguresarebasedonndingspresentedinRadfordetal.,2011
Againstavastbackgroundofliteratureonadversechildhoodandadolescentexperience,thereferencesto
particular studies in this section have been necessarily selective. However, they resonate clearly with a very
widerangeofotherresearchbothwithinandoutsidetheUK.Althoughtheestimatedprevalenceofparticular
formsofabuseandmaltreatmentvarieswidely,whentakentogethertheydosuggestthattraumaticevents
ofthiskindareverycommoninthegeneralpopulation.
Theavailableresearchalsosuggests,however,thateventsofthiskindareevenmorecommonandpervasive
in the backgrounds of offending groups than in the general population, and some of the relevant data
concerningthisisoutlinedinthefollowingsections.
3.2 The extent of trauma among the young offender population
Intermsofchildrenandyoungpeoplewhocomeintocontactwiththecriminaljusticesystem,evidencefrom
successive studies clearly suggests that they tend to come from the most disadvantaged families and
communities,with high levelsof exposuretosocialandeconomicdeprivation, neglectandabuse. Young
offenders–bothincustodyandcommunity–areaparticularlyvulnerablegroup,frequentlywithahistory
ofneglect, childprotectionintervention,social careplacements,familybreakdownandschoolexclusions
(Harringtonetal.,2005;Jacobsonetal.,2010).Ofcialestimatessuggestthataquarterofboysandtwoin
vegirls incustodyreportsufferingviolenceathome(YouthJustice Board2007)andthat27%ofyoung
menand45%ofyoungwomendisclosehavingspentsometimeincare(HMInspectorateofPrisons2011;
Caplan,1961).
A detailed study examining the backgrounds and psychiatric morbidity of youngof fendersin custody in
Englandand Waleswas commissionedbythe Department ofHealth(Lader etal.,2000). Itskeyndings
includedthefollowing:
• 29%ofthemalesentencedgroup,35%ofthewomenand42%ofthemaleremandgrouphadbeen
taken into local authority care as a child.
• Approximatelytwo-fthsofthewomenandaquarterofthemeninterviewedreportedhavingsuffered
from violence at home.
• Approximatelyone-thirdofthewomenreportedhavingsufferedsexualabusecomparedwithjustfewer
than one in 20 of the men.
0%
5%
10%
15%
20%
25%
30%
35%
Male
Severe physical
Female
Under 11s 11 - 17s 18 - 24s
Male Female Male Female
1% 0% 1% 1%
5% 6% 5% 6% 7% 7% 7%
5%
14% 13% 12% 13%
31%
18% 18%
10%
19% 20%
18%
3%
Contact sexual abuse
Severe maltreatment by a parent or guardian
All severe maltreatment

Trauma and young offenders – a review of the research and practice literature | 22
• 29%ofwomen,13%ofmaleremandand11%ofmalesentencedrespondentsreportedhaving
receivedhelpformentaloremotionalproblemsintheyearbeforecomingtoprison.5
• Aroundonein10malerespondentsandoneinsixfemaleyoungoffendershadbeenofferedhelpfor
mental,nervousoremotionalproblemswhichtheyhadturneddownintheyearbeforecomingto
prisonandasimilarproportionhadturneddownsomeformofhelpsincecomingtoprison(orinthe
past year).
StuartandBaines(2004),intheirresearchfortheJosephRowntreeFoundation,reportedthatamongtheir
sampleof100girlsacrossveestablishmentsand2,500boysacross14maleestablishments:
• 40–49%hadahistoryoflocalauthoritycare
• 40%ofgirlsand25%ofboyssufferedviolenceathome
• 33%ofgirlsand5%ofboysreportedsexualabuse
• 50%ofgirlsand66%ofboysreportedhazardousdrinking
• 85%(acrossbothboysandgirls)showedsignsofpersonalitydisorder
• 66%ofgirlsand40%ofboysreported
anxiety/depr
ession
However,thegures maybe evenhigherthantheseself-reportstudiessuggest. Areviewoftheliterature
conducted by Day et al. (2008) estimatedthatanythingbetween33%and92%ofchildrenincustodyhave
experiencedsomeformofmaltreatment.Thisvariationintheguresmaybeexplainedbytheuseofdiffering
denitionsofmaltreatmentinthevariousstudiesandtherelianceonself-reportinginsomeofthestudies.
Researchonchildrenwhohadcommittedmoreseriousoffencessuggestthattheremaybesomecorrelation
betweenseriousoffendingandseriousandongoingabuse,andthattheprevalenceofabuseishigherin
thosewhocommitmoreseriousoffences(Boswell,1996,1997;Widom,1998,2000).
Jacobsonandcolleagues(2010)undertookacensusofnearly6,000childrenimprisonedinthesecondhalf
of2008.Theirresearchhighlightedthatwithintheirsub-sampleof200children,therewereconcernsabout
vulnerabilityincustodyforalmosthalfofthem.Only6%ofthesamplehadnopreviousconvictions.Almost
halfofthechildrenwithpreviousconvictionshadtheirrstconvictionattheageof13oryounger.Interms
oftheprevalenceofhomeandfamilydisadvantagesandpsycho-socialandeducationproblems(amongthe
sub-sampleof200),thefollowingfactorswerefound:
• 76%ofchildrenhadanabsentfather(i.e.haslivedapartfromfatherforsignicantperiodof
childhood,notsolelythroughbereavement)
• 54%ofchildrenwereinvolvedintruancyorothernon-attendanceofeducation(currentlyorpreviously,
due to refusal to attend, lack of provision or other reason)
• 48%hadexperiencedschoolexclusion(currentlyorpreviously,xed-termand/orpermanent)
• 47%hadeverrunawayorabsconded
• 39%hadeverbeenonthechildprotectionregisterand/orhadexperiencedabuseorneglect
• 38%hadaparentand/orsibling(s)involvedincriminalactivity
• 33%hadanabsentmother(i.e.haslivedapartfrommotherforsignicantperiodofchildhood,not
solelythroughbereavement)
• 31%wereinvolvedinsubstanceusethatplacedthematparticularrisk(e.g.injecting,sharing
equipment,poly-druguse)and/orhasadetrimentaleffectoneducation,relationships,daily
functioning,etc.
5Questions about helpreceivedfor mental,ner vousor emotional problemsin the yearbefore comingtoprison this timewere only
addressedtothosewhohadbeeninprisonforlessthantwoyears–itwasfeltthatthosewhohadbeeninlongerwouldnotbeableto
recall the information accurately.

Trauma and young offenders – a review of the research and practice literature | 23
• 28%hadwitnesseddomesticviolence
• 27%hadeverbeenaccommodatedinlocalauthoritycare(throughvoluntaryagreementbyparents
and/orcareorder)
• 26%haddifcultieswithliteracyand/ornumeracy
• 20%hadself-harmed
• 17%hadaformaldiagnosisofemotionalormentalhealthcondition
• 13%hadexperiencedbereavement,ofaparentand/orsibling(s)
• 11%hadattemptedsuicide
Theauthorssummarisedtheimplicationsoftheirndingsforcriminaljusticepolicyasfollows:
 Thehighlevelofcorrelationbetweenoffendingbehaviourbychildrenandmultipledisadvantage
suggeststhatthepreventionofoffendingdepends,atleastinpart,oneffectiveactiontotacklethese
children’sdeep-rootedandcomplexneeds.Inotherwords,ajusticesystemthatputsmoreemphasis
onaddressingwelfareandlessemphasisonpunitiveresponsesislikelytoachievebetterresultsin
termsofreducingoffendingandreoffending.
(Jacobson et al., 2010)
Aquarterofboysand twoinve girlsincustody havereportedsufferingviolenceat home (YouthJustice
Board,2007)and27%ofyoungmenand45%ofyoungwomenhavesaidthattheyhavespentsometime
in care (HM Inspectorate of Prisons, 2011).
Theexperienceoftraumaticabuseand/orsignicantlosshasbeenidentiedasasignicantfactorinthe
livesofthemajorityofyoungviolentoffenderssentencedtocustody.6Boswell’s1996examinationof200
les(onethird ofthepopulation)for violentyoungoffenderssubject towhathasnowbecome aSection
90/91sentencerevealedthat:7
• 72%hadexperiencedabuse;thiswasbrokendownintoemotionalabuse28.5%,sexualabuse29%,
organised/ritualabuse1.5%,combinationsofabuse27%
• 57%hadexperiencedsignicantlossviabereavementorcessationofcontact,usuallywithaparent
• 91%ofSection90/91offendershadexperiencedabuseand/orloss(only18outofthe200cases
studied had no reported evidence of either phenomena)
• 35%hadexperiencedbothabuseandloss,suggestingthattheexistenceofadoublechildhood
traumamaybeapotentfactorinthelivesofviolentyoungoffenders
Amongtheindividualsfocusedontheabovestudy,only18(9%)hadnoreportedevidenceofeitherabuse
or loss.
Whiletheremaybeexperiencesof abuse andlosswhichtook placewhentheyoung offenders weretoo
young to be able torecall them, the researchers emphasise that child abuse and loss are not the only
potentialcauses of violent offending,nor does every abused child becomes an offender.Yetunresolved
trauma is likely to manifest itself in some way at a later date. Many children become depressed, disturbed,
6Youngpeoplefromdeprivedbackgroundsaremorelikelytobe caredforbytheirgrandparentswhich placesthemat greaterriskof
losingtheirprimarycaregiverduringtheirchildhood.
7Section90/91sentences,underthePowersofCriminalCourts(Sentencing)Act2000,canonlybegivenataCrownCourt.Section90
ispassedonamurderconviction.Section91isusedforyoungpeoplewhohavecommittedcrimessoseriousthatifanadultcommitted
themtheywouldgotoprisonformorethan14years.

Trauma and young offenders – a review of the research and practice literature | 24
violentorall three, with girls tending to internalise and boys toexternalisetheirresponses(Alisicetal.,
2014). Theresearchersconcludethattheseexperiencesaresufcientlyprevalenttowarranttheintroduction
ofsystematicassessmentforviolentyoungoffenders–amessagealsoechoedbySmithandMcVie(2003)
andLöselandBender(2006).
Inanattempttoelicitthevoicesoftheyoungpeoplewhosebehaviourandbackgroundsgivecause for
concern,the‘MyStory’project(Grimshawetal.,2011)encouragedyoungpeoplewhohadbeenconvicted
ofgravecrimesas children to recount theirlifestories,therebyshedding light on the relationshipsand
events that had shaped their lives. In asking participants to describe their life experiences,the project
sought to help them form a coherent narrative about their lives, uncovering traumatic histories which
included interruption of care, abuse and domestic violence – all of which seriously affected the participants’
childhoodattachmentrelationships.Thereport highlightedanumberofthemes derivedfromthestories,
including:
• The inaccessible parent
• Parental jealousy
• Impulsivecourtingofdanger
• Therootsofsexualassault
• Bereavement
• Normalisationofcontinuousandintrusivetrauma
• Multigenerationalabuse
• Failuresofintervention
Theserst-handstoriesbothconrmanddevelopmuchthattheresearch,citedinthisandprecedingsub-
sections,hasshownaboutthe lifeexperiencesof troubledyoungpeople.Theauthorsstresstheneedfor
positive,nurturingsupporttohelpthemforgemorepositivelivesandmaximisetheirpotentialtodesistfrom
offendinginthefuture:
 Itisimportanttoavoidtheimpressionthatyoungpeoplesubjectedtoviolentandabusivechildhoods
are ‘puppets’ who have been simply propelled into despair and violence. Their emotional needs do not
meanthattheycannotmakechoicesoracknowledgewrongdoing;theurgencyofthoseneedscan
sometimesbemanagedbytheapplicationofotherinnerpsychologicalresourcesthatenablethe
individualtosurvive.Agrimbackdropofemotionalneed,however,isinescapable,unlessitis
addressedbypositivenurturing.
(Grimshaw et al., 2011: 8)
Thendingsreportedwithinthestudiesdiscussedinthissubsectionindicateahighprevalenceoftraumatic
eventsandexperiencesinyoungoffenders’lifehistories,withsomeevidencetosupportthesuggestionthat
exposure to multiple types of mistreatment maybe linked with of fenceseverity (Smith and Thornberry,
1995).Nevertheless,directrepresentationfromsomeoftheyoungoffendersthemselvesremindsusthat
choiceandchangearenotimpossibleforthem,especiallyifprotectiveorresiliencefactorsarepresentin
their lives or provided by professional intervention. Such intervention can stem the development of traumatic
stress,asfurtherdiscussedinSection4.Thefollowingsubsectionsdiscussthesymptomswhichmayensue
fromtraumaexperiences.
3.3 Trauma and mental health conditions
As noted in Section 1, there is a vast literature on the subject of mental health, and trauma is a phenomenon
which may constitute both cause and effect of adverse mental health conditions. Specic connections

Trauma and young offenders – a review of the research and practice literature | 25
betweentraumaticexperiencesinchildhoodandanincreasedlikelihoodofsubsequentmentalillnessare
verywelldocumented(e.g.,Watts-Englishetal.,2006),althoughcauseitselfisdifculttoisolateoutsideof
randomcontroltrials,whicharerarelyconductedinthiseld.
The ensuing subsections focus largely on trauma in the backgrounds of different types of incarcerated
populationswherementalhealth problems haveemergedasprevalent,incorporating studies containing
comparisonswithprevalenceinthegeneralpopulation.
3.3.1 Trauma and mental health in adult prisoners compared with the general
population
Overtime,andatallstagesoftheCriminalJusticeprocess(policecustody,courtsandprobation)research
hasindicatedhigherratesofmentalillnessamongthosewhohavecontactwiththesystemthanamongthe
generalpopulation(Gudjonssonetal.,1993;MairandMay,1997;Shawetal.,1999).Figure3illustrates
the prevalence of a range of mental health and related dimensions within adult prison populations as
comparedwiththegeneralpopulation.
Figure 3 – Mental illness among adult prisoners and the general population
BasedondatafromSingletonetal.(1998)andSingletonetal.(2001)
Theabovedata revealsverymuchhighermentalillness levelsamongadultprisonersthaninthegeneral
population;these kindsofstatistics arecommonlyfoundinthe literatureonprisoners ofbothsexesand
across the age span. Further examplesare provided by the Prison Reform Trust and the Mental Health
Foundationbelow:
• 10%ofmenand30%ofwomenhavehadapreviouspsychiatricadmissionbeforetheyenteredprison.
Arecentstudyfoundthat25%ofwomenand15%ofmeninprisonreportedsymptomsindicativeof
psychosis.Therateamongthegeneralpublicisapproximately4%.
• 26%ofwomenand16%ofmensaidtheyhadreceivedtreatmentforamentalhealthprobleminthe
yearbeforeenteringcustody.
• Personalitydisordersareparticularlyprevalentamongpeopleinprison.62%ofmaleand57%of
female sentenced prisoners have a personality disorder.
• 49%ofwomenand23%ofmaleprisonersinaMinistryofJusticestudy(Lightetal.,2013)were
assessedassufferingfromanxietyanddepression.16%ofthegeneralUKpopulation(12%ofmen
and19%ofwomen)areestimatedtobesufferingfromdifferenttypesofanxietyanddepression.
0%
10%
20%
30%
40%
50%
60%
70%
80%
Neurotic disorder
(eg. depression)
Alcohol
dependency
Personality
disorder
Drug
dependency
Delusional disorder
(eg. schizophrenia)
General Population
13.8% 11.5%
5.3% 5.2% 8.0%
0.5%
66.0%
45.0%
30.0%
45.0%
Prisoners

Trauma and young offenders – a review of the research and practice literature | 26
• 46%ofwomenprisonersreportedhavingattemptedsuicideatsomepointintheirlives.Thisismore
thantwicetherateofmaleprisoners(21%)andhigherthaninthegeneralUKpopulation,amongst
whomroughly6%reporthavingeverattemptedsuicide.
PrisonReformTrust(2015)
TheMentalHealthFoundation(2015)alsosummariseskeystatisticsfromavarietyofsources:
• Morethan70%oftheprisonpopulationhastwoormorementalhealthdisorders;inparticular,male
prisonersare14timesmorelikelytohavetwoormorementalhealthdisordersthanmeningeneral,
andfemaleprisonersare35timesmorelikelythanwomeningeneral(SocialExclusionUnit,2004,
quotingPsychiatricMorbidityAmongPrisonersinEnglandandWales,1998).SeealsoRamsay,2003.
• Thesuiciderateinprisonsisapproximately15timeshigherthaninthegeneralpopulation.(In2002
theratewas143per100,000comparedtonineper100,000inthegeneralpopulation.Seefurther:
TheNationalServiceFrameworkforMentalHealth:FiveYearsOn,DepartmentofHealth,2004;
SamaritansInformationResourcePack,2004).
AsSingleton’sand the PrisonReformTrust’sgures indicate, PersonalityDisorderis extremely prevalent
within adult prison populations and has remained consistently so over time. For example, the survey
conductedbyGunnetal.,(1991)witha5%sampleofmenservingprisonsentencesacrossEnglandand
Walesfoundthat652(37%)hadapsychiatricdiagnosis.8Withinthis,atotalof177participants(10%)were
diagnosedwith apersonalitydisorder,a21(1%)diagnosed withschizophreniaand15(1%)withorganic
disorders. The only disorder more prevalent than personality disorder was substance misuse in 407
participants(23%).AsinthecaseofPTSD,personalitydisorderisusuallydiagnosedfollowingcriteriasetby
theDiagnosticandStatisticalManual(DSM)oftheAmericanPsychiatricAssociation,orbytheWorldHealth
Organisation’sICD-10ClassicationofMentalandBehaviouralDisorders(seesection2.2.4).TheDSM-IV-
TRdenition(unchangedinDSM-5)willserveforthissection’sdiscussion:
 Anenduringpatternofinnerexperienceandbehaviourthatdeviatesmarkedlyfromtheexpectationsof
the individual’s culture. (American Psychiatric Association, 2000)
Morerecently,Fazeland Danesh(2002)conductedasystematicreviewof62studies from12countries
publishedbetweenJanuary1996andJanuary2001,investigatingtheprevalenceofpersonalitydisorders
in prison populations. The total number of participants across the 62 studies comprised 22,790. Of these,
18,530 (81%) were men and 4,260 (19%) women. They reported that Anti-Social Personality Disorder
(ASPD) was most prevalent. Other notable forms include Paranoid Personality Disorder and Borderline
PersonalityDisorder,thelatterhavinghighco-morbiditywithASPD(Moran,2002).Ofthestudiesspecically
reportingit,5,113(47%)of10,797menand631(21%)of3,047womenhadASPD.
Ofoffendersdetainedinhighsecurityhospitals,researchhasshownthatthosewithapersonalitydisorder
aremorelikelytoreoffendafterdischargecomparedwithmentallyilloffenders(JamiesonandTaylor,2004).
Theauthors conducteda 12yearfollow-upofa cohort of204patients dischargedfromUKhighsecurity
hospitalsin 1984.Theyfoundthat 38%werereconvicted,26% forserious offences.Dischargedpatients
with a personality disorder were seven times more likely to commit a serious offence than mentally ill
offenders.
8Participantswereselectedfrom16 adultmale prisonsandnine youngoffender institutions,representative ofprison type,security
levelsandsentencelengthnationally.Allparticipantscompletedsemi-structuredinterviewstoassesstheirpresentmentalstate.Prison
leswereexaminedtoobtain demographic,clinical andbehaviouralinformation.Thesample comprised1,769participants, ofwhich
1,365(77%)wereadultmenand404(23%)youngadultmen(17-21years).

