Assessment and Treatment of Correctional Inmates With ADHD

Mr. A is a 32-year-old inmate in a medium-security prison who is being treated by the facility psychiatrist for recently diagnosed attention deficit hyperactivity disorder (ADHD). His school records are not available, but Mr. A's parents report that they always struggled to get him to do his homework and that he had academic difficulties from the third or fourth grade. They recall his teachers reporting that he easily became bored in class, often fidgeted, could not sit still, had problems focusing on schoolwork, and generally did not perform up to his potential. He did not complete high school. While in prison, he enrolled in GED courses, and the instructors confirm that despite his apparent motivation, he still has difficulty concentrating, organizing his work, and finishing projects. He also has a job in the prison kitchen, and his supervisor reports that Mr. A often forgets to complete assigned tasks and makes mistakes with tasks that involve multiple steps. He has received a warning that he could lose his job if his performance does not improve. Officers on his cellblock report that he seems restless during times of high activity or noise on the unit. Mr. A never had a clinical assessment for his problems prior to his incarceration. Not long after his arrival, the prison psychologist administered an ADHD symptom questionnaire and tested for problems with attention. Interview and test results were consistent with a diagnosis of ADHD. The prison psychiatrist prescribed a 2-month course of 400 mg/day of bupropion, which brought no noticeable improvement. Mr. A has also enrolled in an ADHD educational group at the prison that includes a focus on organizational skills and impulse control. Mr. B is a 29-year-old inmate in a maximum-security prison who presents with the complaint "I need something to help me concentrate and keep me out of trouble." He reports that he was always a "lousy student" and is a high school dropout. He also states that he was diagnosed with ADHD as a child and took methylphenidate prior to incarceration. He complains that it now takes him a long time to read a book or to complete a letter, and he has received several disciplinary reports for fighting, for disobeying correctional officers, and for positive urine drug screens for benzodiazepines and opiates. He endorses multiple ADHD symptoms on a self-report checklist. Since his incarceration, he has not tried to enroll in educational, work, or other prison programming because he believes that he would not be able to focus on any of these tasks. Mr. B will not consent to contact with his family or sign a release for past treatment records and states that "none of that matters" to what he needs now. He refuses additional psychological testing, and he believes that group treatment is "just a lot of talk and a waste of time." He knows that other inmates receive stimulant medications for their ADHD, and he has no interest in trying any medication other than a stimulant.