ADHD and youth crime
Earlier this week I posted some thoughts on the government's new Youth Crime Action Plan which highlighted a diagnosis of Attention Deficit Hyperactivity Disorder as a way of spotting those youngsters at greatest risk of becoming criminals.
I reproduce the chart here with our labelling corrected. (The original can be found in the report [pdf] however there is little or nothing in the way of explanation in the accompanying text.)
Thanks to those who alerted me to the mistake and thanks too for some fascinating analysis of the data on the link between ADHD and crime.
As happyclucker, Prodnose and statisticslecturer all pointed out, the chart suggests that well over 40% of young offenders have been diagnosed with ADHD - of which the vast majority are high-rate offenders.
This strikes me as a remarkable finding given that an estimated 3-7% of school children suffer from the disorder.
As I said in my earlier post, there is a danger that we assume causation here - that ADHD causes crime - when it might be that those youngsters with behavioural problems are subsequently diagnosed with ADHD.
But some medical literature argues that ADHD is a neurobiological condition, a chemical imbalance in the brain which affects impulses and concentration. Sufferers are sometimes prescribed psychostimulants or antidepressants, drugs which help the brain to work "in a more normal way".
All of which poses some important questions, I think.
I would very much like to hear from readers who have first-hand experience. Is ADHD a genetic condition or are there social causes? Do the treatments work? Are we simply finding a medical label for bad behaviour? Or could an understanding of ADHD help us in the fight against crime and delinquency?
I'm 
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ADHD is not a genetic condition, it is a social phenomenon - and I speak as someone "diagnosed" with the condition. I was fortunate in that the diagnosis was not made until my late twenties - when I was at school, ADHD was pretty much unheard of.
Because school staff did not automatically reach for medication they instead used a little known technique called "teaching", although this seems to have fallen out of use nowadays.
The fundamental problem is that the term ADHD has the implicit assumption that there is a "correct" amount of attention that a child should always pay to a teacher - which is patently ludicrous. My teachers obviously realised that I got bored quicker than most so they simply gave me shorter pieces of work and more of it. As a result, I moved ahead quickly and they bred the habit into me of compulsively devouring any information that I could get my hands on and being able to quickly switch between topics/problems - which came in handy doing a degree in physics.
Teachers nowadays do not have the time or ability to do this due to an overly prescriptive curriculum and so the behaviour/attitude of children is seen as something that must be stopped before learning can begin instead of being something that can be harnessed and used.
As for the chemical imbalance argument, this is still based on an unfounded assumption. Namely, that it is "normal" for young children to sit quietly in school and learn what they are told to. Those who do not behave "normally" are sometimes found to have slightly different regions of there brain active during a certain task, but there is no baseline measure of a "normal" brain to compare against other than the kids who are well-behaved because we have decided, against all observable evidence, that it is "normal" for children to behave like compliant adults.
Maybe those normal kids should be treated for their wierd compulsive behaviour that causes them to divert all of their attention to one very small area.
There are people who genuinely have serious issues with impulse control, but they are a tiny fraction of those diagnosed with ADHD and the severity of their condition is down-played by it's over-diagnosis.
Frankly, I have never found myself unable to pay attention, put I have come across many teachers who were unable to interest me. Maybe we could find some medication to solve their Interest Deficit Disorder.
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Mark:
There is a collaborative effect on ADD/ADHD and youth crime in the recent years....
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I am in the unenviable position of being able to both sides of the argument. Like MB, I was a ‘difficult’ student at school. I struggled with subjects that I found unfulfilling and was often lambasted for ‘failing to pay attention’
I was hopeless at mathematics and was therefore held back within the class streaming structure prevalent in 1970’s schools. Consequently I was ‘unchallenged’ by much of the work I was presented with and quickly became bored.
Later, at college I was to discover that I am a natural mathematician, it was my Secondary School teachers who were quite simply incompetent. I left college with a HNC in mathematics, but I had only achieved a CSE grade 4 at school.
Had the ADHD diagnosis been available then, would I have been prescribed drugs to ‘help me concentrate’?
