Case Study: Insights on the Incarcerated Adult ADHD Population
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1 Case Study: Insights on the Incarcerated Adult ADHD Population The Attention Deficit Disorder Association s 14 th International Adult ADHD Conference Detroit, MI July 19 th 2013 Kyle Dopfel
2 Objectives: Explain the structure of the research being conducted through the ADHD Corrections Project; introductory information, population parameters, methodology, etc. Review the results of the research- both the empirical statistical data and any qualitative findings. Analyze the significance of the research results to both the target population and our society.
3 Attention Deficit Hyperactivity Disorder (ADHD) occurs in 5% of the general adult population in the United States, but has been found in over 25% of our adult incarcerated population. ADHD incidences in correctional facilities may range from 20% to greater than 50%. 1
4 As demonstrated by its prevalence within the prison population, the role ADHD plays in one s decision-making process is particularly relevant to issues of criminal justice.
5 Distractibility Selective Attention: focusing on one task at a time Sustained Attention: staying on task until complete Working Memory Deficit: forgetfulness Impulsivity People with ADHD have problems inhibiting their prepotent responses: responses that favor short-term reinforcement at the cost of long-term outcomes. Sense of time impairment: Now vs. Not Now Reward Deficit: focus on immediate gratification Increased difficulty achieving mainstream success can lead to esteem issues, a sense of feeling misunderstood and a tendency toward alternative pathways for finding acceptance and achievement e.g. gangs. The need for more frequent and intense rewards can lead to sensation-seeking behaviors, such as substance abuse. (Also as a means of self-medication.) Hyperactivity AD/HD has been linked to an increased likelihood of developing Oppositional Defiant Disorder and Conduct Disorder, characterized by behaviors such as: Defiance, stubbornness, temper problems (ODD) Aggression, theft, destruction of property (CD) Other serious violations of societal rules
6 Initial Contact: ADHD symptoms may set off red flags: Irritability, restlessness, defiance of authority, inability to prioritize what s immediately important and follow instructions. Offer elaborate explanations- unconvincing. Trouble keeping story straight- suspicious. Court & Judgment: Attention impairments may make one appear unconcerned or uncooperative- bad attitude. Probation & Parole: The challenges facing all inmates upon reentry are significantly amplified for those with ADHD. Working-memory deficit: forgetfulness, difficulty holding events in mind. Sense-of-time impairment: impacts ability to prepare for upcoming events, judge the passing of time, and accurately assess time requirements problematic procrastination. ADHD impairments result in increased difficulty completing tasks and fulfilling obligations, which can result in serious problems, e.g. missed appointments.
7 People with untreated ADHD may enter the criminal justice system because of neurological differences. Although ADHD is not an excuse for law-breaking or inappropriate behaviors, those with ADHD are more prone to engaging in criminal activity when exposed to a criminogenic environment. Once in the system, these deficits will often snowball into progressively worse outcomes. Inability to follow requirements set by police, attorneys, parole officers and judges can escalate legal troubles. The challenges facing all inmates upon re-entry are significant amplified for those with the disorder. Thus, ADHD not only increases the likelihood that an individual finds themselves in corrections, but also makes it more difficult for them to successfully return to the community.
8 The ADHD Corrections Project In 2010, ADDA partnered with the Delaware Center for Justice (DCJ) to create a pilot project that would address the issue of undiagnosed and/or untreated ADHD in our correctional system. The project targets the reentry population of local prisons in Wilmington, Delaware. Howard R. Young Correctional Institution (also known as Gander Hill Prison) is a Level 5 men s facility in the northeast section of Wilmington. Head Start is a reentry program with its own housing unit, which accommodates approximately 60 inmates and operates on a 3 month cycle.
9 The ADHD Corrections Project: Structure Introductory Presentation: To the target population, covering basic information on ADHD and our program. Preliminary Screenings: Offer ASRS-form screenings to those inmates who express interest following the presentation. Simultaneously gather background information for research. Group Coaching: 7 regular weekly sessions in the prison, leading up to release date. Diagnostic Interviews: Coordinated with Mental Health Department for those screened positive. Research: Collect and analyze data along the way to assess the program and to learn more about the relationship between ADHD and Corrections. Follow-Up: Coordinate local meet-up groups for continued support following release. Use database of local resources to connect clients with services in the community. Public Education: Attend, organize, and/or present at events where information and knowledge obtained through the project can be shared with key audiences.
10 Although ADHD is not an excuse for law-breaking or inappropriate behaviors, those with ADHD are more prone to engaging in criminal activity when exposed to a criminogenic environment.
11 Research: Data Collection Research data gathered during the screening process is analyzed to further assess the influence of ADHD in Delaware s correctional institutions. Methodology: Self-report survey Data is current as of our most recent round of interviews in May, *NB: Because participation in the survey and preliminary screening was offered to all interested inmates following an introductory presentation on ADHD and our program, these statistics are not intended to represent incidence of AD/HD among a random sample pool, but rather represent patterns in relevant background information among informed participants.
12 Statistics are based on a survey of 140 male inmates. The average age of participants was years old. 62.1% of participants screened positive for ADHD, compared to 24.3% screened negative. (13.6% of results were deemed inconclusive.) Only 55% of those screened positive for ADHD had ever been diagnosed. At the time, none were receiving pharmacological or behavioral treatment.
