Childhood ADHD symptoms are associated with lifetime and current illicit substance-use disorders and in-site health risk behaviors in a representative sample of Latino prison inmates

Addressing Emotional Dysregulation and Potential Pharmacogenetic Implication of 5-HTTLPR Genotype in Attention Deficit Hyperactivity Disorder

Background

This review unpacks the emotional presentation of externalizing behaviors in attention deficit hyperactivity disorder (ADHD), by diving into the psychophysiology, neurophysiology, and neurogenetics in relation to executive function. The correlations among these three variables are identified, showing that standard assessments for ADHD leave out the emotional dysregulation element. This may lead to suboptimal management outcomes during the developmental progression into adolescence and adulthood.

Summary

The emotional impulsivity manifestation in adolescence and adulthood related to the under-managed emotional dysregulation in childhood is found to be associated with subtle confounding impact of 5-HTTLPR (serotonin-transporter-linked promoter region) genotype. The genotype of interest affects the neurochemistry, neurophysiology, and psychophysiology of the cognition for executive function. The established practice of using methylphenidate in treating ADHD surprisingly has a neurogenetic effect in targeting the genotype of interest. Methylphenidate provides neuroprotective effects throughout the neurodevelopment timeline from childhood to adulthood.

Key Messages

The emotional dysregulation element in ADHD which is often overlooked should be addressed to improve the prognostic outcomes in adolescence and adulthood.

Unpacking the Layers: Dismantling Inequities in Substance Use Services and Outcomes for Racially Minoritized Adolescents

Minoritized youth have lower prevalence rates of substance use disorders (SUD) compared with White peers, but proportionally those that are diagnosed are less likely to engage in specialized care and there are few culturally responsive treatments or programs available. We examine social determinants of SUD, with emphasis on the impact of trauma, including racial trauma, and include an intersectional approach incorporating race, ethnicity, and gender. This review of the literature highlights evidence-based effective clinical practice as examples for the field in developing therapeutic approaches to SUD for this population.

Retrospective symptoms and learning difficulties predicting ADHD in adults: Differences between prison inmates and the clinical population

People who suffer from ADHD in their childhood are more likely to be involved in criminal acts in late adolescence and adulthood. This study analyses the association between retrospective ADHD symptoms and associated problems (somatic and learning difficulties), and current symptoms in a sample of adults from imprisoned and clinical populations. Four hundred and fifty-seven participants, aged between 17 and 69 years, were divided into four groups: ADHD prison group without clinical history of symptoms (n = 61), prison group (n = 162), ADHD clinical group (n = 176) and clinical group (n = 58). The ADHD-IV scale and Wender Utah Rating Scale (WURS) were administered to the four groups and demonstrated high rates of persistence of ADHD symptoms into adulthood. ADHD groups reported significantly higher impairment both during childhood (symptoms, somatic and learning difficulties) and at present, with the ADHD clinical group being the most severely impaired. Finally, current symptoms of ADHD, along with childhood ADHD symptoms and learning difficulties, significantly predicted current impairments, but only in the clinical group. These findings represent some initial steps into the identification of predictors of ADHD symptomatology in adulthood in order to elucidate its etiopathogenesis and better identify high-risk groups for targeted prevention.

ADHD and offending

OBJECTIVES

International studies have reported disproportionately higher rates of Attention Deficit Hyperactivity Disorder (ADHD) among youth and adult offenders across police custody, prison, probation and forensic mental health settings, estimated to fall at around 25%. This review aimed to investigate the presentation and vulnerabilities of this subpopulation of people with ADHD compared to those with ADHD in the general population and consider how this may impact on the approach to assessment and treatment in this population.

METHODOLOGY

A selective review of the extant literature was conducted to investigate how offenders with ADHD may present differently from their non-ADHD peers in their clinical presentation, criminogenic behaviour and psychological vulnerabilities.

RESULTS

Nearly all (around 96%) offenders with ADHD have additional comorbid problems, including mood, anxiety, conduct, substance use and personality disorders. Compared with offenders without ADHD, they become involved in the criminal justice system (CJS) at a younger age, have higher rates of recidivism, are more likely to make a false confession, engage in behavioural disturbances in custody, have health risk behaviours and a lower quality of life. Assessing and treating ADHD in this subpopulation may be more complex due to their presentation.

