ADHD medication and Criminality.

In November 2012 an article was published in the New England Journal of Medicine investigating how ADHD medication could be reducing criminal activity in Adult ADHD population. The international research team used Swedish national registers in order to obtain a sample of over 25000 patients diagnosed with ADHD as well as data on the pharmacological treatment and criminal activity of these patients. From the premise that ADHD medication is efficacious in controlling ADHD symptoms, the study looks at how this could be affecting criminal behaviour and finds that the crime rate was reduced by 32% for men during treatment periods and by 41% for women under treatment. The overall crime rate of that sample was 28% in comparison to the national Swedish crime rate of 15% (2009) This is a very thorough study, taking in consideration co-morbidities, different pharmaceutical treatments (finding that stimulant and non-stimulant medication had similar impact in reducing crime rate), selection effects (socio-economical background which may affect the rates of convictions), and discontinuation of treatments. Nevertheless making associations between crime and pharmaceutical treatments has to be seen in the context of previous biological or physiological theories of crime, such as Lombrosos, that have presented deterministic and reductionist arguments. This study does not do this, yet in this kind of statistic research the high variability of individual behaviour cannot be captured within the large sample. It is not possible to capture the heterogeneity of the way ADHD is experienced and the behaviours associated with it through statistic; nor can all the other variables that could be associated with crime rates be eliminated in this way. The potential for analysing such data should not be ignored, however it may be more productive for the ADHD community if other associations could be tested such as the one between treatments ( including psychological treatments) and employment; the data in the study also indicated that 25% of the sample was employed in comparison to the national figure of 74% in Sweden ( 2011). Hopefully this may be the focus of a forthcoming study. Examining the details in the study also raises another query. The study takes in consideration the high rate of treatment discontinuation with Adult ADHD, looking at the effect of starting and stopping medication on the rate of criminal activity. But the definition of a treatment period is based on the record of prescriptions made by doctors to their patient, in other words the study equates being prescribed treatment with taking medication. My own experience tells me that these are very different things as I have myself been prescribed medication by my GP which I decided for whatever reason not to collect from the pharmacy. There may also be different reasons why I might start but not continue the treatment. Discontinuation in the context of the study means that the prescribing of treatment has stopped, not necessarily that the person is not medicated. From my contact with adults with ADHD I suspect that this is an issue that is crucial to consider and shed some more cautious light on the conclusions of this study.

Comments on all of the above, but particularly on the difference between the treatment prescribed and the actual taking of medication , are most welcome, on this forum or directly to my email : an802cj@gold.ac.uk Claude Jousselin Goldsmiths College , University of London Reference: Lichtenstein et al (2012): Medication for Attention DeficitHyperactivity Disorder and Criminality. New England Journal of Medicine ;367:2006-14.