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ADHD Presentation

ADHD Presentation. Presenters Phillip Anderton and Stephen Brown. www.adhdandjustice.co.uk. UK and US comparisons. US and UK comparisons. ?. US and UK comparisons. So, a competition. Where is Lancashire?. Day in the life of Lancashire Constabulary. Over 3,500 police officers,

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ADHD Presentation

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  1. ADHD Presentation Presenters Phillip Anderton and Stephen Brown www.adhdandjustice.co.uk

  2. UK and US comparisons

  3. US and UK comparisons ?

  4. US and UK comparisons

  5. So, a competition

  6. Where is Lancashire?

  7. Day in the life of Lancashire Constabulary • Over3,500 police officers, • 368 special constables and nearly • 1,900non-police staff  • get 4366 calls  • deal with 415 crimes                       • arrest 185 people • go to 15 road accidents             • responds to 2,111 incidents • handle 21 motorway breakdowns • breathalyse28 people • solve 124 crimes • recover £28,610 worth of stolen goods

  8. Phil Anderton / Steve Brown • Over 50 years combined police service • Qualified police trainers • Qualified academically • Have been working in the field of mental heath disorders and crime for the past 9 years

  9. Where we have worked in the US before • Cleveland – led to new mental health courts • Atlanta – a more joined up approach and our first CPD • Gainsville FL, Sheriff, Chief of Police, Probation and correction facilities working together • Orlando – set us up for this conference Police officers Community support C.I.T Preventing and reducing crime

  10. What’s in it for CIT officers? Your core elements: Partnerships Community ownership Policies and procedures CIT training Receiving training – specialised care Outreach to other communities

  11. Why ADHD is so important to those elements • Build confrontation out of your working lives • At the time of confrontation work with knowledge, understanding of the perpetrator and self • Get instantly better outcomes – for you as well as them

  12. ADHD • Attention deficit hyperactivity disorder – ADHD • ADD • Bad kids • With bad parents • Dysfunctional families

  13. ADHD • Its pervasive • It is NOT understood • Normally defined as: • Inattentive • Hyperactive • Impulsive

  14. ADHD • It is safe to describe ADHD-ers as: • A pain in the arse • Frequent visitors to police premises • Risk takers

  15. 5% 25% Here are some facts though

  16. Facts Likelihood of being arrested 20% in control group 48% in ADHD group (inc’ CD) (Barkley, Secnik, Swenson, Buesching, Fisher and Fletcher)

  17. Facts • ADHD and arrest profiles • Control group 2.1 arrests • ADHD cohort 6.4 arrests • (Barkley, Secnik, Swenson, Buesching, Fisher and Fletcher)

  18. Facts • Twice as likely to be a criminal • Three times as many offences each • Prolific, predictable and therefore ultimately preventable • And when ADHD is combined with conduct disorder: “Hyperactive subjects (in a US test) have significantly higher arrest, conviction and incarceration rates compared to controls” Satterfield J et al, May 2007 JmAcad Child Adolesc Psych

  19. Arrest comparisons • Lifetime criminality in boys with ADHD • N = 207 • Lifetime arrest records at age 38 • Arrests = 47%-v-24% • Convictions = 42%-v-14% • Incarcerations = 15%-v-1% “Mannuzza, S et al (2008) Psychiatry Res. 160(3)

  20. Gary • “I was a regular burglar, druggy, thief and once I was described as an utter shit. I did everything, you name it, I did it. No one understood me, including myself. The cops all knew me, I was in and out of prison from the age of 10. I had a social services record that is unbelievable. • Then someone diagnosed my ADHD, now I understand ‘me’ – and as long as I comply with my treatment regime I am OK – a good guy. A good father, husband and I know how sorry I am now, I really do”

  21. Michelle • From a ‘good background’ • Was not understood by her parents • Took cocaine and heroine • Earned money through prostitution • Married and divorced at the age of 20 • Incarcerated for her own well being at the age of 23 • Was diagnosed with ADHD at the age of 28 • Now runs a successful international photography business

  22. Problem families • ‘His Dad was a problem’ • ‘We have been expecting him to be a problem and he is’ • What will his kids be like? • Add tall people picture

  23. Convincing you • Creds and quotes • Sherfiiff • AG • ADDISS • Papers • Book

  24. ADHD • Its a medical disorder: • ‘harmful dysfunction’ • that comprises a serious deficit or failure in a functional mechanism and • it produces harm to the individual in terms of greater mortality, morbidity or • impairment in universal major life activities • Wakefield’s definition

