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Baggio S, Billieux J, Dirkzwager A, Iglesias K, Moschetti K, Perroud N, Schneider M, Vernaz N, Wolff H, Heller P. Protocol of a monocentric, double-blind, randomized, superiority, controlled trial evaluating the effect of in-prison OROS-methylphenidate vs. placebo treatment in detained people with attention-deficit hyperactivity disorder (BATIR). Trials 2024; 25:23. [PMID: 38178233 PMCID: PMC10765778 DOI: 10.1186/s13063-023-07827-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/23/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is characterized by difficulty paying attention, poor impulse control, and hyperactive behavior. It is associated with several adverse health and social outcomes and leads to an increased risk of criminality and recidivism. Worldwide, ADHD is thus highly prevalent in prisons. However, ADHD treatment has been neglected in such environments. Stimulant medications such as osmotic-release oral system methylphenidate (OROS-MPH) are first-line treatments in the general population, but they are under-prescribed in prisons due to concerns about abuse, even though such claims are not empirically supported. This project aims to compare the efficacy of a 3-month in-prison OROS-MPH vs. placebo treatment on the severity of core ADHD symptoms and relevant in- and post-prison outcomes. METHODS This study is a phase III, double-blinded, randomized, superiority, controlled trial of OROS-MPH vs. placebo. After randomization, the participants will receive 3 months of treatment with OROS-MPH or placebo (1:1 ratio) while incarcerated. Upon release, all participants will be offered the treatment (OROS-MPH) for 1 year but will remain blinded to their initial study group. The study will be conducted at the Division of Prison Health, Geneva, Switzerland, among incarcerated men (n = 150). Measures will include (1) investigator-rated ADHD symptoms, (2) acute events collected by the medical and prison teams, (3) assessment of the risk of recidivism, (4) medication side effects, (5) medication adherence, (6) study retention, (7) health care/prison costs, and (8) 1-year recidivism. Analyses will include bivariable and multivariable modeling (e.g., regression models, mixed-effects models, survival analyses) and an economic evaluation (cost-benefit analysis). DISCUSSION We expect that early identification and treatment of ADHD in prison will be an important public health opportunity and a cost-effective approach that is likely to reduce the vulnerability of incarcerated individuals and promote pathways out of criminal involvement. The study will also promote standards of care for people with ADHD in prison and provide recommendations for continuity of care after release. TRIAL REGISTRATION ClinicalTrials.gov NCT05842330 . Registered on June 5, 2023. Kofam.ch SNCTP000005388. Registered on July 17, 2023.
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Affiliation(s)
- Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
- Laboratory of Population Health (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland.
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), Lausanne, Switzerland
| | - Anja Dirkzwager
- Netherlands Institute for the Study of Crime and Law Enforcement, Amsterdam, The Netherlands
| | - Katia Iglesias
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
| | - Karine Moschetti
- Health Technology Assessment Unit, University Hospital of Lausanne, Lausanne, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Nader Perroud
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marie Schneider
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
- Medication adherence and Interprofessionality lab, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Nathalie Vernaz
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland
| | - Patrick Heller
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Dayan H, Shoham R, Berger I, Khoury-Kassabri M, Pollak Y. Features of attention deficit/hyperactivity disorder and antisocial behaviour in a general population-based sample of adults. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2023; 33:172-184. [PMID: 37057691 DOI: 10.1002/cbm.2288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/29/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) is known to be a risk factor for antisocial and delinquent behaviour, but there is still a lack of information on how features of ADHD relate to offending behaviour among adults not already defined by their offending. AIMS Our aim was to add to knowledge about relationships between ADHD and antisocial behaviour among adults in the general population by answering the following questions: (A) Does the level of self-reported ADHD features relate to criminal and non-criminal antisocial behaviour? (B) To what extent are self-ratings of ADHD features independent of socio-demographic features previously identified as predictors of antisocial behaviour? METHODS A sample of adults was originally recruited to study public response to the COVID-19 outbreak through an online panel to be representative of the Israeli population. Among other scales, the 2025 participants completed an ADHD self-report scale, an antisocial behaviour self-report scale and a socio-demographic questionnaire probing for age, gender, urbanity, place of birth, socioeconomic status (education and income), family status (being in a relationship and having children) and religiosity. RESULTS Higher mean totals for the inattention and hyperactivity ADHD scale scores were associated with higher mean antisocial behaviour scores. These relationships were only slightly affected by socio-demographic variables, including sex, age, education and income. CONCLUSION Our findings suggest that not only may features of ADHD, even below a diagnostic threshold, constitute a risk factor for antisocial behaviour, but also that the self-rated levels of these problems covary. These findings are important for informing the early detection of risk of antisocial behaviour in the general population and its prevention.
