ADHD and criminality: A primer on the genetic, neurobiological, evolutionary, and treatment literature for criminologists

Abstract

Objective

This state of the art review of 102 studies is a primer on ADHD and its major comorbidities for criminologists unfamiliar with the genetic, neurobiological, and evolutionary literatures.

Materials and methods

Neurological, genetic, medical, and criminal justice data bases were keyword searched for articles on ADHD and/or articles using ADHD as a major independent variable.

Results

ADHD is a disorder that is closely connected to externalizing behaviors, conduct problems, and criminal behavior across the life course.

Conclusions

To date, ADHD research has been carried out primarily by biomedical researchers and de-emphasized by criminologists whose training is overwhelmingly in the social sciences. The special expertise of criminologists in uncovering environmental correlates of antisocial behavior can benefit biomedical researchers who in turn can assist criminologists in uncovering the individual-level correlates of antisocial behavior.

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed behavioral disorder of young children and adolescents. There is an abundance of research that identifies a strong and robust relationship between ADHD and diverse forms of antisocial and allied behaviors including externalizing disorders, poor academic performance, delinquency, criminal behavior, and lifetime psychiatric burden (Aebi et al., 2010, Barkley, 1997a, Barkley, 1997b, Burke et al., 2005, Dick et al., 2005, Gordon and Moore, 2005, Hinshaw, 1987, Hinshaw, 1992, Kessler et al., 2006, Moffitt, 1990, Nigg et al., 1998, Pratt et al., 2002). For instance, a review of 100 studies (Ellis & Walsh, 2000) found that 99 of them reported a positive relationship between ADHD and various antisocial behaviors—violent and property crimes, delinquency, drug abuse.

Individuals diagnosed with ADHD are consistently found to be overrepresented in juvenile detention centers, jails, and prisons worldwide (Rösler et al., 2004), and it has been suggested that ADHD may underlie one of criminology's most revered etiological concepts—low self-control (Chapple et al., 2010, Unnever and Cornell, 2003, Unnever et al., 2003, Vaughn et al., 2007). The risks for delinquent or criminal behavior is increased for individuals who are comorbid for conduct disorder (CD) and oppositional defiant disorder (ODD) (Aebi et al., 2010, Angold et al., 1999, Biederman, Ball, et al., 2008, Biederman, Petty, et al., 2008, Clark et al., 2000, Comings et al., 2005, Egger and Angold, 2006, Loeber, 1990, Price et al., 2001, Raine et al., 2005). For those who are afflicted with all three conditions, ADHD symptoms usually appear first, followed by ODD symptoms, and then CD symptoms.

Gudjonsson and colleagues’ (2009) review of nine studies of ADHD rates among adult prison inmates using various diagnostic criteria in a number of countries found rates ranging from 24% to 67%. A German study (Rösler et al., 2004) found that 45% of the inmates had some form of ADHD (there are three diagnostic subtypes) compared to 9.4% of a control sample. This same study found that 85.5% of the ADHD inmates were comorbid for alcohol and substance abuse/dependence, and that 30.2% of them with either definite or possible antisocial personality disorder. Inmates with ADHD also have significantly more prison violations such as verbal and physical aggression, destruction of property, and self-injury (Young et al., 2009). A study of lifetime criminality among 207 white males diagnosed with childhood ADHD and free of CD compared with a control group found that 42% had been convicted of at least one officially recorded crime by age 38 compared with 14% of controls (Mannuzza, Klein, & Moulton, 2007). Thus, even in the absence of CD, ADHD remains a significant risk of criminal behavior (Loeber et al., 1995, Mannuzza et al., 2004, Moffitt, 1990, van Lier et al., 2007).

Criminologists are familiar with ADHD and its symptoms and correlates, although they may not be familiar with its etiology as understood by natural scientists. One explanation as Unnever, Cullen and Pratt (2003, p. 495) point out is that ADHD research “has been conducted primarily by psychologists and biomedical researchers with few ties to the field of criminology.” They further note that because ADHD is a major risk factor for antisocial behavior that criminologists must become involved with this research because they can offer insights that would be “theoretically consequential.” We agree, and the current review of the ADHD literature explores whether the condition is a true nosological disorder or a normal variant of a human phenotype that happens to be unsuited to modern social conditions. In addition, current correctional treatment protocols used to ease ADHD symptoms are examined.