Hidden Needs Behind Reoffending: Why ADHD and Autism Shouldn’t Be The Only Considerations
Adults in prison who were previously in care show higher rates of neurodisability traits and life adversity, including homelessness, substance use and unemployment. These overlapping vulnerabilities suggest unmet developmental needs and highlight the importance of early identification and tailored support to reduce long-term justice involvement.
Many young offenders have underlying neurodevelopmental or acquired neurological differences that remain unidentified, shaping behaviour, engagement and long-term outcomes
In the past few years, there is increasing evidence highlighting a critical but often overlooked reality within youth justice systems: many young offenders have underlying neurodevelopmental or acquired neurological differences that remain unidentified, shaping behaviour, engagement and long-term outcomes. While much more discussion at the present time is being directed towards ADHD and autism, research shows these represent only part of a much broader neurocognitive picture influencing risk of reoffending.
60% of young offenders have undiagnosed developmental language disorder (DLD)
A study published in the Journal of Child Psychology and Psychiatry and summarised by NIHR found that approximately 60% of young offenders have undiagnosed developmental language disorder (DLD). DLD affects both expressive and receptive language, influencing comprehension, reasoning, narrative skills and social communication. Strikingly, none of the young people in the study had been previously identified as having language difficulties. Even more concerning, those with DLD were more than twice as likely to reoffend within 12 months compared with peers without language difficulties (62 % vs 25 %). This association remained significant after controlling for age, deprivation, IQ and previous offending history, suggesting language needs themselves play a direct role in justice outcomes.
We need to remember what seems the obvious in that communication and comprehension is foundational to participation in any justice processes. Understanding rights, engaging with rehabilitation programmes, following instructions, expressing remorse, negotiating conflict and reflecting on behaviour all rely heavily on communication ability. When systems assume typical language skills, individuals with DLD may appear disengaged, non-compliant or resistant, when in fact they may not fully understand what is being asked of them. In this sense, language ability is not peripheral to justice it is central infrastructure. It may also be why they often opt out of education and also have been excluded too.
Traumatic Brain Injury (TBI)
However, communication differences are only one element of a wider pattern of hidden neurocognitive vulnerability. Another high-prevalence yet under-recognised factor in offender populations is traumatic brain injury (TBI). Evidence from UK and international research consistently shows elevated rates of head injury among justice-involved young people. Studies indicate that around 74% of young offenders report a lifetime history of TBI, often involving loss of consciousness or repeated injuries. This is an astounding level of injury. Research in Scottish youth offender institutions suggests that up to 80% of young males have experienced significant head injury, frequently resulting from assaults, accidents or violence exposure. Data summarised by Headway has also highlighted just how common brain injury histories are within correctional populations compared with the general public.
TBI can affect multiple domains essential for successful rehabilitation, including attention, working memory, impulse control, planning, emotional regulation and processing speed. These functions underpin the ability to benefit from behavioural programmes, comply with conditions of release and navigate social situations safely. Although current evidence does not demonstrate a simple causal pathway between brain injury and offending behaviour, there is substantial overlap between post-injury cognitive-emotional profiles and known risk factors for recidivism. In other words, brain injury may not directly cause offending, but it can create vulnerabilities that increase the likelihood of adverse trajectories when appropriate support is absent. If this is not considered a young person may be assumed to have ADHD traits.
Expanding the neurodiversity lens in justice
Discussions about neurodisability in justice settings often focus narrowly on a small number of diagnostic labels. ADHD and autism are important considerations, but they should not dominate assessment frameworks to the exclusion of other high-prevalence needs. Language disorders, acquired brain injuries, DCD, and Dyslexia along with trauma-related cognitive impacts are frequently hidden, cumulative and interacting.
The evidence points to several consistent conclusions:
- Developmental language disorder is common among justice-involved youth and strongly associated with reoffending risk when unidentified.
- Brain injury histories occur at disproportionately high rates in offender populations and can affect cognition and behaviour in ways that complicate rehabilitation.
- Standard interventions, particularly verbally mediated or insight-based programmes, may be inaccessible or less effective if communication or cognitive needs are unrecognised.
Failure to account for these differences can inadvertently widen inequities. Interventions may be judged ineffective, or individuals may be labelled unmotivated, when the real issue is a mismatch between programme demands and neurocognitive profile.
What needs to change?
Reducing reoffending and improving long-term outcomes requires a broader, needs-led approach to assessment and intervention.
Evidence suggests several system-level priorities:
- routine screening for language needs and TBI histories alongside other neurodevelopmental conditions and not in isolation.
- multidisciplinary teams including speech and language therapists, neuropsychologists and allied professionals
- adapted communication strategies, simplified language and multimodal programme delivery- we need to be inclusive by design.
- staff training to recognise hidden cognitive and communication differences and TBI signs
- personalised rehabilitation plans aligned with individual cognitive strengths and challenges
Such measures are not about excusing harmful or antisocial behaviours. Rather, they are about ensuring that interventions are accessible, fair and effective. Rehabilitation cannot succeed if individuals cannot fully understand, process or engage with what is being offered.
Recognising the full spectrum of neurocognitive diversity and adversity shifts the focus from blame to barrier-removal. When systems identify needs early and respond appropriately, they increase the likelihood of meaningful engagement, reduce recidivism risk and support safer communities. Ignoring these hidden differences, by contrast, perpetuates cycles of misunderstanding, exclusion and repeated justice involvement.
A justice system that truly aims to rehabilitate must therefore move beyond narrow diagnostic frameworks and adopt a comprehensive understanding of neurodevelopmental and neurological diversity. Only then can support pathways match the complexity of the individuals they are designed to serve.
By Professor Amanda Kirby, MBBS MRCGP PhD, CEO, Do-IT Solutions Ltd
Emeritus professor University of South Wales, Honorary Professor at Cardiff University, Visiting Professor, Faculty of Health Sciences, Trinity College Dublin.
References
Headway. Brain injury and offender populations – research summaries. https://biausa.org/public-affairs/media/by-the-numbers-brain-injury-in-the-uk-prison-system
Winstanley M, Webb RT, Conti-Ramsden G. Developmental language disorders and risk of recidivism among young offenders. J Child Psychol Psychiatry. 2021 Apr;62(4):396-403. doi: 10.1111/jcpp.13299. Epub 2020 Jul 14. PMID: 32663331.
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