16 Nov 2021

Dagistan AA et al. J Forensic Sci 2021; Epub ahead of print

The prevalence of ADHD among prisoners is higher than that in the general population; therefore, this study aimed to determine the prevalence of probable ADHD in prisoners in Turkey, the sociodemographic characteristics of those with this disorder, and correlations between diagnosis of probable ADHD and criminal behaviour and recidivism.

This study included Turkish prisoners aged 18–60 years who demonstrated sufficient proficiency in spoken Turkish and were educated to at least primary-school level. Sociodemographic data were obtained for each prisoner, and prisoners were evaluated using the Wender Utah Rating Scale (WURS)* and the Adult ADHD Self-Report Scale (ASRS). Type of crime and other crime-related data were compared between inmates with and without ADHD.

A total of 356 prisoners were included in this study with a mean (standard deviation [SD]) age of 30.9 (9.3) years. Considering both the WURS and ADHD scores, 123 (34.6%) prisoners were determined as having probable ADHD. The average age of inmates with probable ADHD (mean [SD] score: 27.7 [7.0]) was lower than that of inmates without ADHD (mean [SD] score: 32.6 [9.9]; p<0.001). The incidence of being divorced or single was higher in the group of prisoners with probable ADHD (16.3% and 56.1%) than those without ADHD (8.2% and 38.6%; p<0.001). Inmates with probable ADHD were educated to a significantly lower level than those without ADHD (p=0.042). The incidence of job change (45.4% vs 7.8%) and family history of psychiatric illness (24.4% vs 8.6%) was higher in the group of inmates with probable ADHD than those without (p<0.001 for both comparisons).

The mean [SD] number of prior prison sentences of the group with probable ADHD (3.5 [3.5]) was higher than the group without ADHD (2.7 [2.6]; p=0.026). Similarly, the rate of extortion crime (16.3% vs 9%; p=0.042), drug trade (22% vs 11.2%; p=0.007), disciplinary penalty at school (38.2% vs 9.9%; p<0.001) and compulsory military service (31.7% vs 14.2%; p<0.001) was higher in the group with probable ADHD compared to the group without ADHD. In contrast, the presence of smuggling crime was higher in the group without ADHD compared with the group with ADHD (p=0.014).

Of all the inmates included in this study, 40.5% were found to be substance abusers; cases of substance abuse were higher in the group with probable ADHD (61.0%) compared with the group without ADHD (29.6%; p<0.001). The rate of past referrals to a psychiatric clinic (69.1% vs 30.5%) psychiatric diagnosis (43.9% vs 19.3%), hospitalisation (17.1% vs 4.3%) and suicide attempts (52.8% vs 12.0%) was found to be higher in the group with probable ADHD group compared with the group without ADHD (p<0.001 for all comparisons). Approximately one-tenth (11.5%) of all prisoners in this study reported that they had a physical illness, and the prevalence of physical illness was similar in the group with ADHD and the group without ADHD (10.6% vs 12.0%). Linear regression revealed that the presence of probable ADHD affected the number of prior convictions.

In this study, the permissions obtained did not allow face-to-face interviews, and only existing tests could be applied, which the authors noted as a limitation. In addition to this, clinical interviews to diagnose psychiatric disorders other than ADHD could not be conducted; therefore, the effect of comorbid psychiatric disorders on recidivism could not be evaluated. The authors highlight this as a particularly important limitation because the possibility of comorbid psychiatric disorder in ADHD should not be underestimated.

To conclude, the authors stated that the findings of this study suggest that ADHD may increase a person’s risk of being prone to committing certain crimes. It was also emphasised that the presence of ADHD may be associated with early involvement in crime and a higher number of convictions. The authors note that these findings may suggest that psychiatrists’ and authorities’ reluctance to prescribe psychostimulants to prisoners with ADHD, due to the high addiction potential of prisoners, may make these prisoners more likely to reoffend. Questioning the diagnosis of ADHD and its treatment in the prison population is suggested to potentially help prevent recidivism and ensure social integration.

Read more about the rates of ADHD in prisoners here


*The Wender Utah Rating Scale (WURS) consists of 25 items which evaluate the signs and symptoms of childhood ADHD in adults (Ward et al, 1993)
The Adult ADHD Self-Report Scale (ASRS) consists of 18 questions including a group of symptoms that are recommended for ADHD diagnosis in The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – 4th Edition (DSM-IV) (Kessler et al, 2005; American Psychiatric Association, 1994)

Disclaimer: The views expressed here are the views of the author(s) and not those of Takeda.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Washington, DC.: American Psychiatric Association, 1994.

Dagistan AA, Gica S, Aydin A, et al. Prevalence of probable attention-deficit/ hyperactivity disorder in inmates and its relationship with recidivism. J Forensic Sci 2021; Epub ahead of print.

Kessler RC, Adler L, Ames M, et al. The World Health Organization adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med 2005; 35: 245-256.

Ward MF, Wender PH, Reimherr FW. The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Am J Psychiatry 1993; 150: 885-890.

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