Beyond the Gates: Identifying and Managing Offenders with Attention Deficit Hyperactivity Disorder in Community Probation Services

Abstract

Research has indicated that, compared with the general population, the prevalence of offenders with ADHD in prison is high. The situation for offenders managed in the community by the Probation Service is unknown. This study aimed to bridge the gap in our knowledge by (1) surveying the awareness of probation staff about ADHD and (2) screening the rate of offenders with ADHD managed within the service. In the first study, a brief survey was circulated to offender managers working in 7 Probation Trusts in England and Wales asking them to estimate the prevalence of offenders with ADHD on their caseload, the presenting problems of these offenders and challenges to their management, and the training received on the treatment and management of offenders with ADHD. The survey had a return rate of 11%. Probation staff perceived that 7.6% of their caseload had ADHD and identified this group to have difficulties associated with neuropsychological dysfunction, lifestyle problems and compliance problems. They perceived that these problems hindered meaningful engagement with the service and rehabilitation. Challenges to their management were perceived to be due to both internal processes (motivation and engagement) and external processes (inadequate or inappropriate interventions). Few respondents had received training in the management of offenders with ADHD and most wanted more support. In the second study, a sub-sample of 88 offenders in one Probation Trust completed questionnaires to screen for DSM-IV ADHD in childhood and current symptoms. The screen found an estimated prevalence of 45.45% and 20.51% for childhood and adulthood ADHD respectively and these were strongly associated with functional impairment. Thus probation staff considerably underestimated the likely rate, suggesting there are high rates of under-detection and/or misdiagnosis among offenders with ADHD in their service. The results indicate that screening provisions are needed in probation settings, together with training for staff.

Attention deficit hyperactivity disorder as a neglected psychiatric disease in prison: Call for identification and treatment

“…The self-reported assessment of ADHD symptoms showed that 12.9% of the participants were screened as potentially having ADHD. Overall, ADHD seemed underdiagnosed and undertreated among detained people, as suggested previously without empirical support using clinical diagnoses available in prison medical files (Young, González, et al, 2018; Young et al, 2014). As ADHD treatment leads to improved outcomes, such as reduced recidivism (Chang et al, 2016;, all detained persons with ADHD should benefit from timely and appropriate treatment.…”

“…ADHD is usually neglected among incarcerated populations (Young, Gudjonsson, et al, 2018;Young et al, 2014), although the prevalence rate of this disorder is very high in this population (Baggio, Fructuoso, et al, 2018). Untreated ADHD is likely to lead to poor outcomes, such as maladjustment to prison life and recidivism (Berryessa, 2017;González, Gudjonsson, Wells, & Young, 2016;Gordon, Williams, & Donnelly, 2012;Young et al, 2009).…”

Identification and treatment of offenders with attention-deficit/hyperactivity disorder in the prison population: a practical approach based upon expert consensus

“…Compared with inmates without ADHD, inmates with ADHD symptoms demonstrate a high frequency and severity of functional impairment that worsen in proportion to the severity of their ADHD symptoms [4, 5]. …”

“…ADHD is associated with early age criminality [ 1 ], a high rate of recidivism [ 2 ], and a two to three-fold increased risk of later arrest, conviction, and imprisonment [ 1 ]. While ADHD is a treatable condition best managed by a combination of appropriate medication and psychological treatments [ 3 ], among individuals in the criminal justice system ADHD remains both mis- and under-diagnosed [ 4 – 6 ] and consequently inadequately treated.…”

“…ADHD is characterized by symptoms of pervasive and impairing inattention and/or hyperactivity and impulsivity [ 7 ] that starts during childhood or early adolescence and persists in around half of individuals into adulthood [ 8 ], where it is associated with significant personal, social, and occupational problems [ 9 ]. Compared with inmates without ADHD, inmates with ADHD symptoms demonstrate a high frequency and severity of functional impairment that worsen in proportion to the severity of their ADHD symptoms [ 4 , 5 ].…”