CONCLUSIONS

Offenders with ADHD are disadvantaged within the system by their ADHD symptoms being unrecognised and/or misunderstood; their diagnosis of ADHD may be missed or misdiagnosed. This is at cost to the individual, from both a health and rehabilitative perspective, as well as more broadly to society.

ADHD Among Offenders: Prevalence and Relationship With Psychopathic Traits

Objective: Longitudinal studies have shown a strong association between ADHD and criminal behavior. The aims of this study were to examine the prevalence of adult ADHD in a high-security facility and to investigate the relationship between ADHD symptoms and psychopathic traits in criminal offenders. Material and Methods: Participants were recruited between October 2015 and January 2016 among the inmates from a high-security all-male correctional facility in Portugal. Self-report scales were used to measure ADHD symptoms, current psychopathology, and psychopathic traits. An interview was conducted to collect sociodemographic data, along with information about adverse childhood experiences, substance use, and criminal record. The statistical analysis was conducted using STATA 13 with the significance level set at .05. Results: From the final sample of 101 male prisoners, 17 participants (16.8%) screened positive for ADHD. Participants positive for ADHD had higher levels of general psychopathology and psychopathic traits. Psychopathic traits remained significantly higher in ADHD offenders after controlling for age, substance abuse, and early childhood adversities (OR = 1.07, p = .002) and this was explained by differences in the Meanness subscale (OR = 1.11, p = .013). Discussion/conclusions: The present study shows that ADHD symptoms are highly prevalent among offenders and might have a modulating effect on the course of delinquent behavior. The cross-sectional association between ADHD symptoms and psychopathic traits reinforces the previously documented correlation between these disorders and can lead to a better understanding of the prevalent criminal behavior in ADHD patients.

Attention-Deficit/Hyperactivity Disorder (ADHD), antisociality and delinquent behavior over the lifespan

Attention-Deficit/Hyperactivity Disorder (ADHD) is closely linked to the development of conduct problems during socialization in early life and to an increased risk for antisocial activities and delinquency over the lifespan. The interaction between ADHD and common comorbid disorders like substance use disorders as well as changing environmental conditions could mediate the course of antisocial and delinquent behavior with increasing age. However, this complex interaction is only partially understood so far. This review presents current knowledge about the association of ADHD with antisociality and the development of delinquent behavior. Thereby, the relationships between ADHD, conduct disorder and antisocial personality disorder in offenders are discussed, as well as the impact of comorbid psychiatric disorders and psychosocial conditions on offending behavior. Also, treatment studies in offender populations with ADHD are presented. Although our understanding of the role of ADHD in the development of criminal behavior has substantially improved during the last two decades, more research is needed to further elucidate the mechanisms generating unfavorable outcomes and to engender adequate treatment strategies for this population at risk. Moreover, more attention is needed on children with conduct problems in order to avoid antisocial or delinquent behaviors over the lifespan.

Substance and Alcohol Misuse, Drug Pathways, and Offending Behaviors in Association With ADHD in Prison Inmates

Objective: The objective of the study is to quantify the extent of specific polysubstance use, drug transitions to current substances, and describe the association with alcohol use disorders among inmates with ADHD. We also examined health risk behaviors and patterns of offending in relation with ADHD. Method: A total of 387 male British prison inmates were screened and interviewed via the Diagnostic Interview for ADHD in Adults 2.0 (DIVA-2). Results: Male prisoners with ADHD endorse more methadone and amphetamine use. There was a significantly higher linear trend among those with ADHD for the number of substances ever used. ADHD was positively associated with increasing levels of alcohol use disorder severity, and with alcohol dependence. Transition along the pathways of substance misuse and persistence of drug misuse was better explained by the presence of conduct disorder/antisocial personality traits. Conclusion: Higher rates of alcohol dependence and stimulant-cocaine misuse suggest these inmates have maladaptive coping mechanisms, such as self-medication behaviors.

