Introduction

Most individuals develop language and communication skills that are utilized with little apparent effort. In most cases, occasional miscommunication or misinterpretation is easily corrected, but for some individuals, however, communication may be disrupted by factors such as hearing loss or difficulties with articulation, voice, language, fluency or disruption of some of the diverse biological systems required for communication, thus causing what are known as Human Communication Disorders¹.

Good communication is essential for resolving social conflicts, especially in a closed community such as a prison. However, we have observed that language and communication disorders are more frequent among prison inmates than in the general population, reducing their problem-solving ability and increasing conflicts.

Social communication is often the area in which problems are initially recognized because a lack of social-communicative skills prevents a child from having normal social interactions with family, peers, and other adults².

People who engage in activities considered illegal, usually have a history characterized by learning difficulties, poor academic performance, and high levels of school dropout³. Speaking and listening skills are necessary for individuals who have problems with the law to handle the legal system's demands and to participate in educational programs designed to reduce recidivism⁴.

Beitchman et al. suggest that communication difficulties tend to be interpreted by educators as school conduct problems⁵. Whitmire observed that adolescents with language disorders are vulnerable to problems in developing relationships with their peers and family members, as well as meeting school expectations⁶. Difficulty in language development has been associated with a higher risk of getting involved in criminal activities⁷. About 90% of young people who have committed infractions have some kind of language disorder, compared to 7.5% of the general population⁸.

Children with early language impairment had significantly higher rates of anxiety disorder in young adulthood when compared to unimpaired children. The majority of participants with anxiety disorders had a diagnosis of social phobia⁹. In 2010, the Royal College of Speech and Language Therapists held a conference at the Polmont Young Offenders Institute, attended by 55 participants, including young offenders, professionals, and organizations working in the criminal justice system in Scotland, and found that 100% of participants agree that “speech, language, and communication needs are a problem in the criminal justice system”¹⁰. It has been reported that 28-38% of young offenders have communication disorders and have difficulties in understanding their rights³.

Communication disorders in adults are clearly associated with poor general educational performance in some individuals with reading and learning disabilities and other special education problems. Adults with speech and hearing disorders should be treated. An individual who has a severe communication impairment may find it difficult to maintain or even acquire a job while on probation¹¹.

In general, the prison population is growing along with its health and communication needs. The impact of any communication disorder that affects an individual's ability to understand, detect, or apply language and speech to effectively engage in discourse can lead to a variety of conflicts. The aim of this review, therefore, is to analyze and identify the most prevalent communication disorders in individuals deprived of liberty. With this, we will demonstrate the importance of research in the penitentiary system, generate new incentives, programs and future research.

Material and method

A systematic review was carried out, based on the guidelines and main items to report systematic reviews and meta-analyses (PRISMA). The PRISMA Statement consists of a 27-item checklist and a four-phase flow. The aim of the Statement is to help authors improve the reporting of systematic reviews and meta-analyses¹².

In this systematic literature review, electronic databases (Medline, SciELO and LILACS) were searched, and a manual search was performed of all studies published in all languages from 1983 to December 2021. The selection of key words: prisons, rights of prisoners, criminal law, social justice, criminals, communication disorders and language disorders, was made using controlled language in DeCS and MeSH, thus obtaining the results shown in Table 1.

Inclusion criteria: studies that evaluate prison inmates with communication disorders. Exclusion criteria: reviews, animal studies and those that do not address the topic of interest.

The MeSH and DeCS terms were united with the Boolean operators AND and OR: “prisons” OR “prisoners” OR “ Rights of prisoners” OR “criminal law” OR “social justice” OR “criminals” AND “communication disorders” OR “language disorders”. Different searches in databases were performed with the search equation as shown in Table 2.

Assessment of the methodological quality of the included studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology. The STROBE Statement is a 22-item checklist that we consider essential for good reporting of observational studies. These items refer to the title of the article and item 1 of the abstract, the introduction (items 2 and 3), methods (items 4 to 12), results (items 13 to 17) and discussion sections (items 18 to 21) and other information (point 22 on financing). 18 items are common to the three designs, while four (items 6, 12, 14, and 15) are design-specific, with different versions for all or part of the item¹³.

