King's College London, Institute of Psychiatry, London, UK.
World J Biol Psychiatry. 2011 Sep;12 Suppl 1:124-8. doi: 10.3109/15622975.2011.600319.
To present the needs and psychological treatment options for offenders with ADHD.
Key papers are discussed in relation to this topic.
Research suggests there is a disproportionately high number of individuals with ADHD involved with the Criminal Justice System. UK studies among offenders have indicated around 45% of youths and 24% of male adults screen positive for a childhood history of ADHD, 14% of whom have persisting symptoms in adulthood. Those with persisting symptoms have a significantly younger onset of offending and higher rate of recidivism. ADHD was the most powerful predictor of violent offending, even above substance misuse. They accounted for 8-fold more institutional aggressive behavioural disturbances (critical incidents) than other non-ADHD prisoners. Critical incidents have also been associated with personality disordered patients screening positive for ADHD and detained under the Mental Health Act. It is the impulsive symptoms and mood instability associated with ADHD that most likely increase the risk of critical incidents within institutional settings.
There are international guidelines available for the treatment of ADHD; however, serious offenders with ADHD will require more complex and comprehensive interventions than their non-offending peers. In particular psychological interventions need to be provided that contain a prosocial competence component. One such programme, the R&R2 for ADHD Youths and Adults, has demonstrated improvement in ADHD symptoms, anxiety, depression, antisocial behaviour and social functioning at three month follow-up with medium to large effect sizes.
介绍 ADHD 患者的需求和心理治疗选择。
本文主要讨论了与该主题相关的关键论文。
研究表明，涉及刑事司法系统的 ADHD 患者数量不成比例地高。英国对罪犯的研究表明，约 45%的青少年和 24%的成年男性筛查出有儿童时期 ADHD 病史，其中 14%的人在成年后仍有持续症状。那些持续有症状的人犯罪的起始年龄明显更早，累犯率更高。即使在药物滥用之上，ADHD 也是暴力犯罪的最强预测因素。他们比其他非 ADHD 囚犯发生机构性攻击性行为障碍（关键事件）的几率高 8 倍。关键事件也与筛查出 ADHD 并根据《精神卫生法》被拘留的人格障碍患者有关。正是与 ADHD 相关的冲动症状和情绪不稳定，最有可能增加机构环境中发生关键事件的风险。
国际上有治疗 ADHD 的指南；然而，有严重犯罪行为的 ADHD 患者将需要比没有犯罪行为的同龄人更复杂和全面的干预措施。特别是需要提供包含亲社会能力成分的心理干预措施。一项名为 R&R2 的 ADHD 青少年和成人计划，在三个月的随访中，在 ADHD 症状、焦虑、抑郁、反社会行为和社会功能方面均有改善，且具有中等至较大的效果量。
