Prevalence Of ADHD Research Articles

23.3 Trends in the Diagnosis and Treatment of ADHD in Individuals with an Opioid Use Disorder

ADHD in childhood is a risk factor for the development of a substance use disorder (SUD). SUD, particularly opioid use disorders (OUDs), are associated with substantial morbidity and mortality. This study examines trends in the prevalence and treatment of ADHD among individuals with an OUD in the United States.

Factors Impacting Gender Diagnostic Differences in ADHD: A Review

ADHD is a neurodevelopmental disorder commonly diagnosed in children. To date, it is more commonly diagnosed in boys compared to girls although there has been no significant difference reported in adulthood. The objective of this review is to investigate various factors affecting gender differences in ADHD including, historical context, symptom presentation, age of onset, physician biases, and comorbidities. This review includes literature from a variety of academic databases such as Web of Science, MEDLINE, ERIC, PubMed as well as from grey literature. Our findings include systemic gender discrepancies that exist in the reported prevalence, diagnosis, and treatment of ADHD. Additionally, there are several gender-based factors that may contribute to the differences in ADHD presentation for girls including a more inattentive subtype, later age of onset, and misdiagnosis due to comorbidities. This discrepancy in diagnosis has been attributed to various factors which include ineffective diagnostic criteria, physician bias, and comorbidities. Limitations of this review include evident gaps in the literature on the association between ADHD and non-binary gender development, misdiagnosis of girls with comorbidities, as well as differences in the effectiveness of treatment on different genders. Furthermore, there is little standardization in methods and variables collected, especially the minimal recruitment of female participants. Lastly, future studies should investigate the impact of clinical versus community-based settings on children with ADHD.

Correlation of attention deficit hyperactivity disorder with gut microbiota according to the dietary intake of Korean elementary school students.

We investigated the impact of dietary patterns on the gut microbiota and concentration of short-chain fatty acids in the feces of Korean elementary school students. The dietary intake and ADHD assessment of 40 Korean elementary school students were analyzed using a dish-based semi-quantitative food frequency questionnaire. Analysis of gut microbiota and short-chain fatty acids composition were performed using the real-time polymerase chain reaction, metagenomics, and gas chromatography methods. The dietary patterns of participants were divided into four groups: healthy, processed food, fish and shellfish, and meat. The participants were also divided into two groups according to their ADHD scores: 0–30, control group; over 30, ADHD group. The ADHD score of the processed food group was significantly higher than that of the healthy group. The processed food and ADHD groups showed significantly higher abundance of harmful bacteria, such as the Enterobacter, Escherichia coli, and Clostridium strains, and markedly lower abundance of beneficial bacteria, such as the Bifidobacterium and Ruminococcus strains, than the control group. The heat maps of metagenomics indicated that each group was separated into distinct clusters, and the processed food and ADHD groups showed significantly lower α-diversity of gut microbiota than the control group. In these groups, the concentration of acetate or butyrate in the feces was significantly lower than that in the control group. These results may indicate that imbalanced diets can disturb the colonic microbial balance and are likely to become a potential risk factor for the prevalence of ADHD.

Adult attention-deficit hyperactivity disorder among patients with substance use disorders

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is a childhood neurodevelopmental disorder that persists into adulthood. ADHD is a well-known risk factor for substance use disorder (SUD). However, the actual contribution of comorbidity is largely unknown. The current study investigated the prevalence of ADHD in a sample of abstinent patients compared to healthy controls.Compared to 51 healthy controls, 51 patients seeking medical treatment for SUD were abstinent from any substance for at least 1 month, interviewed by the use of the ICD-10 symptom checklist, the Social Classification Scale, the Addiction Severity Index, Conners adult ADHD Rating Scales Self-Report (CAARS-S:L), and the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL).ResultsUsing CAARS-S:L, the ADHD index showed that 9 subjects (17.6%) were diagnosed with adult ADHD. Using K-SADS-PL, 8 of the participants (15.7%) were found to have an adult ADHD diagnosis. Lower scores of the ADHD index are related to increased patients’ age, while increased scores of the ADHD index are related to more alcohol-related problems of the patients. The strongest predicting factors of increased ADHD index were drug problems and legal status.ConclusionsThe current study provides evidence of an increased diagnosis of adult ADHD in patients with substance use disorder, regardless of the type of substance abuse.

