Justice and ADHD - Quality advice based on experience

ADHD and crime generally

Imagine that you have something ‘wrong’ with you that makes you break rules, makes people dislike you and it forces you to withdraw from your peer groups because of ridicule. Continue those imaginative thoughts as you withdraw into yourself, despite your gregarious and extremely lively personality and that this eventually leads to depression. Now stop imagining and accept that for 5% of our population those descriptions describe their condition, Attention Deficit Hyperactivity Disorder, ADHD. 5% may sound like a startling number, 1 in 20, but it’s a medical fact that this number of people suffer this mental health disorder, that’s worldwide, it respects no boundaries, race or creed, and as such, the police service and other agencies within criminal justice should recognise the importance of this on everyday activities.

Perhaps the case isn’t made in this opening paragraph, so let’ apply some robust statistics to the debate to see if they catch your attention:

  • People with ADHD are twice as likely to commit crime
  • People with ADHD commit three times as many offences as those without the  disorder
  • People with ADHD are more susceptible to problematic drug use
  • People with ADHD are more likely to attempt to take their own life.

The current difficulty with the ADHD debate is the diagnosis, it’s not from blood

results or objective medical tests, diagnosis is as a result of behavioural observations by trained and qualified paediatricians or psychiatrists. It’s therefore subjective and open to criticism and opinion. But those issues should not prevent the service from accepting the seriousness of this issue and dealing with this element of the public in an appropriate manner.

ADHD is a neurological disorder of the brain. In simple terms the chemical reactions within the ADHD brain do not function correctly and this leads to three main changes in behaviour:

  • Impulsivity – where the brain activity to control behaviour, to allow people to pause before acting is deficient
  • Hyperactivity – where the brain keeps on going, and going, and going to the point where the sufferer cannot sit still, rest or relax, and
  • Distractibility – where the attention span is severely compromised to the point where focused attention is nigh on impossible.

There are many routes into the criminal justice system for people with ADHD, an examination of the behaviours listed above reveals the ease in which this becomes a reality for some.

Offences such as criminal damage and violence are prevalent in this cohort, whereby typically the offender is inappropriately egged onto to commit crime by peers, and they go on to do the act to curry favour and seek lifts in personal esteem. People with ADHD are nearly three times more likely to commit arson.

Problematic drug use has two entry pathways for this group. Firstly the way the ADHD brain functions can be simplified as mainly by a deficit in chemical reactions, the uptake of dopamine being the most examined agent. The taking of some unlawful substances, such as cannabis, amphetamines, cocaine and heroin, serve to increase this chemical process in the brain. Whereas for the ‘norm’ this would produce a ‘high’, for the ADHD cohort this produces a more normal state, where the user is less hyperactive, able to focus and concentrate and to pause before acting on impulse. In short, this act of ‘self-medication’ brings about a more normal state and behavioural acceptance amongst society.

Secondly, when challenged with low self esteem and withdrawal from peer groups, young people with ADHD are observed through case studies migrate to ‘hanging out’ with older, dysfunctional’ gangs and groups. These groups often present opportunities for smoking heavily, drinking under age and general withdrawal from the accepted behaviour for the sufferers age group. Being drunk presents similar feelings of acceptance and calm as described for unlawful substances, but this is not sustainable in the longer term. Most participants move, impulsively, under either duress or encouragement from the new ‘friends’ into what are often termed ‘harder’ drugs, which despite the inherent medical risks are more sustainable over time than excessive drink.

The transition from ‘soft’ to ‘hard’ drugs is proven to be quicker in people with ADHD, as is the development from user, through abuser to total dependence.

Disappointingly, when compared to some European models, the US and UK’s drug treatment regimes do not adequately acknowledge ADHD as a prevalent cause of problematic drug use; this fact alone is independently a cause of the failure to keep people ‘clean’ over time.

The key challenges for the criminal justice agencies is to focus on improving services for this population, and it is a key population that both deserves and requires improvement. Recent research suggests that up to 25% of the UK prison population has some form of mental health disorder, typically ADHD, and this disproportionality with general population figures should be a cause for concern.

