Prisoners with Attention Deficit Hyperactivity Disorder: co-morbidities and service pathways

• DOI: https://doi.org/10.1108/IJPH-03-2021-0020
• Published date: 13 August 2021
• Date: 13 August 2021
• Pages: 245-258
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice
• Author: Eddie Chaplin,Amina Rawat,Bhathika Perera,Jane McCarthy,Ken Courtenay,Andrew Forrester,Susan Young,Hannah Hayward,Jess Sabet,Lisa Underwood,Richard Mills,Philip Asherson,Declan Murphy

Prisoners with Attention Deficit

Hyperactivity Disorder: co-morbidities and

service pathways

Eddie Chaplin, Amina Rawat, Bhathika Perera, Jane McCarthy, Ken Courtenay,

Andrew Forrester, Susan Young, Hannah Hayward, Jess Sabet, Lisa Underwood,

Richard Mills, Philip Asherson and Declan Murphy

Abstract

Purpose –This paper aims to examine effectivediagnostic and treatment pathways for attentiondeficit

hyperactivitydisorder (ADHD) in prison settings giventhe high prevalence of ADHD and comorbiditiesin

the prisonpopulation.

Design/methodology/approach –Two 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

pathwayfor prisoners with ADHD.

Findings –Of 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 tothose without. The QI project led to a significant increasein the number of prisoners

identifiedas requiring ADHD assessment but a modest increase in the number of prisonersdiagnosed or

treatedfor ADHD.

Originality/value –Despite variouschallenges, an ADHD diagnostic and treatmentpathway was set up

in a prison using adaptedQI methodology. Further research is neededto explore the feasibility of routine

screening for ADHD in prison and examineat a national level the effectiveness of current ADHD prison

pathways.

Keywords Prisoners, Quality improvement, Neurodevelopmental disorders, ADHD, Service pathways,

Comorbidities

Paper type Research paper

Background

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with a world

prevalence of 5.9% in youth and 2.5% in adults (Faraone et al., 2021). Of children diagnosed

with ADHD, 40%–60% have symptoms that persist into adulthood with significant psychosocial

impact, comorbidity, inadequate health-care access and impacts on society (Faraone et al.,

2021;Volkow and Swanson, 2013). There is well-establis hed evidence that ADHD is associated

with criminality (Barkley et al.,2004;Mannuzza et al.,2008;Mohr-Jensen and Steinhausen,

2016;Satterfield et al.,2007). A meta-analysis found that the prevalence of adult ADHD in

incarcerated populations was 25.5% (Young et al.,2015). A study of female prisoners in the UK

found that 41% of female prisoners met the diagnostic criteria for adult ADHD with high levels of

impairments secondary to ADHD (Farooq et al.,2016).

Studies have shown an association of ADHD with poorer outcomes for people within the

criminal justice system. These include higher arrest rates, convictions, incarceration,

(Informationabout the

authorscan be found at the

end of this article.)

Received 14 March 2021

Revised 10 June 2021

2 July 2021

Accepted 2 July 2021

Funding information for Study

1: Guy’s and St Thomas’

Charity, Grant/Award Number:

G101019; St Andrews

Healthcare; Northampton, UK.

DOI 10.1108/IJPH-03-2021-0020 VOL. 18 NO. 3 2022, pp. 245-258, ©Emerald Publishing Limited, ISSN 1744-9200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 245