Attention Deficit Hyperactivity Disorder in Prisoners: Increased Substance Use Disorder Severity and Psychiatric Comorbidity

OBJECTIVES

Attention deficit hyperactivity disorder (ADHD) and substance use disorders (SUD) are overrepresented among incarcerated populations. We examined whether ADHD was associated with increased severity of comorbid SUD and with increased psychiatric comorbidity among prisoners.

METHODS

Cross-sectional study of 500 randomly selected Latino male prisoners in the Puerto Rico Correctional System using validated diagnostic measures to assess Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) ADHD and SUD diagnosis, antisocial personality disorder (ASP) and borderline personality disorder (BPD), major depression, and generalized anxiety disorder (GAD). We defined SUD severity by symptom count and by presence of at least 2 current SUD diagnoses (polysubstance).

RESULTS

Participants with ADHD had increased risk for lifetime (p < 0.05) and current (p < 0.01) SUDs, all comorbid psychiatric disorders, and suicidality (p < 0.001). They had more severe SUD, both in number of symptoms and number of SUD (polysubstance) diagnoses (p < 0.01). ADHD was associated with increased psychiatric comorbidity, as participants with ADHD were more likely to have a second diagnosis, and a greater number of comorbid disorders (p < 0.001). ASP, BPD, major depression, and GAD, but not ADHD, were significant predictors of SUD severity in adjusted models.

CONCLUSIONS

Findings highlight the complex mental health needs of incarcerated populations, where SUD, ADHD, and other psychiatric disorders are prevalent and interrelated.

Onset and Severity of Early Disruptive Behavioral Disorders in Treatment-Seeking Substance Use Disorder Patients with and without Attention-Deficit/Hyperactivity Disorder

AIMS

This study addressed the age of onset of conduct disorder (CD) and oppositional defiant disorder (ODD) in treatment-seeking substance use disorder (SUD) patients with and without adult attention-deficit/hyperactivity disorder (ADHD) and its association with early onset of SUD.

METHODS

We examined data from the 2nd International ADHD in Substance Use Disorders Prevalence Study, including 400 adults in SUD treatment from Puerto Rico, Hungary, and Australia. ADHD, SUD, and CD/ODD were assessed with the Conners Adult ADHD Diagnostic Interview for DSM-IV, the MINI International Neuropsychiatric Interview, and the K-SADS, respectively. Cox regression analyses modeled time to emergence of CD/ODD separately for SUD patients with and without adult ADHD. Linear regression models examined associations between age of onset of SUD and presence of ADHD and adjusted for sex, age, and country. To assess the mediating role of CD/ODD on the association of ADHD with onset of SUD, adjusted regression models were estimated.

RESULTS

Treatment-seeking SUD patients with ADHD presented an earlier onset of CD/ODD compared with those without ADHD. CD/ODD symptom loads were higher among the SUD and ADHD group. Age of first substance use and SUD were significantly earlier in SUD patients with ADHD, and these findings remained significant after adjustment for demographics and coexisting CD/ODD.

CONCLUSIONS

ADHD is associated with earlier onset of SUD as well as with an earlier onset of more frequent and more severe disruptive behavioral disorders. These findings may inform preventive interventions to mitigate adverse consequences of ADHD.

Prisoners' ambivalent sexism and domestic violence: a narrative study

PURPOSE

Gender inequality and sexism are often at the root of domestic violence against women and children, with both serving to justify male domination. This runs in parallel with mother-blaming bias, which constitutes a pervasive common sense and scientific error derived from the myth of the good and the bad mother, characterising a large part of studies on deviance. The purpose of this paper is to consider the possible role of sexism in prisoners' deviant biographies; for this, the authors considered the role of the mother in the biographies of prisoners, and the results lend support to the idea that mother-blaming is a serious fallacy. Starting from a critical psychology point of view and following the retrospective methodology, the authors interviewed 22 drug-addicted prisoners through Interpretative Phenomenological Analysis (IPA) regarding their biographies and their relationships with parents and partners.

DESIGN/METHODOLOGY/APPROACH

In the survey, the authors followed the same intention, and the results lend support to the idea that mother-blaming is a serious fallacy. The authors interviewed 22 drug-addicted prisoners through IPA concerning their biographies and their relationships with parents and partners.

