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Attention-deficit hyperactivity disorder (ADHD) awareness, understanding ADHD’s impact on sexuality, and neurodivergent friendly interventions are key to successfully treating people with ADHD who have sexually offended. Effectively diagnosing and treating ADHD is an essential first step to that success.
During her presentation at the International Forensic Psychiatry Lecture Series, Dr. Lyne Piché discussed why the unique characteristics of ADHD should be considered when working with people who have sexually offended.
Dr. Piché highlighted the newness of the research and theories, acknowledging that there is still much to learn about successful interventions for people who are neurodivergent and offend. She also highlighted the importance of upstream prevention programs that target neurodivergent families and communities.
Relevance of Addressing Neurodiversity
There is a long history of research specific to ADHD and its association with criminal behaviour. ADHD is reported to be five times more prevalent among people in detention than among the general population. Even so, mental health professionals typically apply the same neurotypical interventions to all detainees, without considering the unique needs of people with ADHD.
Many ADHD symptoms align with the criteria commonly used to assess the risk of criminal behaviour, and many people who are incarcerated have ADHD. However, most assessments do not consider ADHD when evaluating risk. Because of this, clinicians often misdiagnose ADHD as bipolar disorder, borderline personality disorder, or antisocial personality disorder, which results in inappropriate treatment.
Practitioners typically base their approach to working with people who have sexually offended on neurotypical considerations. This approach does not acknowledge neurodiversity in general, nor the unique thinking processes of people with ADHD.
ADHD affects more than just attention and concentration. It can impact many aspects of functioning, including the presence of anxiety as well as sensory issues. In addition, many people with ADHD experience difficulties with hyperfocus, which means they may become intensely caught up in a topic, interest, passion, or thought. The added combination of impulsiveness and emotional dysregulation complicates the clinical picture even further.
Difficulties perceiving bodily sensations — such as hunger, thirst, pain, and heart rate — can mean some interventions, such as teaching mindfulness or how to name their feelings, may be ineffective, heighten feelings of incompetence or failure, or both.
ADHD’s Effect on Common Sexual Problems
Several ADHD symptoms may have a unique impact on common sexual problems. Some people with ADHD may act more impulsively in sexual situations and find it harder to think about consequences ahead of time. This pattern can be linked to unfortunate decision-making. In addition, symptoms may range from hypersexual behaviour to hyposexual behaviour, both extremes creating unique therapeutic challenges.
ADHDis mostly inherited, and understanding the biological connection could change how mental health practitioners and the criminal justice system interpret criminal sexual behaviour. Considering ADHD as a disorder that causes impulsive behaviour because of biology, and not just social and environmental factors, places a different lens on how to prevent and understand sexual offences by people with ADHD.
Why Improving ADHD Symptoms is Important
Misdiagnosis and inappropriate treatment protocols do not support effective interventions for people with ADHD.
Placing a person with ADHD into a program geared toward neurotypical people may be ineffective if their ADHD symptoms remain untreated. Dr. Piché recommends starting with an intermediate program that supports managing ADHD using the pills and skills formula. With this approach, the person would receive proper medication to manage symptoms, along with skills training that aligns with the individual’s unique way of thinking. Moving away from expecting individuals to conform to neurotypical expectations within a standardized program may lead to improvements for this unique population.
ADHD awareness and treatment can help reduce the risk of domestic violence and sexual violence occurring or recurring. With proper treatment, a person with ADHD can better manage their behaviours and choices, reducing their risk of committing violence.
Written by Carolyn Johnstone and approved by Dr. Lyne Piché.
