AGGRESSIVE BEHAVIOR

Volume 36, pages 338–349 (2010)

Role of Executive Dysfunction in Predicting Frequency

and Severity of Violence
Megan Hancock, Jennifer L. Tapscott, and Peter N.S. Hoaken

The University of Western Ontario, London, Ontario, Canada

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The adverse consequences of violence on society are tremendous. The proportion of offenders incarcerated for violent offenses is
large, and the cost of keeping these offenders incarcerated is startling. Understanding and treating the causal underpinnings of
violent crime is of utmost importance for individuals and society as a whole. Several factors have been identified as potential
contributors to violent crime, including cognitive deficits in executive functioning [Hoaken et al., 2007]. To investigate this further,
77 offenders from Fenbrook Institution, a federal facility, were tested on a battery of executive functioning measures. Offenders
were found to have broad and pervasive dysfunction in their executive abilities. In addition, specific scores from the battery were
found using regression techniques, to predict the frequency and severity of past violent offending but not nonviolent offending. This
speaks of the possibility of a new type of correctional rehabilitation program, one that focuses on the rehabilitation of basic
executive functions. Aggr. Behav. 36:338–349, 2010. r 2010 Wiley-Liss, Inc.

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Keywords: executive functioning; violence; Delis–Kaplan Executive Function System; Poisson regression; binary logistic regression

Violence has profound social, legal, and political
costs. The victims of violent crime can lose valuable
possessions, their health, ability to work, and
sometimes their lives [World Health Organization,
2002]. In the United States in 2008, 4,856,510 violent
offenses were committed [Bureau of Justice Statistics,
2009]. Violence results in significant financial con-
sequences for society; so, researchers urgently need
to understand factors predisposing individuals to
use violence, both in order to develop preventative
strategies for individuals who are at risk and also to
develop rehabilitation programs for individuals who
are already violent.
Historically, researchers have worked at identify-
ing psychosocial risk factors in childhood that are
related to an increased likelihood of aggression and
violence later in life. Several reviews indicate that the
predictors of aggression in adolescence are diverse
and include the characteristics of adolescents’ family
(e.g. parental attitudes toward aggression), school
experience (e.g. strict and inflexible classroom rules),
peer groups (e.g. poor peer relations), and commu-
nity [e.g. neighborhoods low in socioeconomic
status; Flannery et al., 2005; Kashani et al., 1999].
Furthermore, research has demonstrated that genetic
factors are a major risk factor for violent behavior
when compared with nonviolent antisocial behavior
[for a review, see Burt, 2009]. Clearly, the con-
tributors to violence are myriad.
A more recent approach to better understanding
violent behavior has involved the assessment of
specific aspects of cognition. Rather than focusing
on environmental variables, some researchers have
begun to examine individual cognitive abilities to see
whether there is a pattern of functioning character-
istic of those who manifest aggressive or violent
tendencies. The rationale for evaluating the relation-
ship between cognitive variables and violent beha-
vior comes from research examining brain
anomalies in aggressive and violent individuals
[Marsh and Martinovich, 2006]. For example,
research has repeatedly shown that acquired brain
injury is much more prevalent in incarcerated
populations than in the general public. The
incidence of mild brain injury in the general public
Grant sponsor: Social Sciences and Humanities Research Council of
Canada; Grant number: 410-2008-2461.
Correspondence to: Megan Hancock, Department of Psychology,
Westminster Hall, The University of Western Ontario, London,
ON N6A 3K7, Canada. E-mail: mhancoc6@uwo.ca
Received 18 December 2009; Accepted 4 June 2010
Published online 30 June 2010 in Wiley Online Library (wileyonline
library.com). DOI: 10.1002/ab.20353

r 2010 Wiley-Liss, Inc.


