Why do so many ADHD children fail at school and fall foul of the criminal justice system?

by Kaj Bartlett
NPAA ADHD Lead & Sussex Police Deputy Coordinator

Attention Deficit and Hyperactivity Disorder (ADHD) is a neurodevelopmental condition affecting five percent of the UK population. Indications are that it is underdiagnosed. Lack of societal awareness of the condition means that many believe it only affects young boys and they grow out of it during the transition to adulthood. This is a myth. ADHD affects all ages, both genders and across all social classes.

There are many symptoms which affect someone living with ADHD, and like autism, not everyone experiences the condition in the same way. It is now known that there are three sub-types of ADHD: inattentive, hyperactive and combined type. There are screening tools which help signpost if someone has ADHD; however diagnosis is ultimately based on a psychiatric assessment of behavioural traits according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM5). lt is classed as a ‘hidden disability’, because many of the challenges faced by a person who lives with ADHD aren’t always obvious. There are many positive aspects of living with ADHD, however the purist medical concept of the condition defines it through a ‘double whammy’ of being a deficit and a disorder. Most often it is the negative behavioural traits which are exhibited and observed, which are impatience, impulsivity, hyperactivity, significant emotional dysregulation, and poor executive functioning skills. ADHD is not a behavioural disorder: neuroscience now proves that it is a difference in brain function for those who live with it.

ADHD, like autism, cannot be cured; however there are psychological, behavioural, educational and pharmacological interventions which can transform lives. There is a genetic basis for ADHD being passed down the generations, although there is currently no definitive genomic variance conclusion which determines a predisposition for ADHD. Symptoms present differently in women and girls than they do in men and boys.

ADHD can be comorbid with many other conditions including anxiety and depression, and neurodiverse conditions such as dyslexia, dyspraxia and autism. lt is more often that not the comorbid condition will be the one which is identified first, as they are often easier to diagnose. Whilst treatment steps to manage those other conditions will help, a syndrome mix including ADHD will still mean the individual will struggle in life in many ways. Self-medicating can also take the form of substance and alcohol misuse. Adults living with ADHD are 78 percent more likely to be addicted to tobacco and 58 percent more likely to use illegal drugs than those without ADHD. Even food and purchasing addictions are more prevalent. 38 percent of young adults with unmanaged ADHD have been pregnant or have caused an unwanted pregnancy.

Taking that back a step further, children with neurodiverse conditions and in particular ADHD, will inevitably cause problems in the classroom. They will behave differently to their peer group, because they have a different learning style which is not catered for in schools. ADHD is first often seen through disruptive, challenging behaviour in schools, where there can be a prevalence of fighting, defiance and aggression, and damage being caused. lt can also present in more subtle ways and the individual will be the class chatterbox or clown. Usual ways of managing behaviour do not and will never work to moderate and alter the behaviour of those who live with ADHD. Undiagnosed and unsupported children living with ADHD are losing the opportunity for learning as their behaviour in school becomes the only focus, leading to sanctions and a hundred fold increased likelihood of permanent exclusion. Child and adolescent ADHD is widely, and incorrectly believed to be caused by poor parenting, poor diet, too much screen use and lack of self-control. Society expects individuals to exhibit certain levels of self-control, commensurate with the age of the individual. ADHD affects the neurodevelopmental abilities and pathways needed to acquire those skills in life. Challenging, aggressive behaviour arises through deficits of skill, not will. Unmet educational needs leads to criminality and longer term recidivism.

Academic research has estimated 30 to 40 percent of those incarcerated within the prison system have ADHD. There is a soon to be published piece of academic evidence which reinforces the importance of addressing the critical public health issue of ADHD for people living in detention, through (i) systematically offering initial screening and diagnosis to all individuals entering detention, and (ii) delivering treatment, monitoring and care for ADHD during and after detention. These strategies are believed to reduce recidivism and reincarceration, as well as violence in detention settings, in addition to improving the health and wellbeing of people living in detention.

