Prevalence of attention deficit–/hyperactivity disorder (ADHD) and comorbid disorders in young male prison inmates*

  • M. RöslerEmail author
  • W. Retz
  • P. Retz-Junginger
  • G. Hengesch
  • M. Schneider
  • T. Supprian
  • P. Schwitzgebel
  • K. Pinhard
  • N. Dovi–Akue
  • P. Wender
  • J. Thome



This study was performed to evaluate the prevalence of ADHD as well as comorbid conditions among young male prison inmates.


We investigated 129 prison inmates (mean age ± SE: 19.2±2.0 years) and 54 healthy male control subjects (mean age ± SE: 22.2±3.12 years) for the presence of adult ADHD using the Wender Utah Rating Scale (WURS), the Eysenck Impulsivity Questionnaire (EIQ), the diagnostic criteria for ADHD according to DSM–IV and ICD–10–research criteria and the Utah criteria for adult ADHD. In order to determine comorbid personality disorders we applied the International Personality Disorder Examination (IPDE). Externalization (ED) and Internalization Disorders (ID) were evaluated by means of the Achenbach Scales. Alcoholism (ALC) was examined via the Alcohol Use Disorder Test (AUDIT) and substance use disorder (SUD) has been investigated with the Structured Clinical Interview for DSM–IV (SCID).


The overall prevalence of ADHD according to DSM–IV was 45%. The prevalence of disturbance of activity and attention (DAA) and hyperkinetic conduct disorder (HCD) via the ICD–10 research criteria was 21.7%. Sole DAA without any comorbid condition could be detected in one case. The most common diagnostic combinations were DAA/HCD and SUD/ALC (89% of all DAA/HCD cases).


The prevalence of DAA/HCD or ADHD in young adult prison inmates is significantly elevated when compared to nondelinquent controls. Generally the population of young adult male prison inmates exhibits a considerable psychiatric morbidity. Of the total sample, 64% suffered from at least 2 disorders. Only 8.5 % had no psychiatric diagnoses. This indicates the urgent need for more psychiatric expertise in young offender facilities.

