Development of a clinical guideline for diagnosis and treatment of ADHD in juvenile corrections

Background: Attention-deficit hyperactivity disorder (ADHD) is most common neurodevelopmental disorder among children and adolescents in the United States today. In young male prisoners, the overall prevalence is as high as 45% compared to 2-18 % in community samples. Juveniles in the correctional setting have a unique opportunity to benefit from effective treatment of ADHD in a controlled, closely monitored environment.

Objectives: The goal of this initiative, part of a medical school community health clerkship, was to develop ADHD treatment guidelines. The parameters were adapted from standards proposed by the following medical organizations and adjusted for their applicability to the correctional setting: American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians.

Discussion: Barriers to correctional guidelines are multiple, including possible short time in custody, abrupt discontinuation of treatment, inadequate follow-up, shortage of adolescent behavioral health expertise, reluctance to provide offenders with drugs having street value, and lack of commitment to treatment by juvenile offenders. Establishing guidelines for the diagnosis and management of inattention, hyperactivity, and impulsivity in ADHD in correctional settings will aid standardization of diagnostic and management criteria. Implementation of these practice parameters may improve short and long-term outcomes and reduce recidivism.