FINDINGS

The main result of this qualitative study was the recognition of a fundamental sexism assumed by participants, characterised by a paradox between the representation of the mother and the representation of the ideal woman. Despite the mother being their positive affective referent, and battered by her husband/partner, the same participants had been witnesses of domestic violence, and sometimes victims, they interiorised from their father an ambivalent sexism: benevolent sexism with regard to their mother and exhibited hostile sexism with their partner. On the one hand, it emerged that female empowerment was desirable with respect to the mothers. On the other hand, the ideal woman was exactly as their mother was, that is, being absolutely subordinated to men (a patient, caring, submissive housewife, totally dedicated to her children and her husband).

RESEARCH LIMITATIONS/IMPLICATIONS

From a mainstream psychological perspective, the limits of the research are linked to the utilisation of the narrative method. Also, this methodology does not verify any hypotheses, so quotations from the participants are used to illustrate themes, and thus, it is difficult to report the informational complexities arising from the dialogues. However, the literature has emphasised that these limitations do not invalidate qualitative research findings, despite the difficulties in generalising the results of the qualitative studies. Thereafter, the critical analysis moved within the intersection of experience-centred approaches and the culturally oriented treatment of narratives, so that the focus on the stories of the prisoners makes meaning because it applies structure to experience, albeit, with the form and content of the texts. This research did not permit us to measure and evaluate post-hoc any post-traumatic hypotheses, which, in turn, would give room for further research. Another limitation of the research was that the relationship between culture of origin and gender biases, especially with participants from non-European countries, was not analysed. This topic would require an important in-depth study, which encompasses how women are treated in different countries and its effects on social maladjustment for immigrants in Italy.

PRACTICAL IMPLICATIONS

The outcome of this study suggests that within similar structures in the Institute of Mitigated Custody, the theme of sexism should be considered in more depth. Since sexism justifies violence against women, and is therefore a factor that can cause recidivism in the antisocial behaviour of prisoners once they have served their sentences. It is important to allow them to analyse the relationship between their sexist attitudes, witnessing violence in childhood and the possibility of changing moral values of reference in favour of equality. This type of psychological intervention must necessarily be based not only on the elaboration of traumas suffered during childhood with an abusive father, but also on issues related to gender equality and the theme of social inclusion.

SOCIAL IMPLICATIONS

The study suggests the idea that male sexism can be a factor responsible for suffering and maladjustment for men and that therefore an education that promotes equality of gender differences can also help prevent the social distress associated with drug addiction and deviance.

ORIGINALITY/VALUE

The paper considers some cogent issues inherent to ambivalent sexism that pervades prisoners' aspirations for their future.

Sex differences in traumatic events and psychiatric morbidity associated to probable posttraumatic stress disorder among Latino prisoners

Latinos comprised 17.1% of the U.S. population and 33.1% of US prisoners, yet they are underrepresented in the psychopathology literature. Despite higher rates of trauma among incarcerated individuals than in the general population, most of the previous research in this area focused primarily on women samples, and very few studies examined sex differences in PTSD and traumatic experiences. In addition, there is a need for research assessing traumatic experiences and probable PTSD in men and women Latino inmates to inform culturally competent care and sex sensitive care for this vulnerable and underserved population. Our study examined whether men and women Latino inmates with probable Posttraumatic Stress Disorder (PTSD), based on the cut off 40 or more symptoms on the Davidson Trauma Scale (DTS), differed significantly by the number of event types experienced, the type of potentially traumatizing event, and in co-occurring psychiatric conditions. A multi-stage sample design was used to select a probabilistic sample of 1,331 inmates from 26 penal institutions in PR of which 1179 participated in the study. Bivariate associations were calculated for each type of traumatic event and probable PTSD. Mean number of types of potentially traumatizing event experienced was comparable for both sexes (F = 3.83, M = 3.74) yet sex differences were found in the nature of the event. Women with probable PTSD had higher rates of experiencing rape and sexual abuse. Men had higher rates of experiencing combat in war, a life-threatening accident, of witnessing violence, and being threatened with a weapon. Men with significant ADHD symptoms in childhood and with Generalized Anxiety Disorder (GAD) during adulthood were almost 5 and 7 times as likely to score above threshold on the DTS whereas women were >3 times as likely in the presence of ADHD symptoms in childhood or depression during adulthood. This study underscores the need to improve understanding of the clinical manifestations of trauma and co-occurring psychiatric conditions for appropriate sex sensitive interventions targeting Latinos living in prisons.