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Affiliation(s)
- Haym Dayan
- Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Itai Berger
- Hebrew University of Jerusalem, Jerusalem, Israel
- Assuta Ashdod University Medical Center, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University, Beersheba, Israel
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Murray AL, Nagin D, Obsuth I, Ribeaud D, Eisner M. Young Adulthood Outcomes of Joint Mental Health Trajectories: A Group-Based Trajectory Model Analysis of a 13-Year Longitudinal Cohort Study. Child Psychiatry Hum Dev 2022; 53:1083-1096. [PMID: 34059956 PMCID: PMC9470602 DOI: 10.1007/s10578-021-01193-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/21/2022]
Abstract
Developmental trajectories of common mental health issues such as ADHD symptoms, internalising problems, and externalising problems can often be usefully summarised in terms of a small number of 'developmental subtypes' (e.g., 'childhood onset', 'adolescent onset') that may differ in their profiles or levels of clinically meaningful variables such as etiological risk factors. However, given the strong tendency for symptoms in these domains to co-occur, it is important to consider not only developmental subtypes in each domain individually, but also the joint developmental subtypes defined by symptoms trajectories in all three domains together (e.g., 'late onset multimorbid', 'pure internalising', 'early onset multimorbid'). Previous research has illuminated the joint developmental subtypes of ADHD symptoms, internalising problems, and externalising problems that emerge from normative longitudinal data using methods such as group-based trajectory modelling, as well as predictors of membership in these developmental subtypes. However, information on the long-term outcomes of developmental subtype membership is critical to illuminate the likely nature and intensity of support needs required for individuals whose trajectories fit different developmental subtypes. We, therefore, evaluated the relations between developmental subtypes previously derived using group-based trajectory modelling in the z-proso study (n = 1620 with trajectory data at ages 7, 8, 9, 10, 11, 12, 13, 15) and early adulthood outcomes. Individuals with multimorbid trajectories but not 'pure' internalising problem elevations showed higher levels of social exclusion and delinquency at age 20. These associations held irrespective of the specific developmental course of symptoms (e.g., early versus late onset versus remitting). There was also some evidence that intimate partner violence acts as a form of heterotypic continuity for earlier externalising problems. Results underline the need for early intervention to address the pathways that lead to social exclusion and delinquency among young people with multiple co-occurring mental health issues.
