ADHD & Crime

A recent report published by the ADHD Foundation raised eyebrows when it suggested that as many as one in four prisoners in the UK may have Attention Deficit Hyperactivity Disorder (ADHD) [1]. However, the report also emphasised that ADHD itself does not predispose individuals to become criminals. This controversial topic has led to a deeper exploration of the complex relationship between ADHD and criminal behaviour.

ADHD

Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder characterised by inattentive, hyperactive, and impulsive behaviours. It primarily affects children, but the condition can persist into adulthood, although it may present differently in grown individuals.

ADHD in the Criminal Justice System

The prevalence of ADHD within the criminal justice system is significantly higher than in the general population. In juvenile detention centres, up to 30.1% of young people have been found to have ADHD, representing a fivefold increase compared to the general population. Among adults in prison, the prevalence escalates to 26.2%, indicating a tenfold increase [2]. This stark difference in prevalence raises questions about the potential link between ADHD and criminal behaviour.

Different ADHD Presentations and Criminal Activity

One interesting aspect to consider is the potential relationship between different presentations of ADHD and patterns of criminal activity. Studies have suggested that individuals with predominantly impulsive presentations of ADHD tend to engage in crimes that are naturally impulsive, such as robbery and basic theft. In contrast, those with predominantly inattentive presentations tend to commit more premeditated crimes, such as burglary and drug dealing [3].

Cognitive and Emotional Factors

ADHD often coexists with cognitive deficits, including executive dysfunction. This executive dysfunction is related to the dorsolateral prefrontal cortex (DLPFC) and leads to impaired cognitive functions, such as working memory, organisation, behavioural inhibition, and more. Reduced activation of the DLPFC has been identified as a neurological biomarker of ADHD [1]. These deficits contribute to problems like processing long-term consequences and delayed rewards, potentially explaining impulsive behaviour and criminality.

Emotional regulation, controlled by the DLPFC, may also play a role in violent behaviour. Studies have shown that individuals with lesions in the ventromedial PFC are more likely to resort to threats and intimidation [4]. Emotional issues are not part of the ADHD diagnostic criteria but have been proposed as an addition. Emotional problems, especially related to empathy and emotional response, are associated with the risk of offending.

The Impact of Trauma on Offending Outcomes

While ADHD may contribute to a heightened risk of criminal behaviour, it’s crucial to acknowledge the role of trauma in the lives of individuals involved in the criminal justice system. Trauma, often multifaceted and repetitive throughout a child’s life, can take various forms. These can include neglect, physical, sexual, and emotional abuse, as well as witnessing violence. Research indicates a strong connection between adverse childhood experiences (ACEs) and criminal behaviour [5].

Educational Difficulties and Self-Esteem

Many individuals with ADHD experience difficulties in educational settings, which can lead to suspension from school. The association between school suspension and later offending behaviour underscores the importance of addressing educational issues for children with ADHD [1]. These struggles often result in lower self-esteem among children with ADHD, and this low self-esteem can contribute to various problems, including a propensity for exaggerated self-blame and an increased risk of false confessions.

Rejection Sensitivity and Peer Associations

Rejection sensitivity, often referred to as “Rejection Sensitive Dysphoria” (RSD), is common among individuals with ADHD. This emotional dysregulation frequently leads to aggressive responses, especially in the face of peer rejection. ADHD individuals often face higher levels of rejection from peers, leading to a greater likelihood of forming associations with peers exhibiting maladaptive behaviours. The influence of peer pressure and impaired impulse control can contribute to criminal activities.

Comorbidity: ADHD and Other Disorders

ADHD frequently coexists with other psychiatric disorders. The report highlighted comorbidities, such as substance use disorder, conduct disorder, and personality disorders, which can complicate the relationship between ADHD and criminal behaviour. Conduct disorder is linked to a higher risk of offending, and the presence of both ADHD and conduct disorder increases this risk [6,7].

Psychopathy, a complex personality disorder, is associated with ADHD, especially in girls. Research suggests that ADHD symptoms alone may not be correlated with dissocial personality disorder, emphasising the multifaceted nature of these associations [8].

