"If He
Outgrew It, What Is He Doing in My Prison?" by T. Dwaine McCallon, M.D.
Since the seventies, there have been many papers following the life
stories of adolescent boys with ADHD into adulthood. A concerning link
with future criminal behavior was found in a higher percentage of such
youngsters than in control, non-ADHD youngsters. Impulsive acts, poor attending
and distractibility, especially from consideration of consequences of your
actions, put ADHD youth and adults at risk for criminal activity.
The peculiarities of how mind activity develops and
works under the inclinations of different inherited personality and learning
features can be dramatically seen in brain scans. Even the lay public is
exposed to this thrilling new knowledge through Discovery documentaries
or on The Learning Channel.
In spite of this, professionals in my field of medicine
or in education or even in juvenile justice, remain uninformed about
new understandings of the “criminal connection” with ADHD, Tourette disorder
and other learning disabilities. Several of us in correctional medicine
have noted this for some time now.
Over four years ago, an impressive study was done in the
state of Utah where Dr. Paul H. Wender has pioneered the understanding
that ADHD and its relatives are life long conditions which in many cases
are not simply “outgrown”. Many of the subjects carried the diagnosis of
bipolar manic depressive disorder.As is the case in our own treatment study,
most were very depressed at being in prison, not quite understanding how
their life had gone down the tubes, and had occasional ADHD type moments
of exuberance and acting out. The clinicians who had seen these men
over the years could not tell the difference between this most common of
learning disabilities (ADHD) and the less common bipolar patients
they were following.
The Utah survey found approximately 24 % of male
inmates to have ADD/ADHD with classical clinical findings. Other studies
and our own experience have led us to believe that upwards of 40% of our
residents in a medium security prison have the findings along the Tourette/ADD
spectrum. If you separate out the nonviolent, impulsive criminals (whom
I term my basic, charming and even lovable car thieves and traffic offenders),
the percentage is much greater.
Nearly nine years ago, a clinical social worker, a clinical
PhD psychologist and I began a small unfundedstudy/treatment project for
these men, who form a very significant sub-population of our prison inmates.Our
program was politically hazardous for we understood that medication was
essential in this group of adult patients with ADHD. If your ADHD is so
disabling that you have found yourself living in a remote walled prison
of over 1,000 men, then it is unlikely that you will progress toward rehabilitation
without the aid of medication. Stimulant medicine can can greatly enhance
the ability to learn how to learn,to develop caution and judgment, and
to learn a job skill. So we did not hesitate to employ Ritalin, Cylert
and an array of newly found SSRI medications to amplify the focus and processing
memory (key to judgments) at the beginning of “talk therapy” and training.
Naturally, careful controls on these medications had to
be developed as well as a contractual agreementfor conduct with each of
our patients. Our program lasts from 6 months to over 2 years, depending
onprogress. Patients are given 30 days supply of their medications upon
parole and placed in contact with local support groups, counselors and
physicians who are comfortable with and understand the condition.They are
never “cut loose” with new suit, $100.00 and a bus ticket!
Our results have stunned us, even though we have a great
deal of experience treating ADHD. In brief, after graduation from this
program,our subjects who completed the requirements have had a two year
recidivism rate under 10% for either parole violation (three only) or a
new criminal charge (one only) in a group of 41 paroled over two years.
This is in contrast to the usual 53-58% recidivism rate nationwide.
Several observations are disturbing to me. The great majority
of the men we have diagnosed with Tourette or ADHD were treated in childhood
but the treatment was not continued beyond 1-2 school years! Over half
of these recall being told they
would not need treatment beyond the teens as they would
outgrow their ADD. None whom we have worked with were treated into their
twenties.18% had discovered that crystal meth on the street would give
them focus and a sense of calmness. 20% found solace from the feeling of
“being a meathead”, “still being the retard kid” by seeking oblivion with
marijuana and heroin.
Four, still in prison, found focus in risk taking
and self-medication with their own adrenaline: armed robbery, torching
a hospital, and two multiple homicides during rage responses. All four
have become focused, advanced to college studies, developed trades and
counsel high school students. Two are artists,and two are musicians now.
They find some satisfaction in training other inmates how to avoid these
act Its all they have left as they are doing life sentences.
Repeatedly, I have heard saddened parents mourn the fact
that they and their son were told this was a character problem and more
severe discipline would change it. Many were told, even some are still
being told, not to worry - growth and time would make this problem
disappear. The guilt they feel, even though they followed the advice
of the “experts” in my field and in education, is indescribable when they
visit their children in prison.
Our nation now has 1.71 million persons behind bars, from
local and state to federal youth facilities to federal maximum security
prisons. The previous highest rate of incarceration for an industrialized
nation was South Africa during apartheid (3.2 per1,000 population). We
are over double this rate presently.
My message is this: we have perhaps 600,000 inmates
who have reason to hope if this condition(ADHD) is treated. Rarely does
a prisoner really not want to change his behavior and life path. We must
recognize this most treatable of the genetic conditions of learning/behavior
and continue to treat and intervene before someone like me has to treat
your child “inside the walls” and behind razor wire. Never stop advocating
for your child with ADHD. Dealing with the scorn of others who do not understand
is a pittance compared to the experience of visiting him or her in
prison.
Confront your doctor with this as I did recently: "If
he outgrew it, what is he doing in my prison?”
T. Dwaine McCallon, M.D. Medical Director,
Buena Vista Correctional Facility, Asst. Chief Medical
Officer,Colorado Dept. of Corrections
Each
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