Abstract
Background: Previous studies have reported a high prevalence of attention deficit hyperactivity disorder (ADHD) among people living in detention (PLD) corresponding to a five- to ten-fold increase compared to the general population. Our main study objective was to provide an updated ADHD prevalence rate for PLD, including PLD in psychiatric units. Sub-objectives included (i) comparing different ways of assessing ADHD, including DSM-5 criteria and (ii) identifying which types of PLD are more likely to have ADHD.Methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines and the MOOSE checklist. PubMed/Medline, PsycINFO, and Web of Sciences were searched combining “ADHD” and “prison” keywords and synonyms for articles published between January 1, 1966 and January 2, 2018. Potential sources of variation to the meta-analytic ADHD prevalence rate were investigated using meta-regressions and subgroups analyses.Results: The meta-analysis pooled 102 original studies including 69,997 participants. The adult ADHD prevalence rate was 26.2% (95% confidence interval: 22.7–29.6). Retrospective assessments of ADHD in childhood were associated with an increased prevalence estimate (41.1, 95% confidence interval: 34.9–47.2, p < 0.001). There was no significant difference in the prevalence estimate between screenings and clinical interviews in adulthood. Only three studies used the DSM-5 definition of ADHD and results were non-significantly different with other DSM versions. We found no difference according to participants' characteristics.Conclusion: Our results confirmed the high prevalence rate of ADHD among PLD, corresponding to a five-fold increase compared to the general population. In light of such high ADHD prevalence, our results reinforce the importance of addressing this critical public health issue by (i) systematically offering ADHD screening and diagnosis to all individuals entering detention, and (ii) delivering treatment, monitoring, and care for ADHD during and after detention. These strategies may help reduce recidivism and reincarceration, as well as violence in detention settings, in addition to improving the health and wellbeing of people living in detention. Additionally, our study suggests that using screening scales may be a reliable way of assessing ADHD, although caution is needed because a complete evaluation by an experienced clinician is required to provide a formal diagnosis.
Highlights
attention deficit hyperactivity disorder (ADHD) in the General PopulationAttention deficit hyperactivity disorder (ADHD) is a disorder characterized by difficulties paying attention, poor impulse control, and hyperactive behaviors
We excluded 527 publications after a first screening because they did not focus on ADHD in people living in detention (PLD) or did not report empirical findings
After further review of the remaining 166 publications, 81 were excluded: 23 articles did not report ADHD prevalence rates or gender-disaggregated prevalence rates, 8 used samples composed of participants with 100% ADHD, 47 relied on data already used in other articles, and 3 because we had no access to the full article
Summary
ADHD in the General PopulationAttention deficit hyperactivity disorder (ADHD) is a disorder characterized by difficulties paying attention, poor impulse control, and hyperactive behaviors. There is growing evidence that adult ADHD is a major health concern [2] It is associated with at-risk behaviors and comorbid psychiatric disorders [3] and affects several areas of life, such as psychosocial functioning, school, work, and health care access and health care use [4]. ADHD is associated with an increased risk of having judicial contact at a younger age, including rule-breaking behaviors, delinquency, criminality, and recidivism [5,6,7]. Previous studies have reported a high prevalence of attention deficit hyperactivity disorder (ADHD) among people living in detention (PLD) corresponding to a five- to ten-fold increase compared to the general population. Sub-objectives included (i) comparing different ways of assessing ADHD, including DSM-5 criteria and (ii) identifying which types of PLD are more likely to have ADHD
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