of North America varies from 0.1 to 0.6%,
depending on the data collection method [Cassidy
et al., 2004]; conversely, much higher rates, ranging
from 29 to 100%, have been reported in various
violent forensic samples [Marsh and Martinovich,
2006; Martell, 1992; Slaughter et al., 2003]. This
research suggests that diminished functional brain
capacity may be implicated in aggressive and violent
behavior.
A specific area of the brain that has received a
great deal of attention in the forensic literature is the
frontal cortex. Evidence implicating this region
comes from a series of studies finding structural
and functional abnormalities in the frontal lobes of
individuals who are aggressive and violent [for
reviews, see Brower and Price, 2001; Bufkin and
Luttrell, 2005]. Although aggression and violence
cannot be attributed exclusively to brain dysfunc-
tion, it is important to integrate this information
into an understanding of the variables that are
related to an increased likelihood of aggressive and
violent behavior.
A number of researchers have suggested that the
relationship between these brain anomalies and
violent behavior may be mediated by an inability
to adaptively utilize what have been referred to as
‘‘executive functions’’ [Bufkin and Luttrell, 2005;
Marsh and Martinovich, 2006].
Although executive functioning is frequently
discussed in the literature, an agreed-upon definition
has not yet been established [Suchy, 2009]. One
point of agreement is that executive abilities allow
individuals to shift mindsets quickly in a constantly
changing environment (i.e. adapt to novel and
diverse situations while simultaneously inhibiting
inappropriate behaviors). Executive abilities are
essential for success in school, in work, and in
everyday living as they mediate the ability to
organize thoughts in a goal-directed way.
Early executive functioning research was stimu-
lated by neuropsychological patients with frontal
lobe damage. Although able to perform well on
other cognitive tasks, including tests of intelligence
[Shallice and Burgess, 1991], these patients exhibited
difficulty controlling or regulating their behavior
and displayed deficits on tests of organization,
set-shifting, and goal-directed behavior. This early
research led neuropsychologists to suspect that the
frontal lobes of the brain may be largely responsible
for executive functioning. Although that view is now
thought to be oversimplistic with a contemporary
understanding of some limited limbic involvement
[Jurado and Rosselli, 2007; Stuss and Alexander,
2000], the point remains that the frontal lobes have
Predicting Frequency and Severity of Violence 339
been implicated in both executive abilities and
violence. Given the profound effects that violent
behavior has on society, it is of interest whether
there is a relationship between executive functioning
and violent behavior and, more specifically, what
aspects of executive function predispose individuals
to these behaviors. That information could prove
very important to theory-based efforts at prediction
and treatment.
Years of research from a broad range of fields
certainly suggests that impaired executive functioning
correlates with aggressive and violent behavior
[Broomhall, 2005; Hoaken et al., 2003; Marsh and
Martinovich, 2006; Raaijmakers et al., 2008;
Séguin et al., 2004]. However, although a number
of studies have examined the relationship between
executive functioning and criminality, it has not yet
been consistently demonstrated which particular
components of executive functioning are impaired
in offenders. Furthermore, some researchers argue
that executive deficits are characteristic of all
individuals who commit crime [Greenfield and
Valliant, 2007; Hoaken et al., 2007], whereas others
argue that these deficits are more characteristic
of those who commit violent crime specifically
[Baker and Ireland, 2007; Barker et al., 2007;
Miura, 2009].
A large number of studies have examined the
relationship between executive functioning and
criminality, antisocial behavior, aggression, and
violence; yet, each of these studies used a slightly
different conceptual definition of executive functioning.
Moreover, a number of different measures were used
to assess executive abilities. However, not all these
measures are thought to assess the same abilities or
share the same psychometric properties. To compli-
cate matters more, some researchers evaluate
aggression and violence using self-report and others
examine criminal histories or directly observe
behavior. Some researchers only consider an offen-
ders’ index offense, whereas others take into account
their complete criminal history. All being said, the
overall theme within the literature is that executive
functioning, however loosely defined, is related to
criminality. For example, in a meta-analysis of 39
studies, individuals who took part in antisocial
behaviors performed .62 standard deviations worse
on measures of executive abilities than individuals
who did not, despite controlling for age, sex,
ethnicity, and intelligence [Morgan and Lilienfeld,
2000].
A recent development to this line of investigation
has been the publication of the Delis–Kaplan
Executive Function System [D-KEFS; Delis et al.,
Aggr. Behav.
340 Hancock et al.
2001], a valid and normed tool that measures
several aspects of executive function. Broomhall
[2005] was the first in the forensic field to make use
of this tool, assessing the capacity of violent
offenders on three D-KEFS subtests. Broomhall
found that violent offenders were significantly
impaired on these tests, relative to the general
public, but noted that ‘‘the results did not provide
the depth of understanding required to inform
adequate prediction of future dangerousness,
assessment, or treatment of individuals who
commit violent crime’’ (p 379).
This review has established that incarcerated
offenders are characterized by executive dysfunction.
Although some evidence suggests that dysfunction is
more characteristic of individuals who are aggres-
sive, more research is needed. In addition, the
executive deficits that have been identified are rather
vague, and it is not well understood how these
deficits translate into everyday behavior. The goals
of this study were: (A) to examine a sample of
offenders to see whether deficits in executive
functioning were identified, using a valid and
normed measure (the D-KEFS), (B) to examine
whether these deficits would be correlated with the
frequency of offending in general, with the fre-
quency of nonviolent offending or with the
frequency of violent offending, and (C) to assess
whether scores were able to predict crime in general,
nonviolent offending, violent offending, or serious
violent offending. Violence was assessed using a
continuous scale, which took into account the
frequency and severity of violent acts. In compar-
ison with earlier research in which offenders are
often dichotomized as violent or nonviolent, in this
study we examined and recorded each offender’s
entire adult criminal history, thereby avoiding
categorization all together. Violence severity was
also considered because, though an offender with a
murder charge and an individual with an assault
charge are both ‘‘violent offenders,’’ these indivi-
duals may be quite dissimilar.
This study was primarily exploratory in nature;
therefore, no hypotheses were made about which
specific executive functioning scores would be
impaired or about which scores would predict
offending. However, it was hypothesized that
offenders would evidence a significant pattern of
executive dysfunction and that this dysfunction
would be more characteristic of those who commit
violent offenses. Furthermore, it was hypothesized
that an increased frequency and an increased
severity of violence would each be related to greater
executive dysfunction.
Aggr. Behav.
METHOD
Participants
The sample for this study consisted of 80 adult
male offenders from Fenbrook Institution, a
medium security federal prison in Gravenhurst,
Ontario. Participants were assessed on two inclusion
criteria: proficiency in English and normal or
corrected-to-normal vision. Only 3 of the 80
participants were excluded for failing to meet these
criteria. Approximately 65% of the offenders
recruited had served a sentence for a violence-
related crime. The offenders ranged in age from
19 to 57 (M 5 33.35, SD 5 9.19).
Materials
Kaufman Brief Intelligence Test, Second Edition
(KBIT-2): Intelligence was measured using the
KBIT-2 which can be administered in approximately
20–30 min and provides Verbal and Nonverbal
Scores, as well as a composite IQ score [Kaufman
and Kaufman, 2004]. The KBIT-2 was administered
to ensure that any relationships that were detected
between executive functioning and offending were
not solely a function of differences in intelligence.
Delis– Kaplan Executive Function System (D-KEFS):
The D-KEFS is a battery of nine tests that
comprehensively assesses the key components of
executive functioning. In light of the available data
on the psychometric properties of the D-KEFS, this
battery is considered among the most valid means
of assessing executive functioning [Baron, 2004;
Homack et al., 2004]. Owing to time constraints,
only four of the subtests could be administered
[i.e. the Tower Test, Verbal Fluency Test, Color-
Word Interference Test (CWIT), and Sorting Test;
see Shunk et al., 2006, for a detailed description of
the subtests], but this decision was not thought to
affect the psychometric properties of the subtests,
given that the D-KEFS subtests were designed to
‘‘stand alone.’’
During the Tower Test, participants assembled a
number of towers by moving disks of different sizes
across three vertical pegs. The Tower Test assesses
executive abilities, including planning, rule learning,
inhibition of impulsive and perseverative responding,
and the ability to establish and maintain the
instructional set [Delis et al., 2001].
The Verbal Fluency Test consists of three condi-
tions: Letter Fluency, Category Fluency, and
Category Switching. This test measures participants’
ability to generate words fluently in an effortful,
phonemic format (Letter Fluency), from overlearned

