IMPORTANCE OF EARLY DIAGNOSIS OF ADHD:

IMPLICATIONS FOR ILLICIT DRUG USE AND RECIDIVISM

Sonya W. McCrea, B.S. and Kristine M. Jacquin, Ph.D.

Abstract

v Attention-deficit/hyperactivity disorder (ADHD) was once considered a childhood disorder, but studies have shown that the disease can persist into adulthood (Young & Thome, 2011).

v ADHD is an early onset neurodevelopmental disorder that is highly heritable (Kooij et al., 2010), affecting 3-7% of youths and 1-5% of adults (Asherson, 2004).

v According to the DSM-5, ADHD is a persistent pattern of hyperactivity-impulsivity and/or inattention that interferes with development and functioning (APA, 2013).

v Individuals with ADHD often have coexisting psychiatric disorders. Approximately 80% of adults with ADHD also have psychiatric comorbidity (Wilens, Morrison, & Prince, 2011).

v ADHD along with oppositional defiant, substance abuse, conduct, and antisocial personality disorders have a high risk for criminal offending (Eme, 2009).

Discussion

v Persons diagnosed with attention deficit/hyperactivity disorder (ADHD) are at increased risk of being repeat offenders (Eme, 2009) and abusers of illicit drugs (Jacquin & Ford, 2019). This poster presents research results that demonstrate the effects of ADHD on criminality and the use of illegal drugs. Empirical literature addressing this topic is sparse in the United States. Therefore, additional research is imperative to better understand how early intervention could decrease criminal offenses and the abuse of unlawful drugs by Americans with ADHD.

v Previous research has determined that individuals with ADHD have neuropsychological deficits (e.g., hyperactivity/impulsivity) which often increase their risk of criminal behaviors and becoming abusers of unlawful drugs, especially when ADHD is left undiagnosed and/or untreated.

v Individuals with ADHD may resort to illegal actions to obtain drugs such as prescription and non-prescription psychostimulants and other drugs to self-medicate symptoms of ADHD (Jacquin & Ford, 2019).

v There is a lot of research that has studied individuals with ADHD and the influence this disorder may have on criminal behavior and engagement in illicit drugs.

v Unfortunately, most of this research was performed out of the United States.

v According to Young and Thome (2011) prisoners with ADHD have a higher rate of substance abuse disorder (SUD), concurrent psychiatric morbidity, and personality disorders when compared with other inmates.

v Based on long-term follow-up studies it has been determined that ADHD, independent of conduct problems, predicted later criminality in males (Farrington, 1990).

v Whereas, Satterfield et al. (2009) reported in his study, which followed hyperactive outpatient boys, that increased risk of criminality was only seen in individuals with ADHD combined with conduct disorder.

Percent Incidence of ADHD Among Prisoners

(Young & Thome, 2011)

v In contrast to other research, Mordre et al. (2011) found that individuals with conduct disorder and ADHD did not have increased risk of criminality.

v Individuals who are treated for ADHD tend to have a more positive outcome.

v Stimulant medications manage symptoms of ADHD by increasing dopamine levels. Certain illicit drugs (e.g., cocaine, opiates, methamphetamine, etc.) also increase synaptic dopamine concentrations, especially in the reward center (e.g., nucleus accumbens) of the brain. In theory, individuals with untreated ADHD use certain illicit drugs to increase dopamine levels as a way to self-medicate (Jacquin & Ford, 2019).

v However, individuals treated for ADHD tend to have a more positive outcome. An extensive Swedish study of adults with ADHD discovered that treatment with medication (i.e., methylphenidate) significantly decreased the prevalence of criminal behavior (Lichtenstein et al., 2012). The study also saw women and men reduce their criminality rates by 41% and 32%, respectively, when they remained on their medication.

v However, a meta-analysis of 42 studies performed in 15 countries found that people who are untreated seem to have increased judicial contact and present a high risk within the court system (Young, Moss, Sedgwick, Fridman, & Hodgkins, 2015).