Key words

ADHD comorbidity young offender epidemiology delinquency 


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  1. 1.
    Achenbach TM (1991) Manual for the Youth Self-Report and 1991 Profile. Burlington University of VermontGoogle Scholar
  2. 2.
    Achenbach TM (1997) Manual for the Young Adult Self-Report and Young Adult Behavior Checklist. Burlington, University of VermontGoogle Scholar
  3. 3.
    August CJ, Stewart MA, Holmes CS (1983) A four-year follow-up of hyperactive boys with and without conduct disorder. Br J Psychiatry 143:192–198PubMedGoogle Scholar
  4. 4.
    Babinski LM, Hartsough CS, Lambert NM (1999) Childhood Conduct Problems, Hyperactivity-Impulsivity, and Inattention as Predictors of Adult Criminal Activity. J Child Psychol Psychiatry 40:347–355CrossRefPubMedGoogle Scholar
  5. 5.
    Banaschewski T, Brandeis D, Heinrich H, Albrecht B, Brunner E, Rothenberger A (2003) Association of ADHD and conduct disorder—brain electrical evidence for an existence of a distinct subtype. J Child Psychol Psychiatry 44:356–376CrossRefPubMedGoogle Scholar
  6. 6.
    Barkley RA (1996) Attention-deficit/hyperactivity disorder. In: Mash EJ, Barkley RA (eds) Child Psychopathology. New York, Guilford Press, pp 63–112Google Scholar
  7. 7.
    Barkley RA, Murphy KR (1998) Attention-Deficit Hyperactivity Disorder. A Clinical Workbook. Guilford New YorkGoogle Scholar
  8. 8.
    Biederman J, Faraone SV, Spencer T, Wilens T, Norman D, Lapey KA, Mick E, Lehman BK, Doyle A (1993) Patterns of Comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. Am J Psychiatry 150:1792–1798PubMedGoogle Scholar
  9. 9.
    Blocher D, Henkel K, Retz W, et al. (2001) Symptoms from the Spectrum of Attention-Deficit/Hyperactivity Disorder (ADHD) in Sexual Delinquents. Fortschr Neurol Psychiat 69:453–459CrossRefPubMedGoogle Scholar
  10. 10.
    Chae PK, Jung HO, Noh KS (2001) Attention Deficit Hyperactivity Disorder in Korean Juvenile Delinquents. Adolescence 36:707–725PubMedGoogle Scholar
  11. 11.
    Costa PT, McCrae RR (1992) Revised NEO Personality Inventory (NEO-PI-R) and NEO Five Factor Inventory, Professional Manual. PAR, Odessa FloridaGoogle Scholar
  12. 12.
    Curran S, Fitzgerald M (1999) Attention deficit hyperactivity disorder in the prison population. Am J Psychiatry 156:1664–1665Google Scholar
  13. 13.
    Doreleijers TA, Moser F, Thijs P, van Engeland H, Beyaert FH (2000) Forensic assessment of juvenile delinquents: prevalence of psychopathology and decision-making at court in the Netherlands. J Adolesc 23:263–275CrossRefPubMedGoogle Scholar
  14. 14.
    Eysenck SBG, Daum I, Schugens MM, Diehl JM (1990) A crosscultural study of impulsiveness, venturesomeness and empathy: Germany and England. Zeitschr Diff Diagn Psychol 11:209–213Google Scholar
  15. 15.
    Faraone SV, Biederman J (1997) Do attention deficit hyperactivity disorder and major depression share familial risk factors? J Nerv Ment Dis 185:533–541PubMedGoogle Scholar
  16. 16.
    Faraone SV, Biederman J, Mennin D, Russell R, Tsuang MT (1998) Familial subtypes of attention deficit hyperactivity disorder: a 4-year follow-up study of children from antisocial-ADHD families. J Child Psychol Psychiatry 39:1045–1053CrossRefPubMedGoogle Scholar
  17. 17.
    Grützmacher H (2001) Unfallgefährdung bei Aufmerksamkeitsund Hyperaktivitätsstörung. Deutsches Ärzteblatt 98:1898–1900Google Scholar
  18. 18.
    Haapasalo J, Hamalainen T (1996) Childhood family problems and current psychiatric problems among young violent and property offenders. J Am Acad Child Adolesc Psychiatry 35:1394–1401CrossRefPubMedGoogle Scholar
  19. 19.
    Heiligenstein E, Conyers LM, Berns AR, Smith MA (1998) Preliminary Normative Data on DSM-IV Attention Deficit Hyperactivity Disorder in College Students. J Am Coll Health 46:185–188PubMedGoogle Scholar
  20. 20.