Trauma and young offenders – a review of the research and practice literature | 27
Youngpeople under the age of 18 years cannot be diagnosed with a personality disorder though their
behaviourandsymptomsmayleadtodiagnosisinadulthood.Asthenextsectiononwider mentalhealth
conditionsamongyoungpeopleshows,however,itsingredientsmaylieinearlierlifeeventsand/orpreviously
diagnoseddisorders.
3.3.2 Trauma and mental health in young offenders compared with the general
population
Inits2004study,theOfceofNationalStatisticsestimatedthatonein10childrenandyoungpeopleaged
5–16hadaclinicallydiagnosedmentaldisorder(ONS,2004).Thisisbrokendownasfollows:
• 4%hadanemotionaldisorder(anxietyordepression)
• 6%hadaconductdisorder
• 2%hadahyperkineticdisorder
• 1%hadalesscommondisorder9
Thestudyalsofoundthat2%ofchildrenhadmorethanonetypeofdisorderandthatboysweremorelikely
tohavea mental disorder than girls. Among 5–10yearolds,10%of boys and 5% of girls had a mental
disorder.Intheolderagegroup(11–16yearolds),the proportions were 13% forboysand10% forgirls
(ONS,2013).Theexperienceofemotionalandbehaviouraldifcultieshadparticularlyseriousimplications;
amongyoungpeopleaged11–16whohadanemotionaldisorder,28%saidthattheyhadtriedtoharmor
killthemselves.Amongyoungpeopleaged11–16whohadaconductdisorder,21%saidthattheyhadtried
toharm or kill themselves(ONS,2013).The report also highlightedthat194young people aged 15–19
committedsuicidein2011(ONS,2013).
Worryingastheseguresare,ratesof mental health problems are estimated tobeatleastthreetimes
higherforyoungpeopleinthecriminaljusticesystemthanforthoseinthegeneralpopulation.Leon’s2002
reviewof the mental health needs of youngoffenderssuggeststhat13%ofgirlsand10%of boys aged
11–15yearsinthegeneralpopulationhavementalhealthproblems,whiletheprevalenceforyoungpeople
incontactwiththe criminaljusticesystemrangesfrom25%to81%,withthe highestestimatesbeingfor
youngpeopleincustody.10
AstudycommissionedbytheYouthJusticeBoard(Harringtonetal.,2005)focusingonyoungoffendersin
custodyandinthecommunityidentiedthatone-thirdofyoungoffendershadamentalhealthneed.11 This
was broken down as follows:
• Almostafth(19%)ofyoungoffendershadproblemswithdepression
• Onein10youngpeoplereportedahistoryofself-harmwithinthelastmonth
• Approximatelyonein10(11%)youngpeopleweresufferingfromanxiety
• 11%ofyoungpeopleweresufferingfromPTSD
• 7%ofyoungpeoplereportedhyperactivity
• 5%reportedpsychotic-likesymptoms
The researchers found that female offenders had more mental health support needs than males and that
youngoffendersfromethnicminoritieshadhigherratesofpost-traumaticstress.Thestudyalsofoundthat
the most common reason for unmet need was the failure to adequately assess and review the young
9Includingautism,tics,eatingdisordersandselectivemutism.
10Themostcommondisordersforbothgroupsareconductdisorders,emotionaldisordersandattentionaldisordersalthoughsubstance
misuseisalsoasubstantialproblem(Leon,2002).Thewiderangeintheseestimatesisaresultofdifferencesinthewaythatthestudies
canvassed by this author operationalised ‘mental health problems’, and the area of the criminal justice system that they focused on.
11SeealsoChitsabesanetal,2006.

Trauma and young offenders – a review of the research and practice literature | 28
people’sneeds.In8%(n=46)ofcases,Asset12hadnotbeencompletedandafurther8%oflescouldnot
be found to ascertain whether the Asset had been completed or not. Of the 600 Asset forms that were
evaluated,only15%ofyoungpeoplewithmentalhealthproblemswereidentied13 – a much lower rate than
the 31% that the research team identied through use of their needs assessment tool. The authors
concludedthatAssetwas notsufciently sensitiveinidentifyingmentalhealth needsinyoungoffenders.
They consequently recommended that an initial structured assessment of risk and mental health needs
formthebasisforplanninginterventionsforeveryyoungperson.
Youngpeopleinprison(whetherthesearejuvenileoffendersagedunder18,oryoungadultsaged18-20)
haveanevengreaterprevalenceofpoormentalhealththaneitherotheryoungoffendersoradultsinprison:
95%areestimatedtohaveatleastonementalhealthproblemand80%havemorethanone(Laderetal.,
2000;Durcan,2008).AstudyofpsychiatricmorbidityamongprisonersinEnglandandWales(Laderetal.,
2000),commissioned bytheDepartmentofHealth,found hugedivergenceintheratesofmentalhealth
difcultyforyoungpeopleincustodycomparedtothoseinthegeneralpopulation:
• 51%ofyoungmenonremandreporteddepression,asdid36%ofsentencedyoungmaleoffenders
and51%ofsentencedyoungwomen.Incontrast,6%ofyoungmenand11%ofyoungwomenfromthe
household sample reported depression.
• 42%ofsentencedyoungmaleoffendersand68%ofsentencedyoungwomenreportedexperiencinga
neuroticdisorder;14whilstratesamongthegeneralhouseholdpopulationwere7%foryoungmenand
19%foryoungwomen.
• Nearlyonein10ofthefemalesentencedyoungoffendersreportedhavingbeenadmittedtoamental
hospital.
• 20%oftheyoungoffendersinterviewedforthestudywereselectedtoparticipateinasecondstage
clinicalinterview.Amongthisgroup,84%ofmaleremandand88%ofmalesentencedyoungoffenders
wereidentiedashavingapersonalitydisorder,while10%ofmalesentencedand8%ofmaleremand
offendershadexperiencedfunctionalpsychosisinthepreviousyear.
• Highproportionsofrespondentsreportedsuicidalideation:38%ofmaleremandyoungoffendershad
thoughtofsuicideintheirlifetime;30%inthepreviousyearand10%intheweekpriortointerview.
Ratesofsuicideattemptswerealsohigh–20%ofmaleremandyoungoffenderssaidtheyhad
attemptedsuicideatsometimeintheirlife,17%intheyearbeforeinterviewand3%intheprevious
week.Womenreportedhigherratesofsuicidalthoughtsandsuicideattemptsthanthemales:athird
of the female sentenced respondents had tried to kill themselves in their lifetime – twice the
proportionofmalesentencedyoungoffenders.
• Ratesforself-harmwithouttheintentionofsuicide(parasuicide)rangedfrom7%formaleremand
youngoffendersto11%forfemalesentencedyoungoffenders.
Evidenceofhighratesofbothdiagnosedmentalillnessandbehavioursthatareoftenindicativeofemotional
distressiswide-ranging.JointworkbytheYJBandPrisonService(StuartM.andBainesC,2004)onyoung
peopleincustodysuggeststhat 85%showsignsofpersonalitydisorder,two-thirdsofgirlsandoneinve
boys report
anxiety/depr
ession, and
halfofgirlsandtwothirdsofboysreportedhazardousdrinking.
Giventhesehighratesofvulnerabilityandthestressfulexperienceofincarceration,itisnotsurprisingthat
prisonersexhibit highratesof self-harmandsuicidal ideationand/orattempts.Inparticular,youngadult
malesaresignicantlymorelikelytocommitsuicidewhileinprisonthanwhentheyareinthecommunity
(Fazel et al., 2005). In 2004 the AuditCommission highlighted that up to 300 young people in secure
12AssetisastructuredassessmenttoolusedbyYouthOffendingTeams(YOTs)inEnglandandWalesonallyoungoffenderswhocome
into contact with the criminal justice system.
13InAsset,thoseidentiedwithmentalhealthproblemsscoreathreeorfouronthementalhealthsection.
14Themostcommonneuroticsymptomsamongmalesamplegroupsweresleepproblemsandworry(notincludingworryaboutphysical
health),followedbyirritabilityanddepression.Amongwomen,fatiguewasthemostcommonsymptom.

Trauma and young offenders – a review of the research and practice literature | 29
establishments were requiring transfers to specialised mental health facilities, concluding that, ‘The
provisionofmentalhealthcareforyoungpeopleinprisonsisparticularly
poor
’(AuditCommission,2004).
Furthercommentsonlinksbetweentraumaandmentalillnessaremadeinlatersections,butitisimportant
to stress that the body of research cited in this section has demonstrated with considerable consistency
that,incomparisonwithgeneralpopulations,adversementalhealthconditionsarehighlyprevalentinboth
adultandyoungoffenderpopulations,wheretraumaticlifeeventsaresimilarlyprevalent.Sincemanyyoung
offenders become adult prisoners in their later years, this progression probably serves to explain the
prevalenceinthatadultpopulation,andisatrajectoryuponwhichgreaterknowledgeandawarenesscould
intervene in the future.
3.4 Trauma and neurodevelopmental disorder with particular reference to brain
injury
In addition to the highly disadvantaged and traumatising backgrounds described in previous sections,
mentalhealthdifculties,communicationdifculties and neurodevelopmental disorders are all far more
commonamongyoungpeopleincustodythanamongthoseinthegeneralpopulation(Hughesetal.,2012).
This includes the incidence of brain trauma, which is specically associated with involvementin violent
offencesandayoungerage of incarceration. Thefollowingtable summarises ndings from a numberof
researchstudiestocomparetheprevalenceofavarietyof neurodevelopmentaldisordersbetweenyoung
peopleingeneralandthoseincustody:
Table 1 – Neurodevelopmental disorder rates: young people in general and those in custody
Neurodevelopmental disorder Reported prevalence among young
people in the general population
Reported prevalence among
young people in custody
LearningdisabilitiesA2-4%B23-32%C
Dyslexia 10%D43-57%E
Communicationdisorders 5-7%F60-90%G
Attentiondecithyperactivedisorder 1.7-9%H12%I
Autistic spectrum disorder 0.6-1.2%J15%K
Traumatic brain injury 24-31.6%L65.1-72.1%M
Epilepsy 0.45-1%N0.7-0.8%O
Foetalalcoholsyndrome 0.1-5%P10.9-11.7%Q
(ReproducedfromHughesetal.,2012:23)
A Therearespecicconcernswithdenitioninthiscategory,asoutlinedintheHughesetal.(2012)report.
B McKayandNeal,2009;AustralianInstituteofHealthandWelfare,2003;Gerber,1984.
C Krolletal.,2002;Rayneretal.,2005.
D www.bdadyslexia.org.uk/about-us.html(BritishDyslexiaAssociation,2015).
E Rack,2005;ReidandKirk,2002;Snowlingetal.,2000.
F Bryan,2004;Tomblinetal.,2000;LarsenandMcKinley,1995.
G Bryanetal.,2007;Bryan,2004;Snowlingetal.,2000;GregoryandBryan,2011.
H SIGN,2001;NICE,2008;MerrellandTymms,2001.
I Fazeletal.,2008.
J ChakrabartiandFombonn,2001;Gillberg,1995;Bairdetal,2006.
K Anckarsater et al, 2007.
L McKinleyetal,2008;McGuireetal,1998.
M Williamsetal,2010;Daviesetal,2012.
N BellandSander,2001;MacDonaldetal,2000;GunnandFenton,1969;Fazeletal,2002.
O Fazeletal,2009;Fazeletal,2002;Rantakallioetal,1992;Kendalletal,1992.
P Mayetal,2009;MayandGossage,2001;Young,1997;AbelandSokol,1991.
Q Popovaetal,2011;MurphyandChittenden,2005;RojasandGretton,2007.

Trauma and young offenders – a review of the research and practice literature | 30
Asshowninthetableabove,communicationdisordersand braintraumaareparticularlycommonamong
youngpeopleincustody–thelatterarisingforalmosttwo-thirdsofthem,approximately16%ofwhomhave
sufferedmoderateorseverebraininjury(WilliamsH.2013).
Furtherstudiesconrmthattraumaticbraininjury(TBI)isthemostprevalentformofbraininjury(Fleminger
andPonsford,2005).Among thegeneralpopulation,approximately8.5%are estimatedtohavesuffered
mildtosevereTBI(Silveretal.,2001). Inmales,arangeof5-24%ofprevalenceforTBIofallseveritieshas
been given across studies (McGuire et al., 1998). While less than 10% of the general population has
experiencedaheadinjury,studiesfromacrosstheworldhavetypicallyshownthatthisisbetween50-80%
in offender populations.
Thisisparticularlyimportanttorecognisebecauseheadinjuryhasbeenassociatedwithayoungeraverage
ageofincarcerationforoffenders,andithasbeenfoundthatthegreaterthenumberoftimesanindividual
hasbeen knockedout,thegreatertheir likelihoodofcommitting violence.Sincetraumatic braininjuryis
clearly the most prevalent neurodevelopmental disorder both in the general young person and young
offender populations, with the latter being particularly high, it is important to highlight it as particular
conditionthatmayincreasetheriskofoffending.Yetmanyofthosewithinthecriminaljusticesystemhave
receivedlittleornotreatmentandtheirinjuryisgenerallynottakenintoaccountinthewaytheyaredealtwith.
Withsuchconsistentndingsoverthedisproportionatelyhighprevalenceofneurodevelopmentaldisorders
amongstyoung peopleinthe custodialestate, Hughesetal. (2012)raise anumberof keyissues forthe
youth justice system in England and Wales. Considerations include how the behaviour and cognitive
functions associated with neurodisability increase the risk of offending and how, in the absence of
systematically applied assessment of neurodisability and associated needs, criminal justice interventions
and sentences can further criminalise young people, rather than encourage desistance from further
offending.Moreover,theyquestionwhetherthecurrentcriminaljusticesystemapproachisfairincommitting
youngpeoplewithneurodisabilitytocustody,whenthoseyoungpeoplemaynotbeabletounderstandthe
consequencesoftheiractionsorhavethecognitivecapacitytoinstructsolicitors.
3.5 Post-traumatic stress disorder (PTSD) among young offenders
InexaminingtheprevalenceofPTSDinthegeneralpopulationanditsrelationshipwithspecictraumatic
events,the most useful ndings emanate fromstudieswhichhaveemployedformaldiagnostictests.As
explainedin section2.2.4,arange ofpsychologicaltests, scalesandchecklists thatfollowthe formatof
successiveDiagnosticandStatisticalManualPTSDcriteria,havebeendeveloped.Theyhavetendedtobe
utilisedwithex-militarypopulationsandthosewhohavebeenexposedtonaturaldisasters,ratherthanin
thewidercommunity.Anexceptiontothis,however,isastudy byFrissaetal.(2013)utilisingthePrimary
CarePTSDscreen(PC-PTSD)(Prinsetal.,2003)astructuredface-to-faceinterview,whichwasdesignedto
capturethefourPTSDsymptomclustersofre-experiencing,numbing,avoidanceandhyperarousal.
Frissaetal.(2013),interviewedarepresentativecommunitysampleof1,698 adultsaged 16andabove,
fromtwosouthLondonboroughs,inordertoestimatetheprevalenceofthesefoursymptomsandexamine
theirassociationwithtraumaticevents.CurrentsymptomsofPTSDexistedfor5.5%ofthesample.Women
were more likely to screen positive (6.4%) than men (3.6%), and symptoms of PTSD were high in the
unemployed(12.5%),inthosenotworkingbecauseofhealthreasons(18.2%)andinthelowesthousehold
incomegroup(14.8%).Currentsymptomsof PTSDwerefoundtobeassociatedwith bothchildhoodand
lifetime trauma, to the extent that as cumulative traumatic events increased, so did the likelihood of
reportingsymptomsofcurrentPTSD.Almostfourinve(78.2%)ofthestudypopulationhadexperienced
traumaintheirlifetimeandmorethanone-third(39.7%)reportedchildhoodtrauma.Althoughthehighest
prevalenceofcurrentsymptomsofPTSDwasfoundinthosewhomigratedforasylumorpoliticalreasons
(13.6%),theprevalenceofexposuretomosttraumaticlifeeventswashigherinthenon-migrantgroup.The

