AD/HD & Corrections

Kyle Dopfel

Delaware Center for Justice &

Attention Deficit Disorder Association

Is AD/HD Real?

• Yes.

• Because AD/HD is a relatively new diagnosis,

we are still learning more about the disorder.

• Over the past 25 years, medical

and mental health experts in

many countries have reviewed

scientific data and strongly

agree that AD/HD is a legitimate

neurodevelopmental disability.

What is AD/HD?

A neurodevelopmental disability present at birth,

directly related to different from usual chemical

signaling in the nervous system

that can be passed on from parent to child and

may be negatively impacted throughout life by brain

trauma and injury. (Kramer)

Impacts the behavior, emotional functioning,

learning and cognition of effected individuals.

Hereditary:

• While environmental factors may influence how the disorder presents itself, AD/HD is primarily caused by genetics.

• Of those with AD/HD: about 80% are born with the disorder and 20% may acquire it later on. (Barkley 2006)

• Among parents who have AD/HD, 57% of their children will also have it. (Barkley 2006)

Neurological Impact:

• Chemical signaling in the

nervous system operates

differently for those with AD/HD.

• AD/HD affects the frontal-

striatal-cerebellar circuit

• Neurotransmitter pathway through

the middle of the brain

• Compared to those without AD/HD,

the frontal-striatal-cerebellar circuit

shows decreased activity, is

smaller or has structural

differences

Brains effected by AD/HD have deficiencies

in at least two neurotransmitters:

Dopamine & Norepinephrine

• The dopamine brain circuit acts like

a fine tuning dial on a radio: it enables the

brain to focus on a signal and eliminate static

• When there isn’t enough

dopamine, the brain’s ‘tuner’ is

impaired. This results in ‘noise’

or ‘static,’ experienced as

distractibility and bombardment

by internal and external stimuli

• The brain compensates for low

dopamine levels with increased

sensitivity to external stimuli

Rewards are objects or events that make us come back for more. They teach us how to make good behavioral choices, and as such they are essential for survival.

People with AD/HD are less sensitive to rewards- they need more intense rewards more often to keep them engaged.

Another function of dopamine is to signal the

brain when something is rewarding

What does AD/HD do?

Neurobiological disorder that impairs the brain’s

executive/management functions, thereby

impairing self regulation and self control.

(Brown 2005)

• Executive functions: Set of processes having to do with

managing yourself and your resources in order to

achieve a set goal

• Various brain mechanisms that prioritize, integrate, and

regulate other cognitive and behavioral functions…

Monitoring and self-

regulating action

Impulsivity, non-thinking,

thrill seeking behaviors,

impatience, difficulty in

delaying gratification,

insatiability

Utilizing working memory

and accessing recall

Failure to appreciate gravity of

situation, poor time management

and planning for the future

Organizing, prioritizing,

and activating to work

Regulating alertness,

sustaining effort, and

processing speed

Managing frustration

and modulating emotion

Failure to start, procrastination

Focusing, sustaining

focus, and shifting

focus between tasks

Failure to sustain effort,

follow through,

or complete tasks

Overreaction, poor emotional

regulation, Low frustration

tolerance, explosive temper,

irritability, suggestibility

Disorganization, poor

money management skills,

inability to save

Or, the Defining Triad of

AD/HD Symptoms:

• Distractibility (attention deficit)

• Hyperactivity (hyperactivity)

• Impulsivity (dis-order)

Attention

• Many individuals with AD/HD have a working memory deficit, which results in chronic forgetfulness and procrastination

• These impairments increase the risk of academic, professional, and personal failure for individuals with AD/HD

• Selective attention allows us to focus on one task at a time. When this ability is impaired, it results in easy distractibility

• Sustained attention describes the ability to stay on task and complete that task. When this is affected, it results in motivational impairment

• Hyperactivity and Impulsivity

• Symptomatic defiance and irritability

• Individuals with AD/HD cannot inhibit prepotent responses- i.e. responses that favor short-term reinforcement at the cost of long-term outcomes

• A sense of time impairment prevents those with AD/HD from functioning beyond categories of ‘now’ or ‘not now’

• A reward deficit makes individuals with AD/HD less sensitive to reward and reinforcement. This results in boredom, impatience, and a focus on immediate reinforcement.

Behavioral Disinhibitions

So, what does this have to do with the Justice System?

• AD/HD has a significant influence over the behavior of

effected individuals.

• As shown by its prevalence within the prison population,

the role this disorder plays in one’s decision-making

process is particularly relevant to issues of criminal justice.

• While AD/HD is not an excuse for law-breaking or

inappropriate behaviors, those with AD/HD are more

prone to engaging in criminal activity when exposed to a

criminogenic environment

Statistics • Generally quoted incidence of AD/HD among the adult population in

the United States is about 4% (3% of women, 5-7% of men)

• It is estimated that up to 37% of prison inmates in the United States are

challenged with AD/HD- many of whom were never diagnosed, nor

were aware of the disorder’s existence.

• Studies by Robert Eme and Patrick Hurley in their book, Spinning Out of

Control, found that AD/HD incidences in correctional facilities ranged

from 20% to greater than 50%

• Russ Barkley’s research of US youth matched for socioeconomic settings

and followed for 10 years

• 20% of his control group without AD/HD were arrested compared to 48%

of the AD/HD group

• Control group was arrested on average 2.1 times compared to 6.4 times for

the AD/HD group

Why? • Increased difficulty in achieving success can lead to the development of

esteem issues, sense of being misunderstood and a tendency towards alternative pathways.

