ADHD and Implications for the Criminal Justice System

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Though much remains to be learned, research has provided the criminal justice community practical insights into Attention-Deficit/Hyperactivity Disorder.

Dr. Goldstein is a clinical instructor at the University of Utah School of Medicine in Salt Lake City.

Interaction between the mental health and criminal justice professions traditionally occurs over issues such as a defendant's claim of temporary insanity or overt mental disorders exhibited by criminal offenders. Recently, however, professionals in these two fields have begun to explore a broader range of behavioral disorders that could bring individuals into contact with the criminal justice system.

This article focuses on one set of temperamental qualities that occur in a small but significant group of people. The mental health community refers to these qualities under the diagnostic description Attention-Deficit/Hyperactivity Disorder (ADHD).1 Because individuals with ADHD come into contact with the criminal justice system at a statistically higher rate than others in the general population,2 criminal justice officials, including police administrators, should be aware of the implications ADHD has for the profession.

The severity of ADHD symptoms in adolescence and adult- hood apparently coincides with an increase of problems related to aggression and conduct. Thus, the worse an individual's ADHD symptoms get, the more likely that the individual might progress to criminal behavior. Further, the rate of borderline and antisocial personality disorders appears much higher in individuals with histories of ADHD.

Well-controlled prospective studies of children with ADHD find that at least 70 percent continue to meet the full diagnostic criteria for the disorder into adolescence. By young adulthood, this population has more academic problems and is more oppositional and delinquent than peer groups. Compared to other young adults, they engage in activities that result in more school suspension (14 percent vs. 2 percent), have more adversarial contacts with law enforcement agencies (19:3), and are more likely to be admitted into juvenile justice facilities (5:1).8 Researchers increasingly identify the development of aggressive behavior during childhood and adolescence as the connecting bond between ADHD, substance abuse, and criminal behavior.9 While aggression does not represent one of the diagnostic criteria for ADHD, approximately 50 percent of those with ADHD evaluated in clinics progress to a level of aggressive behavior defined by most law enforcement agencies as delinquency.10 ADHD appears to be a catalyst with primarily family variables increasing the risk that ADHD behavior will lead to delinquency and substance abuse problems.

A number of studies show that individuals with ADHD are as much as seven times more likely than others to develop an antisocial personality or drug abuse problem in adulthood.12 Studies also suggest that this group is likely to cause and experience more automobile accidents, and sustain more bodily injuries associated with accidents, than others. Members of this group also are more likely to receive traffic citations, particularly for speeding.

One study revealed that even before receiving their operator's permits, a group of adolescents with ADHD was three times more likely to have driven a vehicle without a valid driver's license and had done so nine times more often than others of the same age. Not surprising, a significantly higher proportion of adolescents with ADHD had had their licenses suspended or revoked.

Researchers consistently report an overlap of ADHD and addictive disorders beginning in adolescence and continuing into early adulthood affecting at least 10 to 20 percent of the adult population with ADHD. Males appear to predominate. Problems with antisocial behavior in this subpopulation are the norm rather than the exception.15 In addition, research suggests that one-third of adults with ADHD abuse alcohol, with one-fifth having a history of drug abuse. Studies have found that nearly 40 percent of all cocaine and opiate abusers meet the diagnostic criteria for ADHD.16 In comparison to other opiate and cocaine abusers, those with a history of ADHD generally began their abuse at an earlier age, exhibited more severe abusing habits, and showed higher rates of criminal and antisocial behavior.

Some studies have explored the relationship between childhood ADHD and later adult substance abuse and criminal behavior. One study, published in 1989, followed 103 males in New York State who had been diagnosed with ADHD at ages ranging from 6 to 12. When this group reached 16 to 23 years, the team conducted followup interviews with the subjects and their parents. The researchers then compared the subjects' arrest records with a control group of 100 individuals in the same age range. The researchers found that significantly higher percentages of individuals with ADHD had been arrested (39 percent vs. 20 percent), convicted of a crime (28:11), and incarcerated (9:1).

However, the research showed that ADHD in adulthood by itself was not a significant factor contributing to delinquent behavior. These findings and others indicate that childhood ADHD represents a risk factor for later criminality but that this relationship is almost exclusively mediated by the onset of serious aggression during adolescence leading to development of an anti-social personality disorder in early adulthood.

INTERACTION WITH THE CRIMINAL JUSTICE SYSTEM

Although studies indicate that adolescents and adults with ADHD interact with the criminal justice system more frequently than do members of the general population, research has yet to produce a comprehensive assessment that could be used by law enforcement personnel as a guideline for dealing with these subjects. The majority of data now available concerning adolescents and adults with ADHD may be more applicable to corrections and court officials than to law enforcement personnel.

However, a number of issues have emerged related to ADHD of which law enforcement personnel should be aware. As research in this area continues, law enforcement and the criminal justice community may benefit considerably from an expanded understanding of this disorder.

Identification and Interrogation

Criminal offenders often act irrationally. How can law enforcement officers distinguish between individuals who merely act in a rash manner and individuals who suffer from ADHD? Further, is it important that they do so?

It never hurts for officers to understand as much as possible about the people with whom they come into contact. No data exists to suggest that symptoms of ADHD in and of themselves require any specific types of interview or interrogation techniques. However, impulsive qualities often compel affected individuals to lie, speak their minds, or say anything necessary to get themselves off the hook.

Although there is no simple way to determine if an individual suffers from ADHD, investigators interested in exploring whether the disorder may have contributed in part to an individual's criminal behavior may wish to consider the following questions as part of their interrogation:

Do you have difficulty paying attention during conversations, classes, at work, etc., and find that your mind drifts off easily?
Do you feel excessively stressed or overwhelmed?
Do you become sidetracked easily, leave tasks unfinished, or disrupt tasks in progress to switch to other matters?
Do you become frustrated easily?
Do you procrastinate?
Do you forget to complete things that you intended to do?
Is your work inconsistent and your performance erratic?
Do you have sudden outbursts of intense anger?
Do you easily misunderstand directions?

Affirmative responses to these questions strongly suggest that an individual manifests underlying symptoms consistent with ADHD. Law enforcement personnel or prosecutors should gather evidence and refer it to a qualified mental health professional for a diagnosis. However, criminal justice officials should understand that problems with impulsivity generally play a more significant role in connection to minor status offenses. ADHD symptoms offer much less insight into understanding the behavior of criminals manifesting more serious violent and anti-social behavior. Investigators who believe that an individual suffers from ADHD should suggest a pre-trial psychiatric or psychological assessment for the subject.