concepts (Category Fluency), and while simulta-
neously shifting between overlearned concepts
[Category Switching; Delis et al., 2001].
The CWIT is similar to the classic Stroop Test, but
it consists of four conditions. The first two condi-
tions provide a baseline measure of the two basic
skills that are required to complete the higher-level
tasks: naming of color patches and reading of color
words. The third condition assesses inhibition, as
participants must inhibit reading the words in order
to name the dissonant ink colors in which those
words are printed [Delis et al., 2001]. The fourth
condition measures both inhibition and cognitive
flexibility [Delis et al., 2001].
Finally, the Sorting Test consists of two condi-
tions—a Free Sorting condition and Sort Recogni-
tion condition. The Sorting Test assesses a number
of important component processes of executive
functioning, including (a) initiation, (b) concept
formation skills, (c) modality-specific problem-
solving skills (verbal vs. perceptual), (d) the ability
to explain the sorting concepts abstractly, (e) the
ability to transfer sorting concepts into action,
(f) the ability to inhibit previous sorting responses
in favor of flexibility of behavior, and (g) the ability
to inhibit previous description responses in favor of
flexibility of thinking [Delis et al., 2001].
The D-KEFS was normed on a sample of more
than 2,000 individuals. Consequently, most of
the D-KEFS raw scores were transformed into
age-adjusted standard scores, ranging from 1 to 20
(M 5 10, SD 5 3). However, because some raw
scores were restricted in range in the normative
sample, these raw scores were instead transformed
into age-adjusted cumulative percentile ranks.
Unless otherwise noted, a higher score reflects
superior performance, and those scores that were
converted to cumulative percentile ranks will be
identified where appropriate. See Table I for a list of
abbreviations for the D-KEFS scores.
Procedure
Offenders were initially recruited during an
information session held within the prison, but
additional offenders were recruited when they
approached the researchers and expressed interest
in participating. The researchers made it explicit that
participation was voluntary and that the results
would have no bearing on any subsequent correc-
tional decisions. After obtaining informed consent,
the researchers explained that no feedback would
be provided. The order of administration of the four
D-KEFS subtests and the KBIT-2 was partially
Predicting Frequency and Severity of Violence 341
TABLE I. List of Abbreviations From the D-KEFS
Abbreviation Variable name
CWITI-CN Color-Word Interference Test—Inhibition Condition
minus Color Naming. Scaled Score
CWITICE Color-Word Interference Test—Inhibition Condition
Corrected Errors. Cumulative Percentile Rank
CWITIUE Color-Word Interference Test—Inhibition Condition
Uncorrected Errors. Cumulative Percentile Rank
CWITI/S-CN Color-Word Interference Test—Inhibition/Switching
Condition minus Color Naming. Scaled Score
CWITI/S-R Color-Word Interference Test—Inhibition/Switching
Condition minus Reading. Scaled Score
CWITI/SCE Color-Word Interference Test—Inhibition/Switching
Condition Corrected Errors. Cumulative Percentile
Rank
CWITI/SUE Color-Word Interference Test—Inhibition/Switching
Condition Uncorrected Errors. Cumulative
Percentile Rank
STCCS Sorting Test—Confirmed Correct Sorts. Scaled Score
STFSDS Sorting Test—Free Sorting Description Score. Scaled
Score
STSRDS Sorting Test—Sort Recognition Description Score.
Scaled Score
STPR Sorting Test—Perceptual Rules. Scaled Score
STVR Sorting Test—Verbal Rules. Scaled Score
STOAD Sorting Test—Overly Abstract Descriptions.
Cumulative Percentile Rank
STPSA Sorting Test—Percent Sorting Accuracy. Scaled Score
TTMAR Tower Test—Move Accuracy Ratio. Scaled Score
TTMFMT Tower Test—Mean First Move Time. Scaled Score
TTTAS Tower Test—Total Achievement Score. Scaled Score
VFLF-TC Verbal Fluency—Letter Fluency—Total Correct.
Scaled Score
VFCF-TC Verbal Fluency—Category Fluency—Total Correct.
Scaled Score
VFCS-TC Verbal Fluency—Category Switching—Total Correct.
Scaled Score
VFCS-SA Verbal Fluency—Category Switching—Switching
Accuracy. Scaled Score
counterbalanced, but complete counterbalancing
was not possible owing to the number of tests
administered.
As prescribed by the Correctional Service of
Canada, offenders were not eligible to receive
compensation for participation. The overall time
to complete the experiment for the offenders was
approximately 2 hr. To prevent experimenter bias,
no questions regarding current or past criminal
activities were asked during the testing session.
File Review
Only after an offender had completed the test
battery was his file reviewed. Two of the authors
(M.H. and J.L.T.) collaboratively reviewed offen-
ders’ complete adult criminal history through the
Offender Management System, the computerized
Aggr. Behav.
342 Hancock et al.
case file management system that is used by the
Correctional Service of Canada and the National
Parole Board. The first 20 files were recoded to
ensure that there had been no coder drift.
The term violence has various proposed defini-
tions, but this study defined violence as behavior
involving an intentional act of physical aggression
against another individual that is likely to cause
physical injury [Meloy, 2006]. All violent offenses
were coded according to Cornell’s [1996] guidelines.
That is, severity of violence was coded along a
6-point scale that had the following anchors: 1 (assault
without injury), 2 (minor injury; e.g. bruises, minor
medical treatment, attempted rape), 3 (serious injury
requiring substantial hospital treatment; e.g. broken
limb, rape, gunshot wound), 4 (severe injury resulting
in lasting impairment or life-threatening injury), 5
(homicide), and finally 6 (extreme homicide; e.g.
multiple killings, mutilation). It should be noted that
a slight modification to Cornell’s coding scheme was
made such that, in accordance with our definition of
violence, threats of violence were coded as nonviolent
offenses. Dependent variables were then generated
from these ratings. On the basis of the file review, the
frequency of nonviolent, violent, severe violent, and
total offending was determined. Severe violent
offenses included the subset of the violent offenses
that produced serious, lasting physical harm (i.e.
severity of 4, 5, or 6).
RESULTS
Analytic Rationale
This study investigated frequency of offending
during adulthood. Therefore, the dependent variables
of interest are count variables. Count data present a
challenge to researchers in the correctional and
forensic fields; however, these challenges can be
managed with statistical techniques designed specifi-
cally for this type of data [for reviews, see Hutchinson
and Holtman, 2005; Walters, 2007]. The benchmark
model for fitting count data is the Poisson distribu-
tion and the standard regression model for analyzing
count data is the Poisson regression.1
Although the initial intent was to use Poisson
regression to predict frequency of nonviolent offending,
violent offending, and severe violent offending, none
1
Psychology data are often overdispersed and, therefore, better
analyzed by a negative binomial model. An estimate of the dispersion
parameter can be calculated through Stata which indicates whether a
Poisson or negative binomial model is more appropriate. This
statistic indicated that a Poisson model was most appropriate for the
present data.
Aggr. Behav.
of the offenders in the sample had committed more
than one severe violent offense. Therefore, this
dependent variable was dichotomous. Consequently,
binary logistic analyses were conducted to examine
predictors of severe violent offending.
An explanation of how regression coefficients
were interpreted needs to be provided before
presenting the results. Briefly, because Poisson
regression is ‘‘linear in the logarithm’’ [Coxe et al.,
2009], when all other variables are held constant, a
1-unit increase in a predictor results in an increase of
the natural logarithm of the predicted count that is
equal to the value of the unstandardized regression
coefficient (b). This interpretation is straightfor-
ward, but has the disadvantage of interpreting the
change in the unit of a transformation of the
outcome (i.e. the natural logarithm of the predicted
count). As such, for the Poisson models, the
exponentiated unstandardized regression coefficients
(i.e. eb) are presented in the tables, which can
be interpreted as incidence rate ratios. That is, for a
1-unit change in the predictor, the predicted rate is
multiplied by eb. Similarly, for the binary logistic
model, exponentiating the regression coefficients
produces an odds ratio. Odds ratios are interpreted
as the change in the likelihood of an offender having
committed a severe violent offense given a 1-unit
change in the predictor.
Poisson regression assumes that the period of risk,
also known as exposure, is the same for all
observations. This assumption was violated in this
study, considering that offenders were of different
ages and, consequently, had been at risk of
committing adult offenses for different periods of
time. To control for nonuniform exposure times, the
natural logorithm of years at risk of committing an
adult offense was entered as a covariate in each of
the regression analyses with its parameter fixed at
1.00. As a result of the inclusion of this variable, the
outcome variable predicted in each analysis was the
rate of log-offenses per unit of exposure (i.e. per year
of adult life) instead of simply the frequency of
offenses.2
2
Another factor that needs to be considered when deciding whether
or not to use Poisson-class regression is whether the number of zero
counts exceeds what the Poisson model can handle [Walters, 2007].
Zero-inflated models for Poisson regressions allow for an excessive
number of observed zeroes [Ridout et al., 1998]. A zero-inflated
Poisson regression was conducted to test whether it provided a better
fit than the standard model. The Vuong test compares the zero-
inflated model to the standard model to determine which model is a
better fit. The z-values were not significant when the outcome
predicted was frequency of violent offending meaning that the zero-
inflated Poisson regression is not a better fit than the standard
Poisson regression.
 Predicting Frequency and Severity of Violence 343

