ADHD and the Criminal Justice System. Dr Girish Vaidya
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1 ADHD and the Criminal Justice System Dr Girish Vaidya
2 Self-disclosure Secure Children s home (4 beds YJB + 4 beds Section 25 Children s Act) Looked After Children s Mental Health Team Community Forensic CAMHS Family Court Criminal Court Clinical Director of Community Wellbeing and Mental Health
3 Declaration Speaker fees from: Shire Janssen Cilag Conference support from: Shire Janssen Cilag Eli Lilly
4 Disclaimer Today s case(s) are part-fictitious but represent similar cases seen by me and may represent similar cases seen by you in the audience. Any resemblance is therefore part of the range of cases seen by professionals
5 Clinical vignette - Jack In care since age 2 Multiple placement breakdowns Final foster placement Multiple reports on Attachment Disorder Referred aged 7 Clinical presentation suggestive of ADHD Guess where he is now, aged 19?
6 Children s mental health the stats % of CYP aged 5 16 have a mental disorder (11.5% - aged 11 16) 2. Most common diagnostic categories: a. Conduct disorder (5.8%) b. Severe ADHD (1.5%) c. Anxiety (3.3%) d. Depression (0.9%)
7 What defines a disorder: Impairment Disability Handicap
8 What defines a disorder: Impairment: Any loss or abnormality of psychological, physiological, or anatomical structure or function. Disability: Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.
9 Handicap: A disadvantage for a given individual, resulting from an impairment or disability, that, limits or prevents the fulfillment of a role that is normal, depending on age, sex, social and cultural factors, for that individual. Handicap is therefore a function of the relationships between disabled persons and their envirnoment.
10 High risk groups for offending 1. Diagnosis: a. ADHD b. Conduct Disorder c. Autism Spectrum Disorder 2. Environment: a. Looked after child(ren) (LAC) in particular living in residential care b. Socio-economic deprivation c. Parental substance misuse
11 Diagnosis of ADHD
12 Symptoms of ADHD Inattention Hyperactivity Impulsivity
13 Symptom Groups Inattention Does not focus Fails to finish tasks Can t organise Avoids sustained effort Loses things, forgetful Easily distracted Hyperactivity Fidgets Leaves seat in class Runs/climbs excessively Cannot play/work quietly Always on the go Talks excessively Impulsivity Talks excessively Blurts out answers Cannot await turn Interrupts others Intrudes on others
14 Developmental Impact of ADHD Behavioural disturbance and head injuries School Disengagement Family conflicts Self-esteem worsens Criminal Record starts Illicit substance abuse Occupational failure No skills Relationship problems Injury/accidents Preschool School-age Adolescent Early Adult Adult Behavioural disturbance Academic problems School isolation Poor self-esteem Academic failure Occupational difficulties Lengthening criminal record Substance abuse increases (self treatment) Injury/accidents due to driving
15 Care / Offending Journey of an ADHD child Parental Rejection / neglect Institutional care On-site education Increasingly restrictive lifestyle (3:1) Formal Criminal record No skills life/family No competencies Institutionalised Preschool School-age Adolescent Early Adult Adult Enters care (foster care) Change of schools /placement Loses contact with roots, birth family Leaving care No anchors Prison Spells Early signs of institutionalisation
16 Treatments Medication hugely effective Psychotherapy - Skills / education early intervention is key
17 So, what can a commissioner do? Early identification Focus on Looked After Children (LAC) Transition services Skills acquisition PbO Life-span services?
18 What happened to Jack?
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