There is a well-documented association between ADHD symptoms and antisocial behaviour. The relationship between ADHD symptoms and critical incidents within a Scottish prison was investigated. A total of 198 serving prisoners were screened for both childhood and adult ADHD symptoms using the DSM-IV checklist of symptoms (DCS). Antisocial personality disorder (ASDP) was measured by the MCMI-III and used as a covariate. Behavioural problems in prison were determined using a measure of recorded critical incidents over a period of three months, including verbal and physical aggression, damage to property, self-injury, and severity of aggression. Functional impairment was determined by extreme number of critical incidents. Forty eight (24%) of the prisoners met DCS criteria for childhood ADHD, of whom 11 (23%) were fully symptomatic, 16 (33%) in partial remission and 21 (44%) in full remission. The 27 participants who were fully symptomatic or in partial remission of symptoms, had significantly more aggressive incidents and were more functionally impaired in terms of their behaviour than those participants who were symptom free, after controlling for ASPD. Symptomatic prisoners, including those in partial remission, engaged in extreme incidents in terms of both frequency and severity. It is important to identify and treat prisoners who remain symptomatic for ADHD.
Several studies have reported an association between antisocial behaviour and adults with attention deficit hyperactive disorder (ADHD) (Babinski et al., 1999, Brassett-Grundy and Butler, 2004 and Satterfield et al., 1994). Despite this, there have been only a few published studies investigating the prevalence of ADHD in adult prison populations and none have specifically explored the association of ADHD symptoms with behaviour in this restricted environment (Dalteg et al., 1999, Eyestone and Howell, 1994, Gudjonsson et al., 2008, Rasmussen et al., 2001 and Vitelli, 1995). These five studies suggest that approximately 50% of inmates had childhood ADHD and of those about half met full or partial remission criteria for ADHD in adulthood.
Fazel and Danesh (2002) found that when compared with the general population in America and the United Kingdom, prisoners had about a ten fold excess of antisocial personality disorder (ASPD). They found a prevalence rate of 65% for ASPD, which is similar to the 50–75% reported in studies carried out within the United States penal system (Singleton, Meltzer, Gatward, Coid, & Deasy, 1997). In addition to conduct problems in childhood and antisocial personality disorder in adulthood, substance misuse is strongly associated with adult ADHD, but this may only occur when there is co-morbid antisocial behaviour (Lynskey & Hall, 2001).
Children with ADHD are at risk of the development of psychiatric problems, conduct disorder, and antisocial personality disorder (Brassett-Grundy and Butler, 2004 and Young et al., 2003). In a meta-analysis of 20 studies, a strong relationship was found between ADHD measures and criminal/delinquent behaviour (Pratt, Cullen, Blevins, & Unnever, 2002). Lynam (1996) argues that children with ADHD, and who have conduct problems, are at a high risk of becoming psychopathic in adulthood and chronic offenders. The antisocial behaviour of people with ADHD seems to be mediated by poor behavioural control (Barkley, 1998), which suggests that they would be likely to display more critical incidents within a prison environment. Indeed, their behavioural problems may become exacerbated once they are incarcerated in prison where deficits of behavioural control and cognitive function related to ADHD may result in an increased level of inconsistent and unacceptable behaviour (i.e. critical incidents, including verbal and physical aggression).
The principal aim of this study was to investigate whether partial, as well as full symptoms, are associated with behavioural problems in the prison after controlling for the effects of ASPD.
