Date Published: March 17, 2014
Publisher: AIMS Press
Author(s): Susan Young, Gisli H Gudjonsson, Emily J Goodwin, Amit Jotangia, Romana Farooq, David Haddrick, Marios Adamou.
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.
In recent years there has been growing acknowledgement of the high rates of young people with ADHD who come into contact with the criminal justice system. Rates vary depending on the screening methods and diagnostic criteria used, but a general consensus from data reported in international studies suggests that around 30% of adult male offenders in the prison population have ADHD . A rate of 23.5% has been reported for those in police custody . Youth offender rates may be higher , and female adult rates may be lower . This compares with general population rates of around 5% in children and 2.5% in adults ,. These young people with ADHD are reported to present in the criminal justice system at a younger age, even as young as 10 years old ,. They are four to five times more likely to be arrested and are more likely to have multiple arrests and convictions than those without ADHD –. They have greater clinical and personality pathology than their non-ADHD peers –. In custody they are more likely to present with demanding and/or aggressive behaviours ,,.
This study is the first of its kind with a focus on the probation service and, as hypothesised, there was a significantly greater estimated rate of offenders with ADHD being managed in the community by probation services than reported in the general population. The rates obtained were generally consistent with those reported in prison studies e.g. ,,, with an estimated prevalence of 45.45% and 20.51% for childhood and adulthood respectively. Furthermore these offenders reported significantly greater functional impairment in both childhood and adulthood with large effect sizes, which has important implications regarding their ability to cope effectively in the community. The probation staff, by contrast, estimated that 7.6% of their caseload consisted of offenders with ADHD, suggesting that there may be high rates of under-detection and/or misdiagnosis among offenders on probation.
There is a consistent over-representation of offenders with ADHD presenting in custodial and community probation settings. With respect to the latter, this study has highlighted two important needs. Firstly, screening protocols and procedures are required in probation settings in order to assist offender managers to identify offenders who may be affected by persisting symptoms of ADHD. Unidentified symptoms are likely to impact on both the ability of the offender to use the support that is available and the ability of staff to tailor appropriate treatment and support. Secondly there is a clear training need to support staff in their management of a challenging group of offenders with a high rate of functional impairment who may have difficulty adhering to a community treatment protocol and who are likely to benefit from treatment. The evidence regarding the vulnerabilities of offenders with ADHD in the criminal justice system is growing. We now have the knowledge base and something needs to be done as the evidence is taking us beyond ‘food for thought’ and towards a call for action.