• Susceptibility to gangs as an alternative source of acceptance & achievement

• The requirement for more intense, frequent, and novel rewards to become and stay motivated (due to reward deficit) results in sensation seeking behavior, such as substance abuse

• AD/HD has been linked to an increased likelihood of developing Oppositional Defiant Disorder and Conduct Disorder, which are characterized by behaviors such as:

• Defiance, stubbornness, temper problems (ODD)

• Aggression, theft, destruction of property (CD)

• Other serious violations of societal rules

Offenders with untreated AD/HD may enter criminal justice system because of brain deficits.

Once in the system, these deficits will often ‘snowball’

into progressively worse outcomes.

Inability to follow requirements set by police, attorneys, parole officers and judges can escalate legal troubles.

AD/HD not only increases the likelihood that an individual

finds themselves in corrections, but also makes it more difficult for them to successfully return to the

community.

Initial Contact AD/HD traits that increase the likelihood of problematic encounter:

• Irritability, Inattentiveness, Restlessness, Defiance of authority, Inability to

prioritize what’s immediately important

Behaviors that may falsely indicate guilt:

• Often offer elaborate and unconvincing

scenarios for what has occurred

• Have difficulty keeping story straight

• Have trouble keeping secrets

• Not good at lying, faces may flush or betray a guilty

look almost immediately upon questioning

• Officers can learn to recognize possible AD/HD traits and share this

useful information to the psychologist, defense attorney, or

probation/parole officer- e.g. via their investigation reports

Court and Judgment

The attention impairments of those with AD/HD can make one appear unconcerned or uncooperative, which is not the ideal attitude to portray in a criminal justice setting.

Criminal justice professional can learn to

distinguish defendants with untreated AD/HD and attempt to include some

sort of assessment or follow-up treatment as part of sentencing

Probation and Parole

• The challenges facing all inmates upon re-entry are significantly amplified for those with AD/HD

• Working memory deficit results in forgetfulness, difficulty holding events in mind

• Sense of time impairment impacts ability to prepare for upcoming events, judge the passing of time, accurately estimate how much time it will take to finish task- resulting in problematic procrastination

• AD/HD impairments result in increased chance of failure in completing tasks and fulfilling obligations, e.g. missed appointments

What Can We Do?

• AD/HD is a very treatable condition and once diagnosed, steps can be taken to reduce its negative impact.

• With appropriate treatment and support, individuals can learn to manage the behaviors that can get them into trouble.

• Providing AD/HD therapy to incarcerated individuals with continued support upon their release has been shown to reduce rates of recidivism.

• Addressing the specific needs of inmates challenged with AD/HD ultimately benefits all of society in the form of lowered recidivism, safer communities and savings to taxpayers.

AD/HD Treatment • While the cornerstone of AD/HD treatment

is medication, this is by no means a complete treatment plan.

• It has been demonstrated that the most effective means of treating AD/HD is with a comprehensive program, incorporating both pharmacotherapy and cognitive behavioral psychotherapy, or coaching

• Effective lifeskills training focuses on structured problem solving, communication skills, and social skills- with the objective of reducing levels of social rejection and frustration.

The Primary Task: Identification

… because many individuals with ADHD are unaware that they have the disorder, and it is often masked by more obvious problems. (AD/HD commonly occurs alongside other problems such as depression or addiction)

• Despite the fact that AD/HD and learning disabilities are the most common disabilities among arrestees and offenders, very few courts or jails in the United States include intellectual, learning, and developmental disability screens as a part of their screening process.

• In December of 2009, the United Kingdom passed legislation requiring that upon entry into the criminal justice system, each individual be screened for AD/HD.

AD/HD Corrections Project • The Delaware Center for Justice (DCJ) and Attention Deficit

Disorder Association (ADDA) have partnered to create a program to help inmates with AD/HD successfully re-enter the community.

• Research and raising awareness on the impact of AD/HD on our Justice System

– Conferences, Advocacy, Trainings, Educational Materials, etc.

• Provide information on AD/HD

• Offer preliminary screening and diagnostic interviews

• Group training sessions held by a certified AD/HD coach

• Coordinated Meet-Up Groups for continued support upon release

• Access to our directory of local resources to facilitate continuation of care in the community

Sources Admire, David S., Janet P. Kramer, and Judy F. Cox. "The Case for Recognizing, Treating and Accommodating

Those with ADHD in the Correctional System." National Conference on Correctional Healthcare.

Baltimore, MD. 18 Oct. 2011. Lecture.

Barkley, Russell A. Take Charge of ADHD - Attention Deficit Hyperactivity Disorder. Dingley VC: Hinkler, 2005.

Print.

Brown, Thomas E. Attention Deficit Disorder: the Unfocused Mind in Children and Adults. New Haven: Yale

UP, 2005. Print.

Hallowell, Edward M., and John J. Ratey. Driven to Distraction. New York: Pantheon, 1994. Print.

Hurley, Patrick J., and Robert Eme. ADHD and the Criminal Justice System: Spinning out of Control. S.l.: S.n.,

2008. Print.

Schultz, Wolfram. "Behavioral Theories and the Neurophysiology of Reward." Annual Review of Psychology

57.1 (2006): 87-115. Print.

Westmoreland, Patricia, Tracy Gunter, Peggy Loveless, Jeff Allen, Bruce Sieleni, and Donald W. Black.

"Attention Deficit Hyperactivity Disorder in Men and Women Newly Committed to Prison." International

Journal of Offender Therapy and Comparative Criminology (2009). SAGE Publications. Web.