A Review of Canadian Diagnosed ADHD Prevalence and Incidence Estimates Published in the Past Decade.

(1) Background: ADHD is recognized as one of the most common neurodevelopmental disorders. The worldwide prevalence of ADHD is estimated at 5.3%; however, estimates vary as a function of a number of factors, including diagnostic methods, age, sex and geographical location. A review of studies is needed to clarify the epidemiology of ADHD in Canada. (2) Methods: A search strategy was created in PubMed and adapted for MEDLINE and PsycINFO. Papers were included if they examined diagnosed ADHD prevalence and/or incidence rates in any region of Canada, age group and gender. A snowball technique was used to identify additional papers from reference lists, and experts in the field were consulted. (3) Results: Ten papers included in this review reported on prevalence, and one reported on incidence. One study provided an overall prevalence estimate across provinces for adults of 2.9%, and one study provided an overall estimate across five provinces for children and youth of 8.6%. Across age groups (1 to 24 years), incidence estimates ranged from 0.4% to 1.2%, depending on province. Estimates varied by age, gender, province, region and time. (4) Conclusions: The overall Canadian ADHD prevalence estimate is similar to worldwide estimates for adults. Most studies reported on prevalence rather than incidence. Differences in estimates across provinces may reflect the varying number of practitioners available to diagnose and prescribe medication for ADHD across provinces. To achieve a more comprehensive understanding of the epidemiology of ADHD in Canada, a study is needed that includes all provinces and territories, and that considers estimates in relation to age, gender, ethnicity, geographical region, socioeconomic status and access to mental healthcare coverage. Incidence rates need further examination to be determined.

Why we should be scrutinizing the rising prevalence of adult ADHD

Why we should be scrutinizing the rising prevalence of adult ADHD

Consistency of parent-report SLC6A1 data in Simons Searchlight with Provider-Based Publications

BackgroundSLC6A1-related disorder is a recently identified, rare, genetic neurodevelopmental disorder that is associated with loss-of-function variants in SLC6A1. This gene encodes GABA transporter type I that is responsible for re-uptake of GABA from the synapse into the pre-synaptic terminal or circulating neuroglia. Based upon retrospective review of published cases and available research databases including Epi25 collective and SLC6A1 Connect patient database, the phenotypic spectrum is broad and includes developmental delay, epilepsy, and autism or autistic traits. SLC6A1 is one of the genes included in the Simons Searchlight registry, which includes standardized data collection across genetically identified neurodevelopmental conditions.MethodsIn this study, we compare parent-report measures of phenotypic features in the Simons Searchlight registry to previously published, provider-reported cases to assess if parent-report measures are consistent with what has been reported in the literature.ResultsThere were 116 participants in the provider-reported dataset compared to 43 individuals in the caregiver-reported dataset. Carriers in Searchlight had 83 unique pathogenic or likely pathogenic variants in SLC6A1, which were predominantly missense or nonsense variants. There was no significant difference between groups for the prevalence of developmental delay, ASD, or ADHD. Caregivers more often reported hypotonia, while epilepsy was slightly more frequently reported by providers.ConclusionsWe propose that standardized parent-report data collection methods are consistent with provider reports on many core features of SLC6A1-related disorder. The availability of patient registries and standardized natural history studies may fill an important need in clinical trial readiness programs, with larger sample sizes than smaller published case series.

Prisoners with Attention Deficit Hyperactivity Disorder: Co-morbidities & Service Pathways

IntroductionEffective diagnostic and treatment pathways for ADHD are needed in prison settings due to the high prevalence of ADHD and comorbidities in the prison population.ObjectivesIn this presentation, we will describe two studies conducted in seperate London prisons in England. In the first study, the aim was to identify prisoners with ADHD with a focus on describing comorbidity. In the second study, using QI (quality improvement) methodology, the aim was to measure the practicability and effectiveness of a specialist ADHD diagnostic and treatment pathway for prisoners.MethodsTwo 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.ResultsOf 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.ConclusionsDespite 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.DisclosureNo significant relationships.