The economic consequences of attention-deficit hyperactivity disorder in the Scottish prison system

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) is highly prevalent amongst prison inmates and the criminal justice system (CJS) likely bears considerable costs for offenders with ADHD. We aimed to examine the relationship between ADHD and health-related quality of life (HRQoL) and quality-adjusted life years (QALY) amongst imprisoned adults; and to estimate the annual expenditure associated with ADHD status in prison.

METHODS

An observational study was performed in 2011-2013, at Porterfield Prison, Inverness, United Kingdom (UK). The all male sample included 390 adult prison inmates with capacity to consent and no history of moderate or severe intellectual disability. Participants were interviewed using the Diagnostic Interview for ADHD in Adults 2.0. The Health Utilities Index Mark 3 (HUI3) was used to measure health status, and to calculate attribute specific HRQoL scores and QALY. Health service utilisation was obtained through inspection of medical prison records. Inmates with ADHD were compared with inmates without ADHD.

RESULTS

Inmates with ADHD had significantly lower QALYs, with a clinically significant adjusted difference of 0.13. Psychiatric co-morbidity accounted for the variation of ADHD on the HUI3 emotion domain only. Medical costs for inmates with ADHD were significantly higher; and behaviour-related prison costs were similar to prisoners without ADHD, reflecting a low frequency of recorded critical incidents.

CONCLUSIONS

ADHD may directly contribute to adverse health and quality of life through cognitive and executive function deficits, and co-morbid disorders. The extrapolation of conservative cost estimates suggests that the financial burden of medical and behavior-related prison care for inmates with ADHD in the UK is approximately £11.7 million annually. The reported cost estimates are conservative as there is great variability in recorded critical incidents in prisons. In turn, for some prison establishments the prison care costs associated with prisoners with ADHD may be considerably greater.

Health-related quality of life in prisoners with attention-deficit hyperactivity disorder and head injury

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) and head injury (including traumatic brain injury (TBI)) manifest in high levels across prison samples and guidance from the National Institute for Health and Care Excellence notes that people with acquired brain injury may have increased prevalence of ADHD. We aimed to examine the association of ADHD with TBI and the impact of the association upon health-related quality of life (HRQoL) and service use among imprisoned adults.

METHODS

An observational study was performed in 2011-2013, at Porterfield Prison, Inverness, United Kingdom (UK). The all male sample included 390 adult prison inmates with capacity to consent and no history of moderate or severe intellectual disability. Head injury was measured with a series of self-reported questions, addressing history of hits to the head: frequency, severity, loss of consciousness (LOC), and sequelae. Participants were interviewed using the Diagnostic Interview for ADHD in Adults 2.0. The Health Utilities Index Mark 3 was used to measure health status, and to calculate attribute specific HRQoL and Quality-Adjusted Life Year (QALY) scores.

RESULTS

72% of prisoners sampled reported at least one head injury in their lifetime. Among those, 70% of head injuries occurred before age 16 and 70% experienced LOC. Prisoners with ADHD were nearly twice more likely to have TBI. Prisoners with ADHD-only and ADHD with co-morbid TBI had significantly lower scores in several HRQoL attributes, compared with TBI only or the absence of either condition. Adjusted logistic regression models indicated an average reduction of 0.20 QALYs in inmates with ADHD-only and 0.30 QALY loss in those with ADHD with co-morbid TBI compared with inmates with neither condition.

CONCLUSIONS

There is a robust association between ADHD and TBI, and ADHD with co-morbid TBI confers significantly greater impairment in terms of HRQoL. Managing the short and long-term consequences of TBI is essential to improving care for prisoners and to addressing the criminogenic factors related to them.

