Legal Repercussions of Untreated ADHD in Adults
Impulsivity and risk-taking behavior can lead to life-altering consequences for people with untreated or poorly managed ADHD.
The teen driver, who had stopped taking her ADHD medication, was heading to a friend’s house after school. She wasn’t paying attention when the vehicle ahead of her slowed down to turn a corner. She crashed into the car, causing it to veer into traffic. The elderly driver and passenger were severely injured. Arrested for reckless driving, the teen now faces charges that could escalate to vehicular manslaughter if the victims do not survive.
At a crowded pub, a man with ADHD and a history of emotional volatility attacked a patron who he believed was flirting with this girlfriend. The beating left the victim with serious injuries. The attacker is now serving a five-year prison sentence for aggravated assault.
These cases stem from my work as a clinical psychopharmacologist in the criminal justice system and they reveal a harsh reality: Untreated ADHD can lead to life-altering legal consequences. This reality is reflected in the makeup of the U.S. prison population: An estimated 25% to 40% of incarcerated individuals are believed to have ADHD.1 While most people with ADHD never face legal trouble, it’s critical to know that impulsivity, impaired decision-making, and poor self-control contribute to risk-taking or criminal behaviors for some.
Consequences of Untreated ADHD in Adults
Susan Young, Ph.D., a clinical psychologist who has worked with offenders in prison and mental health settings in London, says that untreated ADHD “can derail lives.”
“Impulsivity, poor emotional regulation, and low tolerance for frustration mean many young people with ADHD are constantly in trouble, often misunderstood, and quick to react without thinking,” she says. “It’s not hard to see how that can spiral into police contact, especially when no one’s ever helped them make sense of their behavior.”
[Read: What ADDitude Readers Wish Police Knew About ADHD]
Studies show that comorbid disruptive behavior disorders contribute to arrests, convictions, and incarcerations among teens with ADHD. There is considerable overlap between ADHD and oppositional defiant disorder (ODD), and anxiety, depression, and/or mood disorders are also common.2, 3 Adolescents with ODD and the more serious behavioral condition called conduct disorder (CD) show higher levels of aggression, anger, defiance of authority, drug use, and arrests, than do adolescents without the disorder. Males are diagnosed with these disorders at higher rates than females.
For many girls with untreated or poorly managed ADHD, the path into the criminal justice system often starts with social rejection. They feel like outsiders with a desperate need to belong, Young says. This social isolation can make then easy targets for people with bad intentions.
“They get pulled into the wrong crowds, praised for risky behavior, and ultimately groomed to steal, offer sex, run drugs,” Young says. “It’s not rebellion. To them, it’s survival. And it’s preventable.”
Former inmates with ADHD have higher-than-average recidivism rates.4 Why? As a group, people with ADHD experience more conduct disorders and exhibit more antisocial behaviors than their neurotypical peers. Disorganization and forgetfulness may lead to missed parole meetings and other requirements outlined in conditions of release. Impulsivity and poor decision-making may lead to criminal behaviors.
[Read: The Dangers of Undiagnosed Adult ADHD]
Early Intervention Can Prevent Poor Outcomes
A proper ADHD diagnosis and effective treatment are critical for improving outcomes. Early interventions aim to stop the escalation of problems associated with emotional dysregulation and disruptive behavior disorders. Caregivers should pay particular attention to periods of transition, when adherence to treatment may fall off. These include the transitions to adolescence, from high school to work or higher education, and into first jobs and serious relationships.
People who adhere to their ADHD treatment are better able to avoid criminality. In a study using population-based registers, researchers gathered information on about 26,000 adults with ADHD who had criminal convictions in Sweden from 2006 to 2009. The researchers found that when the men had taken their ADHD medication, their crime rate decreased by 32%. The drop in crime was even bigger for women: 41%, according to the study, which was published in the New England Journal of Medicine.5
“ADHD isn’t a character flaw. It’s a condition that needs understanding, structure, and empathy,” says Young. “What makes the difference? Being seen, being heard, and being supported. With the right diagnosis, the right support, and a few people who believe in them, individuals with ADHD can thrive. But without that? All too often they’re set up to fail.”
Can ADHD Be Used as a Defense in Court?
If you have a loved one in jail awaiting criminal trial, and you suspect they have ADHD, request a formal evaluation by a clinician. A new diagnosis of a condition such as ADHD, which may have contributed to their criminal actions, could impact their case.
If you’ve been prescribed ADHD medication and find yourself in legal trouble, here’s something you should know: If you are not taking your ADHD medication (which blood levels can indicate), and there is a medical record of a positive response when you are adherent, you could be held negligent on criminal charges – and you might encounter more severe charges and sentences. Minor offenses, citations, and convictions on your record can also worsen the outcome of those cases.
If you or a loved one are transitioning from incarceration into the community, do the following:
- Work with prison staff to understand the release process. Will they schedule follow-up parole appointments, or will it be your responsibility?
- If a social worker is available at the prison, discuss how to access housing, a job or training, and resources for other basic needs.
- Ask loved ones to investigate and inquire with community resources, such as re-entry programs.
Untreated ADHD in Adults: Next Steps
- Study: “Untreated ADHD in Adults Leads to ‘Dire Consequences’”
- Read: Policing the Neurodivergent — Safely
- Read: Prepare Your ADHD Driver for Traffic Stops
Clinton W. Wright, Pharm.D., is WebMD’s Medscape Education Director. He is a former psychopharmacologist with the Texas Department of Criminal Justice and Texas Youth Commission through a partnership with the University of Houston College of Pharmacy.
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View Article Sources
1 Ginsberg, Y., Hirvikoski, T., & Lindefors, N. (2010). Attention Deficit Hyperactivity Disorder (ADHD) among longer-term prison inmates is a prevalent, persistent and disabling disorder. BMC psychiatry, 10, 112. https://doi.org/10.1186/1471-244X-10-112
2 Reale, L., Bartoli, B., Cartabia, M., Zanetti, M., Costantino, M. A., Canevini, M. P., Termine, C., Bonati, M., & Lombardy ADHD Group (2017). Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. European child & adolescent psychiatry, 26(12), 1443–1457. https://doi.org/10.1007/s00787-017-1005-z
3 Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC psychiatry, 17(1), 302. https://doi.org/10.1186/s12888-017-1463-3
4 Mohr-Jensen, C., & Steinhausen, H. C. (2016). A meta-analysis and systematic review of the risks associated with childhood attention-deficit hyperactivity disorder on long-term outcome of arrests, convictions, and incarcerations. Clinical psychology review, 48, 32–42. https://doi.org/10.1016/j.cpr.2016.05.002
5 Lichtenstein, P., Halldner, L., Zetterqvist, J., Sjölander, A., Serlachius, E., Fazel, S., Långström, N., & Larsson, H. (2012). Medication for attention deficit-hyperactivity disorder and criminality. The New England journal of medicine, 367(21), 2006–2014. https://doi.org/10.1056/NEJMoa1203241
