ADHD and offenders.

OBJECTIVES: To present the needs and psychological treatment options for offenders with ADHD.

METHODS: Key papers are discussed in relation to this topic.

RESULTS: Research suggests there is a disproportionately high number of individuals with ADHD involved with the Criminal Justice System. UK studies among offenders have indicated around 45% of youths and 24% of male adults screen positive for a childhood history of ADHD, 14% of whom have persisting symptoms in adulthood. Those with persisting symptoms have a significantly younger onset of offending and higher rate of recidivism. ADHD was the most powerful predictor of violent offending, even above substance misuse. They accounted for 8-fold more institutional aggressive behavioural disturbances (critical incidents) than other non-ADHD prisoners. Critical incidents have also been associated with personality disordered patients screening positive for ADHD and detained under the Mental Health Act. It is the impulsive symptoms and mood instability associated with ADHD that most likely increase the risk of critical incidents within institutional settings.

CONCLUSIONS: There are international guidelines available for the treatment of ADHD; however, serious offenders with ADHD will require more complex and comprehensive interventions than their non-offending peers. In particular psychological interventions need to be provided that contain a prosocial competence component. One such programme, the R&R2 for ADHD Youths and Adults, has demonstrated improvement in ADHD symptoms, anxiety, depression, antisocial behaviour and social functioning at three month follow-up with medium to large effect sizes.