Prevalence of high risk of ADHD among adult users of Instagram in Russian Federation

IntroductionThe problem of diagnosis and treatment of ADHD in adults in the Russian Federation remains very relevant. Unfortunately, very little time is devoted to the topic of adult ADHD in standard and advanced training programs. In connection with these problems, it is important to study the prevalence of ADHD in the Russian population.ObjectivesTo determine the prevalence of an increased risk of adult ADHD on the example of Russian Instagram users.Methods In the professional blog of one of the authors of the article in Instagram (@gentlepsydoc), a link was posted to an anonymous survey conducted using Google docs, in which patients filled out the Adult ADHD Self-Report Scale (ASRS v1.1) in the author’s translationResultsA total of 144 people took part in the screening, 87.5% of them were women, the average age of the participants was 35.5±12.3 years (from 20 to 56). An increased risk of ADHD according to the indicators of the ASRS scale was detected in 13.2 % of participants.ConclusionsAmong Instagram users, the prevalence of an increased risk of ADHD was higher than according to epidemiology data. This indicator could be influenced by a sample of patients, mainly consisting of subscribers of a professional blog of a psychiatrist, as well as the prevalence of women among the participants. In any case, these data speak in favor of the importance of diagnosing this condition in the Russian population, as well as including information about adult ADHD in training programs for mental health professionals.DisclosureNo significant relationships.

ADHD prevalence in patients with hypersexuality and paraphilic disorders: a systematic review and meta-analysis.

Hypersexuality and paraphilic disorders have been associated with increased ADHD in several studies. To determine the prevalence of ADHD in hypersexuality and paraphilic disorders. Three databases (Medline, Web of Science and Google Scholar) were explored. Using random effects models, we calculated the pooled estimate of ADHD prevalence. The leave-1-out method and subgroup analyses were carried out to identify sources of heterogeneity. Seven studies from three countries (N = 730 patients with hypersexuality) were included (including five US studies). The overall estimate of the prevalence of ADHD in patients with hypersexuality or paraphilic disorders was 22.6% (95% interval: 17-29.4) with high heterogeneity (I2 = 63%). No publication bias was observed according to Egger's test. We found no significant difference in ADHD prevalence between the following subgroups: hypersexuality vs. paraphilic disorders, studies exploring the history of childhood ADHD vs. adult ADHD, US studies vs. others. The French study was a source of heterogeneity with a much lower rate than others (4.5%) but did not significantly change the prevalence estimate. Removing this study increases the prevalence to 25%. We found no association between the year of publication and ADHD prevalence. ADHD is much more frequent in populations with hypersexuality or paraphilic disorders compared to the general population. It should be systematically screened. The subgroup analyses were not sufficient to identify all sources of heterogeneity, other sources should be explored in further studies.

Offending Trajectories in Violent Offenders: Criminal History and Early Life Risk Factors.

The understanding of offending, and thus its possible prevention, is expanded through longitudinal studies on criminal trajectories depicting early life risk factors. This longitudinal study aimed to explore criminal trajectories, criminal histories, and early life risk factors in a cohort of violent offenders. A Swedish nationally representative cohort of male violent offenders (n = 266), clinically assessed while imprisoned aged 18 to 25, was followed through national registers from age 15 to 25-34. Substantial differences in criminal histories between violent offenders and a matched comparison group (n = 10,000) were demonstrated. Five trajectory groups were identified: four persisting and one desisting. Although differences were observed between persisting trajectory groups, a higher prevalence of early life risk factors was generally displayed compared to the desisting, especially in conduct problems and experiences of out-of-home placements. Neurocognitive ability and prevalence of ADHD and autism were similar across trajectories. Severe early life risks highlight the population's need for early interventions.

ADHD in Adults: A Systematic Review and Meta-Analysis of Prevalence Studies in Outpatient Psychiatric Clinics

Objective: Systematic review and meta-analysis to estimate the pooled prevalence of ADHD in adult attendees of outpatient mental health clinics and to investigate factors influencing prevalence rates. Methods: The following were extracted: demographics, design of the study (screening only or two-phase), scales/criteria for diagnosis of ADHD, number of ADHD, and non-ADHD participants. Results: The pooled prevalence of ADHD from screening studies (n = 9) was 26.7%, (95% CI [17.2–37.4]), ADHD = 1727, No ADHD = 3,578. From studies employing a two-stage design (n = 5), prevalence was 14.61%, CI [10.39–19.41], ADHD = 561, No ADHD = 3,578. Age and gender did not have any significant effect on the estimated prevalence. By contrast exclusion of psychotic disorders lowers prevalence. The screening scale used also influence prevalence rates. Conclusion: Meta-analysis shows high rates of adult ADHD among psychiatric outpatient clinics. Applying DSM-5 criteria increased prevalence rates. More methodologically robust studies, using two-stage design, need to be conducted to help assist in service planning.

