Untreated ADHD common in male convicts

Working with the Swedish Prison and Probation service, the researchers conducted a comprehensive survey of the inmates of Norrt?lje prison in order to ascertain the extent of ADHD and prepare the ground for trials of effective therapies.

"We have discovered that inmates with ADHD have greater functional impairment and more obvious symptoms than a corresponding ADHD group in outpatient psychiatric care," says consultant psychiatrist Ylva Ginsberg, doctoral student at the Department of Clinical Neuroscience.

In the present study, the researchers examined symptoms of ADHD during childhood and adulthood of 315 long-term prisoners. A group of 34 who indicated ADHD on a questionnaire survey were then put through a thorough diagnostic assessment. The results of the prison group were subsequently compared with those of 20 adult males with ADHD and 18 healthy controls, all of whom were examined at a specialist psychiatric outpatient clinic.

The study suggests that as many as 40 per cent of the inmates had untreated ADHD. The 30 inmates who, after a more extensive neuropsychiatric examination, were given an ADHD diagnosis had more pronounced symptoms and a much lower educational level than the outpatient ADHD group. They also performed less successfully than the outpatient and control groups on many of the neuropsychological tests that they performed, differences that remained when differences in ability levels were controlled for. The researchers found that the prison group grew up without adequate treatment and support for their functional impairments. Despite the fact that many of the inmates had needed extra support during their school years and contact with the health services during their childhood and adolescence, only a small minority were examined for ADHD or other neuropsychiatric disorders, and even fewer received treatment.

Drug abuse is more common in people with untreated ADHD, and in the present study all inmates with the diagnosis had had problems with drugs. The researchers also found that other psychiatric diseases requiring treatment were over-represented in this group, almost half of whom were on medication for psychiatric comorbidity. On examination, almost 25 per cent also received a diagnosis in the autism spectrum. They also met the criteria for one or more personality disorders, of which the most common was antisocial personality disorder. Psychopathy was rare.

"Given the threat that untreated ADHD poses to the individual and the community, it?s imperative that the prison and probation services learn more about the condition," says Dr. Ginsberg.

The present study formed the basis of a treatment study, in which the researchers assayed whether ADHD drug therapies could reduce symptoms and improve functional capacity in order eventually to reduce the risk of drug abuse and criminal behaviour. The results of this study are under preparation and will be presented shortly.

ADHD is a neurobiological and development-related functional impairment that has its debut in childhood and that displays symptoms of poor attentiveness and/or hyperactivity and impulsiveness. ADHD is often associated with failure in school and at work, a higher risk of incapacity leave and unemployment, and poorer psychological and social functionality, resulting in a lower quality of life. ADHD also increases the probability of other psychiatric conditions, drug abuse and antisocial behavior.

More information: Ylva Ginsberg, et al. Attention Deficit Hyperactivity Disorder (ADHD) among longer-term prison inmates is a prevalent, persistent and disabling disorder. BMC Psychiatry, 10:112, 22 December 2010 doi:10.1186/1471-244X-10-112

Provided by Karolinska Institutet