Attention deficit disorders

Abstract The diagnosis of attention-deficit/hyperactivity disorder (ADHD) in correctional settings is in itself problematic and quite contentious, and treating the disorder is even more so. ADHD occurs at far greater prevalence rates among justice-involved persons than in the population at large. The nature of the condition, its assessment, and its management combine to create a perfect storm of potentially vexing challenges for the correctional psychiatrist. This chapter reviews those diagnostic and treatment challenges, including the risk of diversion and misuse of controlled medications by incarcerated persons. An assessment and treatment model is presented that takes into account and minimizes risk while helping ensure access to care in appropriately selected cases. Some incarcerated persons have a compelling need for treatment, potentially including stimulant medications. Neither unbridled use nor complete elimination of stimulants makes good clinical or administrative sense for correctional systems. An approach that relies on current impairment in significant functional areas, meaningful involvement in treatment, and an absence of active misuse of substances will allow access to medication for those with verifiable needs while lessening the risks associated with the prescription of controlled substances in jails and prisons. Differential diagnosis, the challenges of appropriate management, and the critical features of a balanced approach to the treatment of ADHD in the correctional setting are discussed in this chapter.