    Jensen PS, Martin D, Cantwell DP (1997) Comorbidity and ADHD: Implications for Research, Practise, and DSM-V. J Am Acad Child Adolesc Psychiatry 36:1065–1079PubMedGoogle Scholar
  21. 21.
    Lay B, Ihle W, Esser G, et al. (2002) Risikofaktoren für Delinquenz bei Jugendlichen und deren Fortsetzung bis in das Erwachsenenalter. Monatsschr Kriminol Strafrechtsreform 84:119–132Google Scholar
  22. 22.
    Loranger AW, Janca A, Sartorius N (1997) Assessment and Diagnosis of Personality Disorders. Cambridge UniversityGoogle Scholar
  23. 23.
    Mannuzza S, Klein RG, Konig PH, Giampino TL (1989) Hyperactive boys almost grown up, IV: criminality and its relationship to psychiatric status. Arch Gen Psychiatry 46:1073–1079PubMedGoogle Scholar
  24. 24.
    Mannuzza S, Klein RG, Bessler A, Malloy P, LaPadula M (1993) Adult outcome of hyperactive boys: educational achievement, occupational rank, and psychiatric status. Arch Gen Psychiat 50:565–576PubMedGoogle Scholar
  25. 25.
    Mannuzza S, Klein RG, Bessler A, Malloy P, LaPadula M (1998) Adult psychiatric status of hyperactive boys grown up. Am J Psychiatry 155:493–498PubMedGoogle Scholar
  26. 26.
    Milberger S, Biederman J, Faraone SV, Wilens T, Chu MP (1997) Associations between ADHD and psychoactive substance use disorders. Am J Addict 6:318–329PubMedGoogle Scholar
  27. 27.
    Milin R, Halikas JA, Meller JE, Morse C (1991) Psychopathology among substance abusing juvenile offenders. J Am Acad Child Adolesc Psychiatry 30:569–574PubMedGoogle Scholar
  28. 28.
    Muhne M, Schachar R, Tannock R (1997) Impact of Comorbid Oppositional or Conduct problems on Attention-Deficit Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 26:1715–1725Google Scholar
  29. 29.
    Murphy K Barkley RA (1996) Prevalence of DSM-IV symptoms of ADHD in adult licensed drivers: Implications for clinical diagnosis. J Attention Disorders 1:147–161Google Scholar
  30. 30.
    Plizska SR (1998) Comorbidity of attention-deficit/Hyperactivity disorder with psychiatric disorder: an overview. J Clin Psychiatry 59(suppl 7):50–58Google Scholar
  31. 31.
    Pliszka SR, Sherman JO, Barrow MV, Irick S (2000) Affective Disorder in Juvenile Offenders: A Preliminary Study. Am J Psychiatry 157:130–132PubMedGoogle Scholar
  32. 32.
    Rasmussen P, Gillberg C (2000) Natural Outcome of ADHD With developmental Coordination Disorder at Age 22 Years: A Controlled, Longitudinal, Community-Based Study. J Am Acad Child Adolesc Psychiatry 39:1424–1431Google Scholar
  33. 33.
    Retz W, Retz-Junginger P, Hengesch G, Schneider M, Thome J, Pajonk G, Salahi-Disfan A, Rees O, Wender PH, Rösler M (2004) Psychometric and psychopathological characterization of young male prison inmates with and without attention deficit/hyperactivity disorder. Eur Arch Psychiat Clin Neurosci (in press)Google Scholar
  34. 34.
    Retz-Junginger P, Retz W, Blocher D, et al. (2002) Wender Utah Rating Scale: The short version for the assessment of the attention-deficit hyperactivity disorder in adults. Nervenarzt 73:830–838CrossRefPubMedGoogle Scholar
  35. 35.
    Retz-Junginger P, Retz W, Blocher D, Stieglitz R-D, Georg T, Supprian T, Wender PH, Rösler M (2003) Reliability and validity of the German short version of the Wender Utah Rating Scale for the retrospective assessment of attention deficit hyperactivity disorder. Nervenarzt 74:987–993CrossRefPubMedGoogle Scholar
  36. 36.
    Rösler M, Retz W, Retz-Junginger P, et al. (2003) Tools for the diagnosis of attention-deficit hyperactivity disorder in adults. Self rating behaviour questionnaire und diagnostic checklist. Nervenarzt 75: published online first, Springer BerlinGoogle Scholar
  37. 37.
    Satterfield JH, Schell A (1997) A Prospective Study of Hyperactive Boys with Conduct Problems and Normal Boys: Adolescent and Adult Criminality. J Am Acad Child Adolesc Psychiatry 36:1726–1735CrossRefPubMedGoogle Scholar
  38. 38.