Stripping that back a layer, another academic research paper concluded that 25 percent of those entering police custody during the study, met the strict assessment criteria to gain an ADHD diagnosis. A further conclusion was that these individuals also needed the most support and care whilst in custody and were the most challenging for custody staff. In these prison and police studies, the vast majority of individuals who fitted the assessment criteria for a diagnosis of ADHD were actually unware that they lived with the condition, meaning they have had no possible opportunity for diagnosis and treatment help. From a policing perspective, those living with ADHD are much more likely to commit impulsive crimes often where a loss of self-control is evident, rather than a pre-planned criminal enterprise. This will be seen in offences such as anti-social behaviour and shoplifting, and opportunist acquisitive crime, public disorder, violent behaviour and criminal damage offences. Driving offences such as speeding and failing to stop for police also feature; driving performance can be affected by ADHD through inattention, impulsiveness and hyperactivity. Seeking risk-taking activities can be a form of self-medicating for unmanaged ADHD to increase the dopamine activity in the frontal lobes of the brain, this being an aspect of the neurochemistry behind ADHD.

The College of Policing Authorised Professional Practice on Detention and Custody covers the risk assessment of police custody detainees. Currently there is no specific reference to adult ADHD, and only a one line reference to it in the Children and Young Persons section of that guidance. Vulnerability is increased through the presence of ADHD, however this vulnerability is not being recognised. In my experience, there is no specific training for our custody officers, nor the wider policing family about ADHD and how to best support and manage those who live with it. Lack of awareness and unconscious bias leads us to focus on the offending and not what could be underpinning it. Our untrained behaviours can and do often lead to compounding the problem as we increase the likelihood of emotional dysregulation, leading to non­compliance from the subject. This often leads to violent behaviour.

ADHD is not an excuse for poor behaviour at any age, yet the negative aspects of its presence leads to poorer social outcomes in life and hidden vulnerability for many. An individual’s social environment does not cause ADHD, yet poor social environment and adverse childhood experiences can exacerbate behavioural symptoms. The neurodevelopmental basis of ADHD creates those skills deficits through biology. Neuroplasticity means ADHD biology can be managed and changed with the right approaches. ∎

Follow Kaj Bartlett on Twitter at @ADHD_InspKaj

Are we approaching workplace stress the wrong way?

by John Nelson
Chair, National Police Autism Association

The last couple of years have seen an increased recognition of the importance of staff welfare within policing. As a service, we are now far more aware of the effects of stress: in years gone by, an officer struggling with the after-effects of a fatality or other traumatic incident might be offered nothing more than a stiff drink in the bar after work; today, Forces offer trauma risk management (TRiM) and access to counselling as standard. The launch of the Oscar Kilo wellbeing portal in 2017 and the Police Federation’s successful ‘Protect the Protectors’ campaign reflect a more enlightened approach to wellbeing within the emergency services.

The focus on dealing with traumatic events tends to overlook another source of stress, and one that particularly affects staff with a neurodiverse condition such as autism, ADHD or dyslexia: day-to-day wellbeing. As a support group, we are often contacted by officers and staff who, for one reason or another, are not having a happy time at work; these reasons usually boil down to basic needs not being met. Despite our improved understanding of wellbeing, the police service is still something of a ‘one size fits all’ culture: as a warranted officer, you’re expected to work anywhere, in any core role, and perform to the same high standard. (Police staff are typically limited to their chosen role but may still be subject to widely varying working environments.) This approach doesn’t always work for everyone, and it especially doesn’t work for staff with hidden conditions and disabilities.

Take the station report writing room, for example – the place where officers start and finish each shift and get case files and paperwork done. With the move to larger police stations, officers are now likely to find themselves working in open-plan offices – sharing facilities with 20 or 30 colleagues at a time is not uncommon. Open-plan offices tend to be noisy – whilst some people might find a certain amount of background noise invigorating and most are are able to block out distractions, staff with sensory sensitivities typical of autism spectrum conditions may find constant background noise and interruptions intolerable and a significant barrier to performance. A supervisor may be sympathetic and willing to consider a reasonable adjustment such as a change of location or finding an officer a quiet room to work in; however all too often such accommodations can be seen as a nuisance (“Everyone else manages, why can’t you?”) or refused outright. What happens next varies, but is never good: if the officer’s performance dips below the minimum, performance management measures may be implemented; this is usually the point at which the officer takes sick leave suffering from stress and we are approached for help. Insisting on reasonable adjustments can sometimes lead to a stand-off between the officer, Occupational Health and local management, the latter being under no obligation to follow recommendations made by healthcare professionals. Even if line managers are willing to accommodate a change in working environment, such accommodations are sometimes made grudgingly, which will negatively impact on the officer’s career development. Or the officer may struggle on, managing to keep their performance above the minimum but coming into work unhappy and resentful every day – hardly a good place to be, and with obvious negative effects on resilience and long-term health.