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Affiliation(s)
| | | | - Ingrid Obsuth
- Clinical Psychology Department, University of Edinburgh, Edinburgh, UK
| | - Denis Ribeaud
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Manuel Eisner
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
- Institute of Criminology, University of Cambridge, Cambridge, UK
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Ramsey KL, Smith SD, Batastini AB, Walbridge FD. Examining the interplay of attention-deficit/hyperactivity disorder symptoms and trait anger as contributing factors to institutional misconduct among justice-involved adolescents. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2022; 32:75-86. [PMID: 35332607 DOI: 10.1002/cbm.2231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Although justice-involved adolescents have a higher prevalence of trait anger and of attention-deficit/hyperactivity disorder (ADHD) than adolescents in the general population, these factors have not been examined in relation to institutional misconduct. AIMS We sought to examine associations between ADHD symptoms and misconduct, including aggression, disruptive behaviours and other rule-violating behaviours among adolescents in a maximum-security residential facility run by the Department of Juvenile Justice and to test the moderating effect of trait anger on such relationships. METHODS Archival data collected from April 2010 to May 2011 comprising a resident cohort (N = 119) of justice-involved adolescents (mean age = 16.74) were analysed; 30% were White and 70% Black. Self-report measures of ADHD symptoms and trait anger were collected 2 weeks after their admission to the facility. Behavioural write-ups of rule violations issued by facility staff during the month following the collection of these measures were coded according to the different forms of institutional misconduct. RESULTS Analyses revealed that trait anger significantly predicted disruptive behaviours occurring within a 1-month time frame following the administration of the anger measure; it also predicted all other rule violating behaviours except aggression. ADHD symptoms, by contrast, were only marginally predictive. Trait anger did not moderate this small relationship between ADHD symptoms and institutional misconduct. CONCLUSIONS These findings that adolescents with a chronic tendency to feel angry are more likely to violate a variety of institutional rules during the first few weeks of admission to a juvenile justice maximum-security residential facility suggest that early intervention efforts are needed to minimise harm within the institution and to prevent these adolescents from continuing on this trajectory, which may affect the conditions of their release.
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Affiliation(s)
- Kathleen L Ramsey
- School of Psychology, The University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Stephanie D Smith
- School of Psychology, The University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Ashley B Batastini
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Fayth D Walbridge
- School of Psychology, The University of Southern Mississippi, Hattiesburg, Mississippi, USA
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5
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Bourke EM, Say DF, Carison A, Hill A, Craig S, Hiscock H, Babl FE, O'Donnell SM. Emergency mental health presentations in children with autism spectrum disorder and attention deficit hyperactivity disorder. J Paediatr Child Health 2021; 57:1572-1579. [PMID: 33963626 DOI: 10.1111/jpc.15535] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/13/2021] [Accepted: 04/21/2021] [Indexed: 11/29/2022]
Abstract
AIM To characterise the key features and management of young people presenting to the emergency department (ED) with a mental health (MH) complaint and a known diagnosis of autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD). METHODS Retrospective review of all ED MH presentations in children aged 7-17 years, presenting over a 12-month period from the 1st of January 2018 to the 31st of December 2018, to the Royal Children's Hospital in Melbourne, Australia. Univariate analyses were carried out to examine the relationship between an underlying diagnosis of ASD and/or ADHD and a number of key presentation variables. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated for ED management outcomes. RESULTS There were 374 presentations in this cohort, representing 28% of the total MH presentations in 2018. The most common reason for presentation was acute severe behavioural disturbance. Young people with ASD and ADHD were at increased risk of having an acute crisis team response activated (ASD RR 2.3, CI 1.6-3.3, ADHD RR 2.2, CI 1.2-4.1). Compared to those without either diagnosis, young people with ASD were more likely to be physically restrained (RR 2.8, CI 1.7-4.6), managed in seclusion (RR 3.3, CI 1.7-6.4) and to receive medication to assist with behavioural de-escalation (RR 2.8, CI 1.6-4.9). CONCLUSIONS Children with ASD and/or ADHD represent one-quarter of all children presenting to the ED with MH complaints. They experience high rates of acute severe behavioural disturbance. Future research is needed to co-design, implement and evaluate better approaches for their management.
