Children with ADHD have a significantly increased risk of exhibiting dissocial behaviors later in life that are conducive to criminal acts, for which they will be prosecuted. Early diagnostic clarification of suspected ADHD is therefore useful. Lic. phil. Cornel Gmür, Specialist Psychologist for Legal Psychology FSP, Adolescent Forensics, Psychiatric-Psychological Service of the Canton of Zurich, explains in an interview which ADHD symptoms promote the development of dissocial behavior and which therapeutic interventions can support ADHD and offense prevention.
Do people with ADHD have a higher risk of becoming delinquent compared to the average population? If so, what is the explanation for this correlation?
lic. phil. Cornel Gmür: A recently published meta-analysis [1] supported the finding that children with ADHD had a two- to threefold increased risk of developing dissocial behaviors in adolescence or adulthood and being punished for them. In addition, there appears to be evidence that ADHD sufferers exhibit dissocial behaviors (social behavior disorder) at younger ages, as well as an increased risk of re-offending. In prison populations, depending on the study population as well as diagnostic criteria, prevalence rates between 14-72% have been found [3].
Based on current knowledge, there does not appear to be a direct relationship between ADHD and delinquent behaviors, but at best an indirect one [2]. It is already known from previous studies that hyperkinetic symptoms in childhood favor the occurrence of a disorder of social behavior. Not only symptoms such as lack of impulse control, low frustration tolerance or emotional overreactivity with aggressive behaviors are significantly involved in the risk of development, but also the negative learning experiences experienced during their development due to dysfunctional coping strategies. Accordingly, hyperkinetic symptoms represent the link between ADHD and social behavior disorder. Moreover, low social status seems to favor the development of a social behavior disorder, which, if persistent, often results in a dissocial personality disorder.
In this respect, what is the significance of the diagnosis and treatment of ADHD for the prevention of delinquency?
Diagnosis and therapy are of great importance in relation to the development of delinquency in ADHD. Thus, it seems indispensable to start treating ADHD patients and any comorbid disorders as early as possible in childhood. In addition to alleviating the core symptomatology, the corresponding therapeutic interventions should also aim to prevent failure and failure in the learning history of ADHD sufferers, if possible, by teaching and practicing socially acceptable coping strategies. Multimodal therapy approaches are also successful in the treatment of adults with ADHD. However, evidence of efficacy of therapeutic interventions for ADHD on delinquent behaviors is currently pending [2].
What are the implications for adolescent forensics.?
Early and comprehensive diagnostic clarification regarding the presence of ADHD appears to be essential for delict-oriented treatment. This is the only way to ensure that the symptoms of ADHD, which usually persist into adulthood, are adequately treated by means of psychoeducation, pharmacotherapy and psychotherapy. In this context, it is particularly important to convey an understanding of their own feelings, so that adolescents and young adults feel that their suffering is taken seriously and that they are understood. On the other hand, this process often has a relieving effect on them. Corrective emotional experiences contribute to affective completion, which in turn forms the basis for new experiences with a corresponding experience of self-efficacy.
Where do you think particular challenges remain in the context of ADHD and delinquency?
A challenge is the initially irritated reaction of many adolescents and young adults with ADHD to the drug treatment with methylphenidate, since they experience their liveliness and creativity as subjectively restricted by the medication, which is also reported back to them accordingly by their environment. Often, ADHD sufferers are unwilling to take on these limitations against a backdrop of still few resources.
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lic. phil. Cornel Gmür Specialist Psychologist for Legal Psychology FSP, Adolescent Forensics, Psychiatric-Psychological Service of the Canton of Zurich |
Literature:
- Mohr-Jensen C, Steinhausen HC: A meta-analysis and systematic review of the risks associated with childhood attention-deficit hyperactivity disorder on long-term outcome of arrests, convictions, and incarcerations. Clinical Psychology Review. 2016; 48: 32-42.
- Ridinger M: Attention deficit hyperactivity disorder (ADHD) in adulthood and delinquency – implications for therapeutic interventions. In Endrass J, et al. (Eds): Interventions with violent and sexual offenders: risk management, methods and concepts of forensic therapy. Medizinisch Wissenschaftliche Verlagsgesellschaft, Berlin 2012.
- Vermeiren R: Psychopathology and delinquency in adolescents: a descriptive and developmental perspective. Clinical Psychology Review. 2003; 23(2): 277-318.