On the other side of the coin, my son does have behavioral challenges. He was slow in his early physical and language development as identified by the health visitor. The nursery he attended reported that he would not interact with other children and would not hold eye contact with anyone. He was eventually assessed by senior health officials to have a higher functioning autism, or ASD as it is now called. Within the ASD model lurks the specter of ADHD.
Without the assistance of drugs, my son at the age of 15 is highly disruptive, irritable, unfocussed and unreasonable. He will storm off at the slightest provocation and has little sense of danger.
With the drugs he becomes far calmer, happier, able to concentrate for longer periods and quite happy to discuss an issue, as long as I eventually agree with him! His sense of danger remains impaired.
So I say yes, ADHD is a real issue, but it is not a diagnosis that a GP can make. Drugs work, as long as they are the right drug for the child (We went through several types of drug until we found the one that works for my son). And there is a real emphasis on education.
My son attends a specialist unit within a main school where they understands the needs of autism and ADHD. They focus the attention of their students onto small, achievable tasks and there is always a teaching assistant available to help out. If things become too much, the school provides a safe place of refuge.
In his early days at school, prior to our acceptance that drugs should be used to calm his temperament, my son was becoming a nomad, unruly and unliked. Today his world, his outlook has changed.
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Mark:
Yes, ADHD is a genetic condition and is accepted by almost all psychiatric professionals as not only existing, but having a profound effect on those who manifest it. Scientists studying ADHD have been working with SPECT brain imaging scans which have proved beyond doubt that people with ADHD have significant differences in their brain structure, size and delivery systems. A diagnosis of ADHD cannot be completely clinically verified unless there is a family history of ADHD life patterns and behaviours. ADHD is now known to never simply 'appear' but to have been passed on through family lines genetically.
Without the (prohibitively expensive) SPECT scanning ADHD is a complicated condition to diagnose and as Patchsims said, cannot be diagnosed by a GP, only suspected. In the case of adults being treated for the first time, the area I feel most qualified to talk about, the diagnostic criteria in the UK is 4 fold.
Firstly an oral history is taken from the person being tested, job history, history of crimes committed, affective lability, enuresis, school performance, emotional and developmental speeds and the presence of co-morbid conditions such as anxiety, depression, substance abuse, bi polar disorder etc. (It is a fact that over 80% of adults with undiagnosed ADHD have a co morbid condition of some sort, treatment of which has often resulted in the referral to an ADHD clinic for exploration). This history is then checked against a collateral informant such as a parent or sibling.
Once the oral history is taken comes the cognitive and psychometric tests, these test reaction, IQ, lateral thinking abilities, inattention, disinhibition and a significant discrepancy in IQ scales between one category and another along with other reaction, processing and memory functions.
This is followed by completion of one (or perhaps more) of the medically accepted rating scales and diagnostic forms (in the UK it is most commonly the Brown Scale used for adults). These tests are filled in both by the patient, the patient's current partner or close friend and by a parent or relative who has known the patient their entire lives. This is where the questions you might commonly see in lay 'do you have ADHD' questionnaires such as 'do you have problems staying in your seat' 'do you have problems waiting your turn' etc etc, appear. Many people mistake these rating scales as being the only component of a diagnosis when in fact they are most likely to be used in determining if a full evaluation is necessary. It is my personal opinion that this misunderstanding is at the root of those who either consider ADHD to be a liberal's excuse for bad behaviour or even a non-existent condition. It is easy to look at the very basic sections of ADHD rating scales and think 'well, I can't concentrate all the time and there's nothing wrong with me', then extrapolate outward to the conclusion that ADHD is not a serious condition or does not exist.
Next comes the examination of any reporting systems in place during the patient's childhood. At the very least these must be school reports and are often supplemented by medical records or, if available and relevant, psychiatric or social service assessments.
The final part of the process comes when all the medical professionals involved in the assessment meet to discuss their informed opinion of the patient's conduct during assessment. These range from the ability to clearly express themselves without deviation or distraction, physical behaviour and general demeanour.
