Post on 05-Oct-2020
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.