Attention-deficit hyperactivity disorder (ADHD), substance use disorders, and criminality: a difficult problem with complex solutions

Abstract

The association between attention-deficit hyperactivity disorder (ADHD) and criminality has been increasingly recognized as an important societal concern. Studies conducted in different settings have revealed high rates of ADHD among adolescent offenders. The risk for criminal behavior among individuals with ADHD is increased when there is psychiatric comorbidity, particularly conduct disorder and substance use disorder. In the present report, it is aimed to systematically review the literature on the epidemiological, neurobiological, and other risk factors contributing to this association, as well as the key aspects of the assessment, diagnosis, and treatment of ADHD among offenders. A systematic literature search of electronic databases (PubMed, EMBASE, and PsycINFO) was conducted to identify potentially relevant studies published in English, in peer-reviewed journals. Studies conducted in various settings within the judicial system and in many different countries suggest that the rate of adolescent and adult inmates with ADHD far exceeds that reported in the general population; however, underdiagnosis is common. Similarly, follow-up studies of children with ADHD have revealed high rates of criminal behaviors, arrests, convictions, and imprisonment in adolescence and adulthood. Assessment of ADHD and comorbid condition requires an ongoing and careful process. When treating offenders or inmates with ADHD, who commonly present other comorbid psychiatric disorder complex, comprehensive and tailored interventions, combining pharmacological and psychosocial strategies are likely to be needed.

Standardised assessment of functioning in ADHD: consensus on the ICF Core Sets for ADHD

“…This is consistent with research that highlight selected environmental factors relevant in ADHD [17][18][19], argue for a better understanding of the environment factors that influence functional outcomes in ADHD [50,51], and promote interventions that help individuals with ADHD to more optimally perform in key environmental contexts [52], such as education [53], vocation [54], and community participation [9].…”

“…ADHD is associated with challenges to functioning in daily life, including academic and vocational difficulties [6,7], social exclusion [8], and delinquency [9,10]. Co-exiting psychiatric issues are also common [11,12].…”

A Randomized Controlled Trial of an Integrated Brain, Body, and Social Intervention for Children With ADHD

“…ADHD is a major public health problem as it is associated with impaired child and family functioning and high societal costs and often leads to academic underachievement, behavior problems, parent–child conflicts, and peer relationship difficulties (Barkley, Anastopoulos, Guevremont, & Fletcher, 1992; Bernfort, Nordfeldt, & Persson, 2008; Efron et al, 2014; Loe & Feldman, 2007; Marton, Wiener, Rogers, & Moore, 2015). ADHD is considered a chronic disorder and, when it is not diagnosed and treated early on, it may result in various negative developmental outcomes (e.g., occupational problems, other psychiatric disorders, substance abuse, criminal activity) across the life span as well as an increased rate of mortality (Cherkasova, Sulla, Dalena, Pondé, & Hechtman, 2013; Dalsgaard, Østergaard, Leckman, Mortensen, & Pedersen, 2015; Knecht, De Alvaro, Martinez-Raga, & Balanza-Martinez, 2015; Kooij et al, 2012; Kuriyan et al, 2013). …”

Risk of Alcohol Abuse in Humans with Attention-deficit/Hyperactivity Disorder Symptoms

“…After review, 49 articles were included based on their significance to ADHD and its association with alcohol abuse. Table 1 lists various studies indicating an interdependence between the risk of alcohol use and ADHD patients [4,8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. Several studies have reported that ADHD and alcohol abuse have a direct positive correlation [30][31][32][33][34][35][36][37][38][39][40][41].…”

“…Even though there are multiple contradictory reports, those in favor of the higher risk of alcohol abuse in ADHD adolescents were found to be greater. Furthermore, an association has also been indicated between alcohol and substance abuse and the risk of criminal behavior in ADHD [15]. Due to the lack of recovery of motor control [47] in patients suffering from ADHD as compared to non-ADHD, the risk of driving under alcohol influence also increases [48].…”