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ADHD, Medication, and Criminality, Part II

Kent pointed to a study that is making some waves which showed that people diagnosed with ADHD and who receive treatment were less likely to be convicted of crimes than those who abstained from treatment.  It's an interesting study authored by some very respected social scientists.   Many are assuming that the take away message of the study is that untreated ADHD is associated with a greater likelihood of criminality because people with ADHD are impulsive.  That may be true, but it's also quite possible that those patients who remain in treatment are simply more responsible or motivated in other areas of their life.  That's always the problem with these types of studies: the conclusions are never as obvious after careful contemplation.  For instance, what can we make of the fact that only 24% of the men and 25% of the women in the study who had ADHD were employed?

But I want to highlight another issue.  The primary treatment modality for ADHD is pharmacological.   The drugs of choice are a group commonly known as stimulants.  These include methylphenidate (aka, Ritalin) and the various amphetamine salts (e.g., Adderall).  These are both controlled substances because they have the propensity for addiction.  We know that people in the criminal justice system have extraordinarily high rates of substance abuse.  Likewise, stimulant drugs act by increasing the levels of dopamine in the brain (as does cocaine) and we know that raising dopamine levels in the brain is associated with aggressive behavior and paranoia.  For people with histories of violent behavior and substance abuse, the concern here is rather obvious.

None of this is to suggest that ADHD is not a real disorder (although it is overdiagnosed) nor that these medicines have no place with offender populations.  But every treatment comes with risks and often those risks are unforeseen.  In offender populations which are loaded with risk, we should be quite cautious in proceeding down the road of handing out these types of drugs without many additional studies.  

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