Trauma and young offenders – a review of the research and practice literature | 31
conclusionwasthathighprevalenceofexposuretotraumamaythusexistinthegeneralcommunity,with
cumulative effects upon current symptoms of PTSD.
Sarkaretal.(2005)examinedratesoftraumaandPTSD amongoffendingand non-offendingpsychiatric
patientswhohadaprimary diagnosisofparanoidschizophrenia.15 They used the PersonalityDiagnostic
Questionnaire,aself–report questionnaire derived from the personality disorders section oftheoriginal
DSM–III (American Psychiatric Association, 1980). Oftheentiregroup,93%reportedprevioustrauma,with
theoffendinggroupreportinghigherratesofphysicalandsexualabuse.Whilenotstatisticallysignicant,
theoffendingpatientshadalso experiencedmoremultiple traumasthanthe generalpsychiatricsample.
PTSDwascommonamongthewholegroup,with27%identiedascurrentlyexperiencingitand40%having
a diagnosis across their lifetime.Of fendingpatients had higher rates of both current (33% v. 21%) and
lifetime(52%v.29%)PTSD.Yetdespitesuchhighrates,veryfewpatientshadreceivedaformaldiagnosis
ofPTSDorwerereceivingtrauma-focusedpsychologicaltherapy.
Aswithgeneralpopulations,formalPTSDtestinghasrarelybeenthenormforresearchwithyoungoffender
populations,despitegrowingevidenceoftraumaintheirlives.Thetwoexceptionssetoutbelow serveto
illustratetheneedforthistestingtobecomemuchmoreroutine.
The Lader et al. study of psychiatric morbidity among young offenders in England and Wales (2000),
discussedinsub-section2.3,alsoexaminedtheincidenceofPTSDamongyoungoffenders,usingtheICD-
10measureofPTSD(WHO,1992).Aboutone-fthoftheyoungmenandtwo-fthsofthesentencedyoung
womenreportedexperiencingatraumaticeventthatwaslikelytocausepervasivedistress.Indeed,between
one-third and a half of those experiencing such an event also reported persistent symptoms (such as
ashbacks) and half of them also met the other criteria necessary to be considered indicative of post-
traumatic stress.16Fourpercentofbothmalesentencedandremandoffenders,and7%offemalesentenced
youngoffenderswerecategorised as having PTSD – proportions that the researchers point out are very
similartothosefoundamongprisonersasawhole(Singletonetal.,1998).
Afurther exampleoftheemploymentofadiagnosticmeasureofPTSD,andits application,isthePTSD-1
test – a psychosocial and cognitive assessment containing 17 items with a summary section, three
introductoryquestions,anda rating keyforrespondentstoindicatethe frequency with which any PTSD
symptomsoccurred.ThisisatestinlinewithDSM-III-R(AmericanPsychiatricAssociation,1987)whichhad
beenshowntohaveveryhighinternalconsistency(Watsonetal.,1991).Whenemployedinresearchina
YoungOffenderInstitution(YOI)enhancedunitforyoungmenwhohadcommittedviolentoffences,itfound
thatone-thirdofthemhadcurrent or lifetimePTSD,which had not been previously diagnosed (Boswell,
2006),with others coming quite close to the threshold (it is important tobear in mind the criticisms of
researchers who believe the criteria tobe too rigid, especially where it applies to young people whose
linguisticandreectiveabilitiesmaynotyetbefullydeveloped(Pynoosetal.,2009).Themajorityofthese
young men had reported traumatic experiences of abuse and/or loss. Yet, despite a mandatory health
requirement in a contemporary Prison Order for a multidisciplinary team (HM Prison Service, 2000) skilled
andexperiencedinadolescentmentalhealth,thisfacilitydidnotappeartobepresent.
ThestudiesdiscussedabovewouldsuggestthatPTSDlinkedwithearliertraumaticeventsispresentinthe
generalpopulationperhapsatleastasmuchasitisintheyoungoffenderpopulation,ifsomewhatmoreso
intheoffendingpsychiatricpopulation.Itispossiblethatitshighestpresenceinamigrantgroupwithinthe
generalpopulationcouldbelinkedwithasylumandpolitical-relatedissuesratherthanwithmorecommonly-
reported trauma experiences. It is clear that more research employing diagnostic tools needs to be
conductedinordertosupplementtheexistinglimitedmaterial.
15Twenty-sevendisorderedoffenderpatientswerecomparedwith28non-offender(general)psychiatricinpatients.
16Thosecriteriaincludeavoidanceofcircumstancesassociatedwiththeeventandtheonsetofsymptomsoccurringwithinsixmonths
of the event.

Trauma and young offenders – a review of the research and practice literature | 32
3.6 Trauma within the overlap between young offenders and looked after children
Whilelookedafter children account for less than 1% ofthetotalchild population, they are hugely over-
representedintheyouthjusticesystem(Bladesetal.,2011).Asurveyof15-18yearoldsinYOIsfoundthat
morethanaquarteroftheboys,andhalfthegirls,wereorhadbeenlookedafteratsomepointpreviously
(Bladesetal.,2011).Thismaybeevenanunder-estimateastheYouthJusticeBoard/PrisonService(Stuart
andBaines,2004)17estimatethat40–49%ofyoungpeopleincustodyhaveahistoryoflocalauthoritycare,
whileNacroalsosuggeststhat50%haveexperiencedtimeincareorsubstantialsocialservicesinvolvement
(2003).
 Manyyoungpeopleatriskofoffendingorwhohavecriminalconvictionsarevulnerablebecauseof
pastabuse,neglectorunstablelivingarrangements.Lookedafterchildrenarealsolikelytohave
receivedpoorqualityparentingandthereisasignicantpossibilityofmaltreatmentpriortoentering
thelookedaftersystem.Thesefactorsmayimpactontheircopingskills,includingtheabilitytoact
appropriately,toexpressthemselvesadequatelyandtoconformtosocialnorms.Insomeinstances,
troublesomebehaviourmayarisemorefromthesedifcultiesthanfromcriminalintent.
 Nacro(2012:4)
Unsurprisingly,the prevalence of mental disorders among children (aged betweenveand17-years-old)
beinglookedafterbylocalauthoritiesandtheirassociationshighlightsimilarlyhighratestothoseforyoung
offenders(Meltzer et al.,2002),18with 45%ofchildren being assessedashavingmorethanonetype of
disorder:
• 45%wereassessedashavingamentaldisorder
• 37%hadclinicallysignicantconductdisorders
• 12%wereassessedashavingemotionaldisorders–anxietyanddepression
• 7%wereratedashyperactive
• 4%ofthesamplewereassessedashavinglesscommondisorders(pervasivedevelopmental
disorders,ticsandeatingdisorders)
Amongthe5–10yearolds,thoselookedafterbylocalauthoritieswereaboutvetimesmorelikelytohave
amentaldisorder; 42% comparedwith8%.Foreach type ofdisorder,theratesfor lookedafterchildren
compared with private household children were:
• Emotionaldisorders:11%comparedwith3%
• Conductdisorders:36%comparedwith5%
• Hyperkineticdisorders:11%comparedwith2%
Theresearchalsofoundthat11–15yearoldslookedafterbylocalauthoritieswerefourtovetimesmore
likelytohaveamentaldisorder(49%comparedwith11%),whichwasthenfurtherbrokendowntoprovide
moredetailedprevalenceratesforcategoriesofdisorder,asfollows:
• Emotionaldisorders:12%comparedwith6%
• Conductdisorders:40%comparedwith6%
• Hyperkineticdisorders:7%comparedwith1%
17Withreferenceto100girlsinveestablishmentsand2,500boysin14maleestablishments.November2003 presentation described
in:JosephRowntree:SafeguardsforVulnerableChildrenwww.jrf.org.uk/sites/les/jrf/1859352278.pdf
18Seealso:ChristineCockeretal.(2003).

Trauma and young offenders – a review of the research and practice literature | 33
Childrenwithamentaldisorderweremorethanvetimesmorelikelythanthosewithnodisordertohave
beenintroublewiththepolice(26%comparedwith5%).Carersofchildrenwithaconductdisorderwerethe
mostlikelytohavereportedthisexperience(29%)andthisgroupwerealsothemostlikelytohavebeenin
troublethreeormoretimes(14%).
AspartofitsOutofTroubleprogramme,ThePrisonReformTrust’sstudybasedonacensussurveyofmore
than6,000childrenincustodysetouttondwhothesechildrenwereandhowandwhytheycametobe
there (Jacobson et al., 2010). Itshowedthatmostyoungpeopleincustodyarebeingdoublypunished:rst,
byhavingverydifcultchildhoodscharacterisedbylossanddisadvantage;then,bybeinglockedup,often
for not very serious crimes. At least three quarters of children had absent fathers, and one-third had absent
mothers;morethanaquarterhadwitnesseddomesticviolenceandasimilarproportionhadexperienced
localauthority care; afth wereknowntohaveharmed themselvesand11% tohaveattemptedsuicide.
Morethanonein10hadsufferedtheuntimelydeathofaparentorsibling.
Amorerecentprisoninspectoratesurveycitesthatone-thirdofboysand61%ofgirlsincustodyhavespent
timeincare(Kennedy,2013).Argumentsconcerning‘doublepunishment’alsoresonatewithaccountsof
imprisonmentsuchasthoseofferedbyWillow(2015)inherbook‘ChildrenBehindBars’,whichexposesa
catalogueofdegradingandabusivetreatmentwhichsomechildrenandyoungpeopleexperienceincustody.
Clearly,then,theproblemsexperiencedas commonplacebyyoungoffendersare further exacerbatedfor
lookedafterchildrenincustody.TheHMIPthematicreviewestimatedthatapproximately400lookedafter
childrenareincustodyatanyonetime,ndingalackofclarityaboutwhowasresponsibleforlookingafter
thechildrenandalackofcoordinationbetweentheagenciesinvolved.Theyoungpeoplethemselveswere
described as, ‘Often pessimistic about their resettlement prospects’ and HMIP stated that outcomes were
indeed poor for those who were followed up. The report concludes that: ‘It remains unacceptable that
childrenwhoare so at risk that they need to be taken into the state’s care also remain low among our
nationalpriorities.’(HMChiefInspectorofPrisonsforEnglandandWales,2012).
3.7 Trauma and women offenders
Womenoffendersformasmallminorityofboththeadultandyoungoffenderpopulations. Theyareoften
overlookedasaseparategroupincriminaljusticestudies,andsotheirexperiencestendtobesubsumed
and ‘lumped together’ with those of their male counterparts. When considering the issue of traumatic
experienceanditseffects,itisparticularlyimportanttoelicittheirdiscreteexperiences.InBoswell’sstudy
of200Section90/91offenders,forexample,the12youngwomeninvolvedhadallbeensubjecttoabuse
and victimisation, but this had hardly been recognised or addressed by criminal justice professionals
(Boswell,1996).
TheCriminalJusticeJointInspectoratethematicreportintoalternativestocustodyforwomen(CJJI,2011)
examinedthecaselesof107womenoffenders,ndingthat54%wereconsideredtohavementalhealth
problems,51%tookillegaldrugs,59%hadproblemswithalcohol,34%werevulnerabletoself-harmand24%
vulnerabletosuicide.Additionally,73%hadbeenvictimsofdomesticabuse,18%hadbeenperpetratorsof
domesticabuseand60%hadnancialproblems.Thesendingsconrmedthefactorsidentiedintheearlier
Corstonreportonwomenwithparticularvulnerabilitiesinthecriminaljusticesystem(HomeOfce,2007).
TheLaderetal.study(2000)describedinforegoingsectionsalsoconsideredthepsychiatricneedsofyoung
femaleoffendersincustody.Thisfoundthatwomenwerefarmorelikelythanmentoreporthavingsuffered
as a result of violence at home and sexual abuse. About two-fths of the women and approximatelya
quarterofthemeninterviewedreportedhavingsufferedfromviolenceathome,whileaboutoneinthreeof
thewomenreportedhavingsufferedsexualabusecomparedwithjustunderonein20ofthemen.Other
keyndingsincludethat:

Trauma and young offenders – a review of the research and practice literature | 34
• 9%ofwomenreportedthatatonetimetheyhadbeenadmittedtoamentalhospital(including2%
whohadastayofmorethansixmonths)
• 27%saidtheyhadreceivedhelportreatmentformental/emotionalproblemsbeforeenteringprison
• 22%hadreceivedhelportreatmentformental/emotionalproblemssinceenteringprison(thebiggest
proportion across all samples)
• One-thirdhadtriedtokillthemselvesintheirlifetime(twicetheproportionofmalesentencedyoung
offenders)
• 11%reportedself-harmwithouttheintentionofsuicide(parasuicide)
• 32%showedevidenceoffourorvedisorders
Themostmarkeddifferencesbetweentheyoungwomenandtheyoungmaleoffendersaroseinrelationto
receiptof treatment formentalhealth problems.Inthe 12 monthspriortoenteringprison,13%of male
remandyoungoffendersand11%ofmalesentencedyoungoffendershadreceivedhelportreatmentfora
mentaloremotionalproblem.At 27%,theproportionamongfemaleyoungoffenderswas double this. A
similarratiowasalsofoundintermsoftheproportionofyoungoffenderswhohadreceivedhelpinprison
–11%formaleremandand14%formalesentencedyoungoffenders,comparedwith22%amongfemale
youngoffenders.
Similargures were reported by Rowan-Szal and colleagues in their studyof trauma and mental health
assessmentsforfemaleoffendersinprison(Rowan-Szaletal.,2012).Thestudyfoundthatfemaleoffenders
report higher levels of trauma and mental health complications than males, although limited resources
preventedconsistentscreening,diagnosisandassessment.
Inrelationtobraininjury,Williams(2012)suggeststhattheprevalenceofTBImaybeevenhigherforfemale
than male prisoners; his analysis suggested that 42% of women offenders who had committed violent
offenceshadexperiencedanaverageoftwoTBIs.Threefactorsweresignicantlyassociatedwithcurrent
violentconvictions:thenumberofyearssincedirectexperienceofdomesticviolenceincidents,thenumber
ofprevioussuicideattempts,andpreviousTBIswithlossofconsciousness.
ResearchconductedintheUSsuggeststhatyoungwomenandgirlsinvolvedwiththejusticesystemhave
highratesoftraumaticchildhoodexperiencebutthattherearefewprogrammestoaddresslinksbetween
traumaandoffending(Smithetal.,2012).Similarndingshavebeengeneratedinstudiesfocusingonadult
womenprisoners(e.g.Valentine2000a,2000b).
Thefollowingstudies arealso US-based,butraisesomekeyconsiderationsthatareequallyapplicablein
theUK.Forclarity,theyaresetoutunderastatementoftheirkeyndings:
Women are more likely to have experienced interpersonal sexual trauma than men
Komarovskaya et al. (2011)analysed gender dif ferencesin traumatic experience and associated PTSD
symptoms reported by prisoners in a sample of 266 (male and female inmates). In their sample, just under
95%oftheinmateshadexperiencedat least one traumatic event, with male prisoners reporting higher
rates of witnessing harm to others in childhood (22%) and adolescence (43%) and female prisoners
reportinghigherratesofinterpersonalsexualtraumainchildhood(31%),adolescence(35%),andadulthood
(28%).WomenshowedhigherratesofPTSD(40%)whencomparedtomen(13%)(asmeasuredbythetotal
PTSD score of the Impact of Event Scale – Revised). For females, interpersonal sexual trauma was a
signicant predictor of PTSD symptoms, and for male prisoners interpersonal nonsexual trauma was a
signicantpredictor.

