This was published a DECADE ago. How long will politicians and the media keep their heads in the sand?
Politicians pretend they think mental health is important, why won’t they fund diagnosis let alone treatment?
If He Outgrew It, What Is He Doing in My Prison?
by T. Dwaine McCallon, M.D. 1998
Since the seventies, there have been many papers following the life stories of adolescent boys with ADHD into adulthood. A concerning link with future criminal behavior was found in a higher percentage of such youngsters than in control, non-ADHD youngsters. Impulsive acts, poor attending and distractibility, especially from consideration of consequences of your actions, put ADHD youth and adults at risk for criminal activity.
The peculiarities of how mind activity develops and works under the inclinations of different inherited personality and learning features can be dramatically seen in brain scans. Even the lay public is exposed to this thrilling new knowledge through Discovery documentaries or on The Learning Channel.
In spite of this, professionals in my field of medicine or in education or even in juvenile justice, remain uninformed about new understandings of the “criminal connection” with ADHD, Tourette disorder and other learning disabilities. Several of us in correctional medicine have noted this for some time now.
Over four years ago, an impressive study was done in the state of Utah where Dr. Paul H. Wender has pioneered the understanding that ADHD and its relatives are life long conditions which in many cases are not simply “outgrown”. Many of the subjects carried the diagnosis of bipolar manic depressive disorder.As is the case in our own treatment study, most were very depressed at being in prison, not quite understanding how their life had gone down the tubes, and had occasional ADHD type moments of exuberance and acting out. The clinicians who had seen these men over the years could not tell the difference between this most common of learning disabilities (ADHD) and the less common bipolar patients they were following.
The Utah survey found approximately 24 % of male inmates to have ADD/ADHD with classical clinical findings. Other studies and our own experience have led us to believe that upwards of 40% of our residents in a medium security prison have the findings along the Tourette/ADD spectrum. If you separate out the nonviolent, impulsive criminals (whom I term my basic, charming and even lovable car thieves and traffic offenders), the percentage is much greater.
Nearly nine years ago, a clinical social worker, a clinical PhD psychologist and I began a small unfundedstudy/treatment project for these men, who form a very significant sub-population of our prison inmates.Our program was politically hazardous for we understood that medication was essential in this group of adult patients with ADHD. If your ADHD is so disabling that you have found yourself living in a remote walled prison of over 1,000 men, then it is unlikely that you will progress toward rehabilitation without the aid of medication. Stimulant medicine can can greatly enhance the ability to learn how to learn,to develop caution and judgment, and to learn a job skill. So we did not hesitate to employ Ritalin, Cylert and an array of newly found SSRI medications to amplify the focus and processing memory (key to judgments) at the beginning of “talk therapy” and training.
Naturally, careful controls on these medications had to be developed as well as a contractual agreementfor conduct with each of our patients. Our program lasts from 6 months to over 2 years, depending onprogress. Patients are given 30 days supply of their medications upon parole and placed in contact with local support groups, counselors and physicians who are comfortable with and understand the condition.They are never “cut loose” with new suit, $100.00 and a bus ticket!
Our results have stunned us, even though we have a great deal of experience treating ADHD. In brief, after graduation from this program,our subjects who completed the requirements have had a two year recidivism rate under 10% for either parole violation (three only) or a new criminal charge (one only) in a group of 41 paroled over two years. This is in contrast to the usual 53-58% recidivism rate nationwide.
Several observations are disturbing to me. The great majority of the men we have diagnosed with Tourette or ADHD were treated in childhood but the treatment was not continued beyond 1-2 school years! Over half of these recall being told they
would not need treatment beyond the teens as they would outgrow their ADD. None whom we have worked with were treated into their twenties.18% had discovered that crystal meth on the street would give them focus and a sense of calmness. 20% found solace from the feeling of “being a meathead”, “still being the retard kid” by seeking oblivion with marijuana and heroin.
Four, still in prison, found focus in risk taking and self-medication with their own adrenaline: armed robbery, torching a hospital, and two multiple homicides during rage responses. All four have become focused, advanced to college studies, developed trades and counsel high school students. Two are artists,and two are musicians now. They find some satisfaction in training other inmates how to avoid these act Its all they have left as they are doing life sentences.
Repeatedly, I have heard saddened parents mourn the fact that they and their son were told this was a character problem and more severe discipline would change it. Many were told, even some are still being told, not to worry – growth and time would make this problem disappear. The guilt they feel, even though they followed the advice of the “experts” in my field and in education, is indescribable when they visit their children in prison.
Our nation now has 1.71 million persons behind bars, from local and state to federal youth facilities to federal maximum security prisons. The previous highest rate of incarceration for an industrialized nation was South Africa during apartheid (3.2 per1,000 population). We are over double this rate presently.
My message is this: we have perhaps 600,000 inmates who have reason to hope if this condition(ADHD) is treated. Rarely does a prisoner really not want to change his behavior and life path. We must recognize this most treatable of the genetic conditions of learning/behavior and continue to treat and intervene before someone like me has to treat your child “inside the walls” and behind razor wire. Never stop advocating for your child with ADHD. Dealing with the scorn of others who do not understand is a pittance compared to the experience of visiting him or her in prison.
Confront your doctor with this as I did recently: “If he outgrew it, what is he doing in my prison?”
T. Dwaine McCallon, M.D. Medical Director,
Buena Vista Correctional Facility, Asst. Chief Medical Officer,Colorado Dept. of Corrections
Undiagnosed and untreated ADHD can be very costly to the individual, their families and society. They are more likely to self medicate with alcohol and drugs, or develop other mental health conditions like depression, dysthemia, anxiety disorders, eating disorders, which leads to addictions problems etc.
Yet here in Vancouver, where it’s hard to find someone who knows enough about adult ADHD to diagnose it (God help you outside the lower mainland), the BC provincial Liberal government and Children’s hospital closed down the only provincial Adult ADHD clinic in the province because the year wait list was politically embarassing.