The UK Adult ADHD Network (UKAAN) was founded by a group of mental health specialists who have experience delivering clinical services for adults with Attention Deficit Hyperactivity Disorder (ADHD) within the National Health Service (NHS). UKAAN aims to support mental health professionals in the development of services for adults with ADHD by the promotion of assessment and treatment protocols. One method of achieving these aims has been to sponsor conferences and workshops on adult ADHD.This consensus statement is the result of a Forensic Meeting held in November 2009, attended by senior representatives of the Department of Health (DoH), Forensic Mental Health, Prison, Probation, Courts and Metropolitan Police services. The objectives of the meeting were to discuss ways of raising awareness about adult ADHD, and its recognition, assessment, treatment and management within these respective services. Whilst the document draws on the UK experience, with some adaptations it can be used as a template for similar local actions in other countries.It was concluded that bringing together experts in adult ADHD and the Criminal Justice System (CJS) will be vital to raising awareness of the needs of ADHD offenders at every stage of the offender pathway. Joint working and commissioning within the CJS is needed to improve awareness and understanding of ADHD offenders to ensure that individuals are directed to appropriate care and rehabilitation. General Practitioners (GPs), whilst ideally placed for early intervention, should not be relied upon to provide this service as vulnerable offenders often have difficulty accessing primary care services. Moreover once this hurdle has been overcome and ADHD in offenders has been identified, a second challenge will be to provide treatment and ensure continuity of care. Future research must focus on proof of principle studies to demonstrate that identification and treatment confers health gain, safeguards individual's rights, improves engagement in offender rehabilitation programmes, reduces institutional behavioural disturbance and, ultimately, leads to crime reduction. In time this will provide better justice for both offenders and society.

Research has indicated that, compared with the general population, the prevalence of offenders with ADHD in prison is high. The situation for offenders managed in the community by the Probation Service is unknown. This study aimed to bridge the gap in our knowledge by (1) surveying the awareness of probation staff about ADHD and (2) screening the rate of offenders with ADHD managed within the service. In the first study, a brief survey was circulated to offender managers working in 7 Probation Trusts in England and Wales asking them to estimate the prevalence of offenders with ADHD on their caseload, the presenting problems of these offenders and challenges to their management, and the training received on the treatment and management of offenders with ADHD. The survey had a return rate of 11%. Probation staff perceived that 7.6% of their caseload had ADHD and identified this group to have difficulties associated with neuropsychological dysfunction, lifestyle problems and compliance problems. They perceived that these problems hindered meaningful engagement with the service and rehabilitation. Challenges to their management were perceived to be due to both internal processes (motivation and engagement) and external processes (inadequate or inappropriate interventions). Few respondents had received training in the management of offenders with ADHD and most wanted more support. In the second study, a sub-sample of 88 offenders in one Probation Trust completed questionnaires to screen for DSM-IV ADHD in childhood and current symptoms. The screen found an estimated prevalence of 45.45% and 20.51% for childhood and adulthood ADHD respectively and these were strongly associated with functional impairment. Thus probation staff considerably underestimated the likely rate, suggesting there are high rates of under-detection and/or misdiagnosis among offenders with ADHD in their service. The results indicate that screening provisions are needed in probation settings, together with training for staff.