The identification and management of ADHD offenders within the criminal justice system: a consensus statement from the UK Adult ADHD Network and criminal justice agencies

Abstract

The UK Adult ADHD Network (UKAAN) was founded by a group of mental health specialists who have experience delivering clinical services for adults with Attention Deficit Hyperactivity Disorder (ADHD) within the National Health Service (NHS). UKAAN aims to support mental health professionals in the development of services for adults with ADHD by the promotion of assessment and treatment protocols. One method of achieving these aims has been to sponsor conferences and workshops on adult ADHD.This consensus statement is the result of a Forensic Meeting held in November 2009, attended by senior representatives of the Department of Health (DoH), Forensic Mental Health, Prison, Probation, Courts and Metropolitan Police services. The objectives of the meeting were to discuss ways of raising awareness about adult ADHD, and its recognition, assessment, treatment and management within these respective services. Whilst the document draws on the UK experience, with some adaptations it can be used as a template for similar local actions in other countries.It was concluded that bringing together experts in adult ADHD and the Criminal Justice System (CJS) will be vital to raising awareness of the needs of ADHD offenders at every stage of the offender pathway. Joint working and commissioning within the CJS is needed to improve awareness and understanding of ADHD offenders to ensure that individuals are directed to appropriate care and rehabilitation. General Practitioners (GPs), whilst ideally placed for early intervention, should not be relied upon to provide this service as vulnerable offenders often have difficulty accessing primary care services. Moreover once this hurdle has been overcome and ADHD in offenders has been identified, a second challenge will be to provide treatment and ensure continuity of care. Future research must focus on proof of principle studies to demonstrate that identification and treatment confers health gain, safeguards individual's rights, improves engagement in offender rehabilitation programmes, reduces institutional behavioural disturbance and, ultimately, leads to crime reduction. In time this will provide better justice for both offenders and society.

Attention Deficit Hyperactivity Disorder and Males in the Juvenile Justice System

“…Studies in countries other than the United States (Canada, Sweden, Finland, Norway, and the United Kingdom) reported an ADHD prevalence rate averaging 45% among juveniles in the correctional system (Young & Goodwin, 2010;Young et al, 2011). These findings provide strong confirmation that the 25% prevalence rate in the United States is indeed a conservative estimate.…”

“…First, the most conservative approach would be to use a nonstimulant medication such as atomoxetine. This approach however suffers from the limitation that it is less effective than the stimulants (Faraone, 2009;Young et al, 2011). Second, stimulant medications can be used that are less vulnerable to abuse.…”

“…The following treatment recommendations are based upon the consensus statement of the United Kingdom ADHD network and criminal justice agencies for the management of juvenile offenders with ADHD (Young et al, 2011). For whichever stage an offender is at (police, court, probation, parole, prison) a protocol should to be established for insuring that intervention meets the needs of offenders with ADHD.…”

“…The delivery of stimulant medication in a prison setting should not be a problem since these settings typically already run medication-based programs for controlled drugs and successfully adhere to policies that reduce the chances of mismanagement (Young et al, 2011).…”

“…Stimulant treatment should always form part of a comprehensive treatment plan that includes psychological, behavioral, and educational interventions (Young et al, 2011). Specific programs have been developed that integrate stimulant treatment with non-pharmacological treatments for ADHD that enhance the efficacy of medication and also treat comorbid problems (Young & Amarasinghe, 2010).…”