Only if every single aspect of the assessment points to ADHD can the diagnosis be confidently applied. If every single other part of the assessment points to ADHD but your school reports reflect no signs of ADHD, you should not be given a 100% diagnosis.
It is an inescapable truth that ADHD is subject to both over and misdiagnosis. This does mean however that the diagnosis itself has no merit or does not exist, rather that there is insufficient training in the complex and involved diagnostic process. Many children and adults who are simply profoundly disturbed or uncomfortably exuberant are given an ADHD diagnosis for the sake of a tick in a box and a 'case closed' mentality. At the same turn many psychiatric inpatients and those considered criminal pariahs are undiagnosed ADHD cases.
The consequences of the general lack of understanding of the ADHD type brain has far reaching consequences for both the individual in question and the society they live in. Studies of the male prison population in America have reported from 30% to 80% of inmates have untreated ADHD. If you translate even the most stringent study's findings into real humans it comes out at just over 26 thousand individuals in the UK prison population. Imagine the effect on society if even a small number of those criminal individuals could have help with controlling their temper, impulses and inability to effectively fit into a 9 to 5 system of work. The changes would be far-reaching and truly transgressive.
I know I've gone on and on but there's one more point I would like to make. The most interesting research (and it is just that at the moment) suggests that there is an evolutionary purpose to the ADHD brain. Studies on indigenous tribes people have discovered that those with ADHD type brain function are the hunter gather/soldier types who's existence is vital to the survival of their tribe. These people, in common with those diagnosed with ADHD, have the ability to 'hyper focus' on any task which raises their brain dopamine levels, they show an inability to measure the passing of time, an inability to learn from mistakes i.e their arm gets ripped of by a lion and yet they will not stop going out to hunt lions, they are intensely reactive and their aggression process is immediate and devastatingly powerful yet immediately retreats once the danger is no longer present , their lateral thinking abilities are far above a non hunter/gather human, their hyperactivity allows them to push themselves physically beyond their natural ability and their cognition is marktly faster in an aroused state than a typical human as is their attention to detail, sensitivity and understanding of human emotional communication. The current hypothesis is that those with ADHD have a different evolutionary purpose to the majority and are therefore not suited to a society where their specific needs and talents are neither understood, nor catered for. I often explain this situation by asking people to think of a left handed person using right handed scissors. They can mange to cut, but the lines will not be straight or scissors easiy controlable. The left handed person may think 'I am rubbish at cutting' when in fact it is the tool which is at a fault.
We are failing most of the 3-5 % of the population who are ADHD types and until wider understanding of the condition is promoted, we will continue to do so.
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"The current hypothesis is that those with ADHD have a different evolutionary purpose to the majority and are therefore not suited to a society where their specific needs and talents are neither understood, nor catered for."
This is why I argue that it's a social phenomenon as opposed to a disease or a disorder. If we moved all of the light switches to seven feet from the floor, I wouldn't be diagnosed with a Height Deficit Disorder.
When the world around me ouputs information at the rate I require it to be input, my "deficit" disappears and the Information Processing Deficit Disorder that my peers suffer from starts to become apparent.
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Both myself and my brother had A D H D although it wasn't called that then. My son also has it and was diagnosed when he was approx. 4 years old. The doctors wanted to put him on drugs and I decided that first I would try changing his diet. No artificial additives, colours, E numbers, reduce sugar and definitely no caffeine. Sweets are only to be eaten at the weekends in the morning before going out to play for the day.
I never disclosed to anyone, not even family, that he has A D H D. Even he doesn't know! I didn't want him 'labelled' or it used as an excuse.
Up until recently, the diet worked. He is now 14 1/2. A few months ago his behaviour changed and I found out that he had been stuffing himself with sweets and cola, and even worse, drinking red bull. Within 1/2 hour of eating or drinking these things he changes into a horrible person. Luckily he can see the change himself and doesn't like who he becomes and has accepted that he just can't have these things, just like Mum can't.
He is known as being a child with a lot of energy and that he can be prone to being unsettled in class but as long as he gets enough sleep, eats decent food and is kept busy, he'll be fine.