v Wilson and Herrnstein’s (1998) criminological theory suggests that children with deficient self-control are at an increased risk of committing a crime. Failing to treat this deficient self-control may contribute to increased risk of crime.

v Despite the daunting life experience of some individuals suffering with ADHD, the cost to society regarding criminality due to this disorder is substantial (Ginsberg, Långström, Larsson, & Lichtenstein, 2013).

v These authors also suggested persistent criminal offenders are very expensive to manage and rehabilitate and cause considerable harm to the integrity and well-being of direct and indirect victims.

v Young and Thome (2011) found that inmates with ADHD are even more costly through earlier inception of offending, more criminal recidivism, more vicious offences, and more recurrent and severe aggression within the institution compared to incarcerated individuals without ADHD.

v More studies conducted in the United States are needed to better understand this phenomenon. With improved understanding, better screening and therapeutic treatments could be implemented during early onset of the mental illness to combat criminal recidivism and substance abuse.

v In addition, policies and laws could be enacted so that judges, attorneys, and prison wardens could ensure criminal offenders are screened for ADHD to ensure proper treatment is offered.

v As a result, many criminal offenders and drug addicts with ADHD would be afforded a better outcome and society would ultimately improve.

Referencesv American Psychiatric Association. (2013). Diagnostic and statistical

manual of mental disorders (DSM-5®). American Psychiatric Pub.

v Asherson, P., Kuntsi, J., & Taylor, E. (2005). Unravelling the complexity of attention-deficit hyperactivity disorder: a behavioural genomic approach. The British Journal of Psychiatry, 187, 103-105.

v Eme, R. F. (2009). Attention-deficit/hyperactivity disorder and correctional health care. Journal of Correctional Health Care, 15, 5-18.

v Farrington, D. P. (1990). Implications of criminal career research for the prevention of offending. Journal of Adolescence, 13, 93-113.

v Ginsberg, Y., Långström, N., Larsson, H., & Lichtenstein, P. (2013). ADHD and criminality: Could treatment benefit prisoners with ADHD who are at higher risk of reoffending? Expert Review of

Neurotherapeutics, 13, 345-348.

v Jacquin, K. M. & Ford, R. (2019). Neuropsychological complaints associated with non-medical use of prescription psychostimulants. Manuscript submitted for publication.

v Kooij, S. J., Bejerot, S., Blackwell, A., Caci, H., Casas-Brugué, M., Carpentier, P. J., ... & Gaillac, V. (2010). European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry, 10, 67.

v Lichtenstein, P., Halldner, L., Zetterqvist, J., Sjölander, A., Serlachius, E., Fazel, S., ... & Larsson, H. (2012). Medication for attention deficit–hyperactivity disorder and criminality. New England Journal of Medicine,

367, 2006-2014.

v Mordre, M., Groholt, B., Kjelsberg, E., Sandstad, B., & Myhre, A. M. (2011). The impact of ADHD and conduct disorder in childhood on adult delinquency: A 30 years follow-up study using official crime records. BMC Psychiatry, 11, 57.

v Satterfield, J. H., Faller, K. J., Crinella, F. M., Schell, A. M., Swanson, J. M., & Homer, L. D. (2007). A 30-year prospective follow-up study of hyperactive boys with conduct problems: adult criminality. Journal of the

American Academy of Child & Adolescent Psychiatry, 46, 601-610.

v Wilens, T. E., Morrison, N. R., & Prince, J. (2011). An update on the pharmacotherapy of attention-deficit/hyperactivity disorder in adults. Expert Review of Neurotherapeutics, 11, 1443-1465.

v Young, S., Moss, D., Sedgwick, O., Fridman, M., & Hodgkins, P. (2015). A meta-analysis of the prevalence of attention deficit hyperactivity disorder in incarcerated populations. Psychological Medicine, 45, 247-258.

v Young, S., & Thome, J. (2011). ADHD and offenders. The World Journal

of Biological Psychiatry, 12(sup1), 124-128.

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Introduction

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