In interview, a suspect who cannot focus, concentrate or is easily led, should be granted special provisions under the legislative controls of legislation, but with widespread misunderstanding and ignorance of the disorder this is not common practice. Given that ADHD is highly hereditary, more so than height, police and court officers should probe parents as to their suitability to act as appropriate adults.

In court proceedings should be encouraged to acknowledge the condition. Judges admit to forming opinions regarding defendants based upon demeanour and behaviour in the court setting. But what if the lack of attention, inability to sit still and concentrate and inappropriate outbursts are medically driven through illness, not as a result of ‘chosen’ disruptive behaviour, are such judgements appropriate? One can only question the fairness of the trial and the relevance of proceedings if the disability of the defendant, and indeed witness, is not accounted for accordingly.

There is third element to the prevalence of ADHD in the policing environment, that being road safety. Whereas a high amount of road safety education now falls to local authorities, the service still has measures regarding collision statistics and injury reduction. People with ADHD are four times more likely to crash a road vehicle, seven times more likely to have two or more incidents and four times more likely to be at fault. Why, well consider being hyperactive, impulsive and inattentive behind the wheel of a car, or for youngsters, on a pedal cycle, and then you have your answer.

The costs to the criminal justice system for people with ADHD are immense when compared to those without the disorder, rising from £200 in a control study to £20K plus for the ADHD cohort, if the moral agenda doesn’t promote activity, perhaps the financial issues will? 

A lot can be done for people with ADHD, especially young people with ADHD. The bullets on these pages offer simple tips for practitioners. Supplementing these tips an examination of when things begin to go wrong for these youngsters, and what the service can do at that point offers more direction. These occasions are beginning to be referred to as the Tipping Points in the person’s life.

Tipping points are:

“those times in a young persons life where if an appropriate and timely intervention is not made, the person concerned has a higher than average chance of going forward into a life that has negative and harmful outcomes”. Typically they occur with:

  • Rejection and group exclusion at school
  • Transition from junior to high school
  • Exclusion, whether temporary or permanent, from school
  • Mixing with older children
  • Early and continued smoking of cigarettes
  • Entry into the criminal justice system
  • Difficulties with achievement
  • The first job  

Activities aimed at reducing the negative impact of Tipping Points are not the sole responsibility of the police, but supported by criminal justice based activities and the moral responsibilities, more can be done with consummate ease. With agencies working together, learning more about their responsibilities, and focusing service delivery in a ‘wrap around’ style with interventions being informed, made with a clear set of objectives and mindful of the particular circumstances appertaining to the young person concerned, improved quality of service is extremely tangible.  

A number of areas in the US have support groups for ADHD and are willing to assist the agencies of the criminal justice system. Do you use them?  

ADHD will never be an excuse for criminal behaviour but it explains a great deal, and given a meaningful explanation the opportunity for improvement becomes clear. 

For the police

If presented with a youth who displays the behaviours described, ask about ADHD Do not ask long, multiple, complicated, leading questions. Expect the use of swear words and strong language, turrettes is a common co- occurring condition. Expect body space to be compromised, lack of self awareness is common Accept that where others have a ‘stop’ sign on their behaviour, people with ADHD only have ‘go’ signs. Consider an appropriate adult, not always a parent. In interview take many breaks to assist concentration.

For courts

Don’t keep defendants waiting, promote hearings at the allotted times. Instruct all legal participants to avoid complicated, leading and multiple questions. Try not to judge guilt or alter sentencing decisions based on the behaviour of the defendant. Allow the court to take regular breaks to allow the defendant (or witness) to re-focus their attention beyond their naturally short span.

For crime fighting partnerships

Work with agencies, sharing information, on what are seen as problem children. Use the skills of Child and Adolescent Mental Health Services to learn more about the disorder and those who have it. Focus attention on service improvement with agencies that work with people with ADHD, traditional focus on the young person are proven to not work. Seek problem solving activities as early as possible, looking for Tipping Points along the way.

We can anticipate some Tipping Points, we can be sensitised to others. If we don’t look we will not find them. And a final message to clinicians…

…it is time to stop treating symptoms and time to begin to treat the outcomes.

Supporting...

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