Another factor which is arguably true for everyone, and especially to neurodiverse staff, is of square pegs not fitting into round holes. People with neurodiverse conditions tend to excel in certain roles and environments and struggle with others – for instance, an officer on the autism spectrum may thrive in a neighbourhoods role, where the focus is on solo working and long-term problem-solving; an officer with ADHD on the other hand may find the constant stimulation of a response role a better fit. Unfortunately there is no pathway for such career preferences to be accommodated, outside of recognised specialisations such as CID; if an officer is unlucky enough to find themselves in the ‘wrong hole’, the only way out may be through requesting a move as a reasonable adjustment, which may only be granted as a means of getting the officer back to work from sick leave. Some managers are more accommodating than others, but this is hardly ideal – our position is that this vital facet of wellbeing should not be a spin of the roulette wheel.

Along with culture, a barrier to wellbeing is austerity – with officers at all ranks being expected to achieve more with less, it is all to easy to view an officer who struggles as a ‘problem child’ (a term that unfortunately is still bandied about in policing circles). Managing resources, performance and sickness tends to fall to local District Commanders – these mid-level managers spend a good deal of time juggling team numbers on their office whiteboards, and with staffing levels constantly at minimum or below minimum, it’s easy to see why an officer requesting a transfer to different location or role would not be seen favourably as a potential high performer. The ‘immoveable object’ behind all of this is the Equality Act: employment law does not recognise that providing reasonable adjustments to disabled staff may ‘upset the numbers’ or be too costly. The ultimate result of getting this wrong is the Force being taken to an employment tribunal – a failure for everyone involved, regardless of outcome.

It’s hard to talk about the importance of wellbeing without looking at what can happen if it’s neglected, but I would like to focus on the positives. Neurodiverse officers and staff who overcome the odds to find their niche can be capable of great things – take for example Detective Inspector Warren Hines, Chief Inspector Nigel Colston and Inspector Kaj Bartlett, senior officers who have forged careers around their strengths arising from autism and ADHD. One of the most satisfying aspects of my role as NPAA Chair is being able to point potential neurodivergent officers to the Media Centre page on our website, where they be can be inspired to turn what many view as a negative into a positive.

I’m often asked what changes I would like to see in the future. An important change for our members would be for officers of all ranks to understand the importance of day-to-day wellbeing rather than just managing trauma, and to recognise that a small expenditure on effort, time and money can make a big difference in getting the best from our staff and giving our best to the public. ∎

The following blogs have been written for us as part of World Autism Awareness Week by two members of our coordinator team who have children on the autism spectrum. Names have been changed to protect the identity of family members.

Liz, Business Development Analyst and NPAA Lead Coordinator

When my son was born there were a lot of myths surrounding autism. One myth was that autism is caused by vaccines. My son, now aged 13 was vaccinated during a media climate of TV news reports which concentrated on showing clips of children not communicating, parents convinced that the MMR vaccine was responsible for their child having autism. The research surround this has now been found to be flawed and although scientists don’t fully understand what causes autism, it is thought to be genetic.

Our son received an autism diagnosis in 2011. As a baby he spoke and had a good command of language, but things like haircuts and changing routine could present a problem. It wasn’t until he was at school, when a teacher suggested we get a referral to the child development clinic that we became aware our son may be on the autism spectrum. It took two years of form filling, assessments and appointments to establish that he was autistic. Upon receiving this news I felt relief. I also experienced grief. What would the future hold for my son? Would he reach the same milestones as his older neurotypical brother? But I was also relieved. Relieved, that my child was autistic, not naughty. His behaviour, which could be perceived as stubborn or obstructive was sometimes due to finding the world overwhelming, and he was unable to express this in words.

