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Tackling ADHD in young prisoners

Oct 2016: Professor Lindsay Thomson is taking part in a study to see whether a drug called methylphenidate can reduce ADHD in young male prisoners.

A new study led by researchers from King’s College London, the University of Edinburgh and Imperial College London, will investigate whether a drug called methylphenidate (MPH) reduces symptoms of attention-deficit/hyperactivity disorder (ADHD) and antisocial behaviour in young male prisoners with the disorder.

ADHD rates among prisoners

Around 30 per cent of young prisoners are thought to have ADHD, compared to three or four per cent of young people in the general population. Although MPH is the first line of treatment for ADHD in the UK, it has yet to be investigated as a treatment for young prisoners. 

ADHD is a developmental disorder marked by severe and impairing levels of inattention, hyperactivity and impulsivity. These are all symptoms that overlap with and could be explained by other mental health disorders seen in prisoners, which is one reason why the disorder currently goes undiagnosed and untreated in prisons.

Clinical trial

The £1.3 million study is an eight-week clinical trial of 200 young adults, aged 16 to 25, at three young offender institutes and prisons, including Polmont in Falkirk, Isis in London and Rochester in Kent. This research builds on a pilot study of 100 prisoners in HMP Isis, which showed significant improvements in ADHD symptoms, antisocial behaviour and attitudes towards violence, following a course of MPH

MPH works by increasing dopamine levels in the brain. This boosts brain activity in areas related to attention and behaviour regulation and can have a huge impact on improved self-control of behaviour and function in education and work. This new study will investigate the effects of a slow release form of MPH on ADHD symptoms and prisoner behaviour. 

Her Majesty’s Inspectorate of Prisons, reporting on the pilot study, said that “some prisoners on the programme to whom we spoke were experiencing some stability of behaviour for the first time in their lives….There should be efforts to ensure continued prescribing of medication and ongoing specialist support for prisoners (who were treated for ADHD) following their release.”

A previous national registry study in Sweden also showed a six-fold higher rate of criminal convictions in adults with ADHD and a 30-40 per cent reduction in crime during periods of treatment with MPH. 

In this new study, the prisoners will be given MPH once a day for eight weeks and ADHD symptoms will be measured through clinician ratings and interviews. The study will also measure a range of other factors, including irritable and angry outbursts, antisocial behaviour, attitudes towards violence and positive engagement with education and rehabilitation activities.  

ADHD in prisoners tends to go undiagnosed and untreated, perhaps due to overlapping symptoms with other mental health issues, such as personality disorder, anxiety, post-traumatic stress and substance abuse. As a result the effects of treating ADHD in prisoners remain unclear. Following a course of methylphenidate, we’re hoping to see a reduction in ADHD symptoms and antisocial behaviour, as well as increased positive engagement with educational and offender rehabilitation programmes.

Professor Philip AshersonInstitute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London

Professor Asherson added: ‘If the treatment is effective in a prison setting, this will pose bigger questions around what happens to prisoners when they are released. Does it lead to better functioning in society and a drop in subsequent criminal offending? These are the issues we will seek to examine in future research.’

 This three-year study is led by Professor Philip Asherson at King’s College London, Professor Lindsay Thomson at the University of Edinburgh and Professor Susan Young at Imperial College London. It is funded by the National Institute for Health Research (NIHR) and the Medical Research Council (MRC) and is expected to report in 2020.