By Sam Goldstein, Ph.D.
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.
Problems characterized as attention disorders and hyperactivity have long constituted the most chronic childhood behavioral disorders and the largest sources of referral to child mental health centers.3 Moreover, the diagnosis of ADHD among children and adolescents is increasing consistently. In 1993, nearly 2 million children and adolescents were diagnosed or being treated for ADHD.4 It appears that this number will continue to rise in the years to come.
Symptoms of ADHD largely stem from impulsive, non-thinking behavior. ADHD reflects an exaggeration of normal behavior–either too much or too little of what should be expected in a given environment.
Often, individuals with ADHD know what to do, but in the heat of the moment their sense of immediate need overwhelms their limited capacity for self-control. They act. Thus, their behavior might be inconsistent and unpredictable. If prone to violent behavior, their actions may be difficult to anticipate from moment to moment.
Three additional behavioral qualities of individuals with ADHD merit consideration. First, these individuals do not respond well to repetitive, effortful, uninteresting activities that others choose for them. It is not so much that they cannot pay attention but that they do not pay attention as well as others under demanding circumstances.
Second, in addition to a low threshold for emotional arousal, many individuals diagnosed with ADHD exhibit very strong emotional reactions. Thus, little things often provoke a disproportionately dramatic response. As adults, these individuals may be labeled as stress-intolerant.5 Many are described simply as short-tempered.
Third, individuals with ADHD appear to require more immediate, frequent, predictable, and meaningful rewards than others. Thus, the payoffs sufficient for others to function in normal society often do not provide enough reinforcement for these individuals. They may seek excitement and stimulation, even at the expense of injuring themselves or violating the rights of others.
The male to female ratio for ADHD is approximately 6 to 1. Nearly 80 percent of children and adolescents with ADHD experience problems related to the areas of impulsivity, hyperactivity, inattention, and rewards. Members of this hyperactive-impulsive group face the greatest risk for coming into contact with the criminal justice system as they approach adulthood.
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.