Thousands of People in Prison Have ADHD. Why Aren’t They Receiving Treatment?

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This story has been updated to include additional prevalence estimates for ADHD among incarcerated populations.

As far back as elementary school, Kurt Myers was always a class clown. “I was a performer,” he says, “trying to get a reaction out of people all the time. I would do things on impulse and pull the whole classroom off track. My grades suffered for it. I was a bright kid, I just didn’t have the control or the attention span.”

He was diagnosed with ADHD when he was 8 or 9 and briefly took Ritalin to control it, but he quit taking it because of the side effects. His junior high placed him in a special ADHD classroom. Myers calls that program “probably the worst idea in the history of public education. We just fed off each other. The whole day was outburst after outburst. No work got done and they didn’t expect us to do any. The point was to separate us from the good kids.”

By the time he entered high school, his chronically disruptive behavior had evolved into full-blown delinquency. He was in and out of juvenile hall for car theft and shoplifting and was drinking and using drugs. At 16, he dropped out.

“I went to juvenile that last time and I was really frustrated with the fact that I couldn’t pull it together. I thought smoking weed was the problem.”

Determined to turn his life around, he checked into rehab on his own initiative. But after he completed the program and came home, his lawlessness escalated. “I was driving around in stolen cars and doing burglaries. It seemed like it was happening on its own, like I couldn’t intervene in my own life.”

Days after his 17th birthday, he was drunk and handling a pistol when it went off, killing his friend. He was charged with manslaughter and sentenced to 16 years in prison.

While ADHD alone didn’t send Myers to prison, his unchecked symptoms made it more difficult for him to correct his course, even as he saw his life careening off track. With adequate treatment, most children with ADHD go on to live normal lives. But in some cases, for people without access to treatment, the results can be tragic. Labeled troublemakers and held back or tracked into classrooms with few opportunities for advancement, they give up on school at a much higher rate than other children and are more likely to fall into addiction and poverty. They end up in jail at nearly three times the rate of those without ADHD. 

“Kids act out, and instead of figuring out the underlying issues and helping the kid resolve them, teachers and school administrators relegate him to detention and dead-end programs,” says Anthony Blankenship, a senior community organizer at Washington nonprofit Civil Survival. “They set kids up for disaster. You see it with ADHD kids all the time, particularly in low-income schools.”

Darrell Jackson was never formally diagnosed with ADHD, but his siblings were, and he recognized their symptoms in his own impulsiveness and distractibility. In school, like Kurt Myers, he struggled to finish assignments or pay attention to teachers.

“I couldn’t stay focused, and I ended up getting held back twice,” says Jackson. He dropped out in tenth grade. “After school, I couldn’t hold a job longer than six months. That was one of the reasons I started selling drugs.”

Within four years of quitting school, he was at Clallam Bay Corrections Center, serving a life sentence for murder.

Undiagnosed or inadequately treated, the trademark impulsiveness, defiance of authority, and thrill-seeking mindset of ADHD often accelerate as a child proceeds through adolescence. These traits frequently become the impetus behind criminal acts. Researchers at Yale found that children with ADHD are roughly 50 percent more likely to commit robbery in adulthood and more than 25 percent more likely to sell drugs.

Robert Eme, a clinical psychologist who served on the Attention Deficit Disorder Association Work Group on ADHD and Correctional Health, told The Appeal, “There is no doubt that ADHD increases the risk of criminal behavior, which explains why individuals with ADHD  are overrepresented, not only in American prisons but in prisons in other countries.”

ADHD saturates the American prison system. While only 4.4 percent of the general public has ADHD, as many as half of adult prisoners and two-thirds of children in juvenile facilities have the condition. (More recent estimates are between 8 and 22 percent for adults in prison and roughly 17 percent for incarcerated children.) Yet no state in the country prioritizes ADHD treatment in its prisons.

Though Kurt Myers had been aware of the impact ADHD had on his academic performance, it wasn’t until he was an adult and serving time at the Washington State Penitentiary that he learned of the full extent of impairments caused by ADHD. He began to understand how those impairments contributed to the totality of his problems in school, his criminal behavior, and, ultimately, the death of his friend.

“That was when I realized my problems weren’t about drugs or my surroundings; the issue was the way my brain worked,” Myers said. “I was in this radically different environment, but I was still in the same kind of destructive behavior patterns. Getting high, getting in fights, going to the hole. I eventually started honing in on skills that helped me get a handle on the ADHD stuff and allowed me to be productive. But there was no help from (the corrections department).  I had to figure it out on my own.”

Blankenship, who draws on his experience with incarceration to assist people coming out of prison, sees the failure to identify and treat ADHD not only as a major blindspot in rehabilitative programming inside prisons but also as a moral shortcoming on the part of the state.

 “We’re abandoning the same people throughout their lives, over and over,” he says. “We have to do better in our schools at helping kids with ADHD, but when we’re unsuccessful, we’ve got to do better when those kids grow up and go to prison.” 

Blankenship is urging prison administrators to recognize the way ADHD symptoms “severely undermine incarcerated people’s efforts to educate themselves. They undermine their ability to finish substance use treatment and parenting classes and therapeutic programming.” 

Ignoring ADHD in the prison population can have a grave impact on individual prisoners as well as the communities they return to. People with ADHD are not only far more likely to reoffend after their release from prison; they reoffend more quickly too. A 2021 evidence review found that 50 percent of people with ADHD were rearrested within seven months of their release from prison, compared to more than two years for those without ADHD.

