The Benefits of Recognizing and Treating ADHD in Canadian Justice and Correction Systems

Key Messages

  • Incident rates of ADHD seen in the correctional population are 5 times that of adults, and ten times that of youth in the general population.1 A study that aggregated the results of 42 previous worldwide papers found that the generally accepted prevalence rate of ADHD within jail systems is 26.1%.1
  • Coexisting mental health disorders as well as rates of suicidality and substance abuse are much higher in those with ADHD than other inmates.2
  • ADHD symptoms of impulsivity and executive functioning impairment result in self-regulation impairment that put those with ADHD are at a much higher risk of becoming involved with the criminal justice system.3
  • These impairments along with difficulty remaining focused and attentive through police questioning and the court and custodial process make those with ADHD more vulnerable through the entire justice system process.4
  • Unfortunately, due to limited awareness and appropriate screening services ADHD still remains underdiagnosed and under treated especially in this population – one study found that only 2 out of 30 inmates with symptoms were diagnosed in childhood.3
  • Studies show that treatment for substance abuse and suicidality is much more effective when co-existing ADHD has been treated first.5
  • A recent US study estimated the cost to society to be $2-$4 billion dollars per year.6 If we extrapolate the study’s finding into Canadian numbers the societal costs would be $200-400 million dollars per year.
  • Building awareness of ADHD and implementing screening and assessment procedures within the justice system would increase the chances that those with ADHD could be flagged and receive appropriate treatment.
  • Newer ADHD treatments are now available that significantly decrease the potential of diversion and abuse.7, 8

Early detection and treatment of ADHD would reduce costs to the justice system by:

  • Improving disruptive behaviour and aggression inmates while incarcerated with the added benefit of reducing additional time on their sentences.7
  • Scientific evidence establishes that treatment for ADHD reduces substance abuse,9 reduces criminal behaviour by 32-41%,10 and reduces recidivism.11
  • We should be assessing and treating youth in corrections as soon as possible, as this may help to prevent the trajectory into adult offending.
  • The reduction in criminal behaviour and improved overall rehabilitation of these inmates will increase their and their family’s quality of life, reduce costs to the justice system, benefit the communities they return to and Canadian society in general. 4

Benefits of Treating ADHD in the Justice System

While there is great reluctance to introduce stimulant medication treatment, into corrections services, the benefits of providing appropriate treatment to those who are amenable, motivated, and responsible will far exceed the risks.  Appropriate treatment, in this environment (with a high prevalence of substance use disorder) would include careful and consistent implementation of risk management strategies, such as rigorous monitoring,  limiting quantities by dispensing daily, and enforcing clear policies that delineate medication discontinuation policies  for those offenders caught misusing and/or diverting medication.  Dr. Gunter Lorberg, another coauthors of the research paper and a treating physician in the field  states, “We have finally reached a point where, with sufficient resources and the right approach, coupled with use of some of the most advanced medications for ADHD, the benefits of treating outweigh the risks.”

Access our Key Messages PPT with information for officers, councils, courts, and corrections.  word-symbol

REFERENCES

[1] Young, S et al, A Meta-analysis of the Prevalence of Attention Deficit Hyperactivity Disorder in Incarcerated Populations. 2015(45): 247-258.

[2] Einarrson E et al, Screening for Attention-Deficit Hyperactivity Disorder and Co-morbid Mental Disorders among Prison Inmates. Nord J Psychiatry, 2009(63): 361-367.

[3] Eme R, Attention-Deficit/ Hyperactivity Disorder and Criminal Behavior, Intl J of Sociological Study 2013:1(2), 29-36.

[4] Usher AM, Stewart LA, Wilton G, Attention Deficit Hyperactivity Disorder in a Canadian Prison Population. Intl J of Law & Pych, 2013(36): 311-315.

[5] Connor DF et al, Adolescent Attention Deficit Hyperactivity Disorder in the Secure Treatment Setting. Criminal Justice & Behaviour, June 2012:39(6), 725-747.

[6] Fletcher J, Wolfe B, Long-term Consequences of Childhood ADHD on Criminal Activities. J Ment Health Policy Econ. September 2009:12(3), 119-138.

[7] Scott DA et al, Expert Opinion and Recommendations for the Management of Attention-Deficit/ Hyperactivity Disorder in Correctional Facilities. J Correctional Health Care 2016:22(1), 46-61.

[8] Bright GM, Abuse of Medications Employed for the Treatment of ADHD: Results From a Large-scale Community Survey. Medscape J Med, 2008:10(5), 111-138.

[9] Konstenius M et al, Methylphenidate for Attention Deficit Hyperactivity Disorder and Drug Relapse in Criminal Offenders with Substance Dependence: a 24 Week Randomized Placebo-controlled Trial. Addiction 2014(109): 440-449.

[10] Lichenstein P et al, Medication for Attention Deficit-Hyperactivity Disorder and Criminality. N Engl J Med. November 2012:367(21), 2006-2014.

[11] Ginsberg Y et al, Underdiagnosis of Attention-Deficit/Hyperactivity Disorder in Adult Patients: A Review of the Literature. Prim Care Companion CNS Discord 2014;16(3):PCC.13r01600.

ADHD General Key messages

  • Attention deficit hyperactivity disorder (ADHD) is NOT a disorder of undisciplined overactive boys. It is a real, complex, multifaceted, often life- long neurobiological disorder that affects people of both genders and all ages.
  • ADHD presents in both genders and although generally associated with children, it is prevalent in adults as well.
  • ADHD doesn’t “go away.” Left untreated, the majority of sufferers will carry symptoms – a short attention span, restlessness or constant fidgeting, and being easily distracted – through to adulthood. The result is significant impairment in their ability to study, work and manage their lives.
  • 80% of children affected with ADHD symptoms can carry the condition into adolescence and in over 60% of adults, the core symptoms will continue to cause impairment.i
  • 90% of adults with ADHD remain untreated leading to unnecessary suffering and unwanted socioeconomic impacts.ii
  • A recent survey found that at least a third of adults with ADHD found it difficult to access an assessment and diagnosis due to the cost or access to a knowledgeable physician.ii
  • Common symptoms of ADHD include difficulty with regulating attention and being unable to focus for any length of time, hyper-focusing with an inability to break focus and difficulty with prioritizing focus to a level of impairment and possibly, but not necessarily hyperactivity and impulsivity.
  • Other symptoms may include:iii difficulty being organized, frequent procrastination, feelings of under achievement, starting numerous projects but not completing them, being easily bored, seeking out high risk activities, impatience, low tolerance for frustration, moods swings, difficulty regulating emotions, problems with self-esteem, difficulty with social interaction, more job changes and job loss, less schooling, difficulty with detail orientated work and difficulty paying bills on time and managing money.
  • While it is possible for many adults with ADHD to thrive in the workplace and find some of their ADHD traits such as high energy, problem solving and creativity as significant benefits in their chosen career, others if left untreated find their symptoms prevent them from working to their potential.iv
  • Myths and misinformation have been prominent in the media and in the community at large for too many years. CADDAC is calling for Canadians and their governments to BECOME AWARE and GET INFORMED about ADHD during October, the month of ADHD Awareness, and all year.

For more detailed key messages on adult ADHD please access Adult ADHD key messages.