This was my English honors project in the spring semester of 2024. It was written under intense pressure and with a limited amount of time to dedicate to a subject like this. With those caveats, I’m proud of it. Also, you have supported me through a tough semester. Besides grades, this is what I have to show for it.
The tl/dr of my grades is that they’re all As. The real achievement of my semester is that I made the best grade in my least favorite subject, a straight 100 in Java programming. Until six years ago, I lived with undiagnosed ADHD. If you know anything about ADHD, it’s probably that it’s almost impossible for us to focus on something that doesn’t interest us. In my opinion, writing code is about as much fun as filing taxes, and I made a perfect grade in a college course.
Having a cognitive disability is what got me interested in writing about them and their effect on people’s lives. Doing actual research has been eye-opening and fascinating. I hope this inspires you to ask your own questions and seek the answers. Your fan,
Jonathan Byrd
Delayed Justice: Cognitive Disabilities in U.S. Correction
Jonathan Byrd
Durham Technical Community College
ENG 112 – Writing and Research in the Disciplines
Professor Marina DelVecchio, PhD
April 30, 2024
Abstract
Extensive statistical and academic evidence exists connecting cognitive disabilities, incarceration rates, and recidivism in the U.S. correctional population. For women and minorities, the connection is further pronounced and more unjust. The research examined herein comes from scholarly journal articles, a doctoral dissertation, and U.S. government statistical reports, all published within the past ten years. Specifically, this paper investigates the connection between ADHD, autism, gender bias, the disproportionate minority prison population, and rates of recidivism.
Keywords: ADHD, autism, developmental disability, intellectual disability, prison, correction, discrimination, mental health, incarceration, minorities, justice
Delayed Justice: Cognitive Disabilities in U.S. Correction
The United States has the largest prison population in the world and the highest rate of incarceration globally (Walmsley, 2018). Adding to the injustice revealed by this statistical imbalance is the increased rate of incarceration for individuals with cognitive disabilities. According to the U.S. Department of Justice’s own report, “Among all prisoners, 24% reported that a doctor, psychologist, or teacher had told them at some point in their life that they had an attention deficit disorder” (Maruschak et al., 2016). In contrast, ADHD is only present in a few percent of the world population (Chaplin et al., 2022). Moreover, African American populations have a higher prevalence of ADHD and a lower likelihood of diagnosis and management (Behnken, 2014). Among women in U.S. prisons, 36.8% reported a cognitive disability (Maruschak et al., 2016). These data points, taken together, illustrate how the U.S. justice system disproportionately affects people with cognitive disabilities and more so among marginalized populations.
Inherent Bias in Diagnosis and Treatment
As with much medical research, most of the studies on ADHD have been done on white males. With significant differences in the expression of symptoms across gender and culture, ADHD is diagnosed, medicated, and accommodated less in females and racial minorities (Behnken, 2014). Amanda George (2021) noted, “Females with ADHD present with symptoms of internalization and inattention, resulting in less disruptive behaviors resulting in lower rates of referrals, diagnosis, and ultimately treatment,” and further studies showed females suffered more symptoms because of childhood abuse. Women in state and federal prisons consistently self-reported more cognitive disability than men, according to statistics that were corroborated in an international study (Chaplin et al., 2022).
African American youth are also disproportionately affected by the fallout of cognitive disabilities and are less likely to be diagnosed, even though studies have shown there is a higher prevalence in those communities. Monic P. Behnken (2014) revealed, “Even after diagnosis, African American families are distrustful of the diagnosis and reluctant to engage in treatment for the condition.” Black prisoners also reported cognitive disabilities much less than white prisoners, perhaps owing to that same distrust of a system that was inherently biased against them and their families in their childhoods. To drive the point home, Baumann et al. (2023) reported, “Black skin… remains disproportionately predictive of increased rate and length of incarceration.” Indeed, according to U.S. census figures, approximately 14% of the population identifies as black, whereas The Federal Bureau of Prison reports that 38.7% of the U.S. prison population is black.
ADHD, School Discipline, and Future Criminality
A teacher’s knowledge of a student’s ADHD diagnosis has been shown to increase disciplinary actions, including suspensions and expulsions, leading to reduced access to education, increased financial burden, and opportunities for risky, unsupervised behavior (Behnken, 2014). Combined with “zero-tolerance” policies — rules that force teachers and administrators to punish students for every infraction — this can lead to an effect now widely known as the school-to-prison pipeline. Behnken (2014) summarized, “After the proliferation of Zero Tolerance policies… the schoolhouse doors began to double as the entrance into the criminal justice system for African Americans.” Taking everything into account, removing discretion from teachers and administrators seems to ultimately harm children with cognitive disabilities.
Even in a journal article primarily focused on African American statistics, Behnken (2014) was compelled to mention the gender gap: “given that… female offenders have higher ADHD prevalence rates than the general population of female non-offenders… clinicians should become more attuned to the experience of ADHD in girls.” The Bureau of Justice statistics agreed with this assessment, showing that female prisoners in state and federal prisons reported more cognitive disabilities than their male counterparts (Maruschak et al., 2016).
The Ineffectiveness of Incarceration for Individuals with ADHD
Judging by the high recidivism rate, incarceration is not effective as a correction strategy for ADHD individuals. Amanda George (2021) reported that violent crimes motivated by impulsivity and repeat offending were all more highly reported among individuals with ADHD as opposed to those without.