Having a name for his behaviour – autism – meant I could focus my attention to learning what may help him in difficult situations. Having this information has enabled me to understand why certain situations can cause anxiety, and having more of the understanding of the condition has benefited us a family. We may have to prepare my son for a new situation so he has an understanding of what to expect. Avoiding queuing is something which makes a family day out much less stressful.

Having an autistic child can have its challenges, but I wouldn’t change my son. Autism is part of him. This is why promoting autism awareness is important to me. I’ve learned so much by having a child on the spectrum and I want to change attitudes and perceptions about the condition. I want to ensure those negative images of autism are challenged. I want my son, his peers and the 700,000 people in the UK known to have the condition to live in a world of understanding and acceptance.

Not every autistic person has a savant skill (someone with significant mental abilities far in excess of average). The skills at which savants excel are generally related to memory; similar to the character in the film Rain Man). Indeed, if my son did have an aptitude for understanding the sequencing of gaming machines I would have long since retired! Autism is unique. It’s a spectrum condition, not a line or scale.

Like any parent I have concern about my child’s future, but I worry about some things you may never have considered if you are a parent.

Will my child be able to make his own way to and from secondary school independently?

Will he ever stop wearing gloves during the month of August?

What will happen if they stop making the only brand of toothpaste he will use?

What would happen if my son needed the help of the police?

Would he be able to communicate effectively?

Would my child become a victim of crime as a direct result of his difference? Autistic people are more likely to be victims and witnesses of crime than offenders.

Will he get a job? Only 16% of autistic adults in the UK are in full-time paid employment, and only 32% are in some kind of paid work.

Will my son ever be able to answer a question without answering “I don’t know”.

Would a police officer be able to help him if he became distressed? (My son refuses to speak when things are difficult, because he’s processing information and may not know what words to use).

Will people always assume my son is rude if he does not give eye contact when being spoken to?

Do police officers have enough understanding of neurodiverse conditions? Neurodiversity is the concept where neurological differences are to be recognised and respected as any other human variation. These differences can include those labelled with dyspraxia, dyslexia, attention deficit hyperactivity disorder (ADHD), dyscalculia, autistic spectrum, Tourettes and others.

My interest in promoting autism awareness had led me to becoming my Force single point of contact for autism, and our Force lead contact for the National Police Autism Association.

Jon, Business Development Analyst and NPAA Deputy Coordinator

My son Peter, while not as outgoing as many of his peers, looks like and – trust me, speaks like your neurotypical teenager! However Peter was diagnosed with high-functioning autism two years ago. Autism is a lifelong, developmental disability that affects how a person communicates with and relates to other people, and how they experience the world around them. Peter suffers from extreme anxiety – his whole life is based around fear and he struggles with social communication. He can easily misinterpret situations and conversation. Living and coping in a world designed for neurotypical people is difficult and challenging and can lead to behaviour issues. For Peter the little things are the BIG things.

Being a parent of an autistic child can be extremely challenging: we face constant struggles, such as explaining on an almost daily basis how Peter thinks and about the condition itself. It can be tiring and frustrating. When the opportunity arose to join the National Police Autism Association as the Deputy Coordinator for my Force, it was an offer I could not refuse. It’s given me the opportunity to raise awareness about the condition. I want to ensure the negative images of autism are challenged. The role has allowed me to pass on my knowledge of the condition and help with the education in how to recognise people with autism and how to understand what steps can be taken in order to communicate and deal with autistic people positively. My lead coordinator and I have recently conducted training sessions with new PCSOs and police officers where we have given input on the subject of autism – the feedback suggests these have been both beneficial and enlightening. We will continue to work with our colleagues raising autism awareness and we encourage everyone to join the NPAA to learn more or seek support. You don’t need to be directly affected to join, just an interest in learning more.

I can empathise with colleagues who themselves may be parents or carers, and who may be going through similar challenges as myself. I have gained an understanding of how difficult and stressful it can be, the challenges, and indeed rewards of raising a child on the autistic spectrum. Knowing you are not alone can make a real difference.

Autism has been highlighted a lot recently in the media with TV dramas such as The A Word and documentaries by celebrities including Chris Packham, who himself has autism. I think it is fantastic the way that my Force and others are embracing autism awareness, and I believe together we can make a real impact in raising awareness and understanding of autism, both within the police service and the wider community.