Recidivism Rates in ADHD Populations

The prevalence of ADHD in the criminal justice system presents a significant challenge in terms of reducing recidivism. Individuals with ADHD are more likely to engage in harmful behaviours while incarcerated [9]. Structured and routine environments, like those in prison, can benefit individuals with ADHD. However, high recidivism rates suggest that additional measures are needed to address the root causes of criminal behaviour in this population.

Conclusion

The relationship between ADHD and criminal behaviour is multifaceted and influenced by a range of factors, including trauma, comorbidities, cognitive and emotional deficits, educational difficulties, and social influences. While ADHD does not excuse criminal actions, a deeper understanding of these complex interactions is essential for effective management.

A trauma-informed, individualised approach that considers the unique experiences of each individual is critical. Early screening, comprehensive assessments, psychometric testing, and appropriate pharmacological or non-pharmacological treatments can help individuals with ADHD manage their symptoms and related criminogenic factors.

Ultimately, addressing the needs of individuals with ADHD involved in the criminal justice system requires a compassionate, holistic approach that takes into account the underlying causes of their behaviour. It is essential to view these individuals as capable of change and rehabilitation, working together to reduce recidivism and protect public safety.

Author, Adam,

Smart TMS St Albans Practitioner

References

[1] ‘Blame it on the Brain’: Exploring ADHD as a Criminogenic Factor. (n.d.). Available at: https://www.rcpsych.ac.uk/docs/default-source/members/faculties/forensic-psychiatry/ls—blame-it-on-the-brain–exploring-adhd-as-a-criminogenic-factor.pdf?sfvrsn=2fcee45d_2#:~:text=Evidence%20hints%20that%20different%20ADHD.

[2] Young, S., Moss, D., Sedgwick, O., Fridman, M. and Hodgkins, P. (2014). A meta-analysis of the prevalence of attention deficit hyperactivity disorder in incarcerated populations. Psychological Medicine, 45(2), pp.247–258. doi:https://doi.org/10.1017/s0033291714000762.

[3] Engelhardt, P.E., Nobes, G. and Pischedda, S. (2019). The Relationship between Adult Symptoms of Attention-Deficit/Hyperactivity Disorder and Criminogenic Cognitions. Brain Sciences, 9(6), p.128. doi:https://doi.org/10.3390/brainsci9060128.

[4] Anker, E., Ginsberg, Y. and Heir, T. (2021). Prevalence of criminal convictions in Norwegian adult ADHD outpatients and associations with ADHD symptom severity and emotional dysregulation. BMC Psychiatry, 21(1). doi:https://doi.org/10.1186/s12888-021-03223-0.

[5] Baglivio, M.T., Wolff, K.T., Piquero, A.R. and Epps, N. (2015). The Relationship between Adverse Childhood Experiences (ACE) and Juvenile Offending Trajectories in a Juvenile Offender Sample. Journal of Criminal Justice, [online] 43(3), pp.229–241. doi:https://doi.org/10.1016/j.jcrimjus.2015.04.012.

[6] Fairchild, G., Hawes, D.J., Frick, P.J., Copeland, W.E., Odgers, C.L., Franke, B., Freitag, C.M. and De Brito, S.A. (2019). Conduct disorder. Nature Reviews Disease Primers, 5(1). doi:https://doi.org/10.1038/s41572-019-0095-y.

[7] Mordre, M., Groholt, B., Kjelsberg, E., Sandstad, B. and Myhre, A.M. (2011). The impact of ADHD and conduct disorder in childhood on adult delinquency: A 30 years follow-up study using official crime records. BMC Psychiatry, 11(1). doi:https://doi.org/10.1186/1471-244x-11-57.

[8] Eisenbarth, H., Alpers, G.W., Conzelmann, A., Jacob, C.P., Weyers, P. and Pauli, P. (2008). Psychopathic traits in adult ADHD patients. Personality and Individual Differences, [online] 45(6), pp.468–472. doi:https://doi.org/10.1016/j.paid.2008.05.022.

‌[9] Gordon, J.A., Diehl, R.L. and Anderson, L. (2012). Does ADHD Matter? Examining Attention Deficit and Hyperactivity Disorder on the Likelihood of Recidivism Among Detained Youth. Journal of Offender Rehabilitation, 51(8), pp.497–518. doi:https://doi.org/10.1080/10509674.2012.702714.

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