    Siponmaa L, Kristiansson M, Jonson C, Nyden A, Gillberg C (2001) Juvenile and young adult mentally disordered offenders: the role of child neuropsychiatric disorders. J Am Acad Psychiatry Law 29:420–426Google Scholar
  39. 39.
    Spencer TJ, Biederman J, Wilens TE, Faraone SV (2002) Overview and Neurobiology of Attention-Deficit/Hyperactivity Disorder. J Clin Psychiatry 63(suppl 12):3–9Google Scholar
  40. 40.
    Stevenson J, Goodman R (2001) Association between behavior at age 3 years and adult criminality. Brit J Psychiatry 179:197–202CrossRefGoogle Scholar
  41. 41.
    Teplin LA, Abram KM, McClelland GM, Dulcan MK, Mericle AA (2002) Psychiatric Disorders in Youth in Juvenile Detention. Arch Gen Psychiatry 59:1133–1143PubMedGoogle Scholar
  42. 42.
    Thapar A, Harrington R, McGuffin P (2001) Examining the comorbidity of ADHD-related behaviours and conduct problems using a twin study design. Brit J Psychiatry 179:224–229CrossRefGoogle Scholar
  43. 43.
    Timmons-Mitchell J, Brown C, Schulz SC, Webster SE, Underwood LA, Semple WE (1997) Comparing the mental health needs of female and male incarcerated juvenile delinquents. Behav Sci Law 15:195–202PubMedGoogle Scholar
  44. 44.
    Ulzen TP, Hamilton H (1998) The nature and characteristics of psychiatric comorbidity in incarcerated adolescents. Can J Psychiatry 43:57–63PubMedGoogle Scholar
  45. 45.
    Vermeiren R (2003) Psychopathology and delinquency in adolescents: a descriptive and developmental perspective. Clinical Psychology Review 23:277–318PubMedGoogle Scholar
  46. 46.
    Vermeiren R, De Clippele A, Deboutte D (2000) A descriptive survey of Flemish delinquent adolescents. J Adolesc 23:277–285CrossRefPubMedGoogle Scholar
  47. 47.
    Vreugdenhil C, Van den Brink W, Wouters LF, Doreleijers TA (2003) Substance use, substance use disorder and comorbidity patterns in a representative sample of incarcerated male Dutch adolescents. J Nerv Ment Dis 191:372–378CrossRefPubMedGoogle Scholar
  48. 48.
    Ward MF, Wender PH, Reimherr FW (1993) The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Am J Psychiatry 150:855–890Google Scholar
  49. 49.
    Weiss G, Hechtman LT, Milroy T, Perlman (1995) Psychiatric status of hyperactives as adults: a controlled prospective 15-year follow-up of 63 hyperactive children. J Am Acad Child Psychiat 24:211–220Google Scholar
  50. 50.
    Wender PH (1995) Attention-deficit hyperactivity disorder in adults. Oxford – New YorkGoogle Scholar
  51. 51.
    Wender PH, Wolf LE, Wasserstein J (2001) Adults with ADHD. An Overview. Ann N Y Acad Sci 931:1–16Google Scholar
  52. 52.
    Wetterling C, Veltrup (1997) Diagnostik und Therapie von Alkoholproblemen. Springer BerlinGoogle Scholar
  53. 53.
    Wittchen HU, Zaudig M, Fydrich T (1997) SKID-I, Strukturiertes Klinisches Interview für DSM-IV. Hogrefe GöttingenGoogle Scholar
  54. 54.
    Woodward L, Fergusson D, Horwood J (2000) Driving outcomes of Young People with Attentional Difficulties in Adolescence. J Am Acad Child Adolesc Psychiatry 39:627–634PubMedGoogle Scholar
  55. 55.
    Ziegler E, Blocher D, Groß J, Rösler M (2003) Erfassung von Symptomen aus dem Spektrum des Hyperkinetischen Syndroms bei Häftlingen einer Justizvollzugsanstalt. Recht & Psychiatrie 21:17–21Google Scholar

Copyright information

© Steinkopff Verlag 2004

Authors and Affiliations

  • M. Rösler
    • 1
    Email author
  • W. Retz
    • 1
  • P. Retz-Junginger
    • 1
  • G. Hengesch
    • 1
  • M. Schneider
    • 1
  • T. Supprian
    • 2
  • P. Schwitzgebel
    • 1
  • K. Pinhard
    • 1
  • N. Dovi–Akue
    • 1
  • P. Wender
    • 3
  • J. Thome
    • 4
  1. 1.Institut für Gerichtliche Psychologie und Psychiatrie, NeurozentrumUniversitätskliniken des SaarlandesHomburg/SaarGermany
  2. 2.Klinik für Psychiatrie und Psychotherapie, NeurozentrumUniversitätskliniken des SaarlandesHomburg/SaarGermany
  3. 3.Harvard Medical SchoolBoston (MA)USA
  4. 4.Zentralinstitut für Seelische GesundheitMannheimGermany

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