ADHD modulates the course of delinquency: a 15-year follow-up study of young incarcerated man

There is growing evidence of an association between ADHD and rule-breaking behaviour and that subjects with ADHD are more likely to be involved in the legal system. However, the research on ADHD as a risk factor not only for delinquency but also for recidivism is scarce and findings are controversial. Therefore, we explored the impact of ADHD on the course of delinquency in a sample of incarcerated young men. We conducted a 15-year follow-up study by investigating the criminal records of 106 former youth prisoners. Criminal recidivism was operationalized through three variables: criminal recidivism; frequency of recidivism; and time to recidivism. The incremental predictive validity of ADHD was analysed using survival analysis and controlled for confounders associated with recidivism. Offenders with ADHD (n = 74) reoffended 2.5 times faster and showed a higher rate of recidivism and further incarcerations compared to non-ADHD offenders (n = 33), even when controlling for general risk factors such as antisocial personality disorder. Median survival rate ranged between 6 and 7 months in the ADHD groups and 25 months in the non-ADHD group. Our results revealed that ADHD has an incremental predictive power on criminal recidivism, even above general risk factors. Moreover, the criminogenic influence of ADHD appeared to be crucial in terms of the interplay of childhood ADHD, irrespectively of the persistence of the symptomatology into later life. Our findings therefore highlight the importance of early intervention and consequently prevention.

Neurodevelopmental disorders in prison inmates: comorbidity and combined associations with psychiatric symptoms and behavioural disturbance

The identification and management of inmates with neurodevelopmental disorders (ND) has been insufficiently addressed in the literature. We estimated the proportion of cases with Attention deficit/hyperactivity disorder (ADHD), Autism spectrum disorder (ASD) and Intellectual disability (ID) in prison, their comorbidity, and associations with disruptive behaviours and with psychiatric symptoms. Further, we examined the role of coexisting ND on psychiatric symptoms and attitudes toward violence. All 390 male inmates underwent an assessment that included the Diagnostic Interview for ADHD in Adults 2.0, the Autism Quotient, the Learning Disability Screening Questionnaire, the Brief Symptom Inventory (BSI), and measures of disruptive behaviours and attitudes towards violence. The percentage of cases with ADHD, ASD and ID were 25%, 9% and 9%. Inmates with ADHD and those with ID had significantly higher levels of disruptive behaviours. The combined ADHD/ASD group had significantly higher scores on global severity symptoms than either ADHD or ASD only. Meanwhile, the combined ADHD/ID group had significantly higher scores of behavioural disturbance than the ADHD-only group. Our findings show the extent of ND in prison, their inter-relations and associations with further mental health problems. Vulnerabilities conferred by ND within the criminal justice system should be addressed via interventions and preventative strategies.

Attention deficit hyperactivity disorder symptoms, type of offending and recidivism in a prison population: The role of substance dependence

BACKGROUND

It is unclear whether adult offenders with a history of attention deficit hyperactivity disorder (ADHD) are more likely to re-offend, and if so, in any specific offences.

AIM

This study aimed to examine correlates of childhood ADHD symptoms among prisoners.

METHODS

A randomly selected sample of 1179 participants from the adult sentenced population of Puerto Rico (USA) reported their history of violent and non-violent offences, age of first arrest and re-offending. Participants completed retrospective measures of ADHD and a diagnostic interview for substance use disorders.

RESULTS

Self-reported ADHD was associated with age of first arrest, a number of violent and non-violent offences and re-offending. The association with any non-violent offending was explained statistically by substance use disorders and other psychosocial covariates. ADHD was independently associated with being under 15 years of age at first arrest and with re-offending.

CONCLUSIONS

Although some associations between ADHD and offending may be accounted for by co-morbidity with substance use disorders, early onset of offending and repeated violent offending appear to be directly related to ADHD. Criminal justice policies should, therefore, incorporate ADHD screening accompanied by appropriate rehabilitation programmes when such neurodevelopmental disorder is identified. Copyright © 2016 John Wiley & Sons, Ltd.

Transitions and Motivations for Substance Misuse in Prison Inmates With ADHD and Conduct Disorder: Validation of a New Instrument

OBJECTIVE

There is a reasonable theoretical base for understanding the possible causes and motivations behind substance misuse and its dependency. There is a need for a reliable and valid measure that delineates the markers of substance use from its initiation and identifies different motivations for drug use transitioning, maintenance, and dependency. We addressed this gap in the United Kingdom by examining and validating the Substance Transitions in Addiction Rating Scale (STARS).