Screening for ADHD in a general outpatient psychiatric sample of adults

Adults (n = 805) seeking outpatient psychiatric care completed the Adult ADHD Self-Report Scale (ASRS) and measures of impairment and co-occurring psychopathology as part of a measurement-based care initiative. Diagnostic indicators of ADHD (i.e., formal diagnosis and/or medication treatment) were recorded from the electronic medical record (EMR). Agreement between screening positive for ADHD and EMR indicators for the diagnosis was explored, and clinical characteristics of adults identified with ADHD using these indicators were examined. Lastly, the contribution of ADHD to functional impairment was examined, controlling for the contribution of other demographic and psychiatric comorbidities. In the full sample, 54.78% of adults screened positive for ADHD based on the ASRS, and using EMR indicators, only 11.93% of adults were identified with ADHD. Agreement emerged between self-reported ADHD and ADHD EMR indicators, although adults screening positive for ADHD generally reported greater psychiatric complexity relative to adults identified with ADHD in the EMR. ADHD was associated with clinical impairment even when controlling for other psychiatric comorbidities. The considerable difference in prevalence of ADHD based on self-report screening versus EMR indicators suggests that ADHD may be overlooked in adult psychiatric care. Findings point to the importance of assessing adult ADHD in routine psychiatric care.

ADHD and addictive behavior in crack-cocaine users

BackgroundCrack consumption is a major public health issue in Martinique with a poor prognosis. A preliminary study has found a high prevalence of history of childhood ADHD (C-ADHD) in crack users. ObjectiveTo determine the prevalence of C-ADHD and adult ADHD (A-ADHD) in crack users and their potential associations with substance use behavior. MethodsAll consecutive patients consulting in the public academic hospital covering 376,000 inhabitants were included in the present study and received a comprehensive battery measuring addictive behavior, psychiatric and somatic comorbidities. C-ADHD groups and A-ADHD groups were defined with the Wender-Utah Rating Scale-25 and the Brown ADD Rating Scale, respectively. Impulsivity was evaluated with the Barratt Impulsiveness Scale (BIS-11). FindingsIn total, 111 participants were evaluated. Among them, 50 (45%) were classified in the C-ADHD group and 20 (18%) in the A-ADHD group. Compared to the patients without ADHD, those with ADHD were found to have higher impulsivity (C-ADHD: BIS total score 67.90 (10.1) vs. 63.28 (10.5), P=0.021, BIS attentional score 17.5 (3.6) vs. 15.3 (3.4), P=0.002, A-ADHD: BIS total score 75.1 (11.3) vs. 63.4 (9.2), P<0.001, BIS motor impulsivity 26.9 (5.3) vs. 22.6 (4.3), P<0.001, BIS attentional score 19.3 (3.3) vs. 15.6 (3.5), P<0.001, BIS planification 28.9 (5.7) vs. 25.10 (4.7), P=0.003). Fifty percent of A-ADHD patients were found with high impulsivity vs. 15% of patients without A-ADHD (P<0.001). However, ADHD was not associated with more severe addictive behavior or history of legal consequences. InterpretationADHD prevalence is high in cocaine-crack users and associated with increased impulsivity. However, neither ADHD nor impulsivity explains addictive behaviors or legal consequences.

Social gradients in ADHD by household income and maternal education exposure during early childhood: Findings from birth cohort studies across six countries.