Trauma and young offenders – a review of the research and practice literature | 35
There is a strong association between female homelessness and previous trauma
Cook et al. (2005) conducted a study to describe the nature, scope, and socioeconomic correlation of
traumaticlifeeventsinarandomsampleof403womenenteringastatecorrectionalfacility.Ofthesample,
99%reportedhavingexperiencedatleastonetraumaticlifeeventand81%experiencedveormore.Those
whoreportedseveralexperiencesdifferedbyrace,ageandmaritalstatus,butthemostsignicantndings
related to homelessness. Those women who had been homeless for a minimum of seven days were between
2.19and5.62timesmorelikelytohaveexperienced14ofthe21traumaticeventsbeingfocusedonbythe
researchers;mostoftheseeventsweredenedbyinterpersonalviolence.
Decision-making for female offenders is signicantly impaired by emotional responses – particularly for
those exposed to trauma
Solomon et al. (2012) examined decision-making behaviours among 213 adolescent female offenders.
Whiletheyoungwomenhadhighperceiveddecision-makingcompetence,thiswassignicantlyundermined
bytheirexperiencesofanger,substance misuse,anddepression – particularly amongthosewith more
exposuretotrauma.Substancemisuseinparticularlinkedtheyoungwomen’spsychosocialcharacteristics
toantisocialdecision-making.
Women offenders may have higher risk of trauma and poorer coping skills than women in the general
population
Grellaetal. (2013)examinedrelationshipsbetweentraumaexposure,familialriskandprotectivefactors,
substanceabuseandPTSDamongincarceratedand non-incarcerated women.Asampleof100women
prisoners were matched with 100 women in thegeneral population (using a casecontrolmethod). The
womenprisonerswerebetween1.7and3.7timesmorelikelytobeatriskoftraumaexposurecomparedto
womeninthecontrolgroup.InrelationtoPTSDspecically,exposuretosexualorphysicaltraumasignicantly
increased the odds of PTSD, as did substance misuse in response to traumatic distress. The researchers
arguethatincarceratedwomenare athighriskforPTSDgiventheirhighratesoftraumaexposureand
apparentlackofappropriatecopingmechanisms,and theysuggestthattheirndingsclearlysupportthe
useoftrauma-specicinterventionsforthispopulation.
Prison fails to address trauma and may further harm women
Fournieret al. (2011)examinedtherehabilitationneedsofwomenin prison in order to assess whether
prison-basedprogrammesandpolicies were addressing these needs. A total of 17incarceratedwomen
fromamedium-securityprisonweresurveyed,revealingsignicanthistoriesoftraumaaswellassignicant
psychosocial decits typically associated with trauma. The ndings suggested not only that there was
signicantunaddressedneedamongwomenprisoners,butthatexistinginstitutionalpoliciesactuallyhad
the potential to further harm survivors of trauma.
3.8 Summary
Theextentoftraumaanditsmanifestationsinboththegeneralpopulationandamongoffendershavebeen
outlined,withagreatdealofevidencetosuggestthatitisparticularlyprevalentamongoffenders.Particular
typesoftraumahavebeenidentiedinthelivesofyoungoffenders,centringaroundexperiencesofchild
abuse,loss,victimisation,mental healthconditions andbraininjury.The‘doublepunishment’,ofbeinga
looked after child and then being incarcerated within the criminal justice systemhas been underlined.
Gender-specicfactorshavebeenexplored,andreferencesmadetoresearchndingswhichindicatethat
althoughfemalesmakeup averysmallproportionof theoffendingpopulation, theyaremore likelythan
malestohavesufferedarangeoftraumaticeventsincludingsexualabuseandfamilyviolence.Thenature
andextentofPTSDandtheimportanceofformaltestingamongyoungoffendershasbeenhighlighted.As
a consequence, it can be seen that:

Trauma and young offenders – a review of the research and practice literature | 36
 Maltreatmentispresentinthelifehistoriesofagreaterproportionofchildrenincustodythaninthe
generalpopulation…[this]shouldberegardedasacriticalandprimarypre-disposingriskfactorin
relationtooffendingbehaviour.
 (Harringtonetal.,2005)
Theevidencethat both thephysicaland mental health of childrenandyoungpeople in contact with the
youthjusticesystemis markedly worse than children in the general population is overwhelming, with at
least43%oftheformerestimatedtohaveemotionalormentalhealthneeds(HMInspectorateofPrisons,
2011;HealthcareCommission2009).NICErecognisesthatchildandadolescent offenders–particularly
thosein secure institutions – are particularlyat risk of mental difculties. They suggest that theknown
numbersof successful suicidesinYOIsstronglyindicateshighlevelsofdepressionthatare notcurrently
adequately assessed or managed. NICE advises that ‘hidden maltreatment’ should be considered in
childrenandadolescentswithunexplainedmooddisorderswherethereisnofamilyhistoryofdepression
and an absence of other overt social adversities. Indeed, the evidence appears overwhelming that the
introductionofaconsistentsystemofprofessionalassessmentforthepresenceoftraumaintheseyoung
people’slivesislongoverdue.

Trauma and young offenders – a review of the research and practice literature | 37
4. WHAT ARE THE IMPACTS OF TRAUMA?
 Withthisarrayofpoorbackgrounds,restrictedopportunities,stressfullifeexperiencesand,inextreme
cases,withdrawalofliberty,itisnotsurprisingthatthemorepersistentorseriousyoungoffendersare
likelytobeadisaffectedandangrygroup.Insomecasestheirbehaviourandmoodcouldbeconstrued
as a reasonable response to the situations in which they nd themselves and even a type of coping
mechanism.
 (Leon,2002;emphasisadded)
Aneventcanbeconsideredtobe‘traumatic’ifitisextremelyupsettingandatleasttemporarilyoverwhelms
the individual’s internal resources (Briere and Scott,2013). But it is well known that individuals having
experiencedthesameorsimilartraumaticeventsdonotalwaysrespondinthesameway.
Inthe rst partofthis section we outline key factors as described in theliterature,whichappear to be
relatedtothekindsofimpactswhichtraumaticexperiencecan generate.Followingsectionsthenprovide
detailsconcerningthoseimpactsthemselves.
4.1 Key factors affecting impact
Traumacanhaveimmediatenegativeimpactsuponanindividualbutitcanalsohavedamagingeffectsover
amuchlongerterm.Yetnotalltraumaticeventsgeneratelastingdamage–theimpactoftraumaticevents
isusuallydependentonarangeoffactors,including:
• Thetypeofeventthatgaverisetothetrauma–interpersonaltraumas(e.g.involvingviolenceorchild
abuse)aremorelikelytohavenegativeimpactsandtoincreasetheriskofsubsequentfurther
traumaticexperiencesandrevictimisation,thannon-interpersonaltraumas(e.g.roadaccidents,
disasters).
• Previousexperienceoftrauma–whereadverseexperiencesaremultipleorchronic,thescopefor
negativeimpactsonindividualhealthanddevelopmentisincreased(andthiscanbeexacerbated
whereapoolingupoftraumaisalsoaccompaniedbyalackofprotectivefactors).
• Mentalandemotionalstrengthsandweaknesses(resilience).
• Whatkindofsupporttheindividualhas–athomeorelsewhere.
Otherfactorssuchaslifestyle,socio-economiccircumstancesandenvironmentalsoplayaroleindetermining
thecomplexpatternsoftraumaticexperienceandtheirimpact.
Concerningthe rst key set of factors listed above, the evidence suggests thatvictimstendto perceive
traumathatiscausedbypeopleasmoreintentional,intrusiveandmalignant–oftengivingrisetofeelings
ofbetrayal–andsuchexperiencesareassociatedwithmorenegativeoutcomes(BriereandScott,2013;
Freyd,Klest,andAllard,2005).Interpersonaltraumasthatarecausedbycare-giverscanhaveparticularly
adverseimpacts,especiallywheresuchincidentsarechronicandbeginataveryyoungage(TheNational
ChildTraumaticStressNetwork(NCTSN)2011;Cooketal.,2005;vanderKolkandCourtois,2005).
Care-givingthatisneglectfulorunpredictablecanalsobetraumatising,leavingachildlessabletodealwith
longer-termeffectsandwithoutanadequatelysecurebasetoturntointhefaceofinsecurityorperceived
threat(PurnellC.,2010).
Therelationship betweendifferenttraumasandthe difcultiestheycause fora youngpersonis complex
(BriereandScott,2013).Childhoodabusemayproducenumeroussymptomsandproblematicbehaviours

Trauma and young offenders – a review of the research and practice literature | 38
inadolescence and adulthood(includingsubstanceabuse, indiscriminatesexualbehaviour andreduced
awarenessofdanger).This,in turn,increases thelikelihoodoffurthervictimisation,aslatertraumas can
lead to further behaviours and responses to these that generate additional risk factorsand even more
complexmentalhealthproblems(BriereandJordan,2009).
Manyabusevictimshaveexperiencedanumberofincidents andtypesofmaltreatmentduringchildhood
(Finkelhoretal.,2007)andareatgreaterriskofrevictimisationinadolescenceandadulthood(Cloitreetal.,
1996).Forexample,abusevictimsaremorelikelytohavealsoexperiencedpsychologicalneglect(Manlyet
al.,2001),childrenexposedtophysicalabusearemorelikelytoexperiencepsychologicalabuse(BriereJ.
andRuntz,M.R., 1990); Higgins andMcCabe,2003),intrafamilialabuseis associated with extrafamilial
abuse(Hansonetal.,2006)andbeingsexuallyabusedasachildsubstantiallyincreasesthelikelihoodof
beingsexually assaultedinadulthood (Classenetal., 2005; Elliottetal., 2004).Furthermore,itappears
that there are cumulative effects of different forms of childhood trauma, above and beyond their individual
impacts(Briereetal.,2008;Folletteetal.,1996).So,whereindividualshavemultipletraumaticexperiences
intheirbackgrounds,theimpactofthesecanbecumulativeandmutuallyreinforcing.
4.2 Impacts on development
As noted earlier, the impacts of trauma on behaviour, and connections between trauma and subsequent
mentalhealthissues,havebeendocumentedovermanydecades.Butdevelopmentalimpacts,andimpacts
on brain development in particular, have become a focus of research only in recent decades.
Where trauma is particularly acute or generated by multiple events (as in the case of child abuse, for
example),therecanbeadversephysicalandemotionalimpactswhich,inturn,canhaveaprofoundeffect
on individual development during childhood and adolescence, and into adulthood. These effects can
conspiretobluntaffectivedevelopmentandsocialisation,levelsofself-esteemorcondence,andalsothe
individual’s ability to form relationships with others. Experiencing multiple incidences of interpersonal
victimisation is particularly harmful, as cumulative experiences may lead to dysfunctional avoidance
behaviour(Freydetal.,2005).
Asidefromitsimmediatenegativeimpact,earlychildmaltreatmentinterruptsnormalchild development,
especiallytheprocessesthroughwhichemotionsaremanaged(BriereJ.,2002).Inordertofullyunderstand
the impact of trauma upon children and young people, it is important to consider their developmental
processandhowthisisdamagedbytheirexperiences:
Adolescents’ key developmental tasks include being able to (NCTSN 2011):
• Learntothinkabstractly
• Anticipate and consider the consequences of behaviour
• Accuratelyjudgedangerandsafety
• Modifyandcontrolbehaviourtomeetlong-termgoals
Trauma can impact upon adolescents by making them (NCTSN 2011):
• Exhibitreckless,self-destructivebehaviour
• Experienceinappropriateaggression
• Over-orunderestimatedanger
• Struggletoimagine/planforthefuture

Trauma and young offenders – a review of the research and practice literature | 39
So, trauma can complicate child development, resulting in youngpeople who are on constant aler t for
danger,andwhoarequicktoreacttothreatsviaght,ight,freeze(Teicher,M.H.2002;NCTSN,2011).The
wayinwhichtraumacanbluntayoungperson’scapacitytomanageemotionscanalsohaveimplications
fortheformationandmaintenanceofhumanrelationships,aswillbeseeninthefollowingsection.
4.3 Attachment
Attachmenttheoryis fundamental tounderstanding childhood emotional development(Grimshawet al.,
2011). This approachseeks to explain how relationships with parents and other carers inuence each
individual’scapacitytodevelophealthyrelationships(Bowlby,1969,1973,1980,1988;deZulueta,2006,
2009).Attachmentformsthroughthecloserelationship betweenan infant and their primarycare-giver,
whichbuildsandsustainsthechild’sfeelingsofsecurity.Aninfantwithsecureattachmentfeelssafeand
condenttoexploretheirsurroundingsandthewiderworld,whileachildwhohasbeenabused,neglected
orrejected,experiencesfeelings of insecurity and disorganised attachment patterns which can result in
anxiety,avoidance,angerandsometimesaggression(TroyandSroufe,1987).
The National Child Traumatic Stress Network (NCTSN) has specied several important functions of the
attachment process, including the regulation of emotions, developing a view of oneself as worthy and
competent, perceiving the worldas ‘safe’ and buffering the impact of any trauma. By anticipating their
caregivers’responsestothem,childrenlearntoregulatetheirbehaviour(Schore,1994)andthisinteraction
allowsthemtoconstruct‘internalworkingmodels’(Bowlby,1980)whichcombinetheaffectiveandcognitive
characteristicsof their primary relationships. As theseearlyexperiencesare occurring at atimeofrapid
braindevelopment,socialinteractionandneuraldevelopmentareinextricablyintertwined.Earlypatternsof
attachmentthusimpactuponthequalityofinformationprocessingthroughoutanindividual’slife(Crittenden
1992).Children with secure attachment learn totrustboththeir feelings and theirunderstandingofthe
world(vanderKolk,2005).
 Repeatedexperiencesofparentsreducinguncomfortableemotions(e.g.,fear,anxiety,sadness),
enablingchildtofeelsoothedandsafewhenupset,becomeencodedinimplicitmemoryas
expectationsandthenasmentalmodelsorschemataofattachment,whichservetohelpthechildfeel
an internal sense of a secure base in the world.
 Siegel,D.(NCTSN2011)
Generally,themoreexposuretodangertherehasbeenthroughneglectorabuse,themoredistortionthere
will be in the attachment response. But disturbance in a child’s early attachment to their signicant
caregiversdoesnotonlyoccur whenthere istrauma (CassidyJ. andShaverP.R.2008)– suchan impact
canarisefrom‘subtraumaticevents’whichinvolvegrowingupinaninvalidating(butperhapsnotextremely
violent)familyenvironment(Linehan,1993).
VanderKolk(2005)describeshowaprimaryfunctionforparentsistohelpchildrenlearntomanagetheir
emotions.Repeatedinterventionstocalmemotionalupsetprovidethebasisfordevelopingasenseoftrust
andsafety(Fahlberg,1991;Cozolino, 2006).Secureattachment canthusmitigate againsttheimpact of
traumauponachildasparents/caregiverscanhelptheirdistressedchildrenrestoreasenseofsafetyand
control.Many young people whohavedifculty regulating emotions and impulses havebeenexposedto
complex trauma (Bath, 2008), which can impair the development of thinking, relationships, self-worth,
memory, health, and a sense of meaning and purpose in life (van der Kolk et al., 2005). From a
neurodevelopmental perspective, the stress activation systems of traumatised children have become overly
sensitized–detectingthreatandtriggeringghtorightresponseswhentheyarenotneeded(Bath,2008).
BrucePerryobservesthat,‘Childrenexposedtosignicantriskwill“reset”theirbaselinestateofarousal,
suchthat—wherenoexternalthreats or demands are present — theywillbeinaphysiologicalstateof
persistingalarm.”(PerryandSzalavitz,2007:32).

Trauma and young offenders – a review of the research and practice literature | 40
Thisconstant activationof‘deepbrain’ emotionalarousalleads toanimpaired ‘higherbrain’capacityto
provide emotional regulation. Thus, many troubled young people are prone to emotional outbursts,
frustrationthatescalatestofuryandrage,anddisappointmentthatdescendsintodepressionanddespair.
Theseyoungpeoplealsodisplayhighlevelsofimpulsivity,emotionalcontagionandrisktaking(Bath,2008),
partlybecause,incrisis,thebrainisfocusingalmostentirelyonperceivedthreatandtheneedforrevenge
or safety.
Unpredictable and inconsistent parenting means that infants are notable to organise their attachment
behaviourinanycoherentpattern(Liotti,2004:2)andmay,asaresult,sufferfromdeeplydividedattachment
feelings– this canincludeasplitperceptionin whichanidealisedrelationshipcohabitswiththestrong
sense of a dysfunctional one (Grimshaw et al., 2011). This can fundamentally impair an individual’s ability
toself-regulatetheiremotionalresponse,resultinginasurgeofpanic,notonlyasaresponsetothreatbut
alsobecauseofperceivedlossofcomfortandprotection.Anysubsequentterrifyingstimulusmayresultin
retraumatisation or defensive violence, and there is a further risk that individuals may identify with their
aggressorandgoontoviolateothers(Grimshawetal.,2011).
Unavailable and rejecting caregivers result in infants with internal representations of themselves as
unworthyandunlovable.ItisworthconsideringwhatvanderKolkhastosayonthisissue:
Whencaregiversareemotionallyabsent,inconsistent,frustrating,violent,intrusive,orneglectful,children
areliabletobecomeintolerablydistressedandunlikelytodevelopasensethattheexternalenvironmentis
abletoproviderelief.Thus,children with insecureattachmentpatternshavetroublerelying on others to
help them, while unable to regulate their emotional states by themselves. As a result, they experience
excessiveanxiety,angerand longings to be takencareof.These feelings maybecomesoextremeas to
precipitatedissociativestatesorself-defeatingaggression.Spacedoutandhyper-arousedchildrenlearnto
ignoreeitherwhattheyfeel(theiremotions),orwhattheyperceive(theircognitions).
Ifchildrenareexposedtounmanageablestress,andifthecaregiverdoesnottakeoverthe function of
modulatingthechild’sarousal,asoccurswhenchildrenexposedtofamilydysfunctionorviolence,thechild
willbeunabletoorganize andcategorizeitsexperiencesin acoherentfashion.Unlikeadults, childrendo
nothavetheoptiontoreport,moveawayorotherwiseprotectthemselves-theydependontheircaregivers
fortheirverysurvival.Whentraumaemanatesfromwithinthefamilychildrenexperienceacrisisofloyalty
andorganize their behaviourtosurvive withintheirfamilies.Being preventedfromarticulatingwhatthey
observeandexperience,traumatizedchildrenwillorganizetheirbehaviouraroundkeepingthesecret,deal
withtheirhelplessnesswithcomplianceordeance,andaccommodateanywaytheycantoentrapmentin
abusive or neglectful situations [Summit 1983] When professionals are unaware of children’s need to
adjust to traumatizing environments and expect that children should behave in accordance with adult
standards of self-determination and autonomous, rational choices, these maladaptive behaviours tend to
inspirerevulsionandrejection.Ignoranceofthisfactislikelytoleadtolabellingandstigmatisingchildren
for behaviours that are meant to ensure survival.
(vanderKolk,B.2005)
Trauma can throw off the healthy developmental trajectory by overwhelming a person’s ability to cope
(Briere). Developmental trauma can result in children developing unfocused responses to subsequent
stress(vanderKolk,2005;CicchettiandToth,1995)leadingtodramaticincreasesintheuseofmedical,
correctional, social and mental health services (Drossman et al., 1990).
An attachment-based interpretation of childhood violence suggests that children’s developmentsuf fers
markedlyin the absence of an early nurturingofsocialrelationships.Ifthisdamagingtypeofinsecurity

