Attention deficit hyperactivity disorder in prison: A neglected public health topic

• In Event: Prison Working Group: Mental health in prisons

Abstract

Attention deficit hyperactivity disorder (ADHD) is characterized by difficulties paying attention, poor impulse control, and hyperactive behaviors. ADHD is associated with increased risks of delinquency, criminality and recidivism. Worldwide, ADHD is thus highly prevalent in prison (26%). However, to date, ADHD diagnosis and treatment have been neglected in prison. Stimulant drugs such as osmotic-release oral system methylphenidate (OROS-MPH) are first-line treatments in the general population, but they are under-prescribed in prison because of concerns of abuse, even if such claims are not empirically supported.
First, we will present empirical findings on this public health issue. In a study conducted in a sample of 158 men detained in a Swiss prison, ADHD was scarcely diagnosed in prison medical files (1.9% [95% CI: 1.1%-5.8%]) and that nobody received ADHD treatment. Using a self-reported questionnaire, 12.9% [95% CI: 8.5%-19.2%] of the participants were screened as potentially having ADHD. These findings suggest that ADHD should receive more attention to promote health equity and rehabilitation.
Second, we will present the protocol of a randomized controlled trial which aims to compare the efficacy of a three-month in-prison OROS-MPH vs. placebo treatment on clinical, behavioral, recidivism-related, and economical outcomes. Prison is an ideal setting to initiate ADHD treatment, because detained people have access to health care and daily support from health care practitioners. We expect that ADHD treatment in prison will be a public health opportunity and a cost-effective approach to decrease the vulnerability of people living in detention and to promote pathways out criminal involvement.

Authors

• Stéphanie Baggio, University of Bern

• Patrick Heller, Geneva University Hospitals