Attention deficit hyperactivity disorder as a neglected psychiatric disease in prison: Call for identification and treatment

Abstract

Mis-diagnosis of attention deficit hyperactivity disorder (ADHD) is an important public health concern because the disease is treatable, yet can have a disastrous effect on the life of those affected. ADHD is associated with delinquency, criminality, and recidivism; and thus, people living in detention are especially at risk of having ADHD. This study investigated prevalence rates of ADHD diagnosis and treatment in prison. Data were collected in a Swiss prison (n=158). Medical files were screened for ADHD clinical diagnosis and treatment, and participants completed five items assessing ADHD symptomatology (ASRS-5). We computed prevalence rates with 95% confidence intervals (CI). Overall, 1.9% [95% CI: 1.1%–5.8%] of the participants had a clinical diagnosis of ADHD in medical files. Nobody received ADHD treatment. For the self-reported questionnaire, 12.9% [95% CI: 8.5%–19.2%] of the participants met the cut-off and were screened as potentially having ADHD. This study suggested that ADHD was under-diagnosed and under-treated in prison, with a lower prevalence rate according to the medical files of the participants in comparison with self-reports and with the worldwide meta-analytic prevalence rate of 26.2%. ADHD should receive more attention in order to promote health equity between incarcerated and general populations, to reduce health (care) disparities, and to enhance rehabilitation following incarceration.

Keywords

• ADHD
• Access to health care
• Health inequality
• Incarceration