Diagnostic accuracy of a brief screening tool for attention deficit hyperactivity disorder in UK prison inmates.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is overrepresented in prison, making it imperative to identify a screening tool that can be quickly applied to efficiently detect the disorder. We explored the discrimination ability of a widely used ADHD screen, the Barkley Adult ADHD Rating Scale (BAARS-IV), against a clinical diagnostic interview. A brief version of the screen was then developed in order to simplify its use in the prison context, and maximize its diagnostic properties. METHOD: A cross-sectional study of 390 male prison inmates was performed in the UK, all participants were screened and interviewed via the Diagnostic Interview for ADHD in Adults 2.0 (DIVA-2). RESULTS: A total of 47 (12.1%) inmates screened positive for ADHD using the full BAARS-IV, and 96 (24.6%) were clinically diagnosed, for a sensitivity of 37.9 and a specificity of 96.3. Our models identified the six items that most predicted ADHD diagnosis, with adjusted odds ratios ranging from 2.66 to 4.58. Sensitivity, specificity and accuracy were 0.82, 0.84 and 0.84, respectively, for the developed brief scale, and 0.71, 0.85 and 0.81 for its validation. Weighted probability scores produced an area under the curve of 0.89 for development, and 0.82 for validation of the brief scale. CONCLUSIONS: The original BAARS-IV performed poorly at identifying prison inmates with ADHD. Our developed brief scale substantially improved diagnostic accuracy. The brief screening instrument has great potential to be used as an accurate and resource-effective tool to screen young people and adults for likely ADHD in the criminal justice system.

Cognitive-behavioural therapy in medication-treated adults with attention-deficit/hyperactivity disorder and co-morbid psychopathology: a randomized controlled trial using multi-level analysis.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by high rates of co-morbid psychopathology. Randomized controlled trials of multimodal interventions, combining pharmacological and psychological treatments, have shown a robust treatment effect for ADHD symptoms but outcomes for co-morbid symptoms have been mixed. This may be accounted for by the type of intervention selected and/or by methodological problems including lack of follow-up and low power. The current study addressed these limitations in a parallel-group randomized controlled trial conducted in Iceland. METHOD: A total of 95 adult ADHD patients who were already being treated with medication (MED) were randomly assigned to receive treatment as usual (TAU/MED) or 15 sessions of cognitive-behavioural therapy (CBT/MED) using the R&R2ADHD intervention which employs both group and individual modalities. Primary measures of ADHD symptoms and severity of illness, and secondary measures of anxiety, depression and quality of life were given at baseline, end of treatment and 3-month follow-up. Primary outcomes were rated by clinicians blind to treatment condition assignment. RESULTS: CBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater reduction in primary outcomes for clinician-rated and self-rated ADHD symptoms. Treatment effect of primary outcomes was maintained at follow-up, which suggests robust and lasting findings. In contrast to the primary outcomes, the secondary outcomes showed significant improvement over time. CONCLUSIONS: The study provides evidence for the effectiveness of R&R2ADHD and demonstrates that there are differential effects over time for ADHD symptoms versus co-morbid problems, the latter taking longer to show positive effects.

Co-morbid psychiatric disorders among incarcerated ADHD populations: a meta-analysis.

BACKGROUND: Rates of psychiatric disorders are highly prevalent among prison inmates, and recent evidence confirms over-representation of youths and adults with attention deficit hyperactivity disorder (ADHD). The risk for psychiatric co-morbidity may be greater among offenders with ADHD. We undertook a systematic review and meta-analysis of reported rates of co-existing psychiatric morbidity with ADHD in prison samples. METHOD: Studies published from 1980 to 2015 were identified using five bibliographic indexes, review articles and reference lists. Included studies had a defined ADHD group and provided additional prevalence on at least one of the following: conduct disorder, substance use disorder, mood disorder, anxiety disorder, or personality disorder. We performed meta-analytical estimates of the prevalence of each co-morbid disorder within ADHD, and estimated the risk for co-existing disorders among prisoners with ADHD by pooling odds ratios (OR) with 95% confidence intervals. RESULTS: Eighteen studies with data for 1615 with ADHD and 3128 without ADHD were included. The risk (OR) of all psychiatric morbidity is increased among adult inmates with ADHD. Associations in youths with ADHD were restricted to mood disorder (OR 1.89, 95% confidence interval 1.09-3.28). CONCLUSIONS: This study quantifies the extent of co-morbidity presented by offenders with ADHD, especially adults. The differences between risk estimates for youths and adults indicate an incremental effect in both frequency and severity for the development of further co-morbid pathology through adulthood. The findings have implications for clinical intervention and for criminal justice policy.