Trauma and young offenders – a review of the research and practice literature | 41
persists, the child’s model of the external world is affected,opening up the potential for violence as a
responsetolater frustrations. It is, therefore,easytounderstandhowthe loss of a primary care-giver –
throughseparation,beingplacedincare,orbereavement–isexperiencedasacutelypainfulandtraumatic.
Whileattachmentdifcultieshavebeenpositivelyassociatedwithexposuretodangerthroughneglectfulor
abusive caregiving, not all attachment difculties arise because of parental or caregiver behaviour.
Environmentalfactorsalsoplayapart,asthefollowingpresentationbyNCTSN(2011)highlights:
Parent contributions to insecure attachment Environmental contributions to insecure
attachment
Ineffective or insensitive care
Physicaland/oremotionalunavailabilityofparent
Abuseandneglect
Parentalpsychopathology
Teenparenting
Substance abuse
Intergenerationalattachmentdifculties
Prolongedabsence
Poverty(Egeland,B.,Carlson,E.)
Violence(victimand/orwitness)
Lackofsupport(absentfatherorextendedkin,
lack of services, isolation)
Multiple out of home placements
Highstress(maritalconict,family
disorganisationandchaos,violentcommunity)
Lackofstimulation
Itisimportanttonotethattraumadoesnotinevitablyleadtoanxiousattachment;childrenmayexperience
hardship but will respond with relatively secure attachment strategies because their caregivers are
adequately protective (Purnell, 2010). However, neglectful, unpredictable or dangerous behaviour by
caregiversisinherentlytraumatisingand leavesachildlessable todealwithitslonger-termtraumatising
effectandwithoutanadequatelysecurebaseforwhendangerthreatens.
4.4 Dissociation and memory
Psychiatristsusetheterm‘dissociation’ to explain how memories are keptawayfrom consciousness. In
order to ward off the effects of extreme anxiety, the individual resor ts to dissociative behaviours that
representdistractions,orattemptstoreassertcontrolinsteadoffeelinghelpless.Self-destructivebehaviours
are therefore common among victims of abuse. Examples of dissociation include losing memories of
traumaticincidents.Recalloftraumacanalsobebothdifcultanduncomfortable.Therearepsychological
reasonsforresistingtheincursionofpainfulmemoriesaboutpeopletowhomwearecloselyattached.
Itisworth noting that manystudies focusingontheprevalenceoftraumaticexperiencesin aparticular
population are based on feedback from individual respondents who are asked toreect back on their
experiences, sometimes over very long periods of time. Yet it is known that trauma and poor infant
attachmentnegativelyimpactuponaccessingmemoriesandnarrativecoherence(Grimshawetal.,2011;
Holmes,2000;Hesse,1999).Giventhesensitivityofdisclosingtraumaticexperiences,combinedwiththe
fact that some of the impacts of trauma include dissociation and avoidance, it is likely that many respondents
willunder-reportsuchexperiences.
Thenarrativestylelinkedwithdisorganisedattachmenttendstobecharacterisedbylevelsofincoherence
(e.g.lapsesanddiscrepanciesbetweenthinkingandfeelingwhilereportingmemoriesofpastattachment
relationships)andleadstoaclassicationcalled‘unresolved’.Unresolvedinterviewsarecharacterisedby
episodicmemoriesor‘attachment-relatedtraumasorlossesthatarenotwellintegrated’(Liotti,2004:3).
Attachment researchers have demonstrated that these children may over-generalise at points in their
narrative,havepeculiarlapsesinnarrative,withunusualsyntax,sequencinganduseofpronouns.Theymay

Trauma and young offenders – a review of the research and practice literature | 42
recount horrible events in a depersonalised manner, without any affect (van der Hart et al., 2006:40).
Transcriptsthatare classied‘unresolvedastotraumas’,andinfantdisorganisedattachmentbehaviour,
bearclose resemblance toclinicalphenomena usually regardedasindicative of dissociation(Hesseand
Main, 2000:4).
Herman and Schatzow (1987) found that 28% or their clinical sample of women in group therapy for
childhood sexual abuse reported ‘severe memory decits’ in relation to their own abuse, for example.
Similarly,BriereandConte(1993)foundthat59%of450womenandmenintreatmentforsexualabuse
sufferedinchildhoodhad‘forgotten’abouttheabusepriortotheageof18.
4.5 Impacts on brain development
Theincidence oftraumaamong offenderswarrantsconsiderationbecausethe evidenceclearly suggests
thatadversechildhoodandadolescentexperiencecanalsoaffectbraindevelopmentitself.
Recentresearchfocusingontheconnectionsbetweentraumaandsubsequentmentalhealthissueshave
benetedfromtechnologicaladvanceswhichhaveallowedimpactsonbraindevelopmenttobeassessed
and measured in much more detail than had previously been possible.
Inthe1980s,post-mortemexaminationofbrainsectionsallowedresearcherstodrawcomparisonsbetween
groupsthathadsufferedseverechildabuseorneglect,forexample,andgroupsfromthenormalpopulation.
Thosestudieshighlightedkeydifferencesbetweenthetwogroupsinrelationtothesizeandfunctioningof
certain parts of the brain (Teicher, 2002).
Researchofthis kindhighlightedstrongcorrelationsbetweenbrainfeaturesforthesegroups,butfurther
researchalsofocusedoncausalprocesseswhichmightgeneratethesekindsofimpacts.Someregionsof
the brain have a higher density of receptors, which are sensitive to stress hormones such as cortisol.
Prolongedexposuretostresshormonesandtheirneurotoxicityovertime(particularlyinrelationtochronic
abuse,forexample)canalterthemorphologyandfunctioningofthebrainitself,inawaywhichaffectsand
shapes an individual’s adaptive responses (Perry, 2001).
Recentresearchhasalsosuggestedthattheimpactsoftraumaonbraindevelopmentmaybegenderedas
well.ResearchundertakenbytheStanfordNeurosciencesInstitute,forexample,involvedstudyingparticular
brainstructuresofboth boysand girls.Theyweredividedintotwogroups,withsomehavingexperienced
trauma(includingcomplextrauma)andothershavinghadnosuchexperience.Thestudyfoundnodifference
inbrainstructurebetweenboysandgirlsinthecontrolgroup(i.e.,thosenothavingexperiencedprevious
trauma),butfoundkeydifferencesbetweenboysandgirlsinthetraumagroup.Aregionofthebraincalled
theanteriorcircularsulcus(whichplaysakeyroleinmonitoringandintegratingemotions)wasfoundtobe
largerinvolumeforboyswhoexperiencedtraumaandsmalleringirls who had such experience. It has
always been known that girls who experience trauma are more likely to develop PTSD than boys who
experiencetrauma,butthestudyhasprovidedsomecluesconcerningwhattheneurologicalcorrelatesof
thatmightbe,andtheresearcherssuggestthatthedevelopmentofsex-specictreatmentsseemswarranted
(StanfordMedicineNewsCenter,2016).
4.6 The impact of trauma upon behaviour
 [T]herearecomplexinteractionsbeginninginearlychildhoodthataffectourabilitytoenvisionchoices
and that may later limit our ability to make the best decisions.
 (PerryandSzalavitz,2007)

Trauma and young offenders – a review of the research and practice literature | 43
We know that adversity affects children’s brain development and that experiencing violence in one’s
formativeyearsheightenssensitivitytoperceivedthreatandangerinothers.But,inadditiontoincreasing
theriskofoffending,theimpairmentofneuro-cognitivedevelopmentmaymakeitdifcultfortheseyoung
people to understand and comply with criminal justice interventions and also to comprehend the
consequencesofbreachingthem.Thechallengesfacedbytheseyoungpeopleintryingtocomplywiththe
criminaljusticesystemisapparentwhenonereectsthattheyarelikelyto(Williams,2013):
• Bedisinhibited,makepoorsocialjudgementsandbehaveinappropriately(Andersonetal.,2006)
• Lackthecommunicationskillsnecessarytoallowthemtonegotiateoutofconict
• Havelimitedplanningskillsandrespondinexiblytochallengingsituations(Mildersetal.,2003)
• Experiencedifcultieswithattention,workingmemoryandcognition(Andersonetal.,2006)
• Misperceive situations (be unable to read others’ emotions (Tonks et al., 2008) or to perceive threat
when there is none)
• Havedifcultyinconsideringalternativebehavioursorcontrollingtheirimpulses–especiallyinconict
situations(Pontiexetal.,2009)
An individual’s experience of traumatic eventsis related to their ability to cope. Three broad classes of
copingmechanismsthatpeopleusetoovercomestressfulsituationshavebeenidentiedas:
1. Consciouslyseekingsocialsupport
2. Consciouscognitivestrategiesemployedintentionallytomasterstress
3. Involuntary mental defence mechanisms that distort perceptions of reality in order to reduce distress,
anxietyanddepression19
Howchildrenandyoungpeoplerespondtotraumaticexperiencesvariesdependingon(NCTSN,2011):
• Theirageanddevelopmentalstage
• Their temperament
• Theirperceptionofthedanger
• Theirhistoricalexperiencesoftrauma(andtheircumulativeeffects)
• Theadversitiestheyfacefollowingthetrauma
• The availability of adults who can offer help, reassurance, and protection
In addition to increasing the risk of offending, the incidence of brain injury results in neuro-cognitive
impairmentthatmakesit difcult for these individuals to understand, comply with and comprehend the
consequencesofcriminaljusticeinterventions.Suchimpairmentscaninclude(Williams,2013):
- Makingpoorsocialjudgements(andbehavinginappropriately)
- Alackofcommunicationskillstonegotiateoutofconict
- Poorplanningandinexibility(Mildersetal.,2003)
- Difcultieswithdisinhibition,attention,workingmemoryandexecutivecontrol(Andersonetal.,2006)
- Pooremotionalunderstandingofothers(Tonksetal.,2008)
19TheDefensiveFunctionScaleofDSM-IVdescribeshowsuchdefencescanhaveseveralmanifestations:toabolishimpulse(e.g. by
reactionformation),orconscience(e.g.byactingout),ortheneedforotherpeople(e.g.byschizoidfantasy)orreality(e.g.bypsychotic
denial).Theycanabolishourconsciousrecognitionofthesubject(e.g.byprojection)ortheawarenessofatransgressor(e.g.byturning
againsttheself)orabolishtheidea(e.g.byrepression),ortheaffectassociatedwithanidea(e.g.isolationofaffect/intellectualisation).

Trauma and young offenders – a review of the research and practice literature | 44
- Misperceptionofsituations(notreadingothers’emotions,perceivingthreatwhenthereisnone)
- Difcultiesinconsideringalternativebehavioursorcontrollingimpulses,especiallyinconictsituations
(Pontifex2009)
- Sensitivitytothreatandangerinothers(Wiliams,2013)
Suchyoungpeoplearelikelytoexperienceattachmentdifculties,feelextremelyisolatedandhavefeelings
ofmistrusttowardsstrangers(forexample,resettlementpractitioners).Havingdevelopedsituation-specic
copingskillsthatmaybedescribedas‘maladaptive’incommunitysituations,theywillbepronetoderailing
interventions,eventhosespecicallydesignedtohelpthem(Bailey,2013).Thosesentencedtocustodymay
experienceparticulardifcultiesincopingwithnewsituationsforuptosixmonths(knownas‘adjustment
disorder’)– thiscanariseboth uponenteringand leavingcustody.Thismeans,unfortunately,thatmany
currentcriminaljusticeinterventionswillbehighlydistressingtoyoungoffenderswhoareparticularlypoorly
equipped to deal with such emotional distress.
With limited psychological resources at their disposal, young people who have experienced a range of
childhoodabuseandneglectwilltendtousedistraction,self-soothingorthe‘articial’inductionofapositive
stateinanattempttoreducetheirnegativeemotions.Suicidalideation,self-harm,substanceabuse,binge/
purgeeating,impulsiveaggression,compulsivesexualbehaviour,dissociationanddysfunctionalbehaviour
mayservethepurposeofreducingemotionaldistressinindividualswhohaveexperiencedmultipleforms
of interpersonal trauma (Briere and Rickards, 2007; Herpertz et al., 1997; Zlotnick et al., 1997). The
experienceofPTSDcanresultinnumbnessorfrozenemotionandso,forsuchoffenderswhohavecommitted
violent crime, it is important that they are enabled to come to terms with their violence and become aware
ofthestepsrequiredtopreventitsreoccurrence(Boswell,2013).
Havingsufferedadversity,youngpeoplemayexhibitarangeofcharacteristics,suchas:
Adversity Potential associated characteristics
Trauma (and PTSD) Suspiciousness
Intolerance
Stubbornness
Hypervigilance
Inexibility
Lackingemotion
Numbnessorfrozenemotion
Havingexperiencedviolenceinone’sformativeyearsheightens
sensitivitytothreatandangerinothers
Neurodisability Hyperactivity, impulsivity, poor emotional control
Cognitiveandlanguageimpairment
Alienation
Braininjury Poordecision-makingcapabilities
Limitedabilitytothinkahead
Lackoffeelings
Difcultyinunderstandingothers’perspectives

Trauma and young offenders – a review of the research and practice literature | 45
4.6.1 Trauma and ‘problematic behaviours’
Traumatic experience is very strongly linked in the literature to higher risks of a range of problematic
behavioursincludingaggressionand violence (Widom, 1989), antisocial/criminal behaviour (Greenwald,
2002),sexoffending(Wardand Siegert, 2002), gambling (Scherrer et al., 2007)andsubstancemisuse
(Kilpatricketal.,2003;OuimetteandBrown,2003;Steward,1996).
Thelinksbetweenoffendingbehaviourand‘psychosocialadversity’arewelldocumented(Harringtonetal.,
2005).
Williamsetal.(2010)alsofoundthatthosewithself-reportedTBIhadanaverageoftwomoreconvictions
thanthose without,whileKenneyandLennings (2007)foundthathistory ofheadinjurywassignicantly
associatedwithsevereviolentoffending.Asiscommoninsuchstudies,TBIwasfoundtobeassociatedwith
wide-rangingcognitiveandbehaviouralproblems.PerronandHoward(2008)alsoreportthatmoderateand
severeTBIisassociatedwithgreaterimpairmentofcognitionandbehaviour,psychiatricdiagnosis,earlier
onsetofcriminal behaviour and/orsubstanceuse,morelifetimesubstance use problemsandpast-year
criminalacts.WhileHuxetal.(1998)foundthatthemajorityofTBIsappearedtobemildandhadnolasting
effects, long-term effects on academic performance, behaviour, emotional control, activity level,and/or
interactions with friends and family members were reported by over one-third of the parents of delinquent
youth.ItshouldalsobenotedthatTBIcancauseacquiredspeechandlanguagedifculties(Ponsfordetal.,
1995).
Allof theseformsof abusewerestronglyassociatedwith poorermentalhealthoutcomes (includingself-
harmandsuicidalthoughts) andhigherlevelsof problematicbehaviour.Forexample,youngpeople aged
11–17yearswho had been severelymaltreatedbyaparentorguardianwere sixtimesaslikelytohave
currentsuicidalideationandvetimesaslikelytohaveself-harmingthoughtsthanthosewhohadnotbeen
severelymaltreated.Thoseagedbetween 18and24yearswhowereseverelymaltreatedby aparentor
guardianadultwerefourtimesmorelikelytohavecurrentself-harmingthoughtsthanthosewhohadnot
been severely maltreated.
4.7 Impacts of combined and cumulative traumas
 Therelationshipamongdifferenttraumas–andthesymptomsanddifcultiestheycauseinagiven
individual’slifehistory–canbecomplex.Childhoodabuse,forexample,mayproducevarious
symptomsandmaladaptivebehavioursinadolescenceandadulthood(forexample,substanceabuse,
indiscriminatesexualbehaviour,andreduceddangerawarenessviadissociationordenial)that,in
turn, increase the likelihood of later interpersonal victimisation... These later traumas may then lead to
further behaviours and responses that are additional risk factors for further trauma, and subsequent,
potentiallyevenmorecomplexmentalhealthoutcomes.
 BriereandScott(2013:16-17)
Someyoungpeoplewho havedifcultyregulatingemotionsandimpulseshavebeenexposedtocomplex
trauma (Briere and Scott, 2013).Complex trauma can hinder the development of thinking, relationship
skills,senseofself-worth,memory,andasenseofmeaningandpurposeinlife.Therefore,‘Atthecoreof
traumaticstressisthebreakdowninthecapacitytoregulateinternalstatessuchasfear,anger,andsexual
impulses.’(vanderKolk2005:403).
So, while isolated traumatic incidents tend to produce discrete conditioned behavioural and biological
responsestoreminders of the trauma (suchasidentiedinaPTSDdiagnosis), chronic maltreatment or
inevitable repeated traumatisation, in contrast, have pervasive effects on the development of mind and

