Long-Term Treatment Outcome in Adult Male Prisoners With Attention-Deficit/Hyperactivity Disorder

Abstract

Despite high rates of attention-deficit/hyperactivity disorder (ADHD) among adult lawbreakers, particularly the long-term effects of ADHD pharmacotherapy remain unclear, not the least because of ethical challenges with preventing control subjects in randomized controlled trials from receiving medication over prolonged time. We followed up adult male prisoners with ADHD who completed a 5-week randomized, double-blind, placebo-controlled trial followed by a 47-week open-label extension of osmotic-release oral system methylphenidate in a Swedish high-security prison from 2007 to 2010 (ClinicalTrials.gov: NCT00482313). Twenty-five trial completers were prospectively followed up clinically 1 year (24/25, 96% participated fully or in part) and 3 years (20/25, 80% participation) after trial regarding ADHD symptoms (observer and self-reports), psychosocial functioning, substance misuse, and criminal reoffending. Methylphenidate-related improvements in ADHD symptoms and psychosocial functioning obtained during the 52-week trial were maintained at 1- and 3-year follow-ups. Specifically, after 3 years, 75% (15/20) of the respondents had been released from prison, and 67% of these (10/15) had employment, usually full time. In contrast, nonmedicated respondents at the 3-year follow-up (5/20) reported more ADHD symptoms, functional impairment, and substance misuse compared with currently medicated respondents (15/20). Further, 40% of the respondents self-reported reoffending, indicating a substantially lower relapse rate than expected (70%-80%).In summary, although these observations need validation from new and larger samples, positive effects were maintained after 4 years of methylphenidate treatment. Most study completers were employed and had no relapse in substance misuse or criminality. These results suggest that motivational support and continued medication are important for improved outcome in adult criminal offenders with ADHD.

Randomized experiments in Scandinavian criminal justice: Reviewing the past and looking to the future

“…Longer-term follow-ups, though not directly addressing crime outcomes, failed to find significant clinical differences after 10 years (Secher et al, 2014). Ginsberg et al (2015) report on the impact of an experimental evaluation of the effects of methylphenidate, a pharmacological treatment for Attention-Deficit/Hyperactivity Disorder (ADHD), on adult male prisoners in a maximum security Swedish prison. The study design included a 5-week randomized, double-blind, placebo-controlled trial followed by a 47-week extension during which all participants received oral methylphenidate (see also Ginsberg and Lindefors, 2012).…”

“…Secondly, we have observed a tentative embrace of random assignment and experimental analyses, even in complex correctional environments and among challenging populations. For example, Ginsberg and colleagues (2015) were able to conduct a 52-week ADHD medical trial in a Swedish maximum security prison, and rehabilitative programming has also been randomly allocated to inmates throughout Scandinavia (for example, Berman, 2004; Forsberg et al, 2011; Gold et al, 2014). Although none of these RCTs included a crime-related outcome, and hence are excluded from this systematic review, there is little reason to suggest that simply including these outcomes would pose additional implementation challenges.…”

Chronic conditions in adolescents

“…The most common pharmacological treatment is stimulant-medication (55). The latter has been shown to prevent risk-behavior such as criminality (56). …”

Attention Problems Predict Risk of Violence and Rehabilitative Engagement in Mentally Disordered Offenders

“…Difficulties in the domains of attention, hyperactivity, and impulsivity are present across adult forensic and forensic psychiatric populations at both clinical (i.e., attention deficit hyperactivity disorder, ADHD) and subclinical levels (1, 2). A meta-analysis by Young et al (3) indicated that 31% of adult prisoners meet criteria for ADHD, compared to 2.5–4.2% in community adult populations.…”