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Affiliation(s)
- Elyssia M Bourke
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Daniela F Say
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anna Carison
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ashley Hill
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Simon Craig
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Health Services Research Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.,Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Sinead M O'Donnell
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
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Turner D, Wolf AJ, Barra S, Müller M, Gregório Hertz P, Huss M, Tüscher O, Retz W. The association between adverse childhood experiences and mental health problems in young offenders. Eur Child Adolesc Psychiatry 2021; 30:1195-1207. [PMID: 32740721 PMCID: PMC8310856 DOI: 10.1007/s00787-020-01608-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 07/20/2020] [Indexed: 01/04/2023]
Abstract
High rates of adverse childhood experiences (ACEs, e.g., abuse and neglect) have been found in young offenders. Furthermore, ACEs seem to increase the risk of developing relevant mental health problems, in non-offending juveniles and adults. However, this association has only seldomly been addressed in offending juveniles and young adults. The present study aimed at evaluating the prevalence of ACEs and mental health problems as well as their association within a sample of male and female young offenders. Altogether, 161 adolescent and young adult offenders (16.8% females) from the youth detention center Worms (Germany) filled out questionnaires concerning ACEs and mental health problems with a focus on attention-deficit/hyperactivity disorder and intermittent explosive disorder. Considerable rates of mental health problems were found, e.g., a prevalence of 35.9% was found for intermittent explosive disorder. Furthermore, a greater proportion of the female offenders fell into the clinically significant category for somatic complaints, anxiety/depression, and attention problems than the male offenders. Female young offenders also reported more frequently about all forms of ACEs compared to the male offenders. Latent class analysis defined three subtypes of young offenders depending on their individual ACE patterns: (1) low ACEs, (2) mainly neglectful ACEs, and (3) multiple ACEs. ACEs were significantly associated with the occurrence of both internalizing and externalizing mental health disturbances, with the multiple-ACE subtype being most likely to report about significant mental health problems. The results of the present study point towards the relevance to routinely assess ACEs in young offenders to identify possible precursors of mental health problems and of future criminal behaviors.
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Affiliation(s)
- Daniel Turner
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany.
| | - Anne Jule Wolf
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
| | - Steffen Barra
- Neurocenter - Institute for Forensic Psychology and Psychiatry, Saarland University Medical Center, Homburg, Germany
| | - Marcus Müller
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
| | - Priscilla Gregório Hertz
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
| | - Michael Huss
- Department of Child and Adolescent Psychiatry, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
| | - Wolfgang Retz
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
- Neurocenter - Institute for Forensic Psychology and Psychiatry, Saarland University Medical Center, Homburg, Germany
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Anker E, Ginsberg Y, Heir T. Prevalence of criminal convictions in Norwegian adult ADHD outpatients and associations with ADHD symptom severity and emotional dysregulation. BMC Psychiatry 2021; 21:226. [PMID: 33941124 PMCID: PMC8091664 DOI: 10.1186/s12888-021-03223-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Attention deficit hyperactivity disorder (ADHD) often co-occurs with antisocial behaviour. Several studies have shown high rates of ADHD among prisoners. However, the prevalence of crime among individuals with ADHD is less known. The aim of the present study was to estimate the prevalence of lifetime criminal conviction (CC) in a clinical sample of adults with ADHD, and the associations with the severity of ADHD and emotional dysregulation (ED). METHODS Patients were admitted to a private psychiatric outpatient clinic in Oslo between 2014 and 2018. Of the 656 patients diagnosed with ADHD, 629 (95.9%) agreed to participate in the study. CC was determined based on self-reporting of the lifetime history of criminal behaviour. ADHD was diagnosed according to the DSM-5 criteria, and ADHD severity was measured using the Adult ADHD Self-Report Scale (ASRS). ED was assessed by the eight-item version of Barkley's Current Behaviour Scale - Self-Report (CBS-SR). RESULTS The prevalence of self-reported CC in this clinical sample was 11.7% among women and 24.5% among men. CC was associated with hyperactive-impulsive severity (p < 0.001) and ED (p = 0.006). CONCLUSIONS The prevalence of self-reported lifetime criminal conviction was high for both genders. CC was associated with symptom severity of hyperactivity-impulsivity and emotional dysregulation. The findings suggest the need for greater research efforts on the avoidance of criminal activity in people with ADHD and targeted intervention for ADHD treatment and CC prevention.