Measuring victim empathy among mentally disordered offenders: validating VERA-2.

There are very few, if any, valid and victim-specific situation empathy measures available at present for use with mentally disordered offenders. The aim of this study was to validate a modified version (VERA-2) of the Victim Empathy Response Assessment (VERA) tool which was developed earlier (Young et al., 2008) to enable victim-specific situation empathy measurement in offenders. A total of 55 mentally disordered in-patients residing in a maximum security hospital were assessed on VERA-2 as well as on measures of antisocial personality traits, global affective empathy, violent cognitions, and reported remorse for the index offence. The VERA-2 cognitive and affective empathy scales were negatively correlated with antisocial personality traits and violent cognitions, and positively related to remorse for the index offence. Global affective empathy was positively related to VERA-2 affective empathy. Participants with a history of sexual offending had significantly higher cognitive empathy than other offenders. Acceptance of violence and remorse for the index offence were the best predictors of both cognitive and affective empathy. The findings suggest that the VERA-2 is a valid instrument for measuring victim empathy among mentally disordered offenders, and may prove useful in the context of future risk assessment and outcomes in this population.

Power regulation and electromigration in platinum microwires.

We introduce a new experimental setup with a biasing circuit and computer control for electrical power regulation under reversing polarity in Pt microwires with dimensions of 1×10 µm(2). The circuit is computer controlled via a data acquisition board. It amplifies a control signal from the computer and drives current of alternating polarity through the sample in question. Time-to-failure investigations under DC and AC current stress are performed. We confirm that AC current stress can improve the life time of microwires at least by a factor of 10(3) compared to the corresponding time-to-failure under DC current stress.

Reduced thalamic volume in men with antisocial personality disorder or schizophrenia and a history of serious violence and childhood abuse.

OBJECTIVE: Violent behaviour has been associated with presence of certain mental disorders, most notably antisocial personality disorder (ASPD) and schizophrenia, childhood abuse, and multiple brain abnormalities. This study examined for the first time, to the authors' knowledge, the role of psychosocial deprivation (PSD), including childhood physical and sexual abuse, in structural brain volumes of violent individuals with ASPD or schizophrenia. METHODS: Fifty-six men (26 with ASPD or schizophrenia and a history of serious violence, 30 non-violent) underwent magnetic resonance imaging and were assessed on PSD. Stereological volumetric brain ratings were examined for group differences and their association with PSD ratings. PSD-brain associations were examined further using voxel-based-morphometry. RESULTS: The findings revealed: reduced thalamic volume in psychosocially-deprived violent individuals, relative to non-deprived violent individuals and healthy controls; negative association between thalamic volume and abuse ratings (physical and sexual) in violent individuals; and trend-level negative associations between PSD and hippocampal and prefrontal volumes in non-violent individuals. The voxel-based-morphometry analysis detected a negative association between PSD and localised grey matter volumes in the left inferior frontal region across all individuals, and additionally in the left middle frontal and precentral gyri in non-violent individuals. CONCLUSIONS: Violent mentally-disordered individuals with PSD, relative to those with no or minimal PSD, suffer from an additional brain deficit, i.e., reduced thalamic volume; this may affect sensory information processing, and have implications for management, of these individuals. PSD may have a stronger relationship with volumetric loss of stress-linked regions, namely the frontal cortex, in non-violent individuals.

ADHD matures: time for practitioners to do the same?

Attention deficit and hyperactivity disorder (ADHD) is not restricted to children. Abundant evidence from follow-up studies accumulated since the 1970s supports the concept of ADHD in adulthood. Genetic research points to a heritability of 76%, and neuroimaging studies have reported structural and functional brain abnormalities in patients with ADHD. Contrary to popular belief, ADHD is not a culturally bound disorder and has been described worldwide. ADHD has a cost for society, as adults with this disorder suffer from increased rates of unemployment and psychiatric comorbidity, including substance use disorders. Studies undertaken in forensic populations describe high rates of ADHD in these groups, particularly amongst young offenders. One of the main issues in the diagnosis of ADHD in the adult is the fact that most clinicians have not been educated to diagnose and treat ADHD. Effective pharmacological treatments for ADHD are available and should be prescribed for these patients. The National Institute for Health and Clinical Excellence (NICE) and the British Association for Psychopharmacology (BAP) guidelines established a benchmark for service development required to treat ADHD adequately in the adult population. However, the implementation of new services has been slow. More resources are needed to effectively assess and treat ADHD in the adult.

