ADHD and Juvenile Delinquency

According to the Centers for Disease Control and Prevention, 9 percent, or more than five million school-aged children, live with ADHD. In any given year, only 56 percent of these youth receive treatment for the condition.

Treatment for ADHD is effective in managing the common symptoms of ADHD—including difficulty staying still, intruding upon others, acting without thinking or on impulse and trouble focusing or paying attention to small details—symptoms, which left untreated, can create serious behavioral challenges.

Positive behavioral interventions, parent training, school-based services and supports and medications are effective in addressing the symptoms of ADHD. Yet, many children and adolescents are not provided with these effective interventions.

Unrecognized and untreated ADHD can have serious consequences. Children and adolescents with untreated ADHD—often in combination with oppositional defiant disorder or conduct disorder—are at higher risk for incarceration, school failure, substance abuse and social problems.

The Consequences of Untreated or Ineffectively Treated ADHD

Juvenile Justice Involvement

• Boys living with ADHD are at increased risk for engaging in delinquent and antisocial behavior (Stern, 2001).
• Significantly more males diagnosed with ADHD in childhood have been arrested, convicted and incarcerated than their peers with no diagnosis (Salvatore, Klein and Moulton, 2008).
• Youth living with ADHD are significantly more likely to be placed in juvenile detention facilities (Winters, 1997).
• Approximately 47 percent of youth in juvenile detention have a diagnosis of ADHD. Youth detained in juvenile facilities are more likely to engage in substance abuse and to live with ADHD or disruptive behavior disorders than any other combination (Teplin, Abram, McClelland, Dulcan and Mericle, 2002).

School

• Students living with ADHD are less likely to finish high school on time when compared with students with other mental health conditions (UC Davis Health System, 2010).
• Thirty two percent of students living with ADHD drop out of high school compared to 15 percent of teens with no mental health diagnosis (UC Davis Health System, 2010).
• As much as 30-50 percent of children living with untreated ADHD are retained in a grade at least once (Barkley, R.A.). Up to 58 percent of adolescents living with ADHD have failed at least one grade in school (Barkley, 2000).
• Three times as many adolescents living with ADHD as those living without ADHD have failed a grade, been suspended or been expelled from school. (Barkley, 2000).
• Up to 50 percent of children living with ADHD are suspended, 15 percent have math or reading disabilities and 80-90 percent are significantly behind in school by fourth, fifth or sixth grade (Centers for Disease Control and Prevention, 1999).

Risk of Injuries

• Children and adolescents living with ADHD have more frequent and severe injuries and hospital inpatient, hospital outpatient or emergency department admissions than their peers living without ADHD (Leibson, Katusic, Barbaresi, Ransom and O’Brien, 2001).

Driving Incidents

• Youth living with ADHD, in their first two to five years of driving, have nearly four times as many automobile accidents, are more likely to cause bodily injury in accidents and have three times as many citations for speeding as young drivers living without ADHD (Barkley, 2000).
• Young adults with high levels of attention difficulties are at greater risk of involvement in a motor vehicle crash, drinking and driving and traffic violations (Woodward, Fergusson and Horwood, 2000).

Peer Relationships

• Parents of children living with ADHD report almost three times as many peer problems as those without a history of ADHD (Strine et al., 2006).
• Parents report that their children living with ADHD are far more likely to have difficulties that interfere with friendships (Strine et al., 2006).

Alcohol Use and Substance Use

• Youth living with ADHD have the onset of substance use disorder (SUD) at younger ages and at higher rates than their same gender peers as seen in the table below (Robb, 2008). ADHD symptoms often precede the development of SUD.
• Young adults living with untreated ADHD have a rate of SUD at 75 percent while treatment with stimulants reduced the rate of SUD to 25 percent, close to the 18 percent seen in young adults living without ADHD (Robb, 2008).

Treatment Works

Effective services and supports for ADHD, including behavioral interventions and medication, help to reduce the symptoms and negative outcomes experienced by children and adolescents living with ADHD.

The National Institute of Mental Health (NIMH) sponsored The Multimodal Treatment of ADHD (MTA) study, which, for the first time, looked at the safety and relative effectiveness of medication and behavioral therapy—alone and in combination for up to 14 months—for ADHD. These treatments were compared to routine community care.

The study found that combined behavioral therapy and medication and medication management alone were both significantly superior to intensive behavioral therapy alone and to routine community care in reducing ADHD symptoms. The study also showed that these benefits last for as long as 14 months. In sum, effective treatment works in reducing symptoms and helping to keep young lives on track.

The Value of Early Identification and Treatment
Early identification and treatment promises to reduce the negative outcomes experienced by children and adolescents living with unrecognized and untreated ADHD. Youth living with ADHD should be identified early and linked with effective services and supports to avoid the all too common consequences experienced by those living with untreated or ineffectively treated ADHD.

Families play a crucial role in the identification and treatment of childhood ADHD. They can help to secure an early evaluation for their child if they suspect that something isn’t right. It is always best to start by asking a pediatrician or primary care provider to do a comprehensive evaluation to determine if a child is struggling with ADHD or whether there may be something else going on.

Schools are also in a key position to identify ADHD and related mental health concerns early and to openly communicate concerns with families. Schools that have an early identification process in place and open communication with families can help to reduce the extreme challenges often experienced by youth living with undiagnosed and untreated ADHD and their families. This can include a failure to develop friendships, poor school performance and involvement in high-risk activities.

The courts and juvenile justice system are also encouraged to adopt programs that promise to increase the identification and treatment of youth living with ADHD who come into contact with these systems. These programs promise to divert youth with mental health needs away from law enforcement, the courts and the juvenile justice system and into mental health services and supports. For more information about these programs, visit the National Center for Mental Health and Juvenile Justice website.

Visit the Resources section for additional information and references.