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Affiliation(s)
- Espen Anker
- Oslo ADHD Clinic, Kirkeveien 64B, 0366, Oslo, Norway.
| | - Ylva Ginsberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Trond Heir
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
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Young S, Cocallis K. ADHD and offending. J Neural Transm (Vienna) 2021; 128:1009-1019. [PMID: 33538909 DOI: 10.1007/s00702-021-02308-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Susan Young
- Psychology Services Limited, London, PO 1735, Croydon, C9 7AE, UK. .,Department of Psychology, Reykjavik University, Reykjavík, Iceland.
| | - Kelly Cocallis
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
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Vélez-Pastrana MC, González RA, Ramos-Fernández A, Ramírez Padilla RR, Levin FR, Albizu García C. Attention Deficit Hyperactivity Disorder in Prisoners: Increased Substance Use Disorder Severity and Psychiatric Comorbidity. Eur Addict Res 2020; 26:179-190. [PMID: 32615575 DOI: 10.1159/000508829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/18/2020] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- María C Vélez-Pastrana
- PhD Program in Clinical Psychology, Universidad Carlos Albizu, San Juan, Puerto Rico, .,Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA,
| | - Rafael A González
- National Adoption and Fostering Service & National Conduct Problems Team, Michael Rutter Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | | | - Rafael R Ramírez Padilla
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA
| | - Frances R Levin
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Carmen Albizu García
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA
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10
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Young S, González RA, Fridman M, Hodgkins P, Kim K, Gudjonsson GH. Health-related quality of life in prisoners with attention-deficit hyperactivity disorder and head injury. BMC Psychiatry 2018; 18:209. [PMID: 29929487 PMCID: PMC6013883 DOI: 10.1186/s12888-018-1785-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 06/12/2018] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Susan Young
- Psychology Services Limited, PO Box 1735, Croydon, CR97AE, UK. .,Reykjavik University, Reykjavik, Iceland.
| | - Rafael A. González
- 0000 0004 0426 7183grid.450709.fEast London NHS Foundation Trust, East London, UK
| | | | - Paul Hodgkins
- 0000 0004 5913 664Xgrid.476678.cSage Therapeutics, Cambridge, MA USA
| | - Keira Kim
- Independent Medical Writer, San Diego, CA USA
| | - Gisli H. Gudjonsson
- 0000 0004 0643 5232grid.9580.4Reykjavik University, Reykjavik, Iceland ,0000 0001 2322 6764grid.13097.3cInstitute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Philipp-Wiegmann F, Rösler M, Clasen O, Zinnow T, Retz-Junginger P, Retz W. ADHD modulates the course of delinquency: a 15-year follow-up study of young incarcerated man. Eur Arch Psychiatry Clin Neurosci 2018; 268:391-399. [PMID: 28612143 DOI: 10.1007/s00406-017-0816-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/06/2017] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
| | - Michael Rösler
- Institute for Forensic Psychology and Psychiatry, Saarland University, Homburg, Saar, Germany
| | - Oriana Clasen
- Institute for Forensic Psychology and Psychiatry, Saarland University, Homburg, Saar, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Toivo Zinnow
- Institute for Forensic Psychology and Psychiatry, Saarland University, Homburg, Saar, Germany
| | - Petra Retz-Junginger
- Institute for Forensic Psychology and Psychiatry, Saarland University, Homburg, Saar, Germany
| | - Wolfgang Retz
- Department of Psychiatry and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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12
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Young S, González RA, Mullens H, Mutch L, Malet-Lambert I, Gudjonsson GH. Neurodevelopmental disorders in prison inmates: comorbidity and combined associations with psychiatric symptoms and behavioural disturbance. Psychiatry Res 2018; 261:109-115. [PMID: 29291476 DOI: 10.1016/j.psychres.2017.12.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/04/2017] [Accepted: 12/14/2017] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Susan Young
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College London, UK; Reykjavik University, Iceland.