Preliminary Analyses [FreqVO], severe violent offending [SevVO],

frequency of nonviolent offending [FreqNVO], and
One offender was missing data for one subtest
the total number of offenses [TotalOFF]) was
owing to his colorblindness. In order to retain as
computed (see Table III). This was a crude estima-
much meaningful data as possible, group means were
tion because the assumptions underlying correlation
utilized to fill the missing data points. See Table II for
analyses are similar to those underlying linear regres-
the mean and standard deviations of scores from the
sion and the present data violated those assumptions.
DKEFS and from the outcome variables. It should be
As such, it was concluded that an inclusive approach
noted that although 10% of the sample of offenders in
for entry into the regression model would be appro-
this study had committed an act of homicide, more
priate to ensure that all possible relationships between
than one-quarter of the incarcerated Canadian federal
the predictors and outcome variables were fully
population has a history of homicide [Motiuk and
explored. Therefore, predictor variables that were
Vuong, 2005]. As such, the results of this study may
significantly related to the outcome variables with a
fail to generalize to offenders who have engaged in
set at .10 were included in the regression equations. See
more severe forms of violence than was committed by
Table III for the correlations between each of the D-
the current sample.
KEFS scores and the covariates to be included in the
In order to determine which variables needed to be
regression analyses (i.e. age and the KBIT composite
entered into the regression analyses, the correlation
score).
between each of the predictor variables and the four
outcome variables (i.e. frequency of violent offending
Regression Analyses

