If He Outgrew It, What Is He Doing in My Prison?

While there are billionaires with ADHD and a MENSA ADHD group with 500+ members, there are also many people with ADHD who have much poorer outcomes.

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.

14 thoughts on “If He Outgrew It, What Is He Doing in My Prison?”

  1. Susan E. Van Hyning

    This is EXACTLY what I’ve been saying and any open minded and knowledgeable therapist understands-my therapist Ellis Berkowitz truly ‘gets it’. I recently received my driving privileges back after a second DUI-well over 3.7. During the preparation for my trial/sentencing I was told that if I were to be sentenced to the 45 jail time, I would not be permitted to take my prescribed meds, given through the Veterans Administration for depression and my ADHD as they weren’t authorized and only seen as ‘speed’. Even with a doctors testament and documented history of proper usage for a specific condition. The jail time was something I was completely prepared for, but the withholding of my meds for even 45 days was a nightmare. I was appalled. I was even informed by my therapist that IF they permitted me to take my antidepressants, it would be ‘whatever they had available’. Not my prescribed med. Baffling at best and gross incompetence at worst on the part of the Courts/Correctional Agencies, in reality.

    I’m one of the lucky ones. I ended up with a very ‘mental health oriented’ judge. Who permitted me to fulfill my sentence with all home confinement, in order for me to remain on my meds and go to all my therapy and VA appointments.

    My therapist tells me of one patient who was well into recovery for her issues but when she returned from a short jail sentence she was in worse shape then when he first began seeing her. Medication had been withheld during her jail time. And of another youth client he had, who was in juvenile court camp for numerous violations. Not being given his meds he would make progress and work toward completing his time but inevitably would ‘act out’ incurring additional time. Virtually running a race with one foot nailed to the ground.

    As the majority of offenders in prisons committed crimes while high or intoxicated~self medication at it’s very worst~and a prime component in many ADHDers history, I’m constantly amazed that the issue of treatment for this issue isn’t understood as the cost of preventive proactive therapy for this issue would certainly be so minimal compared to the cost of long term incarceration.

  2. This article is very personal to me because I went to juvie for a little over a week and had a wake up call. I was a senior in high school and ended up in juvie for basically an incident that could be described as an impulsive rage. I am a good kid and would have never seen myself there, but actually going there made me realize how easy it really is to get there. But I agree that having add makes a person more likely to end up in prison. I recently started medication, Vyanse, and am a sophmore in college. I whole heartedly believe that medication is the way to go if a young adult realizes symptoms havent gone away completely. I don’t want to be 50 years old and look back and say “Wow, its already over, and I don’t ever remember wanting to come down this path.” People with add, at least myself, are passionate people that if given the chance to apply themselves, can accomplish great things!

  3. I’m so glad I read this. It’s good to find ONE PERSON who gets it. I’m here because I have a close family member sitting in jail as we speak. He has ability, but was unable to succeed in school. He hit all the brick walls as you all know about and was finally getting some relief with Adderall. He has had the SPECT scans and everything…has all the documentation……….but guess what;
    the men at the jail “watch him” and don’t see that he needs it. If he causes a disturbance, they might rethink it. Think about it…..we know what they’d “rethink.” The last five years have been wasted and he is prepared for nothing. I’m here because I’m searching all over for help.

  4. I just went on to read more of your site and saw this:
    “”oh you can’t have ADD, you did OK in school.”)
    When our family member finally got to a Dr…..had to wait until AGE 18, as he couldn’t get permission to go………the Dr. said
    “Why do you want medicine for ADD……………..you’re not in school anymore…………YOU QUIT!”

  5. Susan

    “As the majority of offenders in prisons committed crimes while high or intoxicated~self medication at it’s very worst~and a prime component in many ADHDers history, I’m constantly amazed that the issue of treatment for this issue isn’t understood as the cost of preventive proactive therapy for this issue would certainly be so minimal compared to the cost of long term incarceration.”

    Unfortunately it isn’t understood because people with ADHD don’t tell the politicians, media and health bureaucrats about the connections and raise awareness. the more that do that, the more people will gradually clue in.


    yes meds can be very useful also important to develop self awareness and self mangement skills. I agree ADDers can accomplish great things check out this category on my blog


    you might get him some books, audio tapes or websites on ADHD so even if he can’t get meds he can start somewhere. there’s a book called adhd and the criminal justice system spinning out of control

    it can easily be discouraging, but if you quit they win. don’t reward ignorance and stigma

  6. I am currently waiting criminal cort trial for posession of methamphettemine, only my charge in sell and supply because the amount i was caught with wa over 2 grams. I was diaganosed with adhd several years ago and was placed on medication, It changed my life, I felt as if some one had switched on a light in my brain.I have acomplished so much in the past few years while on medication and for once understood how wonderfull life was. About 8 months ago I was taken of my medication because of some mistake my dr made. I imeditaly started to experence problems in my life like before and turned to illeagly self medicating. This help and I again picked up the peaces of my life and begun to live again. unfortunatly I got busted. my whole life now seems to have been for nothing as I will most likley spend the next ten years in jail. I have no prospect in ever being alowed to recieve leagle medication by the health dep again, even if i were not going to jail. Either way I feel I have come to the end of my existance as a life with out legal medication, a lengthy jail sentence with no prospect of ever being able to legally obtain medication once released, my life is just not worth living. I am pleased to have had the few years I did on leagle drugs as atleast I was able to experence some great times. I felt I ad a lot to offer the world once but now just wish I could go to sleep and never wake up.

  7. wow Liza that’s too bad. If one doc takes you off meds you might next time change to another doctor instead of taking illegal drugs. Pretty costly error you made. But there are non stimulant medications for ADHD, not sure if they’re available in jail but they are out of jail, so there’s always hope. Nelson Mandela was in jail for 18 years and he made an amazing positive impact on his community, his country and the world after getting out. There is always hope.

  8. I first read of Dr. McCallon’s study in a research newsletter in 2004. I trained to use the Integrated Visual Auditory continuous performance test developed by BrainTrain a Richmond VA company where one of the personnel told of as very strange experience they had involving Canadian Federal prisons. About 2004 BrainTrain had contracted to assess a large number of inmates for ADHD with a view to diagnosis, treatment and possibly improving inmates’ outcomes and reducing recidivism. Sometime into the study, contact from Canadian officials very abruptly stopped and BrainTrain personnel could not even get any recognition that anyone knew them or what they were referring to.

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