Treatment is more difficult in prison for multiple reasons, keeping incarcerated individuals with cognitive disabilities from developing the skills they need to reform. Prison staff and the prisoners themselves are distrustful of the diagnosis. There are obvious potential abuse problems with distributing stimulant medications in a criminal population, and prisoners with cognitive disabilities have difficulty keeping their appointments due partly to their own lack of executive skills but also to the challenges of coordinating a prisoner transfer between facilities and departments, especially among a staff who may be distrustful of medical solutions to what they perceive as ethical problems (Chaplin et al., 2022).
Prison Administrators and Staff: Training is Crucial
This relationship between incarcerated individuals and staff deserves more study as well. Chaplin et al. (2022) asserted that staffing prisons with experienced mental health professionals and training other staff to recognize symptoms of cognitive disability are crucial for progress, noting that prison staff suspects prisoners of seeking a diagnosis merely to receive stimulant medications to use recreationally and, further, that this lack of awareness of ADHD symptoms among employees was the most serious barrier to referral and treatment. Amanda George (2021) made a similar assessment that “…effective training… would be beneficial to improve the treatment outcome of those served…” and that corrections staff often interpret treatable conditions as bad behavior.
Solutions
There are pathways to resolve this injustice. George (2021) posited that “Pharmaceutical therapies for individuals with ADHD within forensic populations could reduce rates of criminal behavior…a focus should be placed on early intervention programs for juvenile offenders who present with ADHD symptomology to reduce the likelihood of further criminal trajectories.” A UK prison program “attempted to overcome the non-attendance rates by delivering appointment letters directly to the prisoner,” resulting in a significant reduction of no-shows, and their final recommendation was that all prisoners be scanned for ADHD as a matter of routine, considering the extraordinarily high rates of the cognitive disability in the prison population (Chaplin et al., 2022).
Cultural sensitivity is also called for long before children arrive as adults at corrections facilities. As Behnken (2014) recommended, “care should be taken in the clinical settings to consider this diagnosis for African American children having academic and behavioral difficulties and utilize culturally sensitive approaches to the treatment and management of ADHD.” More research is needed on cognitive disabilities in women and minorities to treat these conditions in a diverse population effectively.
There is recent good news and a sense of direction toward a more just future. Overall, the U.S. prison population and the incarcerated percentage of the populace have fallen since peaking in 2012 (Carson & Kluckow, 2023), which Bauman et al. (2023) attribute primarily to community diversion rehabilitation programs and risk-factor accounting. “However,” Bauman et al. (2023) warned, “cognitive functioning deficits, a well-established risk factor for criminal behavior, have largely been overlooked.” Hopefully, prison population trends will continue, and recognizing disabilities will contribute to more equitable sentencing.
Conclusions
Having the largest prison population in the world puts the United States in a unique position to make a difference in the lives of citizens with cognitive disabilities. With such statistically significant numbers of incarcerated individuals with ADHD, it is possible that an effective campaign of treatment could reduce the prison population by upwards of 20%, improving the lives of millions, reducing taxpayer burden, and removing a gross injustice in a country that highly values liberty.
References
Bauman, A., Martinez, K. A., Moroney, K. J., Piros, H., Clark, C. B., & Cropsey, K. L. (2023). Examining the association between cognitive testing results and length of time incarcerated. North American Journal of Psychology, 25(2), 209–226. Retrieved from proquest.com/scholarly-journals/examining-association-between-cognitive-testing/docview/2813693336/se-2
Behnken, M. P. (2014). Linking ADHD to incarceration among African Americans. The ADHD Report, 22(7), 9-16. https://doi.org/101521adhd20142279
Carson, E. Ann & Kluckow, R. (2023). Correctional populations in the United States, 2021. Bureau of Justice Statistics. Retrieved April 23, 2024, from bjs.ojp.gov/document/cpus21st.pdf
Chaplin, E., Rawat, A., Perera, B., McCarthy, J., Courtenay, K., Forrester, A., Young, S., Hayward, H., Sabet, J., Underwood, L., Mills, R., Asherson, P., & Murphy, D. (2022). Prisoners with Attention Deficit Hyperactivity Disorder: Co-morbidities and service pathways. International Journal of Prisoner Health, 18(3), 245–258. https://doi.org/10.1108/IJPH-03-2021-0020
George, A. (2021). Attention deficit hyperactivity disorder in the forensic population [Doctoral dissertation, Walden University]. Proquest. proquest.com/dissertations-theses/attention-deficit-hyperactivity-disorder-forensic/docview/2596938742/se-2
Maruschak, L. M., Bronson, J., & Alper, M. (2016, March 1). Disabilities reported by prisoners. Bureau of Justice Statistics. Retrieved February 16, 2024, from bjs.ojp.gov/content/pub/pdf/drpspi16st.pdf
Walmsley, R. (2018). World Prison Population List, 12th Edition. Institute for Criminal Policy Research. Retrieved April 23, 2024, from prisonstudies.org/sites/default/files/resources/downloads/wppl_12.pdf
This is insightful and thoughtfully written. There is so much to unpack in your research, and it’s heartbreaking to think of the long term effects these situations have on individuals and society. I wish we were doing better to serve the needs of our most at risk communities. The world would be a better place if we did.
I have come to expect no less than this brilliance to come from you, Jonathan! Now don't let it go to your head...Your heart is just fine though! Now onto journalistic activities. Where might you post this? May I post it somewhere?