Trauma and young offenders – a review of the research and practice literature | 46
brain.Chronic traumainterfereswithneurobiological developmentand the capacitytointegratesensory,
emotionalandcognitiveinformationintocohesivewhole(vanderKolk,2005).
Itis, therefore,extremelyimportant forprofessionalstotake, sensitively,afulllifehistory directfromthe
young person they are working with, to ensure that complex trauma is recognised and worked with
appropriately.Thedangers ofnotdoing soarehighlightedinresearchintoyoungoffenderssentencedto
long periods of custody for offences of serious violence and murder, 35% of whom were found to have
experiencedthedoubletraumaofabuseandlossintheirearlierlives(Boswell,1996).
AsBriereandScott(2013)pointout,bylistingseparatelydescribedtraumas,onemighterroneouslyassume
that such traumas are independent of one another.But, in some cases, experiencing one trauma may
actuallyincreasethelikelihood of experiencinganother.Although not trueof‘noninterpersonal’traumas
(suchasnatural disasters), victims of interpersonaltraumasarestatisticallyat greater risk ofadditional
interpersonaltraumas.Such revictimisation occurs in anumber of ways – those who haveexperienced
childhoodabuseareconsiderablymoreliketobevictimisedagainasadults(Classenetal.,2002;Tjaden
andThoennes,2000)andotherlifestyle,environmental,behavioural,personality,and/orsocialissuescan
increasethelikelihoodoftheindividualbeingrepeatedlyvictimised.So, childabuse andneglectnotonly
producesignicant,sometimesenduring,psychologicaldysfunction,butarealsoassociatedwithagreater
likelihoodofbeingsexuallyorphysicallyassaultedlaterinlife(Classenetal.,2005).
Childhood and adult traumas can produce psychological difculties, so the symptoms and difculties
experienced by adult survivors may represent (1) the effects of childhood trauma that havelasted into
adulthood, (2) the effects of more recent trauma, (3) the additive effects of childhood and adult trauma (for
example,ashbacks to both childhoodandadultvictimisationexperiences),and/or (4) the exacerbating
interactionofchildhoodtraumaandadultassault,suchasespeciallysevere,regressed,dissociated,orself-
destructive responses to the adult trauma. This complicated mixture of multiple traumas and multiple
symptomaticresponsesmeansthatitisextremelydifcult–evenforcliniciansspecialisinginthiseld–to
connect certain symptoms to certain traumas, and other symptoms to other traumas or, in fact, to
discriminatetrauma-relatedsymptomsfromlesstrauma-specicsymptoms.BriereandScott’s2013book
describes assessment and treatment approaches to clarify these various trauma-symptom connections or
examinealternativewaysofapproachingmulti-trauma-multi-symptompresentations.
Behavioursuchassuicidality,substanceabuse,dissociationanddysfunctionalbehaviourmay,amongother
things,specically servethepurposeofreducingemotionaldistressinindividualswho haveexperienced
multipleformsofinterpersonaltrauma.Itmaynotbe thelevelofPTSD alonethat triggersandreinforces
suchbehaviours but,moreimportantly,the effectsofhavingreduced capacitytocontrol onesemotional
responses(Briereetal.,2010).
4.8 Impacts related to brain injury
Brain injury typically affects an individual’s capacity to make decisions, think ahead, and understand
feelingsandtheperspectivesofothers(Williams,2013).Inaddition,neurodisability(includingbraininjury)
hasalsobeenassociatedwitharangeofoutcomesthatinclude:
• Hyperactivity and impulsivity
• Alienation
• Cognitiveandlanguageimpairment
• Poor emotional control

Trauma and young offenders – a review of the research and practice literature | 47
Theseoutcomes increase theriskofoffendingamong the individualsandarealso linkedwithotherrisk
factorssuchastruancy,peerdelinquencyandillicit druguse.Evenonlymild braininjuryamongchildren
andyoung peoplecanset themonthe pathwayfromexperiencingattentiondifcultiestoexhibitingpoor
behaviour,toschoolexclusionandthentooffending.Suchriskisfurtherincreasedbyfactorssuchas:
• Detachment from education
• Challengesinparenting
• Failureofservicestorecogniseandmeetspecialistneeds
It is well established that particular neurological systems are of key importance to the way in which
individualsmakedecisionsandanticipatethelongertermconsequencesoftheirbehaviour,andalsotothe
way in which individuals control their impulses (Teicher, 2002). It is also well known that these systems
normallygrowanddevelopduringchildhoodandadolescence,andthatthisdevelopmentcanbeadversely
affectedbybraininjury.Itis,therefore,notsurprisingthatthereisaparticularlystronglinkbetweenbrain
injuryandoffendingbehaviour.Williamsdescribesthisconnection:
 Aschildrendevelop,theirbrainsbecomeevolvedtomanagemorecomplexity,andskills,suchas
these,come‘online’.Childrenandyoungpeoplethereforehaveadegreeofneurologically-based
immaturityrelativetoadults.Unfortunately,thisisatime-periodalsowhereriskofTBIisveryhigh–
theimpactofwhichlimitsmaturitystillfurther.Notsurprising,then,TBIinearlylifeseemstobea
majorissuewithinoffendergroups.Itisassociatedwithearlieronset,moreserious,andmorefrequent
offending.Ofcourse,itisimportanttonotethatitisnotpossibletoknowforcertainhowbraininjury
increaseslikelihoodofoffending,andtheremaybeunderlyingriskfactorsforTBIandoffending
behaviour,includingdeprivation,lackoflifeopportunities,lowconcernforself-care,andevenbeinga
person who ‘takes risks’.
 Theresearch,however,seemstoshowthatTBIisaverystrong‘marker’fortheseotherfactors.Itisfair
tosaythatthecognitiveandbehaviouralproblemsnotedherearecommonlyobservedwithinthe
youngandadultoffendercohorts.EarlyrecognitionandinterventionwhenthereisaTBIinchildhood
and adolescence, as well as in adults, could help to reduce crime.
 (Williams,2012:29)
Findingsfroma number of studiessupport that generalconnectionbetweenTBI and offending,and the
presenceofreportedTBIwithinoffendinggroups.Astudyofyoungoffenders(aged16-18years)incustody
intheUKfoundthatof 186participants,65% reportedthata traumaticbraininjury (TBI)renderedthem
‘dazedandconfused’(Williamsetal.,2010).Forty-sixpercentsufferedanadditionallossofconsciousness
andfor17%thathadlastedformorethan10minutes.Justunderone-thirdofthesample(32%)reported
havingsufferedmorethanoneTBI.SufferingaTBIduringchildhoodorearlyadolescencemarkedlyincreased
theriskofcriminaloffendingamongmentallydisorderedmalesinthecohort.Furthermore,theonsetage
ofoffendingwassignicantlyearlieramongthosehavingTBIsbeforetheageof12thanforthosewhohad
a TBI between the ages of 12 and 15. TBI was also strongly associatedwith co-morbid mental health
disorders and alcoholism.
SimilarrateshavebeenfoundbyDaviesetal.(2012),whoreportedthat72%ofyoungoffendersincustody
intheUKreporthavingexperiencedatleastoneTBIofanyseverity.Forty-onepercentreportedhavinglost
consciousnessand46%reportedsufferingmorethanoneinjury.
Theselinksbetweenbraininjuryandoffendingbehaviourarealsoanchoredinthemoregeneralimpactsof
suchinjury– includinglossofmemoryorconcentration, adiminishedability tomonitoremotionalstates

Trauma and young offenders – a review of the research and practice literature | 48
(bothone’sown,andthoseofothers),anddifcultiesinassessingandnavigatingsocialsituations(Turkstra
etal.,2003;Williams,2012).Forthosewhohavesufferedbraininjuryitismorelikelythatimmatureand
antisocial behaviour, as well as difculties controlling impulses and exercising restraint in the use of
aggression(Andersonetal.,2009),willcontinuefurtherbeyondadolescence.
SomeoftheseimpactsarealsoofclearrelevancetotheabilityofyoungoffenderswhohavesufferedTBIs,
toengage in interventions designed toreduceoffending,tocomplywith conditions imposed on them by
somesentencesandmonitoringarrangements,andtofollowadviceabouthowtobettermanagedifcult
situations.It is because of difculties of thiskindthat researchers such as Williams recommend that a
broad focus be adopted, and that service provision both for those already in the system and for those at risk
ofTBI might require‘closecooperation betweencriminaljustice, health,socialandeducational systems’
(Williams,2012:29).
4.9 Summary
Traumacanhaveaverywiderangeofimpacts,withtheseimpactsalsobeingmediatedbyanumberofkey
factorsincludingthetypeof eventthat gaverise tothe trauma,previousexperienceoftraumatic events,
individualresilience,thedegreeofsupportthatanindividualhas,andthesocio-economiccontextinwhich
theindividual lives.Becauseof wide variationsintermsofthesefactorsandtheirpresence inindividual
cases,similareventscanhavewidelyvaryingimpactsondifferentindividuals.
In terms of development, trauma can have adverse effects on socialisation and also on the individual’s
scopeforformingrelationshipsorattachments.Theseadverseeffectsaremultipliedorcompoundedwhere
traumaticeventshavebeenchronicorongoing,andwheretheyareinterpersonalinnature.
Trauma is also associated with difculties concerning memory and dissociation, where traumatised
individualsdistancethemselvespsychologicallyfromexperiencethatisperceivedtobeoverwhelmingand
toodifculttoprocessorresolve.
In terms of behaviour, trauma is strongly associated with a range of ‘problematic behaviours’ including
aggressionand violence, antisocial/criminal behaviour,sexoffending,gambling,and substance misuse.
Traumaticexperience is found disproportionatelyinthe backgrounds of individuals who engage in such
behaviour,and such experience also increases the likelihood that individuals will suffer from particular
mentalhealthdifcultiesincludingdepressionandPTSD,andmoregenerally,fromanxietyandstress,and
perceptions of low self-worth.
Thereisevidence tosuggestthatprevious traumaticexperienceisalso relatedtoagreater likelihoodof
subsequent re-victimisation.
Althoughtheimpactoftraumaonbraindevelopmentisrelativelynewareaofresearch,itisclearfromthe
evidencethattraumaticexperiencedoesaffectbrainsystemsthatplayakeyroleinregulatingemotion,and
that trauma can alter brain systems in such a waythat there is an increased likelihood of aggression,
anxiety,andsuicideandself-destructivebehaviour.Themostrecentresearchsuggeststhattrauma-related
stress(andthebiochemicalcorrelatesofstress)playsakeyroleinsuchchanges.
Traumaticbraininjuryitselfcanalsohaveimpactsthatarequitesimilartothoseoftraumamoregenerally,
andthereisastrongoverlapbetweentherisksofhavingsuchinjury,andtherisksofsufferingfromother
kindsoftraumaticexperience(suchaschildabuse,neglect,orinterpersonalviolence).

Trauma and young offenders – a review of the research and practice literature | 49
5. TRAUMA-INFORMED PRACTICE
 Peoplewithchildhoodhistoriesoftrauma,abuseandneglectmakeupalmostourentirecriminal
justice population.
(Teplin et al., 2002)
5.1 Why is trauma an important consideration for resettlement practice?
As earlier sections of this report have explored, young offenders’ histories can involve a wide range of
adverse childhood and adolescent experience, including assaults and bullying, domestic violence,
abandonment,separation and bereavement,as wellaswitnessingfamily,schoolor community violence.
Offendersarealsomorelikelytohavesufferedbraininjuryduringchildhoodandadolescencethanistypical
fornon-offendinggroups.Theavailableevidence makesitclearthat offendersare more likelythannon-
offenderstohavesufferedadverseemotional, social,neurologicalanddevelopmentaleffectsfromthese
traumaticexperiences,andthatsomeoftheseimpactsalsoappeartobelinkedtooffendingbehaviour.For
thosereasonsaloneitwouldbeimportantforpractitionerstohavesomeawarenessofissuesconcerning
trauma.Theavailableevidencealsosuggeststhattheeffectsofprevioustraumacannarrowthescopefor
generatingpositiveresettlementoutcomeswithyoungpeopleandyoungadults–itisthereforecrucialthat
understandingof,andappropriateresponsesto,traumaformpartofanyresettlementactivity.
Theeffectsofprevioustraumacan,forexample,erodeayoungperson’scapacitytojudgesocialsituations,
formattachments,copewithstress,consider long-termconsequences,negotiatetheirwayoutofdifcult
situations and respond to authority.
We know that adversity affects children’s brain development and that experiencing violence in one’s
formativeyearsheightenssensitivitytoperceivedthreatandangerinothers.Butinadditiontoincreasing
theriskofoffending,theimpairmentofneuro-cognitivedevelopmentmaymakeitmoredifcultforthese
youngpeopletounderstandandcomplywithcriminaljustice interventions and also to comprehendthe
consequencesofbreachingthem.
Whentakentogether,theevidencepresentedinthisreportstronglysuggestsnotonlythatpeopleinvolved
inoffendingaremorelikelytohavehadadisproportionateamount oftraumaticexperience, butthatthe
impact of those experiences is also likely to reduce the scope for traditional ‘change programmes’ to
generatepositiveoutcomes. There are several reasons for this. Thereare, of course, many people who
simplydonothavean interest in changing, but eventhislackofmotivationto change may be linkedto
previousexposuretotrauma.AsGreenwald(2009)putsit:
 Exposuretotraumaorlossisextremelycommonamongthosewithproblembehavioursandcanlead
toarangeoftreatmentimpediments.Trauma-exposedindividualsmayhaveimpairedempathyandnot
care about the pain they cause others. Posttraumatic stress symptoms may cause your clients to feel
reluctanttotrustyou,dubiousaboutthevalueoftreatment(nothinggood’sgoingtohappenanyway,
sowhybother?),fearfuloffacingemotions,andhighlyreactivetoapparentlyminorprovocationsor
other stressors. In short, posttraumatic stress symptoms may not only contribute to the client’s
behaviourproblemsbutalsopreventyoufrombeingabletohelpyourclienttoresolvetheproblems.
 (Greenwald,2009:ix)
Thechallengefacedbytheseyoungpeopleintryingtocomplywiththecriminaljusticesystemisapparent
whenonereectsthattheyarelikelytohave difculty in controlling impulses and making plans, and in
assessingsocialsituationsandlongertermconsequencesoftheiractions(seesection4.6).

Trauma and young offenders – a review of the research and practice literature | 50
So,youngpeoplewithhistoriesoftraumafaceanumberofimpedimentstoengagingwithandsustaining
involvementininterventions–eventhoseexplicitlydesigned withtheirbestinterestsatheart.Therefore,
acknowledgementoftrauma and its effectsishighly important to thewayinwhich providersworkwith
youngoffenders,theapproachestakentoengagementandtheeffectivenessofeffortstogeneratepositive
resettlement outcomes.
At the current time however, knowledge about the complexities of exposure to trauma, its impactupon
offendingandtheimplicationsforeffectiveresettlementpracticeisverylimited.Researchintothepotential
for psychological interventions with traumatised young offenders is not sufciently advanced to allow
absolute certainty about how best to meet their needs. Substantial investment in mental health support for
youngoffenders is needed, both in termsofscreening/assessment and, equally importantly, the actual
provision of treatment. As Grimshaw explains, ‘Unless there is an adequate mental health services
frameworkforthisgroupofyoungpeopletheextentandcharacteristicsoftheirtraumaswillnotbebrought
to the surface.’ (Grimshaw et al., 2011)
Yet,giventheavailableevidenceconcerningtheprevalenceoftraumaticexperienceinthebackgroundsof
youngoffendersandtheimpactofthatexperienceondevelopmentandbehaviour,therearealreadysome
clear implications for resettlement practice. Aswesawinsection4.2,traumatisedyoungpeopleoftenfeel
extremelyisolatedandhaveadeepmistrustofstrangers.Interactionwiththecriminal justice system will be
perceivedashighlythreateningandextremelydistressingtotheseyoungpeoplewhoareparticularlypoorly
equipped to deal with such stress.Custodialsentencesmaybeextremelydamagingto them.
5.2 Trauma and desistance
Giventhe details outlinedinprevioussections concerningtheimpactsof trauma, itshouldbeclear that
backgroundtraumainthelivesofyoungoffenderswillbeofkeyimportancetoprocessesofdesistance,and
tothecapacityofyoungpeopletoengagewithinterventionsdesignedtopromotedesistance.
InapresentationoftheirTraumaRecoveryModel(TRM),SkuseandMatthew(2015)arguethattheimpacts
oftraumaonindividualdevelopmenttendtobluntthe ‘cognitivereadiness’ofyoungoffendersin several
keyrespectsandthatthis,inturn,reducestheirscopeforderivingbenetsfrommanyprogrammes–such
asangermanagementand victim empathyprogrammes,andsomecognitivebehaviourtherapy (CBT) –
designedtopromotedesistance.
InterventionsofthiskindtendtobedesignedtoaddressbehaviourratherthanwhatSkuseandMatthew
call the ‘underlying developmental and psychological drivers’ (2015:15) of such behaviour. Hence, the
impactsoftraumamaybelinkedtohigherratesofnon-engagementordisengagementofyoungpeoplein
suchprogrammes.
Whatisrequiredinsteadareapproachesthatarelayeredorsequential,withearlystagesofworkfocusing
more directly on basic routines and physical safety, since these are prerequisites for later articulation about
(andprocessingof) previous traumatic experience. In short, effectivedesistance requires a levelofself-
awarenessandself-efcacywhichcanbebluntedbytheeffectsofprevioustrauma–asSkuseandMatthew
put it:
 Non-offendinglifestyleswithinthecommunityandtheopportunitiestoadoptthemaremorelikelyto
beavailableandattainabletoyoungpeoplewhohaveprocessedsomeoftheirownexperiencesand
whohaveanongoingsupportiverelationshipwithanadultoragencywhocanguidethem.
 (SkuseandMatthew,2015)

Trauma and young offenders – a review of the research and practice literature | 51
Similarcommentsabouttheneedfor‘sequencing’supportfordesistanceinordertorecogniseandaddress
background trauma has also been offered by Wilkinson (2009), who describes how participants in her
researchneededtoaddressemotionalissuesrelatingtofeelingsofpersonalcontrolandself-awareness,
beforetheycouldmoveontodevelopwhatwouldnormallyberegardedaskey‘stakesinconformity’.More
generally,shedescribesthewayinwhichtheexperienceofprevioustraumacanhaveakeyeffectonthe
readinessofindividualoffenderstodevelopnewnon-offendingnarratives.
Anderson(2016)alsoforgesusefullinksbetweendesistanceresearchandtheliteratureontrauma, and
arguesthatbearingwitnesstooffenders’previousvictimisationandtraumacanbeacrucialformofsupport
for the desistance process itself.
Linksofthiskindarehighlypromisingfortheeld,althoughresearchfocusingdirectlyonthemhasbegun
to appear only very recently.20
5.3 What is trauma-informed resettlement?
Thereisnowanextensive(andgrowing)literatureontrauma-informedpracticewhichfocusesonarangeof
areasincludingviolence/aggression,offendingandantisocialbehaviour,andsubstancemisuseandother
addictivebehaviour.Trauma-informedpracticeisdenedinanumberofwaysbutmostdenitionsfocuson
awareness-raisingandtraining,theprovisionofsafeenvironments,reducingthescopeforre-traumatisation,
andthecoordinationofprovisiondesignedtoincreaseresilienceandsupport.
Cooperetal.(2007)offerthefollowingdenition:
 Trauma-informedpracticesrefertoanarrayofinterventionsdesignedwithanunderstandingofthe
roleofviolenceand/ortraumainthelivesofchildren,youth,andtheirfamilies.Trauma-informed
strategiesultimatelyseektodonofurtherharm;createandsustainzonesofsafetyforchildren,youth,
andfamilieswhomayhaveexperiencedtrauma;andpromoteunderstanding,coping,resilience,
strengths-basedprogramming,growth,andhealing.Strategiesincludeanarrayofservicesand
supportsthatscreenandassessappropriately,providetrauma-specicserviceswhenneeded,
coordinateserviceswhennecessary,andthatcreateenvironmentsthatfacilitatehealing.
Another, much referred to denition describes trauma-informed approaches as incorporating three key
elements: an understanding of the prevalence of trauma, recognition of the effects of trauma both on
clientsandonthosewhoworkwiththem,andthedesignofserviceswhichareinformedbythisknowledge.
In other words:
 Aprogram,organisation,orsystemthatistrauma-informedrealizesthewidespreadimpactoftrauma
andunderstandspotentialpathsforhealing;recognizesthesignsandsymptomsoftraumainstaff,
clients,andothersinvolvedwiththesystem;andrespondsbyfullyintegratingknowledgeabouttrauma
intopolicies,procedures,practices,andsettings.
Substance Abuse and Mental Health Services Administration (SAMHSA)
Keyfeatures of trauma-informedapproachesrelatetofour keyareasoffocuswhichareexploredinthe
followingsectionsofthereport:
20Given someof thekeyndingspresentedinthisreport however,itis perhapssurprisingthat documentssuch astherecent HMI
Probationinspectionfocusing on‘Desistanceandyoungpeople’ (HMIP,2016)donotevenmentiontraumaorits linkswith offending
byyoungpeople.Within thebroader desistanceliterature aswell, therehavebeenfew referencestothe impactoftrauma untilvery
recently.