ObjectiveThis study aimed to examine social gradients in ADHD during late childhood (age 9–11 years) using absolute and relative relationships with socioeconomic status exposure (household income, maternal education) during early childhood (<5 years) in seven cohorts from six industrialised countries (UK, Australia, Canada, The Netherlands, USA, Sweden).MethodsSecondary analyses were conducted for each birth cohort. Risk ratios, pooled risk estimates, and absolute inequality, measured by the Slope Index of Inequality (SII), were estimated to quantify social gradients in ADHD during late childhood by household income and maternal education measured during early childhood. Estimates were adjusted for child sex, mother age at birth, mother ethnicity, and multiple births.FindingsAll cohorts demonstrated social gradients by household income and maternal education in early childhood, except for maternal education in Quebec. Pooled risk estimates, relating to 44,925 children, yielded expected gradients (income: low 1.83(CI 1.38,2.41), middle 1.42(1.13,1.79), high (reference); maternal education: low 2.13(1.39,3.25), middle 1.42(1.13,1.79)). Estimates of absolute inequality using SII showed that the largest differences in ADHD prevalence between the highest and lowest levels of maternal education were observed in Australia (4% lower) and Sweden (3% lower); for household income, the largest differences were observed in Quebec (6% lower) and Canada (all provinces: 5% lower).ConclusionFindings indicate that children in families with high household income or maternal education are less likely to have ADHD at age 9–11. Absolute inequality, in combination with relative inequality, provides a more complete account of the socioeconomic status and ADHD relationship in different high-income countries. While the study design precludes causal inference, the linear relation between early childhood social circumstances and later ADHD suggests a potential role for policies that promote high levels of education, especially among women, and adequate levels of household income over children’s early years in reducing risk of later ADHD.

Prevalence and Comorbidity of Adult Attention Deficit and Hyperactivity Disorder Among the Patients Applying to Kocaeli University’s Psychiatry Polyclinic

The present study aimed to determine the prevalence of ADHD diagnosis among the patients applying to adult psychiatry polyclinic for the first time and to determine comorbid diseases among the patients diagnosed with ADHD. The present study was carried out on patients who applied to the Psychiatry Polyclinic in the Medical Faculty Hospital of Kocaeli University Turkey between 10.01.2018 and 03.01.2019, with 151 patients involved in this study. After providing the participating patients with a verbal and written briefing about the study, the Sociodemographic Information Form and AADHDS were given to the participants. DIVA2.0 Adult ADHD Diagnostic Interview Scale and SCID-1 were implemented. As found in DIVA 2.0 ADHD Diagnostic Interview Form for Adults, 19.9% of 151 patients were diagnosed with adult ADHD, and 80.1% were not. Given SCID-1 diagnoses of patients, it was determined that, of the patients diagnosed with ADHD, 16.6% were diagnosed with depression, followed by generalized anxiety disorder (10%), and panic disorder and depression (10%), and that 13.3% of participants were not diagnosed with another disorder. Participants diagnosed with ADHD were found to have lower mean age. Prevalence of ADHD diagnosis was found to be lower among singles and students. The individuals diagnosed with ADHD were found to have a more prolonged education period. The prevalence of ADHD was higher among those who received a disciplinary punishment. Making an accurate diagnosis, designing an appropriate treatment, and determining the comorbidities of ADHD and with which psychiatric disorders it is confused would positively contribute to outcomes of treatments and increase the patients’ quality of life.

Prevalence and Associated Factors of Attention-Deficit Hyperactivity Disorder among Children Aged 6-17 Years in North Eastern Ethiopia.

Attention-deficit hyperactivity disorder is one of the public neurodevelopmental disorders characterized by impulsivity and restlessness or hyperactivity. This study aimed to assess the prevalence of Attention-deficit hyperactivity disorder and its associated factors among children aged 6 to 17 years in Shewa Robit town, Northeastern Ethiopia, 2020. A community-based cross-sectional study was conducted among 365 children aged 6-17 years from Feb 1-March 30, 2020, at Shewa Robit town. Systematic random sampling was employed to select study participants. Data were collected by interview using structured and pretested questionnaires. Finally, data was entered using Epi-data 4.2 and analyzed using SPSS version 25. Bivariable and multivariable binary logistic regression analysis was conducted to identify associated factors of attention deficit hyperactivity disorder. Odds ratios with 95% CI were calculated, and variables having a p-value < 0.05 were considered statistically significant. The prevalence of ADHD among children aged 6 to 17 years was 13%. Financial crises [AOR 4.76(95% CI 1.51-15.05)], children a previous history of the mental problem [AOR 8.45(95% CI 1.24-57.43)], C/S delivery [AOR 6.38(95% CI 1.26-32.26)] and substance use in life [AOR 2.43(95% CI 1.09-5.43)] were significantly associated with attention deficit hyperactivity disorder. The prevalence of ADHD in children 6 to 17 years old was high (13%). Financial crises, children's history of mental disorders, C/S delivery, and lifetime substance use were significantly associated with attention deficit hyperactivity disorder. Therefore, particular attention should be given to mothers and children with significant factors.

