Attention Deficit Hyperactivity Disorder and it’s prevalence in the criminal justice system.

There has long been an association between impulse control, executive function, and self-regulation issues and individuals incarcerated in the criminal justice system. Socially deviant and criminal behavior is often regarded as a flaw of character and not a pathology, except usually in cases of extreme violence. For example, If asked what you thought the reason behind someone being incarcerated for distributing substances was, you would likely say something to the effect of, “They didn’t want to get a real job like the rest of us”. “Their parents didn’t raise them right” “That’s what people from that area end up doing.”  When asked the same thing about someone who has committed serial murders, your answer would likely look very different “They are insane”, “they obviously have something wrong in their head” “They’re sick and twisted.”  Stigmatizing statements aside, we don’t really stop to think about the actual reasons behind people’s behavior criminal or not. Anyone outside of the societal norms is automatically regarded as deviant and therefore flawed.

Impulse control, executive functioning, and self-regulation are all aspects that make up a large portion of the symptomology of Attention Deficit Hyperactivity Disorder (Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), 2018). These are also aspects associated with criminal behavior. A research study completed on the identification and treatment of ADHD in individuals in the prison population. The study found that 25% of prisoners met diagnostic criteria for ADHD.  So, one-fourth of the prison population studied had a diagnosable and treatable neurodevelopmental disorder (Young et al., 2018). If ADHD is a treatable neurodevelopmental disorder, then why are so many of the inmates from the study identified as such, and what is the relationship between their diagnosis and their involvement in the criminal justice system? The answer to that is a prevalence of mis and underdiagnosis of ADHD, along with several barriers to treatment for many populations of people. One of the largest issues regarding the mis and underdiagnosis of ADHD is race. There are several existing studies that show that there is a disparity in receiving a diagnosis between white and black children, with white children receiving a diagnosis far more often than their black peers. Conversely, black children are punished far more frequently than their white peers. This isn’t even taking into account the racial disparity impacting diagnosis for Hispanic children and those of other ethnicities (Moody, 2016, p. 154).

In evaluating an incarcerated population of males in a high-security prison in Sweden it was found that with the utilization of medication, rehabilitation, and CBT-based offender groups the population showed a significant improvement in reducing the symptoms of ADHD including behavioral control, global and executive functioning, and quality of life (Ginsberg, Långström, Larsson, & Lichtenstein, 2013, p. 346). This supports the idea that if barriers to treatment prior to becoming an offender are addressed then the likelihood of an individual entering the criminal justice system would decrease, or for previous offenders lower the rate of recidivism.

We’ve talked about one of the main disparities between individuals who receive a diagnosis, but what about barriers to treatment? According to Moody, one of the first barriers to treatment is a lack of awareness. He references a study published by The Journal of the National Medical Association in which they found that less than 70% of black parents had heard of ADHD, 40% of that had accurate and reliable information about it and only about 10% knew that it wasn’t caused by a sugary diet. If there is a lack of psychoeducation available to different populations then the impact on those populations specifically is likely to be much higher than those that do have access to psychoeducation. Lack of social networks is another barrier that Moody discusses, in that because there is a lack of awareness there is a resulting lack of social networks and support available to parents of children with ADHD. The disorder is treated purely as behavioral issues and punishment occurs at home (Moody, 2016, p. 154). Another barrier to treatment is the stigma not only surrounding mental illness as a whole but also ADHD being regarded as somewhat of a “bad kids” problem. The treatment for ADHD being primarily psychopharmacological stimulants also adds to a treatment barrier, as parents do not want their children to be “on drugs”, the knowledge and discussion around non-stimulant medications for ADHD is not frequently discussed enough(Moody, 2016, p. 154).

If there was a nationwide focus on raising awareness, education, and advocacy around ADHD, especially in low-socioeconomic and black communities there would be more opportunity for children to receive treatment and therefore a reduction of about 25% at a minimum in the prison system. Prisons are currently overcrowded and underfunded and a reduction of that magnitude in the population would be significant. What are we waiting for?

 

Sources:

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). (2018, May 8). ADHD and a Pathway Toward Criminality: Preventing Trouble Before It Begins. Retrieved from https://chadd.org/adhd-weekly/adhd-and-a-pathway-toward-criminality-preventing-trouble-before-it-begins/

Ginsberg, Y., Långström, N., Larsson, H., & Lichtenstein, P. (2013). ADHD and criminality: could treatment benefit prisoners with ADHD who are at higher risk of reoffending? Expert Review of Neurotherapeutics, 13(4), 345–348. https://doi.org/10.1586/ern.13.22

Moody, M. (2016). From Under-Diagnoses to Over-Representation: Black Children, ADHD, and the School-To-Prison Pipeline. Journal of African American Studies, 20(2), 152–163. https://doi.org/10.1007/s12111-016-9325-5

Young, S., Gudjonsson, G., Chitsabesan, P., Colley, B., Farrag, E., Forrester, A., … Asherson, P. (2018). Identification and treatment of offenders with attention-deficit/hyperactivity disorder in the prison population: a practical approach based upon expert consensus. BMC Psychiatry, 18(1). https://doi.org/10.1186/s12888-018-1858-9

1 comment

  1. Your post stuck out to me because it relates a lot to my life. My family has a history of ADHD, and its hereditary rate is 60% – 91% when it is passed down from the mother. (Thapar & Stergiakouli 2008). I was lucky, and both my parents have ADHD. Both my siblings and I have ADHD, but it affects us all differently. I was able to take control when I got to my mid 20’s, but not everyone is that lucky. Sadly, my brother falls into the statistic of those who have ADHD in prison. It wasn’t that he is a bad person or didn’t want to get a job. He just faced many hardships when we grew up, and he fell into a never-ending cycle. We had a hard life, and not everyone makes it out successful or happy. We need to focus on why these inmates ended up in jail rather than punishing them for having problems. Like you stated, we do need to look into the reasons they have this criminal behavior. He wasn’t able to be diagnosed and treated because we didn’t have the ability to afford it for all 3 of us. If he were a person of color, the likelihood he would be treated as well as he was in prison would be way lower. This does create a problem in the justice system where people of color are looked over or undertreated for their mental health problems. Living in poverty can highly affect the rate of child disruptive behavior disorders (Acri et al. 2017). Living in poverty, being a person of color, and having little recourses to help creates this terrible cycle. There is a lack of treatment for those who need it the most. It seems there is little education on mental health in these areas creating a judicial cycle.

    Thapar, A., & Stergiakouli, E. (2008). An Overview on the Genetics of ADHD. Xin li xue bao. Acta psychologica Sinica, 40(10), 1088–1098. https://doi.org/10.3724/SP.J.1041.2008.01088

    Acri, M. C., Bornheimer, L. A., Jessell, L., Chomancuzuk, A. H., Adler, J. G., Gopalan, G., & McKay, M. M. (2017). The intersection of extreme poverty and familial mental health in the United States. Social work in mental health, 15(6), 677–689. https://doi.org/10.1080/15332985.2017.1319893

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