Despite this research—and the intense focus from the public and legislators in recent years on reentry programs as a means of reducing recidivism—policymakers have been slow to take notice of the outsized effect of ADHD on rearrest. Legislatures are pumping hundreds of millions of dollars into reentry programs, but none of those programs emphasizes ADHD treatment.

“It’s impossible to overstate what an obstacle untreated ADHD is to getting your life in order, especially if you’re fresh out of prison and still acclimating to the free world,” says Blankenship. “There’s a pressing need to incorporate ADHD screening into the intake process in prisons to start treating it at the front end. But we also really need to follow that up with ADHD-centered services in reentry programs. Without that, a huge number of people releasing have very little chance of making it.”

Several studies support Blankenship’s suggestion. A 2012 study in Sweden found that treatment with stimulant medication reduced offending by 32 percent among men and 41 percent among women. Similarly, a 2019 study in Denmark found that people who received ADHD treatment were 30 to 40 percent less likely to be arrested or incarcerated. Another Swedish study found that people who received ADHD treatment after their release from prison saw a more than 40 percent reduction in their risk of committing a violent crime. 

The idea of prescribing ADHD medication in prison is more controversial. Only a handful of studies have examined the effectiveness of stimulant treatment in carceral settings, with mixed results. While some small-scale trials have yielded positive results, the largest study to date, a 200-subject study in British prisons, reported no difference in treatment outcomes among those prescribed stimulant medication compared to those receiving a placebo.

However, the challenges of conducting research in a prison environment may explain these disappointing results. For example, the majority of participants in the study took fewer than 75 percent of their prescribed doses. Many told the researchers that guards forgot to give them their medication, while others had their treatment regimen disrupted when they were transferred to other facilities. The authors suspect many other subjects had co-occurring mental health issues that complicated their response to treatment. Successful treatment in prison would likely require additional efforts to address the obstacles posed by the prison environment itself.

The problem, says Dr. Dale Guenter, a professor of family medicine at  McMaster University who co-authored a recent review of research on ADHD treatment in prisons and jails, is that there is an insufficient amount of prison-specific research on ADHD management, and data is scarce.

“That does not mean ADHD treatment is not helpful,” Guenter wrote in an email to The Appeal, “and it does not mean it should not be used, it just means [scientific research] has not been done well enough to guide us.”

In an article in Frontiers in Psychiatry, forensic psychiatrist John Tully of the University of Nottingham warns that we shouldn’t expect ADHD medication to be a panacea. Tully cautions against assuming that ADHD is the leading cause of problematic behaviors. Other mental disorders, such as borderline personality or antisocial behavior disorder, are also common among the incarcerated and may play a more significant role in driving violence and other criminal activities. 

He is also concerned about the side effects of ADHD drugs, which include aggression, anxiety, depression, and sleep disorders, as well as irregular heartbeat, hypertension, and GI problems. But without additional research, Tully agrees that it’s difficult to know whether the risks outweigh the potential benefits.

 The reluctance among prison officials to allow stimulant medication prescriptions is a major barrier to closing this evidence gap. None of the experts interviewed by The Appeal knew of any U.S. prison that encourages the use of medication to treat ADHD. Some prison systems actively discourage staff from prescribing stimulant medication. The Washington Department of Corrections’ official health plan, for example, specifically identifies  ADHD drugs  as “medication with a high abuse potential used to treat a non-life-threatening disease” and urges practitioners not to prescribe it “based on the likelihood that any diverted or incorrectly consumed medication has the potential to cause behavior disruptions” and threaten “staff and patient safety as well as the security of the facility.”

That logic seems sound on paper, says Blankenship, but “in reality, prisons are flooded with actual drugs. Why would someone snort Ritalin when he could do meth?”

While it blocks access to ADHD medication on one hand, the Washington DOC—like departments of corrections in Massachusetts, Maine, and several other states—does provide Suboxone to prisoners with opioid use disorder, proving it is possible to safely distribute medication with abuse potential.

Despite his difficulties, Kurt Meyers used his time inside to earn multiple vocational certifications and a college degree. Following his release in 2016, he finally obtained a prescription to treat his ADHD. He describes the clarity and focus that come with his medication as “miraculous.” 

“If you have bad vision,” says Myers, “you know what it’s like to put your glasses back on after you clean them. That’s what Adderall did for my brain. I have no clue how I was functioning without it.”

Myers completed a bachelor’s degree in business administration at the University of Washington in 2018 and is now a grant specialist at the Washington Department of Commerce.

“I’ve had success, but… DOC made things harder than they had to be. The whole time I was in, there were no resources. When I got out, there were no resources. I think about the guys who can’t make it on their own the way I did.”

Even though he continues to battle with his wandering concentration in prison, Darrell Jackson is pursuing an education, writing about mass incarceration and systemic racism, and organizing for the Black Prisoners Caucus.

“I still catch my mind drifting off, but I don’t allow myself to go so far off the deep end,” Jackson says. “I can complete tasks. It would definitely help if DOC made programs or medication available. For now, you’ve got to develop your own method.” 

A huge component of the problem, in Jackson’s estimation, is that “a lot of times you have people who go through life undiagnosed, and they don’t understand the behaviors that cause them problems are from ADHD. What are they supposed to do? How do you fix a problem you don’t even know you have?”

Blankenship insists that rehabilitation should be the Department of Corrections’ top priority and says that it must include treating mental health issues and other impediments to self-improvement. “If we want to afford incarcerated folks every opportunity to become better versions of themselves, it doesn’t make sense to ignore ADHD. But that’s what’s happening.”