Trauma and young offenders – a review of the research and practice literature | 52
• Staffawareness,trainingandsupport
• Assessment
• Approachestoworkingwithyoungoffenders
• Considerationofthetherapeuticwindow
5.3.1 Staff awareness, training and support
Thedevelopmentoftrauma-informedpractice involvesequippingkeystaffwith knowledgeabouttrauma
anditseffectsandsupportingthemintheirworkwithpotentiallytraumatisedyoungpeople,bothbyensuring
thatthere aremechanismsin place forindividual monitoringanddebrieng andbypromotingintegrated
teamwork.
Psychologicallyawareapproachesrecognisethatyoungpeoplewithchallengingbehaviourhaveparticular
supportneeds,oftenarisingdirectlyfromtheirexperiencesofearliertraumaandabuse.Trainingenables
practitionerstodevelopclearandsuitablyconsistentresponsestoyoungpeoplewhomaybechaoticand
distressedandwhohavelearnednottotrust.Withmoreinsightintohowtraumatisedyoungpeoplebehave,
staffcan workmoreeffectivelywiththem,helpingthemtogainanunderstandingoftheirownbehaviour,
takeresponsibility for themselvesanddevelopnegotiated, positiverelationships.Thisapproachleadsto
muchbetterriskmanagement. Itenablesstafftoworkwith thechallengingbehaviourofyoungpeople–
ratherthanrestrictingtheiraccesstosupport until behaviourchanges–sothat vulnerable and chaotic
young people are not excluded from services. This approach is sometimes called ‘elastic tolerance’
(WoodcockandGill,2014),allowingbehaviourthatmightnormallyresultinexclusionfromaservicetobe
tackledcreativelyandwithexibility,therebyaddressingthebehaviourwithoutrejectingtheindividual.
Suchtrauma-informedresettlementis deliveredbypractitioners whounderstandthattraumatised young
people are likely to be in an almost permanent state of emotional arousal – prone to emotional outbursts,
frustration,fury,depressionanddespair.Theseyoungpeoplealsodisplayhighlevelsofimpulsivityandrisk
taking, and in groups may display ‘emotional contagion’. Therefore, one key goal for any resettlement
interventionistoconstantlyde-escalateemotionaltension,ratherthanseektopunishor‘teachalesson’;
apersonoodedbyemotionisunabletounderstandsuch‘lessons’(Bath,2008).
Staffworkingintensivelywithyoungoffendersshouldalsobeassistedinbuilding theirownpsychological
resilience–mappingouttheirownvulnerabilitiesandstrengthsandprotectingthemselvesagainstvicarious
trauma.21Itisimportanttoacknowledgethatparticularyoungpeoplemaygeneratesomenegativefeelings
instaff,includingfrustration,despair,angerandhatred.Staffneedtobeabletodiscloseandexploretheir
emotionsina supportive environment in order to manage their feelings effectively.But, while staff may
struggletoempathisewith alloftheyoungpeople theysupport,it isperhapsevenmore riskyforstaff to
over-identifywithyoungpeople.Inthesecases,staffcanleavethemselvesvulnerableiftheyhavefantasies
aboutbeingableto‘rescue’youngpeopleasthismayleadthemtounderestimatetherisksthattheymay
pose.
It is already recognised that YOTstaf f and those working within the secure estaterequire suppor t and
supervision,butthatthenecessarylevelsofsupportarenon-existentorinadequate,evenfollowingmajor
incidents(Harringtonetal.,2005).Itisimperativethenthatsubstantialinvestmentisdevotedtotraining,
supervisionandsupportforstaffworkingintensivelywithtraumatisedyoungoffenders.
21TelephoneconversationwithDrAndyCornes,EvertonFreeSchool,October2014.

Trauma and young offenders – a review of the research and practice literature | 53
In summary:
• Professionalsneedtobeequippedwitharmknowledgebaseabouttraumaandhowtorecogniseit;
staffandpartnersmayneedtraininginattachment/traumaprinciples
• Staffwillneedsupporttomanagetheirownemotionsanddealwithstress
• Workwillneedtobestructuredinawaythatfacilitatesstaffworkingaspartofaunitedteam
5.3.2 Screening and assessment
As previously stated, because trauma undermines a child’s developmental progression, most young
offendershavespecicsupportneeds,particularlyinrelationtotheiremotionalhealthandfunctioning.As
Boswellalsopointsout(2013),22itshouldnotbesuggestedthattraumaisthesolecauseofoffendingor
that every abused child becomes an offender. However,traumaissoprevalentamongthisgroupofyoung
peoplethatsystematicscreeningandthoroughassessmentiswarranted.
Becausetraumaandmentalhealthproblemsarelikelytoinuencethesuccessofresettlementwork,itis
vital that young offenders’ mental health needs are systematically screened for, and responded to with
timelyprovisionofappropriatespecialistsupport(Harringtonetal.,2005).Previousprocessesandmethods
of assessing mental health needs among young offenders have been ineffective. The Harrington et al.
(2005) study revealed substantial levelsof missing or non-completed assessments for young offenders
underYOTsupervision.23Furthermore,havingassessed600Assetforms,theyfoundthatonly15%ofyoung
offenderswereidentiedashavingmentalhealthproblems,whereastheirnationalstudy(whichusedafully
validatedmentalhealthscreeningtool)identied31%ofyoungoffendersashavingamentalhealthneed.
Theyconcluded:‘Asset,therefore,isnotsufciently sensitiveinidentifying mentalhealthneeds inyoung
offenders.’
WhileintegratedmentalhealthassessmentisnowbeingrolledoutacrossYOIs,itisimperativethatthisis
supplementedbysufcientcommunity-basedmentalhealthresourcesandfullytrainedstaff(Harringtonet
al.,2005).
• Expectationsforprogressneedtobeinformedbyanunderstandingoftraumaanditsimpact.
• Participantsneedregularandreliablefeedbackabouttheirprogress.
• Positiveshiftsinresilience,impulsivity,hope,self-condenceareimportantandsuggestpositive
longertermoutcomes(e.g.reducedre-offending,employabilityandtraumaresolution).
In the community, structured risk and mental health assessment should form the basis for planning
interventions.SpecicassessmentforPTSD,abuseandsignicantlossamongviolentoffenderswouldbe
benecial(Boswelletal.,2003),althoughthetimingofsuchworkneedscarefulconsideration.Closeliaison
withother agenciesworkingwith the youngoffendermaybenecessarytoprovidefullerinsight intotheir
backgrounds.Moreover,asNader(2011)pointsout,becausedevelopmentalissuesinuencethenatureof
children’sreactionstotrauma,itiscrucialthatdiagnosticcriteriaandassessmentmeasuresarespecically
designedfordifferentdevelopmentalagegroupsinordertofacilitatetheselectionofappropriatetreatment.
22Seealso:SmithandMcVie(2003);LöselandBender(2006).
23In46(8%)ofcases,Assethadnotbeencompletedwhenitshouldhavebeen.In anequalnumberofcases (n=46),thelesofthe
youngpeoplecouldnotbefoundtoascertainwhethertheAssethadbeencompletedornot.InAsset,thoseidentiedwithmentalhealth
problemsscore a three or fouron the mental health section.Ofthe 600 Asset formsevaluated,only 15% ofyoungoffenders were
identiedashavingmentalhealthproblems.Thisismuchlowerthanthe31%identiedashavingamentalhealthneedinthisnational
study,usingtheS.NASA–thefullyvalidatedmentalhealthscreeningtool.

Trauma and young offenders – a review of the research and practice literature | 54
However,whenconsideringappropriatearrangementsforassessmentitisworthkeepinginmindthat:
• Youngcustody-leaversfrequentlycomplainaboutwhattheyregardasover-assessment(andmanyof
theyoungpeoplethattheBYCresearchteamhasspokenwithovertheyearshavepointedthisout
directly to us).
• Youngpeopleareoftenresistanttoassessmentswhichareperceivedtolabelthemasvictimsoras
havingemotional/mentalhealthproblems.
• Thereisamoregeneralproblemconcerningassessmentsthattheyareperceivednottobefollowed
upbyanymeaningfulserviceprovision;manyyoungpeoplehavecommentedtoourresearchteam
thattheyaresubjectedtonumeroustestsandthen“nothinghappens”.
Thegeneralpoint to makehere – which applies to trauma-informed practice as well as to resettlement
practicemoregenerally–isthatassessmentofneedideallyshouldbelinkedtodecisionsaboutaccessing
appropriateservices,ratherthan beingpartofa moregeneralapproachtotyoungpeopleintoservices
that are available.
5.3.3 Interventions with young offenders
 Placingchildren’swelfareattheheartofeffortstotackletheiroffendingdoesnotmeanoverlookingor
minimisingthedifcultiesandharmthatthesechildren’sbehaviourcauses.Ensuringthatchildren
understandandtakeresponsibilityfortheirwrongdoing,andmakeamendswhereverpossible,can
andshouldbeanintegralpartofawelfare-basedapproachtooffending.Thisisanapproach,
therefore,thatrecognisesjusthowtroublesomeisthebehaviourofmostchildrenwhoaresentenced
tocustody,whilstalsorecognisingthatthesechildrenarethemselvesverytroubled.
(Jacobson et al., 2010)
Understanding the impact of trauma upon young offenders leads to more effective interventions, and
helpingyoungpeopletobuildtheirpersonalresilienceandsocialsupportsystemsshouldformanimportant
partofallresettlementwork.Therearearangeofinterventionsthatcansignicantlyimprovetheemotional
wellbeinganddesistanceoutcomesforyoungpeople.Educationalandsocialservicescanhelptoprevent
theonsetofseriousviolence(Krugetal.,2002;Silvestrietal.,2009;Rose,2010),supportforparentsand
children affected by domestic violence can reduce harms (WHO/Liverpool JMU, 2009), and children
convictedofgraveoffencescanbenetfromtheservicesprovidedbyLocalAuthoritySecureUnits(Cavadino
and Allen, 2000:14).
Thereis great scope for being able to help youngoffendersmanage their emotions and behaviours. By
addressingtheemotionalandpsychologicalneedsofyoungpeople,services can enable them to better
managetheiremotionsandbehavioursasarststeptowardsmakingotherlong-lastingpositivechangesin
theirlives.Trauma-informed approachesthat seektobuildyoungpeople’sstrengths andattachment can
helptominimisetheimpactoftheircomplicatedlivesandtraumaticexperiences,reducing thelikelihood
that they will engage in high-risk and anti-social behaviour. In other words, ‘The more strengths these
childrenhavedeveloped,thelesslikelytheyaretoengageinhigh-riskbehaviours.Thisresiliencehasmajor
implicationsforbothpreventionandtreatment’(Grifnetal.,2009).
As Leon (2002) identies, meeting the mental health support needs of young offenders is critical for
desistance-focusedwork.Earlydetectionofyoungpeople’s traumaand/ormentalhealth difcultiesmay
reduce both their potential to develop a more chronic disorder in adulthood and the likelihood that they
persistwithoffendingintoadulthood.Ofcourse,providingaccesstotreatmentisnotassimpleasitsounds.

Trauma and young offenders – a review of the research and practice literature | 55
Mostpeople,includingyoungpeopleinthecriminaljusticesystem–andeventhosewithseverepsychiatric
disorders–haveanegativeattitudetowardstheissueofmentalhealthandastrongreluctancetoengage
withanypsychologicaltreatment.Failuretoattendappointmentsorengagewiththetreatmentprocessis
common and, perversely, mental health services typically refuse to work with potential clients who either
misusesubstancesormissappointments,nomatterhowintertwinedwithmentalhealthdifcultiesthose
behaviours are.
Thisis a complexeld of work and no simple blueprint for intervention can be established. Whileevery
individualwillhavetheirownspecicsupportneedsandpreferredstylesofengagementandcommunication,
therearealsopersonalcharacteristicsthatwarrantconsideration.Youngpeoplefromethnicminoritiesare
over-representedincustodyandarelikelytohavespecicneedsthatwarrantfurtherstudy.Gendershould
alwaysbeconsideredwithrespecttoantisocialbehaviourandoffendingbecause ofthedifferentratesof
antisocialbehaviourattributabletoyoungmenandyoungwomen.Thereisalsotheissueoftherelationship
between mental health problems and physical health problems which further complicates the development
ofeffectiveinterventionsforthesegroups.24
Resettlement interventions need to be informed by an understanding of the roots of young offenders’
challengingbehaviourand awarenessof the appropriate responses. This includes amore sophisticated
interpretationoftheirdisinclinationtoengage–notsimplylabellingthemasanindividual‘unmotivatedto
change’,butratherbeinginneedofsupporttobuildandfostertheiroptimism,condenceandcommitment.
Itis,therefore,importanttoopenlyacknowledgeboththedegreeofadversityfacedbyyoungoffendersand
thespecicchallengestheyfaceinadaptingtonewsituations(particularlyadjustingtocustody,orreturning
to the community).
NICE(2005)offerpractitionersthefollowingguidanceon addressingthementalhealthneedsofchildren
andyoungpeople(andinparticularwherethoseneedsarelinkedtotrauma-relateddepression):
• Healthcareprofessionalsinprimarycare,schoolsandotherrelevantcommunitysettingsshouldbe
trainedtodetectsymptomsofdepression,andtoassesschildrenandyoungpeoplewhomaybeat
riskofdepression.Trainingshouldincludetheevaluationofrecentandpastpsychosocialriskfactors,
suchasage,gender,familydiscord,bullying,physical,sexualoremotionalabuse,comorbiddisorders,
includingdrugandalcoholuse,andahistoryofparentaldepression;thenaturalhistoryofsingleloss
events;theimportanceofmultipleriskfactors;ethnicandculturalfactors;andfactorsknowntobe
associatedwithahighriskofdepressionandotherhealthproblems,suchashomelessness,refugee
statusandlivingininstitutionalsettings.
• Healthcareprofessionalsinprimarycare,schoolsandotherrelevantcommunitysettingsshouldbe
trainedincommunicationsskillssuchas‘activelistening’and‘conversationaltechnique’,sothatthey
candealcondentlywithacutesadnessanddistress(‘situationaldysphoria’)thatmaybeencountered
inchildrenandyoungpeoplefollowingrecentundesirableevents.
• Achildoryoungpersonwhohasbeenexposedtoarecentundesirableevent,suchasbereavement,
parentaldivorceorseparationoraseverelydisappointingexperienceandisidentiedtobeathighrisk
of depression (the presence of two or more other risk factors for depression), or where one or more
family members (parents or children) have multiple-risk histories for depression, then should be
offeredtheopportunitytotalkovertheirrecentnegativeexperienceswithaprofessionalintier1and
assessedfordepression.Earlyreferralshouldbeconsideredifthereisevidenceofdepressionand/or
self-harm.
24Forfurtherreadingonthesecomplexresettlementissues, see‘Recognising diversityin resettlement:a practitioner’sguide’ (BYC,
2015), ‘Ethnicity,faithandcultureinresettlement:apractitioner’sguide’(BYC,2015) and ‘Developingagender-sensitiveapproachto
resettlement:policybrieng’(BYC,2015)

