Abstract
PurposeThis paper aims to examine effective diagnostic and treatment pathways for attention deficit hyperactivity disorder (ADHD) in prison settings given the high prevalence of ADHD and comorbidities in the prison population.Design/methodology/approachTwo studies were carried out in two separate prisons in London. Firstly, data were collected to understand the prevalence of ADHD and the comorbidities. The second study used quality improvement (QI) methodology to assess the impact of a diagnostic and treatment pathway for prisoners with ADHD.FindingsOf the prisoners, 22.5% met the diagnostic criteria for ADHD. Nearly half of them were screened positive for autistic traits, with a higher prevalence of mental disorders among prisoners with ADHD compared to those without. The QI project led to a significant increase in the number of prisoners identified as requiring ADHD assessment but a modest increase in the number of prisoners diagnosed or treated for ADHD.Originality/valueDespite various challenges, an ADHD diagnostic and treatment pathway was set up in a prison using adapted QI methodology. Further research is needed to explore the feasibility of routine screening for ADHD in prison and examine at a national level the effectiveness of current ADHD prison pathways.
Highlights
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with a world prevalence of 5.9% in youth and 2.5% in adults (Farrone et al, 2021). 40% to 60% of children diagnosed with ADHD have symptoms that persist into adulthood with significant psychosocial impact, comorbidity, inadequate healthcare access and impacts on society (Faraone et al, 2021, Volkow and Swanson, 2013)
Over 60% of the ADHD prisoners were in the 20-29 age group compared to 36% of those with no NDD
The findings highlight the high rates of mental illnesses, alcohol dependence and self-harm behaviour in prisoners identified with ADHD
Summary
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with a world prevalence of 5.9% in youth and 2.5% in adults (Farrone et al, 2021). 40% to 60% of children diagnosed with ADHD have symptoms that persist into adulthood with significant psychosocial impact, comorbidity, inadequate healthcare access and impacts on society (Faraone et al, 2021, Volkow and Swanson, 2013). Studies have shown an association of ADHD with poorer outcomes for people within the criminal justice system. These include higher arrest rates, convictions, incarceration, aggression in prisons, and poor engagement with probation (Mohr-Jensen et al, 2016, Young et al, 2015). Using data from the Swedish National Register, Lichtenstein et al, 2012, investigated over 25,000 people with ADHD who received medication to treat ADHD. They reported a significant reduction of 32% in the criminality rate for men and 41% for women when using medication to treat ADHD compared to periods when not receiving medications. Apart from the individual benefits of improved quality of life for those prisoners treated for ADHD, there are other important and wider societal implications in developing a structured pathway to identify prisoners with ADHD and offer treatment
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