Predictors of offending among prisoners: the role of attention-deficit hyperactivity disorder and substance use.

The aim of the study was to investigate predictors of offending among prisoners from official records after controlling for age at first conviction and antisocial personality disorder. The participants were 198 Scottish prisoners, who had completed Diagnostic Statistical Manual IV screens for child and adult attention-deficit hyperactivity disorder (ADHD) symptoms and the Millon Clinical Multiaxial Inventory III for Axis I and Axis II disorders. The ADHD symptomatic group had significantly higher rates of total, acquisitive and violent offending than other prisoners, as well as greater regular heroin use. Hierarchical multiple regressions, using child and adult symptoms as dimensions, showed that frequent use of heroin in the year prior to imprisonment was the single most powerful predictor of the extent of total offending, with ADHD symptoms also adding independently to the variance in offending. In contrast, for violent offending, ADHD symptoms were the strongest predictor followed by alcohol dependence. The findings demonstrate the importance of heroin use and ADHD symptoms in the persistence of offending. There is an urgent need to treat drug addiction and ADHD symptoms in order to reduce offending among the most persistent offenders. Recently, treatment programmes have been developed for adults with ADHD, heroin and crack cocaine addiction which can be applied to this population.

Interrogative suggestibility, compliance and false confessions among prisoners and their relationship with attention deficit hyperactivity disorder (ADHD) symptoms.

BACKGROUND: Interrogative suggestibility and compliance are important psychological vulnerabilities during interrogation. The aim of the study was to investigate the relationship of suggestibility and compliance with childhood and current symptoms of attention deficit hyperactivity disorder (ADHD). Compliance has not been studied previously in relation to ADHD. A further aim was to investigate the relationship between ADHD and the reporting of having made a false confession to the police. METHOD: The participants were 90 male prisoners, all of whom had completed the Gudjonsson Suggestibility and Compliance Scales (GSS and GCS) within 10 days of admission to the prison. Childhood ADHD symptoms were screened by the Wender Utah Rating Scale (WURS) and current adult symptoms by the DSM-IV Checklist criteria for ADHD. RESULTS: Half of the prisoners (50%) were found on screening to meet criteria for ADHD in childhood and, of those, over half (60%) were either fully symptomatic or in partial remission of their symptoms. ADHD symptoms were found to be significantly associated with compliance, but not with suggestibility. The relationship with compliance was stronger (effect size) in relation to current than childhood symptoms. The ADHD symptomatic groups were significantly more likely to claim that they had made a false confession to the police in the past. CONCLUSIONS: The findings raise important questions about the potential vulnerability of adults with ADHD symptoms in terms of their ability to cope with interrogation.

Increased radon detection sensitivity: extraction from 200 ml of water and liquid scintillation counting.

To increase detection sensitivity in a radon ground-water monitoring program, radon is extracted and transferred from 200 mL of water to a liquid scintillator by bubbling and circulating air through the two liquids in a closed system using a peristaltic pump. This results in a count rate that is 11 times higher than for samples prepared by the most widely used method, where 10 mL of water are added to 10 mL of scintillator. Preparation of counting samples is simple and takes 4 min. Standard deviation in radon concentration is 5% and minimum detectable activity is 5 mBq L(-1), using a counter with a background of 3 counts per hour and a counting time of 3 h. This method is also suitable for the measurement of radium in water.

Dissolved oxygen in gravity sewers--measurement and simulation.

Dissolved oxygen (DO) concentrations were during 2 months continuously measured in an intercepting sewer. Measurements were made upstream and downstream in a 3.6 km gravity sewer. DO showed significant diurnal variations mainly caused by changes in the organic matter composition of the wastewater. At low temperatures the gravity sewer was strictly aerobic. However, towards the end of the measuring campaign, DO concentrations decreased as temperature increased and the sewer became anaerobic part of the day. A conceptual model that takes into account bulk water and biofilm DO uptake as well as reaeration was used to simulate the DO measured. Using measurements from the upstream station as input, the model was calibrated to yield good validation results of the DO at the downstream station.

Injury proneness and personality.

