ADHD Presentation

www.adhdandjustice.co.uk

Presenters Phillip Anderton and Stephen Brown

UK and US comparisons

US and UK comparisons

?

US and UK comparisons

So, a competition

Slide 6

Where is Lancashire?

Day in the life of Lancashire Constabulary

• Over 3,500 police officers, • 368 special constables and nearly • 1,900 non-police staff

– get 4366 calls – deal with 415 crimes – arrest 185 people – go to 15 road accidents – responds to 2,111 incidents – handle 21 motorway breakdowns – breathalyse 28 people – solve 124 crimes – recover £28,610 worth of stolen goods

Phil Anderton / Steve Brown

• Over 50 years combined police service

• Qualified police trainers• Qualified academically• Have been working in

the field of mental heath disorders and crime for the past 9 years

Where we have worked in the US before

• Cleveland – led to new mental health courts

• Atlanta – a more joined up approach and our first CPD

• Gainsville FL, Sheriff, Chief of Police, Probation and correction facilities working together

• Orlando – set us up for this conference

Police officers

Community support

C.I.T

Preventing and reducing

crime

What’s in it for CIT officers?

Your core elements:PartnershipsCommunity ownershipPolicies and procedures

CIT trainingReceiving training – specialised care

Outreach to other communities

Why ADHD is so important to those elements

• Build confrontation out of your working lives

• At the time of confrontation work with knowledge, understanding of the perpetrator and self

• Get instantly better outcomes – for you as well as them

ADHD

• Attention deficit hyperactivity disorder – ADHD

• ADD

• Bad kids

• With bad parents

• Dysfunctional families

ADHD

• Its pervasive

• It is NOT understood

• Normally defined as:

– Inattentive

– Hyperactive

– Impulsive

ADHD

• It is safe to describe ADHD-ers as:

• A pain in the arse

• Frequent visitors to police premises

• Risk takers

Here are some facts though

25%5%

FactsLikelihood of being arrested

20% in control group

48% in ADHD group (inc’ CD)

(Barkley, Secnik, Swenson, Buesching, Fisher and Fletcher)

0

10

20

30

40

50

60

Control ADHD / CD

Arrest chances

Facts

• ADHD and arrest profiles

• Control group 2.1 arrests

• ADHD cohort 6.4 arrests

• (Barkley, Secnik, Swenson, Buesching, Fisher and Fletcher)

0

2

4

6

8

ADHD / CD Control

Arrests

• Twice as likely to be a criminal• Three times as many offences each• Prolific, predictable and therefore

ultimately preventable

• And when ADHD is combined with conduct disorder:“Hyperactive subjects (in a US test) have significantly higher arrest, conviction

and incarceration rates compared to controls”

Satterfield J et al, May 2007 Jm Acad Child Adolesc Psych

Facts

• Lifetime criminality in boys with ADHD

• N = 207• Lifetime arrest records at age 38

• Arrests = 47%-v-24%

• Convictions = 42%-v-14%

• Incarcerations = 15%-v-1%

“Mannuzza, S et al (2008) Psychiatry Res. 160(3)

Arrest comparisons

Gary• “I was a regular burglar, druggy, thief and once I was

described as an utter shit. I did everything, you name it, I did it. No one understood me, including myself. The cops all knew me, I was in and out of prison from the age of 10. I had a social services record that is unbelievable.

• Then someone diagnosed my ADHD, now I understand ‘me’ – and as long as I comply with my treatment regime I am OK – a good guy. A good father, husband and I know how sorry I am now, I really do”

Michelle

• From a ‘good background’• Was not understood by her parents• Took cocaine and heroine• Earned money through prostitution• Married and divorced at the age of 20• Incarcerated for her own well being at the age of 23• Was diagnosed with ADHD at the age of 28• Now runs a successful international photography

business

Problem families

• ‘His Dad was a problem’

• ‘We have been expecting him to be a problem and he is’

• What will his kids be like?

• Add tall people picture

Convincing you• Creds and quotes

• Sherfiiff• AG

• ADDISS

• Papers

• Book

ADHD

• Its a medical disorder:

– ‘harmful dysfunction’– that comprises a serious deficit or failure in a

functional mechanism and– it produces harm to the individual in terms of greater

mortality, morbidity or– impairment in universal major life activities

– Wakefield’s definition

ADHD

ADHD

Slide 27

• Organising and prioritising work

• Focus and sustaining task focus

• Regulating alertness

• Managing frustration

• Utilising working memory

• Monitoring self regulating action

What is ADHD – executive functions

What is ADHD – executive functions

And this is caused by…

• Chemical deficiencies

• Hard wiring differences

• An explainable natural occurance

Manifestations of ADHD

• Drug taking and abuse

• Criminal behaviour

• Driving risks

• Suicide risks

Drug taking and abuse

• Impulsivity has been associated with increased risk for engaging in health-risk behaviour's, including tobacco and alcohol abuse.