TABLE II. Means, Ranges, and Standard Deviations of Poisson regression analyses were performed to
D-KEFS Scores (Tower Test, Verbal Fluency, Color-Word determine the relationship between D-KEFS scores
Interference, and Sorting Test), and Outcome Variables identified in the preliminary analyses and frequency
(Frequency of Violent Offending [FreqVO], Severe Violent of violent offending. Table IV shows the likelihood
Offending [SevVO], Frequency of Nonviolent Offending
[FreqNVO], and Frequency of Total Offending [TotalOff])
ratio chi-square (LR w2), z values, incident rate ratios,
and significance level for each predictor variable.
Variable Mean (range) SD Owing to the exploratory nature of the research, each
score was included in a separate regression analysis
TTTAS 10.10 (3–15) 2.14
TTMFMT 10.87 (4–14) 2.17 rather than including all scores in a single model. This
TTMAR 8.83 (1–14) 2.57 decision allowed us to identify all variables that were
VFLF-TC 9.17 (2–17) 3.43 individually related to violent offending rather than
VFCF-TC 10.38 (2–19) 3.20 identifying the variables that had unique effects. In
VFCS-TC 9.12 (2–15) 3.07
these analyses, age, intelligence, and frequency of
VFCS-SA 8.91 (1–15) 3.14
CWITI-CN 9.51 (1–19) 3.26 nonviolent offending served as covariates and time at
CWITcICE 38.96 (1–100) 41.96 risk was entered as an offset variable. Three of the
CWITcIUE 61.06 (1–100) 42.07 predictors were statistically significant in the predic-
CWITI/S-CN 9.27 (3–18) 3.11 tion of rate of violent offending. The exponentiation
CWITI/S-R 9.17 (1–15) 3.12
of the regression coefficient for STPR, e .11 5 .90, was
CWITcI/SCE 37.77 (1–100) 40.42
CWITcI/SUE 51.44 (1–100) 38.69 the predicted multiplicative effect of a 1-unit change
STCCS 7.79 (1–14) 3.01 in STPR on the number of violent offenses committed in
STFSDS 7.29 (1–13) 2.86 1 year. In other words, an offender with a STPR score of
STSRDS 7.10 (1–16) 3.09 7 was expected to have a rate of violent offending that
STPSA 10.32 (2–13) 2.57
was 0.90 times the rate of violent offending of an
STcOAD 53.40 (1–100) 42.20
STPR 6.97 (1–17) 3.61 offender with a scaled score of 6 (i.e. he was likely to
STVR 7.05 (1–14) 2.96 commit violent offenses less frequently). The expected
FreqVO 1.29 (0–7) 1.38 rate change in violent offending for a 1-unit change in
FreqNVO 10.35 (0–86) 12.05 CWITI/SCE was 1.01 and TTMFTM was .92.
SevVO 1.00 (0–1) 0.32
Binary logistic regression analyses were used to
TotalOff 11.64 (1–87) 12.27
predict whether an offender had committed a severe
N 5 77. See Table I for the list of abbreviations.
c
violent offense from scores from the D-KEFS.
indicates a cumulative percentile rank, which is out of 100. All other Table V shows the Wald w2, z-values, odds ratios,
D-KEFS scores are scaled scores, which have a mean of 10, a
standard deviation of 3, and a maximum of 20. The outcome and significance level for each predictor variable. As
variables are counts of the offense frequency. an example of how to interpret the coefficients the

Aggr. Behav.
344 Hancock et al.

TABLE III. Correlations Among the D-KEFS Scores (Tower Test, Verbal Fluency, Color-Word Interference and Sorting Test),
Age, KBIT Composite Score, and the Outcome Variables (Frequency of Violent Offending [FreqVO], Severe Violent Offending
[SevVO], Frequency of Nonviolent Offending [FreqNVO], and Frequency of Total Offending [TotalOff])

Variable Age KBIT composite FreqVO SevVO FreqNVO TotalOff

1. TTTAS .04 .20 .21 .17 .08 .14

2. TTMFMT .07 .15 .23 .17 .06 .10
3. TTMAR .01 .00 .14 .21 .07 .08
4. VFLF-TC .04 .38 .15 .02 .07 .09
5. VFCF-TC .02 .32 .06 .07 .01 .01
6. VFCS-TC .01 .29 .16 .21 .03 .05
7. VFCS-SA .00 .37 .05 .17 .08 .09
8. CWITI-CN .04 .09 .11 .03 .00 .06
9. CWITICE .30 .16 .10 .02 .15 .16
10.CWITIUE .02 .32 .03 .09 .06 .06
11. CWITI/S-CN .06 .12 .04 .28 .05 .05
12. CWITI/S-R .03 .18 .02 .15 .12 .12
13. CWITI/SCE .18 .14 .26 .08 .03 .00
14. CWITI/SUE .05 .34 .05 .18 .11 .10
15. STCCS .08 .51 .10 .06 .02 .01
16. STFSDS .13 .56 .13 .07 .05 .04
17. STSRDS .15 .67 .15 .13 .05 .03
18. STPSA .01 .04 .12 .30 .05 .04
19. STOAD .23 .29 .02 .32 .05 .06
20. STPR .14 .64 .21 .10 .02 .00
21. STVR .05 .49 .03 .10 .03 .03

N 5 77. See Table I for the list of abbreviations.