The aim of this research was to investigate some personality factors among groups of 43 physically injured inpatients and 43 non-injured hospital-based controls. The participants completed the Eysenck Personality Questionnaire (EPQ) and the Coping Styles Questionnaire (CSQ). Logistic regression was used to compare the two groups on six psychological risk factors. The univariate regression models suggested three possible risk factors: extraversion, sensitization, and avoidance coping style. The multivariate regression model supported only extraversion and sensitization of emotion. Next, patients in the experimental group were questioned about whether they had considered preventive measures before the accident and whether they felt responsible for their injuries. Correlation analysis showed that introverted subjects felt more responsible for the sustained injuries than their extraverted counterparts. Sensitizers and subjects who scored high on psychoticism, neuroticism, and emotional coping had not considered preventive measures as often as others. Finally, the principal component analysis of risk factors was used to extract two correlates of injury-prone behaviour: extraversion and sensitized avoidance. It was concluded that psychological factors play an important role in predicting injury that is significant enough to require inpatient treatment. Two potential mechanisms of psychological impact have been suggested, notably distraction in extraverted subjects and overestimation in sensitizing avoiders.

Assessing the capacity of people with intellectual disabilities to be witnesses in court.

BACKGROUND: People with intellectual disabilities who have been victims or other witnesses of crime have had limited access to the criminal justice system, often on the basis of assumptions about their incapacity to be interviewed by the police and to give evidence in court. The aim of this study was to assess their capacity to be witnesses in court. METHODS: Forty-nine men and women with intellectual disabilities, all of whom were potential witnesses of ill-treatment, were assessed in order to provide advice, initially to the police, about their capacity to be interviewed for judicial purposes. The assessments included evaluations of each person's intellectual ability, memory, acquiescence, suggestibility, and their ability to explain concepts relating to the oath. RESULTS: Only 37 (76%) were able to complete the assessments. Most of those with a Full Scale IQ score of > or = 60 had a basic understanding of the oath, compared with only a third of those with IQ scores between 50 and 59, and none of those with IQ scores < 50. Nevertheless, some of the people who were unable to demonstrate an understanding of the oath did understand the words 'truth' and 'lie', especially when asked about these concepts in relation to concrete examples. CONCLUSIONS: While intellectual ability appears to be the best overall predictor of the capacity of people with intellectual disabilities to act as witnesses, confining witnesses to those who could explain the meaning of the oath would mean that a number of persons who might be interviewed by the police and subsequently appear in court could be excluded from the judicial process.

Differences and similarities between violent offenders and sex offenders.

OBJECTIVES: To investigate differences and similarities between violent offenders and two types of sex offenders, rapists and child molesters, in terms of their personality, the nature of the victim, the role of alcohol, and their confession to their crime. METHOD: Thirty-six adult sex offenders, 23 child molesters, and 32 violent offenders were compared on personality measures, their relationship with the victim, the presence of alcohol intoxication, their confession rate and retraction at trial, and the reasons they gave for having confessed to the police. RESULTS: Child molesters and adult sex offenders (rapists) were significantly more introverted than the violent offenders. The child molesters had higher social desirability scores than the other groups, they tended to assault relatives and friends, they were rarely intoxicated while committing the offense, and they had strong internal need to confess to the police. Rapists and violent offenders were more commonly intoxicated during the commission of the offense; the former tended to assault acquaintances, where violent offenders most commonly assaulted strangers. Exactly half of the rapists retracted their confession when the case went to trial; in contrast none of the other offenders retracted their confession. CONCLUSIONS: The results show that there are significant differences as well as similarities between the three groups of offenders, which have implications for assessment and treatment.

Eyewitness memory and suggestibility in children with mental retardation.

We examined how well children with mental retardation were able to recall a live staged event one day later compared to CA- and MA-comparable peers. Children with mental retardation performed very well on many measures of eyewitness memory performance, reaching the level of the CA-comparable group for free recall, general questions, open-ended questions, and correctly leading questions. They were, however, more suggestible in response to closed misleading questions than were children in the CA-comparable group, although they were not more suggestible than those in the MA-comparable group. Some relationships were found between a standardized measure of suggestibility and performance on the eyewitness memory task, but most of these relationships were not the same within each of our study groups.

Cognitive distortions and blame attribution in sex offenders against adults and children.