• There is strong evidence that impulsivity is an important trait-marker for a common pathway to addictive behaviour's (Chambers & Potenza, 2003).

Slide 31

Slide 32

In adults with ADHD at least 20 – 30% abuse drugs (Willens 2004)

Over use of nicotine leads to self treatment and acceleration to harder drugs (Biederman (1991)

Drug taking and abuse

Nicotine

Alcohol & softer drugs

Hard drugs

Kim-Cohen et al, Arch Gen psychiatry 2003; 60

Drug taking and abuse

Use

Abuse

Dependence

Drug taking and abuse

Adults with ADHD

• Alcohol abuse/dependence 45% against 17% in general population

• Drug abuse/dependence 30% against 9% in general population

Wilens E.A. Harv Rev Psychiatry 1995;3;160-162

Drug taking and abuse

Slide 36

• Patients with ADHD encounter particular difficulties when they enter a setting for substance abuse treatment.

(Sulliven and Rudnik-Levin 2001)

Drug taking and abuse

Criminal behaviour

• Easily led etc

• Impulsive

• Risk taking

• Need ‘friends’

Reports of criminal activity

Arson – 15% v 6%Runaway – 31% v 16%Assault – 22% v 7% Stealing money – 50% v 36% Burglary – 20% v 8%

Criminal behaviour

Suicide• Children diagnosed with attention deficit hyperactivity disorder (ADHD) at

ages 4-6 face a 3 times greater risks for depression and suicide at ages 9 - 18Archives of General Psychiatry - October 2010

"I don't feel sorry for myself and I'm not looking for you to care. The fact is that I'm glad I tried it [killing himself] and glad it didn't work because it showed me one thing. No one else has ever really believed in me--I mean I know my parents say they love me, but I'm not stupid, I know what they talk about and that they are scared to death I'm going to be a failure. I'm too big a pain for teachers and I don't blame them for the way they treat me. I never believed in myself, but when I realized that I had the guts to do it, it was really weird. It showed that I had a side to me that gave a **** about myself and that there is something good in there."

Suicide

• 6 yrs old – excluded from peer groups• Not taken out by parents• 11 to 12 – school becomes a real issue• Develop inappropriate friendships• Led astray and into crime• Smoke and drugs• Low self esteem• Withdraw from schooling• Run away from home• Take up responsibility for self

Driving risks

Young drivers with ADHD are:

• 2 to 4 more likely to have traffic accidents 1-3

• 3 times as likely to have injuries 2

• 4 times as likely to be at fault 1

• 7 times more likely to be in two or more incidents 1

1 - Barkley RA. et al. Pediatrics 1993; 92: 212–2182 - Barkley RA. et al. Pediatrics 1996; 98: 1089–10953 - Cox DJ. et al. J Nerv Ment Dis 2000; 188: 230–234

14 year olds are 9 times more likely to have a pedestrian accident if they have ADHD

Federal Agency for Occupational health, Safety and medicine. Germany 2001

Use of the roads

Inappropriate braking when car is in 35 mph (56 km/h) and 45 mph (72 km/h) acceleration zones (p=0.04)

Num

ber o

f ins

tanc

esDriving risks - medication

Percentage of missed stop lights and stop signs, (p<.02)

Perc

ent m

issed

Driving risks - medication

Driving risks – help leaflet

Ten top tips:

No friends in the carNo radioRules around driving at night…

Solutions for you

• Engage• Understand• CHADD Chapter• Work in partnership• Make custody a ‘last

resort’

Solutions for you

Where custody is the appropriate option

Responsible adultsAppropriate questioning skillsFair trials

No excuses

Appropriate rehabilitation

Out of justice into medicine

Solutions for CIT officers

Solutions for CIT officers

www.adhdandjustice.co.uk

CIT programme – what’s on offer

• Training your trainers

• Free resources

• Ground breaking partnerships

• San Franscisco – November 2012

Why ?

• We became cops to make a difference

• 5% of our populations are currently beyond us

• We can, when we know about them, make a difference for them

• We can stop them being the next generation of the 25% in prison

And a final word

• Hardly any faculty is more important for the intellectual progress of man than ATTENTION.

• Charles Darwin 1871

• Human beings have been described as ‘zoon logon echon’

• It means we are the ‘more rational animal with language’

• Aristotle 350 BC

‘Michael can’t sit still, Michael can’t be quiet, Michael can’t focus,’

"Your son will never be able to focus on anything."