ADHD Attention Deficit Hyperactivity Disorder in Offenders

By Westmoreland, Patricia | Corrections Today, June 2010 | Go to article overview
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ADHD Attention Deficit Hyperactivity Disorder in Offenders


Westmoreland, Patricia, Corrections Today


Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder whose cardinal symptoms are inattention, impulsivity and hyperactivity. The current diagnostic criteria for ADHD note that at least six symptoms in the categories of inattention, impulsivity and hyperactivity must be present for six months or longer. (1) The symptoms must be present before age 7, and other psychiatric and medical causes for the symptoms must have been ruled out. The symptoms of ADHD are indicative of impairment in the brain's ability to process and organize information so as to respond appropriately to the external environment.

Both frontal and subcortical areas of the brain are thought to be involved in producing the symptoms. Imaging studies using magnetic resonance imaging (MRI) have found abnormalities in the structure and function of the brain in these areas. A study that used MRI to measure the volumes of brain structures found that, in comparison to children without ADHD, children with ADHD had smaller volumes of the frontal cortex, subcortical region and cerebellum; these differences persisted as the children grew older. (2) In addition, studies of brain function (using Positron Emission Tomography, PET, and functional MRI) are consistent in showing malfunctions in the frontal and subcortical regions in patients with ADHD. An imbalance in dopamine and noradrenaline are among the neurochemical abnormalities that may be responsible for these abnormalities in function. Medications for ADHD are thought to work by correcting abnormalities in these pathways. (3)

Risk and Prevalence of ADHD

The risk for ADHD is increased two- to eight-fold in parents of children with ADHD and siblings of children with ADHD. (4) In addition to genetic influences, environmental factors are thought to play a role in the development of ADHD. Risk factors include maternal smoking and alcohol consumption during pregnancy, low birth weight, severe psychological stressors during pregnancy, and obstetrical complications in pregnancy and delivery.

ADHD is the most commonly diagnosed behavioral disorder in youths, with an estimated prevalence of 7 percent, affecting boys three times more often than girls. (5) The disorder is persistent for many people--only 10 percent of children with ADHD achieve full remission in adulthood, while 30 to 70 percent continue to have significant symptoms. (6) The estimated prevalence of ADHD in adults is 4.4.(7) It has been reported that the rates of hyperactivity and impulsivity decline with age and that inattention is the most common persistent symptom in adults, (8) although motor hyperactivity and impulsivity often persist. Additional symptoms include disorganization and problems with controlling emotions. Those patients whose ADHD persists into adulthood are less likely to reach their academic potential, are more likely to have vocational and marital problems, and are at risk for a greater number of (and more serious) motor vehicle accidents. (9) Comorbidity has been reported with other mental illnesses, including mood, anxiety and substance use disorders. (10) Risk of suicide is also increased. (11)

Criminality and ADHD

Childhood ADHD is a stronger predictor than conduct disorder of adult disruptive behavior, arrests, jail stays and felony convictions. (12) Persistence of ADHD into early adulthood is associated with truancy, aggression and delinquency, as well as the development of antisocial and other personality disorders. (13) Predictors of criminality in ADHD include multiple juvenile arrests, arrests for felony crimes in adolescence and incarceration. (14) Recent studies of ADHD in the prison population have shown that 20 percent to 40 percent of inmates meet criteria for adult ADHD, and perhaps as many as an additional 16 percent have subthreshold symptoms. (15)

Study of ADHD in Iowa Department of Corrections Reception Offenders

In order to assess the prevalence of ADHD in offenders newly admitted to the Iowa Department of Corrections (IDOC), clinical characteristics, psychiatric comorbidity and quality of life for these offenders were studied.

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