| | - Rafael A González
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College London, UK; Child and Family Consultation Service, East London NHS Foundation Trust, UK
| | | | - Laura Mutch
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Gisli H Gudjonsson
- Reykjavik University, Iceland; Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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13
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Baggio S, Fructuoso A, Guimaraes M, Fois E, Golay D, Heller P, Perroud N, Aubry C, Young S, Delessert D, Gétaz L, Tran NT, Wolff H. Prevalence of Attention Deficit Hyperactivity Disorder in Detention Settings: A Systematic Review and Meta-Analysis. Front Psychiatry 2018; 9:331. [PMID: 30116206 PMCID: PMC6084240 DOI: 10.3389/fpsyt.2018.00331] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/29/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Previous studies have reported a high prevalence of attention deficit hyperactivity disorder (ADHD) among people living in detention (PLD) corresponding to a five- to ten-fold increase compared to the general population. Our main study objective was to provide an updated ADHD prevalence rate for PLD, including PLD in psychiatric units. Sub-objectives included (i) comparing different ways of assessing ADHD, including DSM-5 criteria and (ii) identifying which types of PLD are more likely to have ADHD. Methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines and the MOOSE checklist. PubMed/Medline, PsycINFO, and Web of Sciences were searched combining "ADHD" and "prison" keywords and synonyms for articles published between January 1, 1966 and January 2, 2018. Potential sources of variation to the meta-analytic ADHD prevalence rate were investigated using meta-regressions and subgroups analyses. Results: The meta-analysis pooled 102 original studies including 69,997 participants. The adult ADHD prevalence rate was 26.2% (95% confidence interval: 22.7-29.6). Retrospective assessments of ADHD in childhood were associated with an increased prevalence estimate (41.1, 95% confidence interval: 34.9-47.2, p < 0.001). There was no significant difference in the prevalence estimate between screenings and clinical interviews in adulthood. Only three studies used the DSM-5 definition of ADHD and results were non-significantly different with other DSM versions. We found no difference according to participants' characteristics. Conclusion: Our results confirmed the high prevalence rate of ADHD among PLD, corresponding to a five-fold increase compared to the general population. In light of such high ADHD prevalence, our results reinforce the importance of addressing this critical public health issue by (i) systematically offering ADHD screening and diagnosis to all individuals entering detention, and (ii) delivering treatment, monitoring, and care for ADHD during and after detention. These strategies may help reduce recidivism and reincarceration, as well as violence in detention settings, in addition to improving the health and wellbeing of people living in detention. Additionally, our study suggests that using screening scales may be a reliable way of assessing ADHD, although caution is needed because a complete evaluation by an experienced clinician is required to provide a formal diagnosis.
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Affiliation(s)
- Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.,Life Course and Social Inequality Research Centre, University of Lausanne, Lausanne, Switzerland
| | - Ana Fructuoso
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Marta Guimaraes
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Eveline Fois
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Diane Golay
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Patrick Heller
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Candy Aubry
- Foundation TDAH-Insight and Association TDAH-ImPulse, Geneva, Switzerland
| | - Susan Young
- Division of Brain Sciences, Department of Medicine, Centre for Mental Health, Imperial College London, London, United Kingdom
| | | | - Laurent Gétaz
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Nguyen T Tran
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.,Faculty of Health, Australian Centre for Public and Population Health Research, University of Technology, Sydney, NSW, Australia
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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14
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Román-Ithier JC, González RA, Vélez-Pastrana MC, González-Tejera GM, Albizu-García C. Attention deficit hyperactivity disorder symptoms, type of offending and recidivism in a prison population: The role of substance dependence. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2017; 27:443-456. [PMID: 27455899 PMCID: PMC5269538 DOI: 10.1002/cbm.2009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 02/14/2016] [Accepted: 06/07/2016] [Indexed: 06/06/2023]
Abstract
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.
