Document Title: Neuropsychological and Emotional Deficits Predict Correctional Treatment Response

The three year study was designed to elucidate underlying neuropsychological and emotional regulatory mechanisms in variable responses to a standard correctional treatment approach among prison inmates. Cognitive-behaviorally based treatment (CBT) programs are generally considered effective in reducing behavioral problems in this population, but there is considerable variation in treatment response and outcome. A significant number of inmates do not respond favorably over time, exhibiting a lack of treatment engagement, a high level of attrition, poor behavioral and emotional self control, repeated institutional infractions, and eventual recidivism. Thus, it is critical to identify underlying bases for individual differences in treatment responsivity for purposes of developing a useful assessment battery that can be applied toward more effective tailoring of intervention approaches to specific needs of different inmate subgroups. While resources are too scarce to match treatments to individuals, at a minimum, research is needed to identify which inmates are likely not to respond to conventional treatments and which require that the approach take into account existing deficits that prevent a favorable response. The present study examined the interrelationship between neuropsychological and emotional regulatory mechanisms and indicators of behavioral treatment response and outcome. Given evidence that integrity of executive cognitive function (ECF) and its modulation of emotional regulation may represent dimensions of neural processes related to risk for conduct problems, we hypothesized that particular dimensions of these functions may also play a key role in differential responses to treatment programming and subsequent posttreatment outcome. The premise of this study was that poor responsivity would be predicted by relative deficits in abilities to effectively process and apply curriculum materials from standard CBT correctional interventions, as reflected in aberrant processing of neurocognitive and affective stimuli and attenuated stress responses that exist at baseline and persist throughout the treatment period. In effect, deficits in these regulatory processes may compromise (i) cognitive processing of intervention curriculum materials; (ii) the ability to shift behavioral strategies based on new information; and/or (iii) inhibition of affective responses that promote maladaptive behaviors. The specific aims of this study were: (1) to determine the extent to which neuropsychological and emotional regulatory functions, including cortisol responses to a stress task, predict variability in (a) program responsivity (e.g., treatment engagement, motivation, attitude and retention) and (b) posttreatment outcomes (e.g., treatment completion, institutional infractions, decision making ability, risky behaviors, and self-reported anger) among inmates during and following participation in a widely used and well-established treatment intervention with a cognitive-behavioral base. (2) to assess the extent to which these functions partially or fully explain the relationship between treatment exposure and posttreatment outcomes. Inmates were tested after the treatment program concluded whether they completed or not; those who dropped out for reasons other than transfer, work duties, and legitimate conflicts were considered poor responders. Treatment exposure was expected to alter neuropsychological and emotional performance, and psychophysiological responses to stress commensurate with any treatment-associated behavioral improvements that predict ultimate outcomes. Analyses included adjustments for age. Several relevant factors were also taken into consideration, including severity of drug use history, age, IQ, and length of incarceration. Theoretically, the extent to which behavioral change occurs may be accelerated by treatment in those who respond favorably. 4 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.