Trauma and young offenders – a review of the research and practice literature | 56
• Wheneverhealthcareprofessionalscomeintocontactwithchildrenandyoungpeoplewholivein
familiesundergoingemotionalupheaval,thementalhealthneedsofthechildren/youngpeopleshould
beconsidered.Recommendedactionmayincludereferraltorelevantsupportgroups(forexample,
relatingtoyoungcarers,substancemisuse,bereavement)orothertargetedself-helpoptions(e.g.
leaets).Duetothecommonoccurrenceofdepressionintheoffspringofdepressedparents,special
considerationshouldbegiventoassessingandsupportingchildrenwithfamilymembersbeingtreated
for depression.
• Familyriskfactorsfordepressioninchildrenandadolescentsincludeparent-childconict,parental
discord, divorce and separation, parental death, parental mental illness and parental substance
misuse...Theriskisthoughtnottolieinthevariablepersebutinitseffectsonattitudes,behaviour
and relationships within the family.
• Depressionmaynotberecognisedassuchbythoseworkingwiththechildoryoungperson(teachers
and school support staff, youth workers, sports coaches, social workers and so on, who may be
employedbystatutoryagenciesinprimaryhealthcare,socialcare,education,orinthevoluntary
sector. Their primary concern may be a behavioural manifestation associated with the depression, like
substancemisuse,delinquency,bullyingorchildabuse.Shameandfearofblamemaymakeithardto
assessthisinsuchsettings.InterventionsmaynothaveinputfromCAMHS[ChildandAdolescent
MentalHealthServices]professionals.
• Whenassessingachildoryoungpersonwithdepression,healthcareprofessionalsshouldroutinely
consider, and record in the patient’s notes, potential comorbidities, and the social, educational and
familycontextforthepatientandfamilymembers,includingthequalityofinterpersonalrelationships,
both between the patient and other family members and with their friends and peers.
However, in addition to this, an awareness of trauma and its effects is also required in order to usefully
informourunderstandingofyoungoffenders’challengingbehaviour,andinformdecisionsaboutappropriate
responses.Forexample,violentoraggressivebehaviourcansometimesbeadaptivefortraumatisedyoung
people,ratherthananindicationofalackofdisciplineoranabsenceofmotivationtochange.Punitiveor
reactive responses can serve to entrench problematic behaviour in such cases rather than address it,
whereassupporttobuildandfosteroptimism,condenceandcommitmentcanbemoreeffective.
Although initially developed for looked after and adopted children, one model that is also helpful in
considering and prioritising approaches and interventions forworking with young offenders is Golding’s
(2007) pyramid of need. This is presented below:
Figure 4 Pyramid of need (Golding 2007)
FEELING SAFE
PHYSICALLY AND EMOTIONALLY
DEVELOPING RELATIONSHIPS
COMFORT & CO-REGULATION
ELICITING CARE FROM RELATIONSHIPS
EMPATHY & REFLECTION
MANAGING BEHAVIOUR IN RELATION TO OTHERS
RESILIENCE & RESOURCES
SELF-ESTEEM & IDENTITY
EXPLORE TRAUMA,
MOURN LOSSES

Trauma and young offenders – a review of the research and practice literature | 57
Asthisdiagramhighlights,therstpriorityistocreateanenvironmentwhereyoungpeoplecanfeelphysically
and emotionally safe – anygroup work activities should be carefully planned to ensure that the risk of
conict between young people is minimised and can be controlled. The next consideration is about
developingpositiverelationshipssothatyoungpeopleareabletoreceivecomfortandcarefrompractitioners
in a carefully boundaried manner.This provides space for young people to reect on their interactions,
enablingthemtodevelopempathyandbettermanagetheirrelationshipsandbehaviourwithothers.The
youngpersonisthenabletodeveloptheirself-esteem,identityandresilienceand,fromsuchaposition,can
begintoaddressthetrauma(s)thattheyhavesufferedandmakepositiveprogress.
Thedevelopmentoftrustbetweenyoungpeople and staff is important in order to help them overcome
‘maladaptive’responsesthatmayunderminethe effectiveness of any interventions. Youngpeople’s full
engagementandownershiparekeyastheyneedtofeelpartoftheirownchangeprocess.Youngoffenders
may need specic support to overcome emotional constraints and to learn to manage their emerging
feelingsappropriately.YoungpeoplewithPTSDwhohavecommittedviolencearelikelytoneedhelptocome
to terms with their actions and the consequences. Even where it is not possible to alter an individual’s
cognitive ability,practitioners can seek to change behaviour (Williams 2013),enabling young people to
bettermanagetheirchangingemotionalstates.
While the key aim of the criminal justice system is to reduce or prevent offending, trauma-informed
resettlementpracticerequiresusalsotoconsidertheyoungperson’ssafety–bothfromotherswhomay
seektovictimisethem,butalsofromthefrustration,despairandangerthattheymayfeelatthemselves.
Such practice also involvesanother consideration: the personal safety and emotional wellbeing of staff
workingcloselywiththem.Thesethreeprioritiesareconsideredinmoredetailbelow:
Helping young people Thedevelopmentofatrustingworkingrelationshipisnecessarybefore
undertakingin-depthassessment,inordertoidentifytheyoung
person’striggerpointsfor(self-)destructivebehaviourandplan
appropriateinterventions.Anemphasisonhelpingyoungpeopleto
develop and sustain positive support networks is crucial.
Protecting the community Thefullrangeofagenciesworkingwiththeyoungpersonneedsto
cooperatetostrategiseandmanagerisk.Safe,accountableand
defensible practice must be delivered consistently by staff from all
agencies.
Ensuring staff safety Thedevelopmentoftrustingrelationshipscanbequitethreateningto
someyoungpeople–especiallyifattemptstocontrolbehaviour
replicateaspectsofpreviouslyabusiverelationships.Whileitis
importanttoencourageyoungpeopletodevelop(temporary)
attachments to project staff, this needs to be approached carefully as
gettingitwrongcanprovokeabuse,aggressionandviolentbehaviour.It
isthereforehighlyimportantthatstaffdevelopskillsinde-escalating
anddiffusingaggression.
Resettlementpractitionerswillalsoneedtodevelopastrongunderstandingofthefamilialandcommunity
contextofyoungoffenders’behaviour. Youngpeoplemayneedhelptoovercometheirlabellingasa ‘bad
kid’,throughthecreation ofanew ‘tolerable’self andshared(family andcommunity)acceptanceofthis
positive new identity.

Trauma and young offenders – a review of the research and practice literature | 58
Key lessons about the content, delivery and partnership support of resettlement interventions can be
summarised as follows:
Programme content
• Programmecontentmustbeinformedbyanunderstandingofindividualparticipant’strauma
issuestoavoidinadvertentlyreinforcingproblematicbehaviour.
• “Startfromwhereyoungpeopleareat” – ‘misaligning’programmecontentandindividualneed
can cause retraumatisation.
Programme delivery
• Workontheprinciplethatservicesshould‘donomoreharm’,usingempatheticapproaches
ratherthanreactive/punitiveones.
• Provision of a safe and predictable environment is very important.
• Staffneedtohaverealisticexpectationsandtakelonger-termapproaches.
• A ‘whole system’ relationship-based approach is best.
Coordinated partnership delivery
• Theprovisionofservicesfortheseyoungpeoplerequiresanintegratedapproachfromallthe
agenciesinvolved,includingtheCriminalJusticeSystem,socialservicesandmentalhealth
services.
• Greater awareness of trauma issues can lead provider teams to understand their own limitations
andacknowledgewhentheyneedtoaccessotherspecialists.
Therapyforyoung peoplecanenablethemtoacknowledgetheiremotionalneedsandhelp improvetheir
relationships,enablingthemtodevelopfullerlivesascitizens, parentsand productiveindividuals(Bailey,
1996).Professionalsoverseeingandsupportingyoungpeopletotellthestoryoftheirowntraumaisakey
positivesteponthetherapeuticjourneytowardsrecovery,enablingthemtobegintheprocessof,asJudith
Herman puts it, ‘Undertaking remembrance and mourning’ (2001:175). Recovery is then followed by
‘reconnection’ – a stage that enables young people to develop a new identity and form new, positive
relationships (Herman, 2001:196).
Whilethetherapeuticliteratureistooenormoustobeexaminedindetailinthisreport,itisworthhighlighting
somekeyconceptsofrelevancetotheresettlementofyoungoffenders.
5.3.4 The use of attachment theory to help understand and resolve trauma
Leftunresolved,traumacanmanifestitselfatanypointinthelivesofchildrenandyoungpeople,whomay
becomedepressed,disturbed,violentorallthree(Boswell,2013).Therearegenderdifferenceshere:girls
tendtointernaliseandboystoexternalisetheirresponses(American Psychiatric Association, 2013). Butthe
impactoftraumacanbemediatedbygoodattachment(Nilssonetal.,2011),soenablingyoungpeopleto
developpositiveattachmentstrategies,therebyimprovingbothhowtheydealwithhistoricalexperiencesof
traumaandtheirpotentialtobuildstrongandsupportiverelationshipsinthefuture,isimperative.
Inthe UnitedStates,awarenessofthe prevalenceoftrauma and its developmental impact upon young
people in custody has led Inomaa-Bustillos (2012) torecommend that probation ofcers be sufciently
trainedtorecogniseemotionalandbehaviouralindicatorsthatmayattesttoexperiencesoftraumawhen
formulatingtheirsentencingrecommendations, planninganddelivering interventions,andinstituting any
breach actions.

Trauma and young offenders – a review of the research and practice literature | 59
Renn(2002) examined the linksbetweenattachmentpatterns, unresolvedchildhoodtrauma,emotional
detachment,substancemisuseandviolentoffendinginadulthood.Thisstudydemonstrateshowattachment
theorycanhelppractitionerstobetterunderstandoffendingbehaviourandmorethoroughlyassessrisk.By
helpingoffenderstodeveloptheirown‘narrativeintelligibility’inrelationtotheirlifestoriesandrelationships,
suchanapproachcanalsohelpyoungpeopletointegratetheirdissociatedthoughtsandemotions,often
resultinginacessationofviolentbehaviour.Bystrengtheningtheoffender’scapacityforreectivethought,
eachindividualcanrectifytheirpreviously‘maladaptive,perceptually-distortedcognitive-affectiveinternal
workingmodels’.
Attachmentstrategiescanbeenhancedeveninadulthood,soitishighlyimportantthatinterventionsare
delivered in an environment that provides a secure base and helps clients to work through unresolved
traumas.Afocusonattemptingtofacilitateprogresstowardsclientsdevelopingamoresecureattachment
strategyinsuchawaythatwillimprovetheirabilitytohandlecloserelationshipsinfutureiscrucial(Purnell
2010).
5.3.5 The need for positive social support
 Itislovingthatsavesus,notlossthatdestroysus.
 (GeorgeVaillant,1985)
Likeadults, young people with support havebettermentalhealth (Green et al., 2013;OfceofNational
Statistics, 2013)and ‘having someone to count on’ is known to signicantly decrease violent offending
amongthosewhohavebeenexposedtotrauma(Maschi,2006).
Levelsof perceived social support are low among young offenders. This is of concern because having a
smallprimarysupportgroup–denedasthreeclosefriends/relativesorfewer–hasbeenassociatedwith
agreaterriskofpsychiatricmorbidity(Brughaetal.,1993);Meltzeretal.,1995).41 In a survey of psychiatric
morbidity,6%ofwomenand7%ofmenlivinginprivatehouseholdssaidtheyhadaprimarysupportgroup
ofthreeorless(Meltzeretal.,1995).25However,twiceasmanyyoungoffendersreportthis(13%ofmale
remandand11%ofmalesentencedyoungoffendersand19%ofthefemalesincustody);suchratesare
closertoguresreportedbyresidentsofinstitutionscateringforpeoplewithmentaldisorder(Laderetal.,
2000). So the development and maintenance of informal support networks is crucial for the facilitation of
positiveoutcomesforthesegroups.
Maschi(2006)investigatedthemoderatingroleofsocialsupportontherelationshipbetweenmaleyouths’
exposuretoviolenceandotherstressfullifeeventsandtheirviolentbehaviour.Self-reportinterviewsfrom
anationallyrepresentativesampleofmaleadolescentsaged 12to17andtheir caretakerswereusedto
assess youths’ lifetime exposure to violence (i.e., being a victim and/or witness to physically abusive
punishment,physicalassault,sexualassault,andwitnessingviolence),past-yearstressfullifeevents(i.e.,
thelossofpositivelyvaluedstimuliandtheblockageofpositivelyvaluedgoals),levelsofsocialsupport,and
theirviolentoffending behaviour.Having ‘someone to count on’ was found to haveapositivemediating
effectontheimpactsassociatedwithbeingavictimofphysicalabuse andwitnessingviolenceonviolent
offending.
5.3.6 Consideration of the therapeutic window
Young people often move within the youth justice system between community and secure sites quite
frequently,buttherehavebeenfewlongitudinalstudiesdescribinghowtheirneedschange.Suchstudies,
25More than a quarterofrespondents in custodyrepor teda severelackof social support comparedwith a little overone-tenth of
thoseaged16–24intheprivatehouseholdsurvey.Afurtherthirdreportedamoderatelackofsocialsupport.Therewerenosignicant
differencesbetweenremandandsentencedyoungof fendersorbetweenmenandwomenin theproportionsreporting alackofsocial
support.

Trauma and young offenders – a review of the research and practice literature | 60
althoughdifculttoconduct, are vital when considering what mental healthresourcesarenecessary to
meettheirchangingneeds(Harringtonetal.2005).
Inrelationtoworkwithtraumatisedyoungpeople,however,itisclearthatpsychologicalinterventionswill
haveagreaterscopeforeffectivenessiftheyareprovidedduringwhathasbeenusefullyreferredtoasthe
‘therapeuticwindow’;thisisthestagewhentheparticipantisreadytoaddresstheirdifcultiesbutisalso
inasecureenoughpositionnottofeeloverwhelmedbythatprocess(Briere,1996,2003;BriereandScott,
2013). It is a delicate balancing act between exposing them to challenges that promote psychological
growth, and ensuring that those challenges are not so powerful as to reactivatethe initial trauma and
further diminish self-capacity. The trauma-informed notion of ‘safe environments’ is particularly important
inthiscontext.
Interventionsthatmissthetherapeuticwindowcanhavenegativeconsequencesinstead:
• Overshootingthetherapeuticwindow(providinginterventionsthataretoointenseorfast-paced).This
mayleadtoresistance,althoughinworstcasescenarioscanleadtoself-harmingandotheravoidance
behaviours such as substance misuse.
• Undershootingthetherapeuticwindow(avoidingtheissueoftraumadespiteaparticipantbeingable
totolerateaddressingit)israrelydangerous,butmaywasteresourceswhengreaterprogresscouldbe
made.
So,resettlementpractitionersneedtoexertcarefulcontroloverthepsychologicalintensityoftheirwork–
withacarefullymanaged, sequentialapproachtoindividual progress.Youngpeopleneedtobegiventhe
opportunitytoconsolidatetheirpsychologicaldevelopmentbeforemovingontomorechallenginggoals.It
isimportanttomaintainanappropriatebalancebetweenpsychologicalsecurityanddevelopmentwiththe
assumption that, when in doubt, the former is always more important than the latter.
5.4 Summary
Thereisnowasubstantialbodyofresearchevidencetosuggestthat:
• Offendershaveadisproportionateamountofchildhoodandadolescenttraumaintheirbackgrounds
• Offenders are more likely than non-offenders to have suffered adverse impacts from traumatic
experiencesinchildhoodandadolescence
• Someoftheimpactsofsuchtraumaappeartobelinkedtooffendingbehaviour
• Previoustraumacanhaveanadverseimpactonourscopeforgeneratingpositiveresettlement
outcomeswithyoungpeopleandyoungadults
This is an extremely complex eld of workand the stigma attached to experiences of trauma makes it
difcultformanypeopletodisclosewhathashappenedtothem.Havingdevelopeddetrimentalmethodsof
dealingwiththeirdistress–perhapsincludingdistrustandrejectionofthoseinauthority–theseindividuals
tend not to engage with services. In doing so, they run the risk of further negative consequences for
breachingcriminaljusticerequirements.Withouttailoringinterventionsinawaythatacknowledgesyoung
people’straumaticexperiencesandsupportstheminlearningnewcopingskills,thelong-termimpactofany
intervention may be quite short-lived.
Most young offenders have experienced adverse (if not traumatic) childhood experiences and so it is
important for resettlement work to build their personal resilience and social support systems. Where
multipleorchronicadversityhasbeen experienced,the youngperson’s health and development will be

Trauma and young offenders – a review of the research and practice literature | 61
impeded–asituationthatcanbeexacerbatedbyalackofprotectivefactors.Theemotionalconsequences
ofsuchexperiencesoftraumacanlimittheeffectivenessofdirectworkwiththemandalsohaveimplications
fortheirpotentialprogressandlonger-termoutcomes.
However, our ownresearchhashighlighted the extenttowhich it is possible evenforhighly traumatised
people, with appropriate support and guidance, to re-shape their life trajectories, to be successful in
accessingopportunitiesandachievingpositivelifeoutcomes.Indeed,someoftheindividualcasestudies
thatBYChasdevelopedandpresentedcountasexamplesofhowindividualswithevensomeofthemost
negativestoriesofchildhoodandadolescenttrauma,cansuccessfullynavigatethekindofchangeprocesses
whicharetheverydenitionofeffectiveresettlement.
Forthosewhoworkwithyoungoffenders,thescopeforgeneratingpositiveoutcomesofthatsort canbe
aided by an understanding of the prevalence and impacts of trauma, and byan understanding of how
resettlement outcomes can be affected by trauma.
Specialist medical rehabilitation canalsoreducethepropensityforviolenceamongyoungpeoplewhohave
sufferedbraininjury(Williams,2013). Signicantlong-lastingpositiveimpactcanstillbeachievedevenwith
highlytraumatisedyoungpeople whosedevelopmenthasbeen severelyconstrained.Thisis becausethe
brain’sneuroplasticity–its abilityto‘rewire’itself–lastsat leastintoanindividual’slatethirties(Bailey,
2013).Afocuson helpingyoungpeopletobuildtheirpersonalresilienceandsocialsupportsystemscan
form an important part of that work.
AsBowlbycommentsmoregenerallyonthescopeforchange:
 ‘Changecontinuesthroughoutthelifecycle,butchangesforbetterorworsearealwayspossible.Itis
continuingpotentialforchangethatmeansthatatnotimeisapersoninvulnerabletoeverypossible
adversity,andatnotimeisapersonimpermeabletofavourableinuence.’
 (Bowlby,1988)

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Authors: Liddle, M., Boswell, G., Wright, S. and Francis, V. with Perry, R.
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