Attention deficit/hyperactivity disorder in female offenders: prevalence, psychiatric comorbidity and psychosocial implications

Abstract

Attention deficit-/hyperactivity disorder (ADHD) is associated with social maladaptation and delinquency in later life. This study was conducted to determine the prevalence of ADHD and comorbid conditions in female prison inmates. One hundred and ten adult female prison inmates of a German prison for women were investigated. SCID-I and -II interviews and standardized German instruments for the assessment of ADHD in adults (HASE) were used. The lifetime prevalence of ADHD was 24.5 and 10% for persisting ADHD according to DSM-IV criteria. A decline of the prevalence of persisting ADHD with age from 17.9% (age <25 years) to 10% (age 26-45 years) and 0% (age >45 years) was observed. Female prisoners with ADHD were younger at their first conviction as compared with females without ADHD and they showed longer incarceration periods in relation to age. The prevalence of other axis I disorders was high in both the ADHD and the non-ADHD female population, but significantly higher in ADHD females. Mean number of axis I diagnoses was 3.6 in females with ADHD and 2.3 in females without ADHD. No differences were found between females with and without ADHD regarding the prevalence of psychotic, affective, anxiety, somatization and posttraumatic disorders. Substance use disorders and in particular the use of stimulants were more frequent in females with ADHD as well as borderline personality disorder and eating disorders. The results suggest a high prevalence of ADHD in female prisoners that exceeds the prevalence estimates from epidemiological studies in general female populations. Moreover, it appears that ADHD is particularly frequent in adolescent and young adult female offenders and increases the risk for further psychiatric morbidity. The results indicate the need of adequate psychiatric support of female prison inmates including therapeutic programs for ADHD.