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Attention Deficit Hyperactivity Disorder in Men and Women Newly Committed to Prison

Patricia Westmoreland, Tracy Gunter, Peggy Loveless, Jeff Allen, Bruce Sieleni, and Donald W. Black (2010). Attention Deficit Hyperactivity Disorder in Men and Women Newly Committed to Prison. International Journal of Offender Therapy and Comparative Criminology, 54(3): 361-377.

In this study, Patricia Westmoreland of the Iowa Department of Corrections and a team of researchers from the Carver School of Medicine at the University of Iowa compared 319 male and female prisoners, with and without Attention Deficit Hyperactivity Disorder (ADHD), who were newly committed to the Iowa Medical and Classification Center in Oakland, Iowa. These prisoners were each assessed for DSM-IV disorders with the Mini International Neuropsychiatric Interview - Plus, for physical and mental functioning with the Medical Outcome Study Short Form-36 Health Survey, and for "primary risk factors" that "contribute to the development of lifetime adjustment problems" with the Level of Service Inventory - Revised (LSI-R). The 68 prisoners (60 male, 8 female) with ADHD were largely male (88.4%) and Caucasian (83.8%).

Although the level of ADHD among women was high, no significant differences were found among these prisoners related to age, gender, education, marital status, or type of offense. However, ADHD prisoners were twice more likely to be at risk of suicide than non-ADHD prisoners. Overall, most ADHD prisoners (91.2%) gave evidence of four or more of 23 symptoms found in the whole group. Individually, the larger extent of these symptoms in ADHD prisoners was in the following categories: money-related impulsivity (92.6%), impulsivity (91.2%), distractibility (89.7%), fidgety (89.7%), "being in a fog" (89.7%), non-achieving (86.8%), underemployment (73.5%), intrusive (70.6%), irritable (70.6%), general disorganization (67.7%), changes jobs (64.7%), disorganized work (58.8%), spousal complaints (48.5%), and two or more divorces (42.6%). Money-related impulsivity was also the most common symptom in the non-ADHD population, but only for 20.7% of them. In addition, ADHD prisoners were more likely to have "lifetime psychiatric diagnoses" such as childhood conduct disorder, comorbid mood and anxiety disorders, psychotic disorders (e.g., schizophrenia), antisocial and borderline personality disorders, body dysmorphic disorder, and "any somatoform disorder."

Meaningful differences in substance abuse and eating disorders were not evident in the ADHD and non-ADHD populations. ADHD prisoners were also found worse-off in terms of mental summary, emotional role limitations, mental health, and social functioning. Interestingly, LSI-R scores were not distinctly different for ADHD and non-ADHD prisoners, and both groups also seemed similar in terms of their general health, physical functioning, and vitality. In terms of treatment, Westmoreland and her colleagues note that corrections staff may be hesitant to order pharmacological options because of the "street value and abuse potential" of these stimulants (they recommend the use of liquid forms). They observe, however, that short rating scales are now available to assess prisoners. "Cognitive behavior therapy," they conclude, "may also be helpful in assisting patients to challenge their cognitive distortions and modify dysfunctional behaviors, especially in the setting of psychiatric comorbidity."

For further information, contact Donald W. Black, M.D., of the University of Iowa's Carver College of Medicine at (319) 353-4431 or (email)



Posted Wed, Mar 2 2011 9:06 AM by Tracey Vessels


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