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Link Between Risk Factors for ADHD and Criminal Conviction?

By Dr. Eappen

What is the relationship between Attention Deficit Hyperactivity Disorder (ADHD) and criminal activity? Several studies have shown high rates of ADHD among prisoners (as high as 50% of incarcerated men and as high as 40% of incarcerated women). However, the prevalence of crime among individuals with ADHD has been less studied.

In one study, designed to assess the prevalence of criminal conviction among a sample of adults with ADHD, researchers found the prevalence of self-reported criminal conviction to be high for both genders (11.7% for women and 24.5% for men). 

When compared with the rates of criminal conviction among the general population (1% and 5% rates in women and men respectively), these numbers should give any parent, raising a child diagnosed with ADHD, pause.

Clearly, the stakes are high when it comes to proper treatment of children with ADHD. What this study suggests is that early and consistent treatment interventions can stop the slide down the slippery slope to criminal conviction. Let’s look more deeply at the most significant findings here.

Child with attention-deficit hyperactivity disorder at therapy

Early Treatment is Key

While it may seem that there’s not much harm in putting off treatment of ADHD symptoms, it’s important to keep in mind that untreated ADHD can lead to other risk factors, such as poor academic performance or antisocial behavior, that can create a snowball effect.

The child and adolescent years are a crucial time for cognitive and emotional development. When a child does not receive the support and treatment they need during these years, it can lead to a lifetime of mental health challenges.

So, what are the symptoms parents should be especially aware of?

There are three main symptoms according to the study that lead to increased risk of criminal conviction:

  • Hyperactivity
  • Impulsivity
  • Emotional dysregulation

Emotional dysregulation is one of the most challenging symptoms for a parent to assess, since it covers a wide variety of behaviors one might observe. You may notice, for example, overwhelming sadness, anxiety, fear, suicidal actions, and multiple emotional outbursts. 

In the study, researchers used a questionnaire known as the Deficient Emotional Self-Regulation questionnaire to evaluate emotional dysregulation. This questionnaire asks patients to score themselves on a scale from 0 to 3 when considering the following eight items:

  1. Quick to get angry or become upset
  2. Easily frustrated
  3. Overreact emotionally
  4. Easily excited by activities going on around me
  5. Lose my temper
  6. Argue with others
  7. Am touchy or easily annoyed by others
  8. Am angry or resentful 

Also, it isn’t simply the existence of untreated symptoms that increases the risk of criminal convictions. It’s also the severity of the symptoms. So if you see signs of ADHD, it’s best to talk to your child’s doctor and get a referral to a mental health professional early on.

Doctor reviewing other risk factors for adhd

Severity of Symptoms

Now, let’s talk about how mental health professionals measure symptom severity. In the above cited study, ADHD symptom severity was measured by what’s known as the Adult Self-Report Scale (ASRS v1). 

This 18-question checklist uses a 5-point scale to determine whether a patient’s symptoms are consistent with ADHD. Six of the 18 questions on the checklist have been found to be the most predictive of symptoms consistent with the disorder. 

Using this assessment, researchers discovered a correlation between patients with severe hyperactive or impulsive symptoms and the prevalence of criminal convictions. Further, the severity of emotional dysregulation symptoms also predicted a greater risk for criminal activity.

Of note, we want to avoid labeling all symptoms of emotional dysregulation as untreated ADHD. Patients often can have other conditions, beyond ADHD, which can mimic the symptoms of ADHD on the questionnaires. 

When we discover additional issues, such as untreated depression, anxiety, or PTSD, for instance, it’s important to (a) treat the most severe condition first and (b) keep in mind that some of the symptoms we may be attributing to ADHD may be caused or exacerbated by other untreated conditions.

Child with attention-deficit hyperactivity disorder struggling to focus

Other Variables

I would never want to overstate the correlation between ADHD and criminal conviction. This is simply one more good reason for parents not to hesitate in having any symptoms checked out by a doctor. And it’s true that there are countless other paths to criminal activity.

For example, those with a history of criminal conviction also tend to have a lower educational level, are less involved in family life or work, and have a higher risk of a history of substance use disorders than those without a history of criminal conviction. But disentangling these different risk factors is a complicated business. 

What’s most surprising is that all of these variables could have also been caused by untreated ADHD itself. So there really is a “chicken and egg” question here. 

In the end, to quote this study, here’s what we do know:

“The association of higher severity of hyperactivity-impulsivity symptoms and emotional dysregulation with criminal conviction suggests that clinical manifestations should be treated carefully. Early identification as well as biological and psychological approaches in the prevention and treatment of ADHD and externalizing behavior should be performed early in childhood and followed up in adulthood by professionals with specific knowledge of treatment and behavioral interactions with the environment. Furthermore, targeted interventions should focus on the preventive effect of academic achievement and higher education for adolescents with ADHD, which could be crucial in avoiding illegal drug use, antisocial behavior, and criminal activity.”

If you have a child who has been diagnosed with ADHD and this article causes concern, please remember that it’s not the diagnosis of ADHD alone that increases the risk of criminal conviction. It’s leaving ADHD symptoms untreated that can lead to further problems in adulthood. 

Concerned about your child’s symptoms? Contact our clinic today to start exploring the treatment that is best for your child. 

About the Author

Seth Eappen, MD, is a board-certified adult, child and adolescent psychiatrist. Dr. Eappen completed medical school at the University of Illinois at Chicago and a residency at the University of Michigan, Ann Arbor. He completed his child psychiatry fellowship at MUSC in Charleston, SC, where he served as chief fellow. He is the founder of the Eappen Clinic, a private outpatient mental health practice with locations in Chicago and Oak Brook, IL.