Po.05; Po.10.

exponentiation of the regression coefficient for
CWITI/S-CN, e .51 5 0.60, was the predicted multi-
plicative effect of a 1-unit change in CWITI/S-CN on
the likelihood of having committed a severe violent
offense (vs. not committing a severe violent offense).
In other words, four scores from the subtests of the
D-KEFS were each related to whether an offender
had committed a severe violent offense or not, over
and above age, intelligence, and frequency of
nonviolent offending.3
Although it is important to interpret the odds
ratios, it was equally important to examine how
accurate the regression models were at correctly
identifying offenders, as those who had committed
severe violent offenses and those who had not. It
was found that for each individual binary logistic
regression 90% offenders were correctly classified.
One of the 9 severe violent offenders was correctly
classified and all 68 offenders who had not
committed a severe violent offense were correctly
classified. Therefore, the sensitivity, or percentage of
occurrences correctly predicted, was 11% and the
specificity, or percentage of nonoccurrences cor-
rectly predicted, was 100%.
Because sensitivity was low, a binary logistic
regression was run containing all the significant
predictors identified by individual regressions.
Table VI displays the z-values, odds ratios, and
significance level for each predictor variable within
this regression. None of the scores were able to
predict whether an offender had committed a severe
violent offense over and above the ability of the
other scores, age, intelligence, and frequency of
nonviolent offending. However, more importantly,
it was found that the regression model’s accuracy of
correctly classifying offenders improved when all the
predictors were input simultaneously. Using this
model, sensitivity improved to 88.89% and specifi-
city remained high at 100%. These predicted values
are significantly higher than those calculated by
chance alone (w2 5 58.84, Po.01).

3
We acknowledge that we have made no mention of power or effect
size throughout the discussion of the regression analyses; however,
this was done intentionally. The regression analyses used in this
study are not completely developed in terms of the traditional types
of testing that are usually available. As there is no established way of
determining effect size or power in these types of regression analyses,
we chose not to make mention of these concepts.
DISCUSSION
Central Findings
Offenders scored below the mean of the normative
sample on many, but not all, of the scores from the
D-KEFS tests, indicating a relative weakness in

Aggr. Behav.
 Predicting Frequency and Severity of Violence 345

TABLE IV. Poisson Regression Models for the Prediction TABLE V. Binary Logistic Regression Models for the
of Frequency of Violent Offending From Individual D-KEFS Prediction of Severity of Violent Offending From Individual
Scores Covarying Age, Intelligence, and the Frequency of D-KEFS Scores Covarying Age, Intelligence, and the
Nonviolent Offending (FreqNVO) Frequency of Nonviolent Offending (FreqNVO)

Model IRR (95% CI) z LR w2(4) Model OR (95% CI) z Wald w2(4)

Predicted outcome: rate FreqVO Predicted outcome: rate SevVO 8.74

CWITcI/SCE 1.01 (1.00–1.02) 2.05 11.30 CWITI/S-CN 0.60 (0.38–0.93) 2.27
Age 0.97 (0.95–.99) 2.34 Age 1.00 (0.91–1.10) 0.09
IQ 0.99 (0.98–1.01) 1.00 IQ 1.02 (0.95–1.10) 0.63
FreqNVO 1.00 (0.98–1.02) 0.18 FreqNVO 0.40 (0.19–0.86) 2.35
Predicted outcome: rate FreqVO Predicted outcome: rate SevVO 9.14
STPR 0.90 (0.83–0.97) 2.82 15.66 STPAS 0.60 (0.39–0.95) 2.18
Age 0.97 (0.95–1.00) 1.79 Age 0.97 (0.88–1.06) 0.66
IQ 1.02 (0.99–1.04) 1.35 IQ 0.98 (0.91–1.05) 0.59
FreqNVO 1.00 (0.98–1.01) 0.54 FreqNVO 0.49 (0.28–0.86) 2.48
Predicted outcome: rate FreqVO Predicted outcome: rate SevVO 11.71
TTMFMT 0.92 (0.85–1.00) 2.04 11.19 STcOAD 1.03 (1.01–1.06) 2.38
Age 0.97 (0.95–0.99) 2.23 Age 0.95 (0.84–1.06) 0.37
IQ 1.00 (0.98–1.01) 0.30 IQ 0.97 (0.92–1.06) 0.32
FreqNVO 1.00 (0.98–1.01) 0.56 FreqNVO 0.56 (0.36–0.88) 2.51
Predicted outcome: rate FreqVO Predicted outcome: rate SevVO 9.08
TTTAS 0.92 (0.83–1.01) 1.79 10.40 TTMAR 1.41 (0.92–2.16) 1.58
Age 0.98 (0.95–1.00) 2.44 Age 0.98 (0.90–1.07) 0.53
IQ 1.00 (0.98–1.01) 0.28 IQ 0.99 (0.93–1.06) 0.33
FreqNVO 0.99 (0.97–1.01) 0.75 FreqNVO 0.54 (0.34–0.86) 2.58
Predicted outcome: rate SevVO 10.93
The four covariates listed under the predicted outcome were included VFCS-TC 0.68 (0.47–0.98) 2.03
in the same model (i.e. only four models were estimated) N 5 77. Age 1.01 (0.83–0.99) 0.21
Age, intelligence, and frequency of nonviolent offending served as
IQ 1.03 (0.96–1.11) 0.88
covariates. Time at risk was entered as an offset variable.
c FreqNVO 0.56 (0.36–0.88) 2.52
indicates a cumulative percentile rank, which is out of 100. All other
scores are scaled scores, which have a mean of 10, a standard The four covariates listed under the predicted outcome were included
deviation of 3, and a maximum of 20. IRR, incidence rate ratio in the same model (i.e. only five models were estimated) N 5 77. Age,
(i.e. the exponentiated unstandardized regression coefficient, eb) intelligence, and frequency of nonviolent offending served as
LR, likelihood ratio; see Table I for the list of abbreviations. covariates. Time at risk was entered as an offset variable.
Po.05; Po.01.
c
indicates a cumulative percentile rank, which is out of 100. All other
scores are scaled scores which have a mean of 10, a standard
these areas compared with the general population. deviation of 3, and a maximum of 20. OR, odds ratio (i.e. the
exponentiated unstandardized regression coefficient, eb); see Table I
When examining the relationship between measures for the list of abbreviations.
of executive functioning and rates of offending, Po.05; Po.01.