The STROBE scores were transformed into percentages to better assess the quality of the articles. Three categories were established for quality assessment: high when the study met more than 80% of the established criteria; medium when 50 to 80% of the criteria were met; and low when less than 50% of the criteria were met. All results from the included studies were specified and presented, regardless of the extraction procedure and variables included.

Results

After placing the descriptors in the Medline, Lilacs and Scielo databases, 1,983 articles were found. After reading their titles and abstracts and applying the eligibility criteria, the review included 25 articles, with 6 countries of origin, published between 1983 and 2021. A sample of 2,188 individuals was evaluated, two studies were conducted with a female population only, while twelve studied exclusively males, and 10 articles had a mixed population. The studies were heterogeneous with a population ranging from 4 to 390 participants. Table 3 summarizes the characteristics of the included studies.

Figure 1 describes the identification, evaluation, eligibility, and selection of the articles included in the review.

Figure 1. Flowchart of identification, screening, eligibility, and inclusion of studies in the systematic review as per the PRISMA Statement. 

Discussion

The results of this systematic review suggest that prison inmates have a high frequency of language and communication disorders, and thus end up being more vulnerable within the correctional system. Communication problems were found in different proportions among the groups; however, they affected all prison populations evaluated in this study.

It is noticeable that even with the presence of speech and language pathology professionals in the correctional system, communication problems still occur, translating into the need for other strategies to improve reception and implementation. Wagner and Potter in 1983 already reported concerns regarding the presence of speech, language, and hearing problems in the prison population ³⁶. In 2021 it was demonstrated that communication disorders are still frequent in the correctional system and that there have been no changes in approximately 40 years¹⁴. It is worth noting that almost all inmates had contact with the justice system previously and did not have assistance in the treatment of their communication disorders.

Good communication between the individual in custody and the State is essential to assure that the rights of the citizen are clearly understood and that his alleged offense will be adequately explained. If a person cannot articulate the facts or is not understood due to communication problems, they can never effectively receive due process in a legal system. A current example shows that in the United States, young people with language disorders are particularly vulnerable to not understanding their Miranda rights and the consequences of waiving them¹⁷. This lack of understanding motivated by ignorance of rights, a hostile environment or inadequate understanding of the language is translated into greater or unfair penalties.

Thus, considering that in most societies, even the most civilized ones, individuals who have restrictions on their freedom belong to social classes with less access to education and culture, leading to less access to the benefits that the State offers. It is observed that the dialogue between the person in custody and the authorities becomes difficult from the onset of any interaction. Thus, there is a need for law enforcement, courts, and the department of corrections to be vigilant, and track neurodevelopmental disorders in young offenders²¹. On the other hand, in addition to fear, there is a culture of insecurity, hostility, and rejection in underrepresented populations. These typically have the lowest socioeconomic status and often consist of immigrants, people with mental problems or African Americans. Once an individual is detained, their first opportunity to explain their actions it is at the police station. At this point, it is worth noting that many suspects have a low educational level, fear of authority, and cannot afford to hire a lawyer. In many countries, the long wait for sentencing often stems from the fear of the authorities towards individuals presumed to be guilty (criminals). This label means that during most of the period in which they are under custody of the State, they do not have access to the full and legitimate legal system. In the articles evaluated in this review, emphasis was placed on the need to closely examine the oral language skills of adolescents who, when they do not possess adequate literacy skills, have difficulties in dealing with the prison system. Once a young person is involved with the legal system, attention must be given to his oral language skills, to allow proper defense and access to their rights as defined by law³².

Thus, our article demonstrates the need for strategies that allow better communication between the State and the inmate population, so that people can have access to their legal rights. To this end, multidisciplinary groups involving psychologists, speech-language pathologists, and social workers should work in harmony with members of the State legal system so that the justice system becomes a tool in favor of the citizen and not a weapon of punishment.

Conclusions

The prison population grows and grows, and that already demonstrates that something needs to change to reduce infractions and recidivism. Many young people and adults who are in contact with the justice system have communication disorders and these difficulties are often not previously recognized. Furthermore, people in prison experience much worse mental and physical health compared to the general population. The articles in this review demonstrate that incarcerated individuals have a high frequency of communication disorders, the main one being language disorders. Speech therapists are important members of the justice workforce and improve the health, well-being, and participation of people in contact with the justice system through prevention, early detection, assessment and treatment of speech, language, communication and even swallowing.