Cognitive Disorders in Incarcerated Offenders, Treatment of

Mental disorders are frequently associated with varying degrees of neurological impairment that pose serious problems for an individual’s ability to self-regulate, avoid self-defeating behaviors, and attain prosocial goals. The term intellectual disability specifically refers to impairment in functional domains usually associated with IQ scores below 70. Cognitive deficits, however, is a more generic term, also encompassing impairment to essential areas of brain function, though not defined uniquely by low IQ. Individuals with cognitive deficits may test in the average range or higher, but they commonly manifest symptoms of executive function problems such as impairments in attention control, strategic goal planning, abstract reasoning, cognitive flexibility, and the ability to organize and adaptively use information contained in working memory.

The estimates of prevalence of intellectual deficits among offender populations as defined by IQ level vary widely; several large-scale studies have found rates similar to those in the general public. While rates of the most severe cases of cognitive impairment are low in most prison systems, few researchers would contest that rates of at least mild cognitive impairment are elevated in prison populations relative to the community. This entry provides an overview of incarcerated offenders with cognitive disorders and then focuses on evidence-based interventions. The second half of the entry explores the need for staff training and the important roles that protective factors, advocacy, and mentoring play in effective interventions.

Overview. Those involved in the criminal justice system can experience deficits that range from mild executive function problems with otherwise average or above average intelligence to more serious impairments that severely limit adaptive function. Individuals with the most severe cognitive deficits are likely to be diverted from sanctions early in the criminal justice process. Those who are incarcerated, therefore, tend to have less severe intellectual disabilities, which may make them harder to identify without the benefit of standardized assessment tools.

The origins of these neurological problems are various; for example, fetal alcohol spectrum disorder (FASD) and alcohol-related neurodevelop- mental disability are conditions acquired during fetal development due to exposure to maternal drinking; various forms of mental retardation are congenital; and traumatic brain injury and organic brain syndrome are acquired through injury, disease processes, or drug and alcohol abuse. Many of the same cognitive deficits and behavior problems are shared by individuals with neurologically based disorders. The considerable overlap in the presentation of many of these conditions suggests that the treatment and case management requirements could be similar across many diagnoses.

Offenders with cognitive deficits are more likely to have comorbid mental health conditions; in particular, rates of substance abuse disorders and personality disorders are elevated. In prison, offenders with cognitive deficits are more likely to manifest a range of problem behaviors and face a number of challenges with respect to their preparation for release. For example, rates of institutional misconducts are elevated and rates of discretionary release (i.e., earlier gradual release) tend to be lower. Offenders with the more serious forms of neuropsychological disorders have complex, lifelong problems that require adapted correctional practices and continued services on release from multiple providers.