OBJECTIVE: Sexual offenders tend to hold attitudes and beliefs which minimize and justify their offending behavior. It was hypothesized that distorted thinking supporting sexual offending and blame attribution would differ depending on the offence characteristics of different groups of sexual offenders. METHOD: Two groups of sexual offenders separated on the basis of the age of their victims (sex offenders against children, 36; sex offenders against adults, 30) were compared on measures of cognitive distortions relating to sex with children and rape and a measure of blame attribution which assesses external, mental element, and guilt feeling attributions. RESULTS: Child sexual offenders endorsed more cognitive distortions relating to sex with children, but there were no group differences in cognitive distortions relating to rape. Those who offended against adults reported more external attributions and child offenders reported more guilt feeling attributions. Mental element attribution related to alcohol intoxication and use of violence in the offence, but was not related to group differences. CONCLUSIONS: Results are interpreted as suggesting that child sex offenders support their offending by more enduring distorted cognitions, while those who offend against adults use blame attributions associated with the particular offence.

Unreliable admissions to homicide. A case of misdiagnosis of amnesia and misuse of abreaction technique.

BACKGROUND: The past decade has witnessed a recognition that unsafe criminal convictions may be occasioned by unreliable confessions. AIMS: To present a case which illustrates the dangers of using abreaction interview techniques in a legal context and demonstrate the relevance of the memory distrust syndrome to an unsafe confession to murder. METHOD: We under took a detailed assessment of a person appealing against his original murder conviction, 'the appellant', and a careful scrutiny of all the relevant papers in the case. RESULTS: The appellant served 25 years in prison before his conviction was quashed as 'unsafe' on the basis of fresh psychological and psychiatric evidence. CONCLUSIONS: Amnesia for an offence had been misdiagnosed, and the use of repeated abreaction interviews had further confused both the appellant and the original court. At the Appeal Court, the advice was that the man had experienced a form of source amnesia which resulted in an unreliable confession.

Sexual adjustment and its predictors after traumatic brain injury.

The aim of this study was to investigate the impact of traumatic brain injury (TBI) on sexual ability, activity and satisfaction and to relate the findings to neurological status, functioning and well-being. A total of 92 TBI persons (65 men, 27 women) participated. Their ages ranged from 20-70 years (median 40 years); the median age at injury was 32 years, ranging from 16-56 years. The elapsed time since injury ranged from 1-20 years (median 9 years). The participants were examined according to a procedure including neurological examination, self-assessment of general health status and functioning and mood, and collection of data on social conditions. A structured study-specific questionnaire was developed to assess various aspects of sexuality before and after the injury. Fifty-three of the participants had a stable partner relationship at the time of the investigation. This study showed that a TBI commonly alters sexual functioning as well as desire. Many of the respondents reported decreased ability to achieve an erection, decreased ability to experience organism, decreased sexual desire and diminished frequency of intercourse. A high degree of physical independence and maintained sexual ability were the most important predictors for sexual adjustment. Considering that many TBI persons in this study reported physiological sexual disturbances and decreased sexual ability, it is important to inform patients about possibilities of optimizing their sexual ability. Organized programmes of sexuality education should be an integral component of TBI rehabilitation.

The functional independence measure in Sweden: experience for outcome measurement in rehabilitation medicine.

The purpose of the study was to describe the Functional Independence Measure (FIM) in Sweden and to analyse some aspects on its structure and the possibility to predict length of stay in a rehabilitation ward. It assesses the degree of dependence with 13 physical and 5 social and cognitive items, using a 7-level ordinal scale. Data are presented from a total of 312 patients and from 267 first admission patients with a mean age of 45 (SD 13) years, 66% being men, in rehabilitation medicine wards in three hospitals in Sweden. The patients were divided into six diagnostic groups. Ratings were made at admission and at discharge. The level of dependence in physical and social cognitive items was reduced during the stay at the ward. Using Rasch analysis, separate physical and social-cognitive items and personal measures were obtained on a linear scale. It was demonstrated that the relative order of the items was similar at admission and discharge. There were minor differences between diagnostic groups for the physical items, whereas more diagnostic-specific differences were seen for the social-cognitive items, for stroke patients with and without aphasia. Individual statistics were used for demonstrating FIM changes during the rehabilitation period. There was a high correlation between admission and discharge FIM values, and the admission FIM (physical items) accounted for up to nearly 50% of the variation in length of stay in a homogeneous sample such as stroke patients, but for less than 40% in the total sample. FIM can be used to follow changes during inpatient rehabilitation and for comparisons between different rehabilitation units.