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Prisoners with Attention Deficit Hyperactivity Disorder: co-morbidities and service pathways

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Eddie Chaplin, Amina Rawat, Bhathika Perera, Jane McCarthy, Ken Courtenay, Andrew Forrester, Susan Young, Hannah Hayward, Jess Sabet, Lisa Underwood, Richard Mills, Philip Asherson, Declan Murphy

Bibliographical note

Funding Information: Currently, in the UK, the assessment, treatment and service provision for prisoners with ADHD is at different stages. Prisons in the UK are defined in four categories by the type of prisoners they keep, i.e. from high security to open prisons. However, support and provision will not only differ between prisons but within the different categories. These two studies based in different prisons offer an overview of assessing vulnerabilities and providing services for this group using alternative approaches within different prison environments in keeping with current best practice. Study 1 describes the methodology to portray the characteristics of prisoners with ADHD in a prison in South London. This was granted ethical approval by the National Research Ethics Service (NRES) Committee North East – Northern and Yorkshire (ref: 12/NE/0040) – and National Offender Management Service (NOMS) approval (ref: 50-12). This study was funded by grants from Guy’s and St. Thomas’ Charity (grant reference: G101019) and St. Andrew’s Healthcare, Northampton, UK. Study 2 describes the methodology behind a QI project subsequently carried out to develop and assess the impact of a specialist ADHD diagnosis and treatment pathway in a prison in North London. Publisher Copyright: © 2021, Emerald Publishing Limited. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors

Abstract

Purpose: This paper aims to examine effective diagnostic and treatment pathways for attention deficit hyperactivity disorder (ADHD) in prison settings given the high prevalence of ADHD and comorbidities in the prison population. Design/methodology/approach: Two studies were carried out in two separate prisons in London. Firstly, data were collected to understand the prevalence of ADHD and the comorbidities. The second study used quality improvement (QI) methodology to assess the impact of a diagnostic and treatment pathway for prisoners with ADHD. Findings: Of the prisoners, 22.5% met the diagnostic criteria for ADHD. Nearly half of them were screened positive for autistic traits, with a higher prevalence of mental disorders among prisoners with ADHD compared to those without. The QI project led to a significant increase in the number of prisoners identified as requiring ADHD assessment but a modest increase in the number of prisoners diagnosed or treated for ADHD. Originality/value: Despite various challenges, an ADHD diagnostic and treatment pathway was set up in a prison using adapted QI methodology. Further research is needed to explore the feasibility of routine screening for ADHD in prison and examine at a national level the effectiveness of current ADHD prison pathways.

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