METHODS

For this review, 390 male prisoners were screened for conduct disorder and assessed with a clinical diagnostic interview for attention deficit/hyperactivity disorder (ADHD). They completed the four STARS subscales regarding their substance use. Exploratory structural equation modeling was performed to assess the STARS structure and to derive factors to assess validity against ADHD and conduct disorder diagnostic categories.

RESULTS

Each of the subscales produced meaningful and reliable factors that supported the self-medication and behavioral disinhibition hypotheses of substance use motivation. The findings robustly show that ADHD is significantly associated with the need for coping as a way of managing primary and comorbid symptoms, but not conduct disorder. The findings were strongest for the combined ADHD type.

DISCUSSION

STARS has a great potential to further the understanding of the motivation behind substance use and its dependency in different populations.

Psychometric properties of the Barkley Deficits in Executive Functioning Scale: A Spanish-Language Version in a community sample of puerto rican adults

Performance-based measures have shown some limitation in the assessment of executive functioning (EF) and rating scales have been proposed as an alternative. Our aim was to conduct a comprehensive psychometric evaluation of the Barkley Deficits in Executive Functioning Scale (BDEFS), as administered in 452 Latino community adults (65.5% female). The BDEFS was back-translated into Spanish. We performed exploratory factor analysis (EFA) to assess the structure of the translated BDEFS and to compare it with the original five-factor structure based on the English-language version. Confirmatory factor analysis (CFA) was performed to test the original language structure of the instrument, and also a modified version with items that loaded equally in both versions. The Adult Self-Report Scale was used to screen for ADHD symptoms. We assessed invariance on the latent factor's mean by age and gender, and to estimate associations with ADHD symptom dimensions. The five-factor structure of the BDEFS was partially supported by EFA/CFA, in which 78 out of 89 items loaded similar to the original English-language structure. Factor scores were significantly associated with ADHD symptom dimensions. Model-based contrasts revealed that inattention was primarily associated with disorganization, time-management and motivational aspects of EF; hyperactivity was predominantly related to self-restraint and self-regulation factors. The BDEFS seemingly assesses similar dimensions of the EF construct in English and in the present Spanish-language versions. Factor scores were differentially associated with ADHD subtypes. Replication and confirmation of the Spanish-language BDEFS in a larger sample is advised. (PsycINFO Database Record

Diagnostic accuracy of a brief screening tool for attention deficit hyperactivity disorder in UK prison inmates

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is overrepresented in prison, making it imperative to identify a screening tool that can be quickly applied to efficiently detect the disorder. We explored the discrimination ability of a widely used ADHD screen, the Barkley Adult ADHD Rating Scale (BAARS-IV), against a clinical diagnostic interview. A brief version of the screen was then developed in order to simplify its use in the prison context, and maximize its diagnostic properties.

METHOD

A cross-sectional study of 390 male prison inmates was performed in the UK, all participants were screened and interviewed via the Diagnostic Interview for ADHD in Adults 2.0 (DIVA-2).

RESULTS

A total of 47 (12.1%) inmates screened positive for ADHD using the full BAARS-IV, and 96 (24.6%) were clinically diagnosed, for a sensitivity of 37.9 and a specificity of 96.3. Our models identified the six items that most predicted ADHD diagnosis, with adjusted odds ratios ranging from 2.66 to 4.58. Sensitivity, specificity and accuracy were 0.82, 0.84 and 0.84, respectively, for the developed brief scale, and 0.71, 0.85 and 0.81 for its validation. Weighted probability scores produced an area under the curve of 0.89 for development, and 0.82 for validation of the brief scale.

CONCLUSIONS

The original BAARS-IV performed poorly at identifying prison inmates with ADHD. Our developed brief scale substantially improved diagnostic accuracy. The brief screening instrument has great potential to be used as an accurate and resource-effective tool to screen young people and adults for likely ADHD in the criminal justice system.

The Role of Emotional Distress and ADHD on Institutional Behavioral Disturbance and Recidivism Among Offenders

OBJECTIVE

The aim of this study was to examine the role of emotional distress as well as ADHD symptomatology in explaining (a) recidivism, (b) behavioral disturbances in prison, and (c) violent and nonviolent offending.

