Saturday, 27 January 2018

A quarter of prison inmates screen positive for ADHD (and beyond)

This is not the first time that I've talked about neurodevelopmental diagnoses such as attention-deficit hyperactivity disorder (ADHD) in the context of the prison population (see here and see here) on this blog and I doubt that it will be the last.

Without making any excuses or condoning / justifying any behaviour(s), I believe it is important to talk about such labels in the context of offending and incarceration because, as in the case of ADHD, there seems to be some real risk(s) attached to such a diagnosis/behaviour(s) that may well be reduced by timely assessment and management/treatment. There may also be some intervention options to be instigated in prisons too [1] in light of other evidence (see here)...

This time around, the findings from Susan Young and colleagues [2] provide the starting research material and their analysis of nearly 400 male prison inmates who "underwent an assessment that included the Diagnostic Interview for ADHD in Adults 2.0, the Autism Quotient, the Learning Disability Screening Questionnaire, the Brief Symptom Inventory (BSI), and measures of disruptive behaviours and attitudes towards violence."

Researchers reported that a quarter of their prisoner population screened positive for ADHD. They also observed that nearly 10% of their population screened positive for autism and a similar percentage for intellectual disability (ID). As is the case in these days of overlapping labels (ESSENCE?), various diagnostic label combinations seemed to occur; some of these combinations also *correlated* with various behavioural patterns. So, for example: "the combined ADHD/ID group had significantly higher scores of behavioural disturbance than the ADHD-only group."

Whilst interested in the Young results, I do have one tiny issue with one of the instruments used: the Autism Quotient (AQ). It's quite a long running thing I have with regards to the AQ and the important question: what does it actually measure? (see here) I know for some, it's their 'go to' self-report 'are you autistic?' instrument (see here) but I'm rather less enthralled by it's specific autism diagnostic potential. Indeed, other (much more important) people have similarly voiced peer-reviewed concerns [3] about the utility of the AQ (see here too). In that respect, I don't think Young et al can conclusively claim that approaching 10% of their prison cohort had autism on the basis of the AQ screen alone. I might also at this point, refer you to a post I wrote some time back on whether autism was in fact under-diagnosed among prisoners that concluded 'probably not' (see here)...

Still, the ADHD findings are important and add to a growing body of work concluding that various long-term adverse events [4] are potentially over-represented when a diagnosis is given alone or in combination with other labels (see here and see here). And medication, whilst providing one important intervention option for ADHD (see here), may not be the only course available to potentially reduce symptoms and onward mitigate any heightened adverse risks (see here and see here)...

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[1] Gesch CB. et al. Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Randomised, placebo-controlled trial. Br J Psychiatry. 2002 Jul;181:22-8.

[2] Young S. et al. Neurodevelopmental disorders in prison inmates: comorbidity and combined associations with psychiatric symptoms and behavioural disturbance. Psychiatry Res. 2017 Dec 15;261:109-115.

[3] Allely C. A systematic PRISMA review of individuals with autism spectrum disorder in secure psychiatric care: prevalence, treatment, risk assessment and other clinical considerations. Journal of Criminal Psychology. 2018; 8: 58-79.

[4] Luderer M. et al. Prevalence Estimates of ADHD in a Sample of Inpatients With Alcohol Dependence. J Atten Disord. 2018 Jan 1:1087054717750272.

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