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Affiliation(s)
| | - Rafael A. González
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College London, UK
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico
| | - María C. Vélez-Pastrana
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico
- Clinical Psychology PhD Program, Carlos Albizu University, San Juan, PR
| | | | - Carmen Albizu-García
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico
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15
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Vélez-Pastrana MC, González RA, Cardona JR, Baerga PP, Rodríguez ÁA, Levin FR. Psychometric properties of the Barkley Deficits in Executive Functioning Scale: A Spanish-Language Version in a community sample of puerto rican adults. Psychol Assess 2016; 28:483-98. [PMID: 26302104 PMCID: PMC4766062 DOI: 10.1037/pas0000171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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
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Affiliation(s)
- María C. Vélez-Pastrana
- Carlos Albizu University, San Juan, PR
- University of Puerto Rico Graduate School of Public Health
| | - Rafael A. González
- University of Puerto Rico Graduate School of Public Health
- Imperial College London, UK
| | | | | | - Ángel Alicea Rodríguez
- Carlos Albizu University, San Juan, PR
- University of Puerto Rico Graduate School of Public Health
| | - Frances R. Levin
- Columbia University, New York, NY, USA
- New York State Psychiatric Institute, USA
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16
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A national epidemiological study investigating risk factors for police interrogation and false confession among juveniles and young persons. Soc Psychiatry Psychiatr Epidemiol 2016; 51:359-67. [PMID: 26537245 PMCID: PMC4819598 DOI: 10.1007/s00127-015-1145-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/13/2015] [Indexed: 01/04/2023]
Abstract
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.
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17
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Young S, Sedgwick O, Fridman M, Gudjonsson G, Hodgkins P, Lantigua M, González RA. Co-morbid psychiatric disorders among incarcerated ADHD populations: a meta-analysis. Psychol Med 2015; 45:2499-2510. [PMID: 25857258 PMCID: PMC4531473 DOI: 10.1017/s0033291715000598] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 03/07/2015] [Accepted: 03/09/2015] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- S. Young
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College, London, UK
- Broadmoor Hospital, West London Mental Health Trust, London, UK
| | - O. Sedgwick
- Broadmoor Hospital, West London Mental Health Trust, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M. Fridman
- AMF Consulting Inc., Los Angeles, CA, USA
| | - G. Gudjonsson
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - P. Hodgkins
- Global Health Economics & Outcomes Research, Vertex Pharmaceuticals, Boston, MA, USA
| | - M. Lantigua
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Puerto Rico
| | - R. A. González
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College, London, UK
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Puerto Rico
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18
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Young S, Gudjonsson GH, Goodwin EJ, Jotangia A, Farooq R, Haddrick D, Adamou M. Beyond the Gates: Identifying and Managing Offenders with Attention Deficit Hyperactivity Disorder in Community Probation Services. AIMS Public Health 2014; 1:33-42. [PMID: 29666825 PMCID: PMC5903397 DOI: 10.3934/publichealth.2014.1.33] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/12/2014] [Indexed: 11/18/2022] Open
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.
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Affiliation(s)
- Susan Young
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Charing Cross Campus, Imperial College London, Claybrook Centre, 37 Claybrook Road, London W6 8LN, UK
- Broadmoor Hospital, Crowthorne, UK
| | - Gisli H Gudjonsson
- Broadmoor Hospital, Crowthorne, UK
- Institute of Psychiatry, King's College London, UK
| | | | - Amit Jotangia
- Institute of Psychiatry, King's College London, UK
- North London Forensic Service, Barnet, Enfield & Haringey Mental Health Trust, UK.
| | - Romana Farooq
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, UK
| | | | - Marios Adamou
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, UK
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19
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Young S, Gudjonsson GH, Goodwin EJ, Jotangia A, Farooq R, Haddrick D, Adamou M. Beyond the Gates: Identifying and Managing Offenders with Attention Deficit Hyperactivity Disorder in Community Probation Services. AIMS Public Health 2014. [PMID: 29666825 DOI: 10.3934/publichealth.2014.1.33)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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.
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Affiliation(s)
- Susan Young
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Charing Cross Campus, Imperial College London, Claybrook Centre, 37 Claybrook Road, London W6 8LN, UK.,Broadmoor Hospital, Crowthorne, UK
| | - Gisli H Gudjonsson
- Broadmoor Hospital, Crowthorne, UK.,Institute of Psychiatry, King's College London, UK
| | | | - Amit Jotangia
- Institute of Psychiatry, King's College London, UK.,North London Forensic Service, Barnet, Enfield & Haringey Mental Health Trust, UK
| | - Romana Farooq
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, UK
| | | | - Marios Adamou
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, UK
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