13 Research: Findings Positive Negative Borderline Ever Diagnosed as having ADHD? * Immediate Family Member with ADHD * Extended Family Member with ADHD Issues During Pregnancy/Delivery Mother Used Alcohol/Drugs during Pregnancy? Mother Used Cigarettes during Pregnancy? Significant Developmental Delays? Serious Childhood Medical Issues? Serious Childhood Head Injuries? ADHD is a hereditary disorder which may be negatively impacted throughout life by brain trauma and injury. (Barkley) It is estimated that 80% of individuals with AD/HD are born with it, while 20% may acquire it later on. (Kramer)
14 Research Findings: Educational Background Positive Negative Borderline Highest Educational Level Completed Ever Repeated Grades? * Ever Skipped Grade(s)? Considered Problem Student? * Praised for Creativity Ever Suspended/Expelled? Ever Discontinued Courses/Dropped Out? Average Grades (GPA Scale) Majority are above average intelligence; however because of ADHD are less likely to work/perform to their potential.
15 Research Findings: Employment Employment Status Prior to Incarceration: Positive Negative Borderline Full Time Part Time Unemployed Student/Other Length of most recent job (in months) Ever Fired? # of Times Fired Ever Served in the Military? While there was very little difference between positive and negative groups in terms of whether or not they had ever been fired from a job, there was a significant difference in the NUMBER of terminations between the two groups. Those screened positive were fired on average twice as many times as than those who screened negative.
16 Research Findings: Driving History Positive Negative Borderline Have, or have ever had, a License License Ever Suspended? * Number of Speeding Tickets? Ever Stopped for OUI? Number of OUI s Arrested on those occasions? Number of Accidents ever involved in? Although there was a 21% discrepancy between the positive and negative groups in terms of possession of a driver s license, there was a difference of only 6% in whether or not their licenses had ever been suspended. It is possible to have one s license suspended even if one does not technically possess a license. For example, one can have their license suspended for driving without a license, or for criminal charges. More members of the positive group reported having had their driver s licenses suspended than actually possessed driver s licenses.
17 Research Findings: Social Positive Negative Borderline Marital Status: Single Partnered Married Separated/Divorced Trouble Making Friends * Excel Making Friends Trouble Keeping Friends Relationship Trouble * Excel in Relationships ADHD can lead to social difficulties, such as trouble with self-esteem.
18 Research Findings: Mood Positive Negative Borderline General Mood: Cheerful/Happy Sad/Depressed Angry/Irritable Anxious/Nervous Bland/Unfeeling Content Changes All The Time Multiple/Other/NA Mood Changes Unpredictably/Frequently Trouble with Temper
19 Research Findings: Medications, Substance Use & Incarceration Positive Negative Borderline Took Medications as Child On Medication Prior to Incarceration Currently on Medication History of Recreational Drug Use? History of Addiction? # of Incarcerations- Total # of Incarcerations- Sentenced Individuals with AD/HD have a higher predisposition for substance abuse, both as a means of self medication & due to a propensity for sensation-seeking behavior. Sometimes the impact of ADHD is more visible in the number of offenses than simply whether or not a violation occurred. Individuals with ADHD experience greater difficulty avoiding repeat offenses, thus making successful reentry even more challenging for them.
20 Adults with ADHD who are incarcerated for the first time, usually have less serious offenses including misdemeanors compared to others who are incarcerated for the first time or have a significant juvenile record. Adults with ADHD who have multiple incarcerations are much more likely to also have a co-occurring disability or mental illness. ADHD frequently exists as comorbid with other disorders, and may often be masked by more obvious or visible problems.
21 Research Findings: Medical History Positive Negative Borderline Head Injury Childhood Past as Adult Current Issue Injury Resulting in Loss of Consciousness Childhood Past as Adult Current Issue Epilepsy/Seizures Childhood Past as Adult Current Issue Migraine Headaches Childhood Past as Adult Current Issue
22 Research Findings: Medical History Positive Negative Borderline Heart Problems Childhood Past as Adult Current Issue High Blood Pressure Childhood Past as Adult Current Issue Diabetes Childhood Past as Adult Current Issue Lead Poisoning Childhood Past as Adult Current Issue
23 Research Findings: Medical History Positive Negative Borderline Problems with Vision Childhood Past as Adult Current Issue Problems with Hearing Childhood Past as Adult Current Issue Allergies Childhood Past as Adult Current Issue Asthma Childhood Past as Adult Current Issue
24 Research Findings: Medical History Positive Negative Borderline Sadness/depression Past Present Both Anxiety Past Present Both Phobias Past Present Both Panic/Anxiety attacks Past Present Both
25 Research Findings: Medical History Positive Negative Borderline Obsessions Past Present Both Compulsions Past Present Both Delusions Past Present Both Hallucinations Past Present Both
26 Research Findings: Medical History Positive Negative Borderline Appetite Past Present Both Sleep Past Present Both Manic Episodes Past Present Both
27 By simultaneously collecting relevant background information and tracking outcomes for our participants, we continue to increase our understanding of the relationship between this disorder and the criminal justice system. The results of this research not only demonstrate the significant (and often overlooked) connection between ADHD and corrections, but also provide valuable insights as to how we can better help our participants overcome the additional challenges to successful re-entry posed by this disorder.
28 In Barkley s research of youth over 10 years, matched for socioeconomic setting: 20% of his control group were arrested, compared to 48% of the ADHD group Control group arrested on average 2.1 times, compared to 6.4 for ADHD group Washington State s CHOICES Program- Consistently reduced recidivism by ~40% over 20 years Unfortunately, the initial mental health screenings now used by the mental health staff in United States correctional facilities do not specifically identify those with ADHD or learning disabilities.
29 Questions?
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