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several small points:
firstly (and the main point of the original article) on using a diagnosis of ADHD to spot potential criminals early is surely doomed to failure when it can take upwards of 7 years to get a child diagnosed...
I do agree that there have been a lot of problems with mainstream perception of ADHD because of mis-diagnoses and many feel it is an excuse for bad behaviour. I think that this point of view arises from lack of information.
My step son has ADHD, which is definitely genetic - he had very little contact with his father (and none at all now for over a decade) and is now 12 1/2. All of his ADHD symptoms were (according to his mother) expressed by his father, and we haven't been able to identify anything in our parenting which would have contributed particularly towards his personal issues. His full sister is totally unaffected as far as we can tell.
Diet helps a little (particularly cutting out e numbers and sugar) but we were astonished after battling for years to avoid medication just how much of a change it can make. He has been on a new mediaction for nearly two years and it does really help.
His symptoms are slightly unusual in that he isnt particularly "hyperactive" - although he slept very little until recently and could wander off and try to leave the house at 2,3,4 or 5am if left unsupervised, and managed to set fire to his bedroom in the middle of the night on one memorable occasion. His main difficulties focus around lack of any sense of personal danger and extremely impulsive behaviour. This led to a lot of issues with stealing (not items of any real value, just things that caught his fancy) which in turn led to him being labelled at school as a thief and a liar and led to more and more behavioural problems.
He can get very upset about his own behaviour and claims that he cant help stealing...
Medication has really helped but doesnt solve all the problems - particularly around personal danger. I still shudder every time he rides a pushbike anywhere near a road, for example, as he tends to think of looking for traffic after he has already entered the road...
His other big problem with criminal behaviour (stealing, lying, and sometimes vandalism) has been that other kids at school are very quick to realise just how easily led he can be. One of them suggests he does something and he will give it a go without pausing for thought. He started secondary school last September and has already had four single day exclusions. Even the school agreed that in almost every case, his behaviour was precipitated by other kids (one or two in particular) and he never got into trouble when away from these others. I wonder how many jail inmates with ADHD are there instead of friends who got them to do their dirty work for them?
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If those who believe ADHD is a genetic disorder perhaps they can tell me whether its a dominant or recessive gene, which chromosome it maps to and which protein this gene produces. I can do this for real genetic diseases like cystic fibrosis.
Its strange how there's suddenly an epidemic of these 'genetic disorders' that weren't around several decades ago. Odd that if the parents were carrying the gene. Its a funny genetic disorder than can be controlled by a good slapping from a parent. Obesity is another one..... weird that all these fat people had perfectly normal grandparents if they inherited the condition.
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"Maybe we could find some medication to solve their Interest Deficit Disorder" - brilliant.
My son has been diagnosed with ADHD - but if you are looking for a happy go-lucky lad who is always leading the pack and with a strong sense of right and wrong he is the person. He wants to be a policeman when he grows up as he does not like injustice. He also keeps on surprising me with comments he comes out with which show he has been listening to what has been going on whilst doing something totally different. I wish I had that skill.
Just wish we could as a society stop looking to blame our problems and faults on something or someone - this leads to lack of decision and action. We are all different so lets celebrate this diversity rather than all trying to conform to a social stereotype the advertising media portray.
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I think its a genetic thing from the stuff i have read across the internet, but on that note i dont think its a problem more of a social inbalance ove the last few decades we have gone from a very industrilised country to a service country. This leaves a large gap in skills learnt and pushes all towards one system of learning which for a lot of young people becomes so repetative they turn off.
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I do not know whether it is biological or environmental, suspecting a bit of each, having worked for the probation service for nearly 20-years, it is my observation that as many as 15% of young offenders would test positive.
This suggests there is a major fault in the criminal justice system for punishing folk who are the way they are due to circumstances not of their chosing.
But I blame not the authoriites but the population who are without mercy, demanding 'something is done about punishing the perpetrators. The fact they need help not punishment says a lot but try tell that to the majority of the population.
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