Association of Food Allergy, Respiratory Allergy, and Skin Allergy with Attention Deficit/Hyperactivity Disorder among Children.

Background: Previous studies have predominately examined associations of respiratory allergy and skin allergy with ADHD, but little is known about the association between food allergy and ADHD. Methods: We included 192,573 children aged 4–17 years from the National Health Interview Survey (NHIS), a leading health survey in a nationally representative sample of the US population. Allergy conditions and ADHD were defined based on an affirmative response in the NHIS questionnaire. We used weighted logistic regression to estimate the odds ratio (OR) of ADHD. Results: Among the 192,573 children, 15,376 reported ADHD diagnosis. The prevalence of ADHD was higher among children with allergic conditions: 12.66% vs. 7.99% among children with and without food allergy; 12.16% vs. 7.63% among children with and without respiratory allergy; and 11.46% vs. 7.83% among children with and without skin allergy. After adjusting for covariates, the OR of ADHD was 1.72 (95% CI, 1.55–1.91) comparing children with and without food allergy, 1.50 (95% CI, 1.41–1.59) comparing children with and without respiratory allergy, and 1.65 (95% CI, 1.55–1.75) comparing children with and without skin allergy. The observed associations remained significant after mutual adjustment for other allergic conditions. Conclusions: In a nationally representative sample of US children, we found a significant association of common allergic conditions (food allergy, respiratory allergy, and skin allergy) with ADHD.

Behavioral and Gene Regulatory Responses to Developmental Drug Exposures in Zebrafish.

Developmental consequences of prenatal drug exposure have been reported in many human cohorts and animal studies. The long-lasting impact on the offspring—including motor and cognitive impairments, cranial and cardiac anomalies and increased prevalence of ADHD—is a socioeconomic burden worldwide. Identifying the molecular changes leading to developmental consequences could help ameliorate the deficits and limit the impact. In this study, we have used zebrafish, a well-established behavioral and genetic model with conserved drug response and reward pathways, to identify changes in behavior and cellular pathways in response to developmental exposure to amphetamine, nicotine or oxycodone. In the presence of the drug, exposed animals showed altered behavior, consistent with effects seen in mammalian systems, including impaired locomotion and altered habituation to acoustic startle. Differences in responses seen following acute and chronic exposure suggest adaptation to the presence of the drug. Transcriptomic analysis of exposed larvae revealed differential expression of numerous genes and alterations in many pathways, including those related to cell death, immunity and circadian rhythm regulation. Differential expression of circadian rhythm genes did not correlate with behavioral changes in the larvae, however, two of the circadian genes, arntl2 and per2, were also differentially expressed at later stages of development, suggesting a long-lasting impact of developmental exposures on circadian gene expression. The immediate-early genes, egr1, egr4, fosab, and junbb, which are associated with synaptic plasticity, were downregulated by all three drugs and in situ hybridization showed that the expression for all four genes was reduced across all neuroanatomical regions, including brain regions implicated in reward processing, addiction and other psychiatric conditions. We anticipate that these early changes in gene expression in response to drug exposure are likely to contribute to the consequences of prenatal exposure and their discovery might pave the way to therapeutic intervention to ameliorate the long-lasting deficits.

Rates and implications of fetal alcohol spectrum disorder among released offenders with mental disorder in Canada.

Fetal alcohol spectrum disorder (FASD) is prevalent among individuals involved in the justice system. However, many of the characteristics of justice-involved individuals with FASD remain unknown. We assessed patients in a forensic mental health hospital (n=26) for FASD before their release. The two objectives were to establish the prevalence of FASD in this unique environment and to describe the mental health and neurocognitive characteristics of individuals with FASD compared to patients with complex needs and those without FASD. The prevalence of FASD was 46%. We found the FASD group to have more than six impaired brain domains, greater than the other groups, and a higher prevalence of ADHD. Given the high prevalence of FASD reported in this study, along with the complexities and adversities associated with FASD and criminal justice involvement, this is a population that requires screening, assessment, and intervention.