it was found that, as hypothesized, scores from the

D-KEFS were related to the frequency and severity
of violent offending. However, none of the scores
were related to either the frequency of nonviolent
offending or the frequency of total offending. These
findings are consistent with research suggesting that
executive dysfunction is characteristic of offenders
who commit violent crimes [Baker and Ireland,
2007; Barker et al., 2007; Miura, 2009], although
inconsistent with other research that has suggested
that offenders who commit violent offenses and
those who commit nonviolent offenses do not differ
in their executive abilities [Greenfield and Valliant,
2007; Hoaken et al., 2007].
Predictors of frequency of violence: Results
suggested that offenders who performed poorly on
measures sensitive to impulsivity (TTMFMT) were
more likely to have committed an increasingly large
number of violent offenses than were offenders who
performed better on these measures. Similarly,
offenders who performed poorly on a measure of
concept formation and cognitive flexibility (STPR)
were more likely to commit an increasingly large
number of violent offenses. Finally, the fewer
corrected errors an offender made on the switching
condition of the CWIT (CWITI/SCE), the more likely
they were to have an increased rate of violent
offending. This latter finding was surprising because
the offenders, as a group, committed a large number
of corrected errors. The current finding is idiosyn-
cratic, and not easily explained by anything cur-
rently in the literature. This finding may be the result
of a Type I error; alternatively, it may indicate that
offenders who commit high rates of violent offenses
become less likely to correct their errors on the
CWIT because they lack the ability to monitor their
behavior as they perform tasks.

Aggr. Behav.
346 Hancock et al.
TABLE VI. Binary Logistic Regression Model for the
Prediction of Severity of Violent Offending From D-KEFS
Scores Covarying Age, Intelligence, and the Frequency
of Nonviolent Offending (FreqNVO)
Model OR (95% CI) z Wald w2(7)
Predicted outcome: rate SevVO 8.42
CWITI/S-CN 0.58 (0.30–1.14) 1.57
STPAS 0.66 (0.32–1.34) 1.16
STcOAD 1.03 (0.99–1.06) 1.63
VFCS-TC 0.65 (0.30–1.40) 1.10
Age 0.99 (0.85–1.16) 0.09
FreqNVO 0.49 (0.20–1.18) 1.58
The seven covariates listed under the predicted outcome were
included in the same model (i.e. only one model was estimated)
N 5 77. Age, intelligence, and frequency of nonviolent offending
served as covariates. Time at risk was entered as an offset variable.
c
indicates a cumulative percentile rank, which is out of 100. All other
scores are scaled scores which have a mean of 10, a standard
deviation of 3, and a maximum of 20. OR, odds ratio (i.e. the
exponentiated unstandardized regression coefficient, eb); see Table I
for the list of abbreviations.
Po.05; Po.01.
Predictors of severity of violence: Results from the
second set of regression analyses suggested that the
more impaired an offender was at inhibiting
prepotent verbal responses (CWITI/S-CN) and in
concept formation (STPAS), the more likely they
were to have committed a severe violent offense.
Similarly, offenders who scored lower on measures
of cognitive flexibility (VFCS-TC) were more likely to
have committed a severe violent offense. Unexpect-
edly, the more intact offenders’ expressive language
abilities (as evidenced by a low number of abstract
sorting descriptions; STOAD), the more likely they
were to have committed a severe violent offense.
This latter finding was surprising because, as a
group, the offenders were impaired in expressive
language abilities. However, it seems that offenders
who are less impaired are more likely to have
committed a severe violent offense. Although
unexpected, an explanation for this finding may
involve the dynamic of escalation in violent
encounters. Many incidents of conflictual violence
are preceded by a verbal exchange (i.e. insults and
provocations). Offenders with more intact expres-
sive language abilities may well incite the escalation
of the conflict to the point of serious violence.
Also of interest was whether these significant
predictors were able to correctly classify offenders as
having committed a severe violent offense or as not
having committed a severe violent offense. The
individual ability of each predictor to correctly
classify offenders was weak. When the significant
predictors were run in a regression together, it was
found that 88.89% of the offenders who had
Aggr. Behav.
committed a severe violent offense were correctly
classified and that 100% of the offenders who had
not committed a severe offense were correctly
classified. These results indicate that executive
functioning may well be a construct that warrants
consideration for inclusion in future research on risk
assessment, a possibility that is discussed in more
detail below.
As mentioned earlier, research investigating
executive abilities in offenders tends to dichotomize
offenders as violent or nonviolent. A major problem
with studying offenders in this manner has been
confusion over what criteria should be used to
identify violent offenders. Serin and Preston [2001]
reviewed a variety of the criteria used to classify
offenders as violent or nonviolent, including index
offense, attitudes (e.g. hostility), emotions, (e.g.
anger), and victim selection (e.g. spousal assault).
Inconsistencies in the use of these criteria contribute
to the ambiguity of findings. Our approach to
dealing with offense history was to avoid classifica-
tion all together and to examine the frequency of
violent offenses, whereas at the same time also
considering severity. This approach, we believe,
constitutes the strength of this study and should
result in more generalizable conclusions.
In summary, if an individual lacks intact executive
abilities, criminal activity—or more specifically,
violent behavior—may be the default response for
navigating through difficult situations (e.g. solving
financial strain, coping with a provocative inter-
personal encounter). For example, an individual
who is not able to accurately examine the outcome
of earlier decisions (owing to difficulties in altering
their behavior in response to environmental
changes, and/or owing to difficulties with inhibition
and problem solving) will likely continue to make
poor decisions in the future.
Theoretical Considerations
Despite the range of executive functioning deficits
associated with violence in this study, a few
theoretical considerations need to be discussed given
the lack of agreement in the literature regarding the
measurement of executive functioning, the relation-
ship between cognitive and social variables, and the
conceptualization of violence as a unitary construct.
First, executive dysfunction in violent offenders
seems to be clinically significant; however, the
ecological validity of experimental tasks and
traditional neuropsychological tests of executive
functioning has been criticized [Chan et al., 2008].
That is, although conventional experimental tasks

