Introduction
Attention deficit hyperactivity disorder (ADHD) is highly prevalent in prison populations (approximately 26%) compared to the general population (2–3%). Studies suggest that ADHD increases the risk of antisocial behavior, criminality, and recidivism. This systematic review examines the impacts of pharmacological treatment of ADHD on criminal recidivism, symptoms of the disorder, and factors related to rehabilitation.
Methods
The review was conducted according to the PRISMA 2020 and AMSTAR guidelines. The search was performed in the PubMed database on September 6, 2023, including original studies published in English in peer-reviewed journals. Studies with participants diagnosed with ADHD (according to any edition of the DSM) and incarcerated at the beginning of pharmacological treatment with osmotic-release methylphenidate (OROS) were selected. Primary outcomes included criminal recidivism; secondary outcomes involved ADHD symptoms and rehabilitation factors (social adaptation, global functioning, normative behaviors, and well-being).
Results
Five studies with 284 participants, based on three cohorts, were included. Only one directly investigated criminal recidivism, reporting lower than expected recidivism rates (27.3% at 1 year and 33.3% at 3 years), while the average recidivism rate in the Swedish prison population is 70–80%. Regarding ADHD symptoms, four studies reported significant reductions with the use of methylphenidate, including cognitive and functional improvements. For rehabilitation factors, the results were heterogeneous: some studies reported improvements in social adaptation and reduction of substance use, while others found no significant impact.
Discussion
The results suggest that pharmacological treatment may reduce ADHD symptoms and contribute to rehabilitation, which in turn could positively impact recidivism rates. However, the lack of rigorous control in some studies and the small number of studies on criminal recidivism limit the generalizability of the findings. Factors such as treatment adherence, dosage, and comorbidities, including substance use disorders, play a critical role in the observed outcomes.
Conclusion
Limited evidence supports the efficacy of pharmacological treatment of ADHD in directly reducing criminal recidivism. However, improvements in symptoms and rehabilitation may indicate a potential indirect effect on recidivism rates. Additional studies with more robust designs are needed to elucidate these effects and provide more precise treatment guidelines for prison populations.
Reference :
Carlander, A., Rydell, M., Kataoka, H., Hildebrand Karlén, M., & Lindqvist Bagge, A.-S. (2024). A remedy for crime? A systematic review on the effects of pharmacological ADHD treatment on criminal recidivism and rehabilitation in inmates with ADHD. Brain and Behavior, 14, e70120. https://doi.org/10.1002/brb3.70120
