Comments on abstract: Attention-deficit hyperactivity disorder (ADHD), substance use disorders, and criminality: a difficult problem with complex solutions.

By Dora Wynchank

I think this is an important paper because it highlights, once again, the dangers of not recognising and treating adult ADHD.

As we know from our colleagues in Sweden, up to 40% of imprisoned men have ADHD (1). Adult ADHD has major public health significance, beyond associated criminality, due to its high cross-national prevalence of 3.4 to 4.4%, and associated educational, psychological and social impairment (2-5). Yet, over 80% of adults with ADHD are not currently diagnosed or treated by psychiatrists (2,6).

When the ADHD comorbid with criminality is treated, the future risk of criminality decreases (7). Substance abuse is also highly comorbid with ADHD (15%), especially in the presence of conduct disorder in childhood (5,8).

This review emphasises the under diagnosis of ADHD in at-risk populations. It explores the benefits to the individual and society when ADHD is treated. I believe that health care funders and government agencies should take heed of this kind of research, because it will improve quality of life for individuals with ADHD. If ADHD is addressed in society, there may also be economic benefits to society in terms of less incarceration, and hence the criminal justice system will also have a lesser burden.

1. Ginsberg Y, Hirvikoski T, Lindefors N. Attention-deficit/hyperactivity disorder (ADHD) among longer-term prison inmates is a prevalent, persistent and disabling disorder. BMC Psychiatry. 2010;10(1):112.
2. Fayyad J, De Graaf R, Kessler R, et al. Cross-national prevalence and correlates of adult attention-deficit/hyperactivity disorder. Br J Psychiatry. 2007;190(5):402–409.
3. de Zwaan M, Gruss B, Muller A, Graap H, Martin A, Glaesmer H, Hilbert A, Philipsen A. The estimated prevalence and correlates of adult ADHD in a German community sample. European Archives of Psychiatry & Clinical Neuroscience. 2012;262:79-86.
4. Simon V, Czobor P, Balint S, Meszaros A, Bitter I. Prevalence and correlatess of adult attention-deficit hyperactivity disorder: meta-analysis. The British Journal of Psychiatry. 2009;194:204-211.
5. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, Secnik K, Spencer T, Ustun TB, Walters EE, Zaslavsky AM. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry. 2006;163:716-723.
6. Retz W, Retz-Junginger P, Thome J, et al. Pharmacological treatment of adult ADHD in Europe. World J Biol Psychiatry. 2011;12(suppl 1):89–94
7. Lichtenstein P, Halldner L, Zetterqvist J, et al. Medication for attention-deficit/hyperactivity disorder and criminality. N Engl J Med. 2012;367(21):2006–2014.
8. Hazell P. Review of attention-deficit/hyperactivity disorder comorbid with oppositional defiant disorder. Australas Psychiatry. 2010;18(6):556–559.