demand relatively simple responses to single events,
more complex multistep tasks in daily life may
require a more complicated series of responses.
Future research should attempt to include more
ecologically valid measures.
Second, the heterogeneity of criminal behavior
makes it unlikely that all forms of crime share the
same etiology. This study examined neuropsycholo-
gical dysfunction in isolation, without considering
the psychosocial predictors of crime. Scarpa and
Raine [2007] reviewed what little is known on the
interaction between neurocognitive deficits and
social variables in relation to antisocial and violent
behavior. These authors concluded that the combi-
nation of neurocognitive deficits and early adverse
life events significantly increased risk for committing
violent offenses over possessing only one set of risk
factors. Joint assessment of both psychosocial and
cognitive contributors to violence is an approach
that warrants further exploration.
Third, owing to the exploratory nature of the
research, violence was conceptualized as homoge-
nous. However, other researchers have distinguished
between instrumental violence, used to obtain some
identifiable goal, such as a monetary gain, and
reactive violence, used as a defense after a perceived
threat [Bushman and Anderson, 2001]. In fact,
Broomhall [2005] found preliminary evidence to
suggest that instrumental and reactive aggressors
may be characterized by different executive deficits.
Instrumental and reactive violence should be differ-
entiated in future research in this area.
Implications of the Current Research
Violence risk assessment: The value of being able
to estimate the likelihood that someone may be
violent in the future cannot be overstated. Currently,
executive functions (or any cognitive abilities for
that matter) are not considered in the most widely
used and validated violence risk assessment tools
[e.g. Level of Service Inventory—Revised: Andrews
and Bonta, 2003; Violence Risk Appraisal Guide:
Quinsey et al., 2006; Historical, Clinical, Risk
Management-20: Webster et al., 1997]. Given that
violence risk assessment is far from perfect, and
given that this study identified specific scores from
the D-KEFS that were able to predict frequency and
severity of past violent offending, executive func-
tioning may be a construct that merits further
exploration in the field of violence risk assessment.
Measures of executive functioning are easy to
administer, they are objective, and executive func-
tions are thought to be relatively stable across
Predicting Frequency and Severity of Violence 347
adulthood. Given these features, executive function-
ing is a good candidate for the evaluation of
potential inclusion in risk assessment.
Potential for rehabilitation: Beyond simply asses-
sing individuals’ risk for future violence, researchers
need to develop interventions to manage or reduce
this risk. Given the findings of this study, executive
functioning is a construct that warrants further
exploration as a potential target for improvement
during the rehabilitation of violent offenders.
Executive dysfunction is not specific to incarcerated
offenders, but rather characteristic of a number of
clinical populations, such as individuals with schizo-
phrenia [Velligan and Bow-Thomas, 1999], atten-
tion-deficit disorders [Pliszka, 2007], Tourette’s
disorder [Bornstein, 1990], and some traumatic brain
injury [Krpan et al., 2007]. Research in cognitive
rehabilitation suggests that with the right techniques,
executive dysfunction can be improved significantly
in these populations [Rath et al., 2003; Worthington,
2005]. Given these findings, perhaps similar strategies
could be applied to developing rehabilitation pro-
grams for offenders identified as having deficits in
executive functioning, and such treatment may teach
offenders an alternative to violence.
Limitations
As with all research, the findings of this study
must be interpreted within the context of their
limitations. The sample for this study was composed
of offenders who had been convicted of violent
offenses of a relatively low severity. The infrequency
with which serious violence had been committed
may be a consequence of sampling from a medium
security forensic facility. Although the total number
of cases (N 5 77) was not restrictively small for
conducting binary logistic regression (the model
used to evaluate severe violent offending), the
number of cases in the severe violence cell was small
(N 5 9), and small groups reduce the efficiency of
the estimates [Stata Data Analysis Examples, 2008].
Research conducted in forensic settings is asso-
ciated with additional limitations that threaten both
the internal and external validity of its findings.
Psychological testing is considered suspicious within
the prison culture. It is possible that offenders with
the most violent histories were the most suspicious,
as they had been incarcerated the longest and were,
therefore, less likely to participate. As such, the
offender population who volunteered to participate
in this study may not be truly representative of
all incarcerated offenders. An additional problem
with testing incarcerated offenders is the issue of
Aggr. Behav.
348 Hancock et al.
motivation; although encouraged to try their best
and despite perceived effort, the offenders may not
have been completely motivated to complete the
battery to the best of their ability, which threatens
the internal validity of the research.
CONCLUSION
This study was the first of its kind. Offenders were
found to be characterized by patterns of broad and
pervasive executive dysfunction. More importantly,
executive dysfunction was found to be related
specifically to violence and to the frequency and
severity of violent offending. Despite the aforemen-
tioned limitations, the results from this study are
exciting and, if replicated, have significant implica-
tions for society. An understanding of the complex
and interconnected variables underlying violence
and criminality is a prerequisite for the early
identification of at-risk youth and for the develop-
ment of interventions for rehabilitating offenders.
Identification of distinct predictors of frequent and
severe violent offending calls into question a ‘‘one
size fits all’’ approach to remediation.
ACKNOWLEDGMENTS
This research was funded by an operating grant
(awarded to P.N.S.H.) from the Social Sciences and
Humanities Research Council of Canada
(Ref ]410-2008-2461). The authors acknowledge
the invaluable help of Marta Shaw, Joel Ginsburg,
Chris Rowntree, and Bradley Corbett.
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