  25. ADHD

  26. ADHD

  27. What is ADHD – executive functions • Organising and prioritising work • Focus and sustaining task focus • Regulating alertness • Managing frustration • Utilising working memory • Monitoring self regulating action

  28. What is ADHD – executive functions

  29. And this is caused by… • Chemical deficiencies • Hard wiring differences • An explainable natural occurance

  30. Manifestations of ADHD • Drug taking and abuse • Criminal behaviour • Driving risks • Suicide risks

  31. Drug taking and abuse • Impulsivity has been associated with increased risk for engaging in health-risk behaviour's, including tobacco and alcohol abuse. • There is strong evidence that impulsivity is an important trait-marker for a common pathway to addictive behaviour's (Chambers & Potenza, 2003).

  32. Drug taking and abuse In adults with ADHD at least 20 – 30% abuse drugs (Willens 2004) Over use of nicotine leads to self treatment and acceleration to harder drugs (Biederman (1991)

  33. Drug taking and abuse Hard drugs Alcohol & softer drugs Nicotine • Kim-Cohen et al, Arch Gen psychiatry 2003; 60

  34. Drug taking and abuse Dependence Abuse Use

  35. Drug taking and abuse Adults with ADHD • Alcohol abuse/dependence 45% against 17% in general population • Drug abuse/dependence 30% against 9% in general population Wilens E.A. Harv Rev Psychiatry 1995;3;160-162

  36. Drug taking and abuse • Patients with ADHD encounter particular difficulties when they enter a setting for substance abuse treatment. (Sulliven and Rudnik-Levin 2001)

  37. Criminal behaviour • Easily led etc • Impulsive • Risk taking • Need ‘friends’

  38. Criminal behaviour Reports of criminal activity Arson – 15% v 6% Runaway – 31% v 16% Assault – 22% v 7% Stealing money – 50% v 36% Burglary – 20% v 8%

  39. Suicide • Children diagnosed with attention deficit hyperactivity disorder (ADHD) at ages 4-6 face a 3 times greater risks for depression and suicide at ages 9 - 18 Archives of General Psychiatry - October 2010 "I don't feel sorry for myself and I'm not looking for you to care. The fact is that I'm glad I tried it [killing himself] and glad it didn't work because it showed me one thing. No one else has ever really believed in me--I mean I know my parents say they love me, but I'm not stupid, I know what they talk about and that they are scared to death I'm going to be a failure. I'm too big a pain for teachers and I don't blame them for the way they treat me. I never believed in myself, but when I realized that I had the guts to do it, it was really weird. It showed that I had a side to me that gave a **** about myself and that there is something good in there."

  40. Suicide • 6 yrs old – excluded from peer groups • Not taken out by parents • 11 to 12 – school becomes a real issue • Develop inappropriate friendships • Led astray and into crime • Smoke and drugs • Low self esteem • Withdraw from schooling • Run away from home • Take up responsibility for self

  41. Driving risks Young drivers with ADHD are: • 2 to 4 more likely to have traffic accidents 1-3 • 3 times as likely to have injuries 2 • 4 times as likely to be at fault 1 • 7 times more likely to be in two or more • incidents 1 • 1 - Barkley RA. et al. Pediatrics 1993; 92: 212–218 • 2 - Barkley RA. et al. Pediatrics 1996; 98: 1089–1095 • 3 - Cox DJ. et al. J Nerv Ment Dis 2000; 188: 230–234

  42. Use of the roads 14 year olds are 9 times more likely to have a pedestrian accident if they have ADHD Federal Agency for Occupational health, Safety and medicine. Germany 2001

  43. Driving risks - medication Inappropriate braking when car is in 35 mph (56 km/h) and 45 mph (72 km/h) acceleration zones (p=0.04) Number of instances

  44. Driving risks - medication Percentage of missed stop lights and stop signs, (p<.02) Percent missed

  45. Driving risks – help leaflet Ten top tips: No friends in the car No radio Rules around driving at night…

  46. Solutions for you • Engage • Understand • CHADD Chapter • Work in partnership • Make custody a ‘last resort’

  47. Solutions for you Where custody is the appropriate option Responsible adults Appropriate questioning skills Fair trials No excuses Appropriate rehabilitation Out of justice into medicine

  48. Solutions for CIT officers

  49. Solutions for CIT officers www.adhdandjustice.co.uk

  50. CIT programme – what’s on offer • Training your trainers • Free resources • Ground breaking partnerships • San Franscisco – November 2012

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