METHOD

In all, 196 male prisoners from Aberdeen prison completed the Symptom Checklist-90, which examines various clinical symptoms and emotional distress. Current adult symptoms were assessed by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria for ADHD.

RESULTS

Emotional distress and ADHD explained the variance in prison records of behavioral disturbance above and beyond antisocial personality (ASP) traits; however, much of the effect of emotional distress was mediated by ADHD symptoms. Only ADHD symptoms were significantly associated to history of violent offending, whereas ASP and age mostly explained nonviolent offenses and overall recidivism.

CONCLUSION

Our results provide support for the conceptual association between ADHD and its related emotional dimension with behavioral disturbance in prison, suggesting a link to reactive violence.

A national epidemiological study investigating risk factors for police interrogation and false confession among juveniles and young persons

PURPOSE

The principal aims of this study are to identify risk factors associated with police arrest and false confessions and to investigate whether the severity of the ADHD condition/symptoms increases the risk.

METHODS

22,226 young persons in Iceland anonymously completed self-report questionnaires screening for conduct disorder and ADHD. In addition, they stated whether they had a diagnosis of ADHD and had received ADHD medication, and their history of offending, police interrogation and false confession. Participants were stratified into two age groups, 14-16 and 17-24 years.

RESULTS

The older group was significantly more likely to have been interrogated by the police but the younger group were much more vulnerable to false confession during interrogation. Males were more likely to be at risk for both than females. The severity of the ADHD condition increased the risk of both interrogation and false confession. Negative binomial regressions showed that age, gender, conduct disorder, offending, and ADHD symptoms were all significant predictors of both interrogations and number of false confessions. Conduct disorder was the single best predictor of police interrogation, but the findings were more mixed regarding false confessions. Young people presenting with a combination of severe ADHD and comorbid conduct disorder had the worst outcome for both interrogation and false confessions.

CONCLUSIONS

The findings endorse the need for support of persons with ADHD to be put in place to ensure fair due process and to prevent miscarriages of justice.

Co-morbid psychiatric disorders among incarcerated ADHD populations: a meta-analysis

BACKGROUND

Rates of psychiatric disorders are highly prevalent among prison inmates, and recent evidence confirms over-representation of youths and adults with attention deficit hyperactivity disorder (ADHD). The risk for psychiatric co-morbidity may be greater among offenders with ADHD. We undertook a systematic review and meta-analysis of reported rates of co-existing psychiatric morbidity with ADHD in prison samples.

METHOD

Studies published from 1980 to 2015 were identified using five bibliographic indexes, review articles and reference lists. Included studies had a defined ADHD group and provided additional prevalence on at least one of the following: conduct disorder, substance use disorder, mood disorder, anxiety disorder, or personality disorder. We performed meta-analytical estimates of the prevalence of each co-morbid disorder within ADHD, and estimated the risk for co-existing disorders among prisoners with ADHD by pooling odds ratios (OR) with 95% confidence intervals.

RESULTS

Eighteen studies with data for 1615 with ADHD and 3128 without ADHD were included. The risk (OR) of all psychiatric morbidity is increased among adult inmates with ADHD. Associations in youths with ADHD were restricted to mood disorder (OR 1.89, 95% confidence interval 1.09-3.28).

CONCLUSIONS

This study quantifies the extent of co-morbidity presented by offenders with ADHD, especially adults. The differences between risk estimates for youths and adults indicate an incremental effect in both frequency and severity for the development of further co-morbid pathology through adulthood. The findings have implications for clinical intervention and for criminal justice policy.

[Opportunities and methodological challenges in health research in the context of prisons in Puerto Rico]

During 2013 the prison population of Puerto Rico was composed of approximately 13,000 persons. Documents describing the enablers and constraints for research related to mental health in prisons in the existing literature are scarce. The present work consisted of identifying elements that facilitate or hinder research in prisons identified by the members of the research team of a project that aimed to validate a scale to measure stress in prisoners. In this article, we present the facilitating and challenging elements of research work in prison, which can help to inform future research in this particular scenario to achieve satisfactory results.