Critical Reflections on Attention Deficit Hyperactivity Disorder (ADHD) in the Criminal Justice System: Swedish Female Ex‐Offenders’ Narratives of Diagnosis
| Date | 01 December 2018 |
| DOI | http://doi.org/10.1111/hojo.12267 |
| Author | LINNÉA ANNA MARGARETA ÖSTERMAN |
| Published date | 01 December 2018 |
The Howard Journal Vol57 No 4. December 2018 DOI: 10.1111/hojo.12267
ISSN 2059-1098, pp. 453–471
Critical Reflections on Attention
Deficit Hyperactivity Disorder
(ADHD) in the Criminal Justice
System: Swedish Female
Ex-Offenders’ Narratives
of Diagnosis
LINN´
EA ANNA MARGARETA ¨
OSTERMAN
Lecturer in Criminology, University of Greenwich
Abstract: Recent years have seen an emerging link between attention deficit hyperactivity
disorder (ADHD) and criminal behaviour. Sweden is a leader in this field of research,
and high levels of ADHD are reported in the Swedish criminal justice system. The
aetiology of the condition, however, remains unclear and there is definite ambivalence
in the literature regarding both diagnosis and treatments. Offering a unique qualitative
perspective on the role of ADHD diagnoses, this article critically explores female first-
hand narratives of ADHD in the Swedish criminal justice system. A number of diagnostic
functions are proposed; (i) on the individual level – via a rationalised explanatory
framework of behaviour; (ii) on a societal level – with attention effectively being deflected
from social and environmental contexts; (iii) on an institutional level – linked to the
medicalised management of offender populations, and lastly; (iv) on a broader market
level – including huge pharmaceutical interests in a relentlessly expanding ‘treatment’
market.
Keywords: attention deficit hyperactivity disorder (ADHD); criminal justice;
diagnosis; female offender; narrative; Sweden
Attention deficit hyperactivity disorder (ADHD) represents the fastest
growing diagnosis over the last decade, reflecting a general trend of in-
creasing levels of mental health diagnoses. It is, today, one of the most
common psychiatric childhood disorders (Stokkeland et al. 2014), with an
estimated 20% of American children aged 9–17 years being diagnosed with
the condition (Brante 2006). ADHD has traditionally been viewed to be a
child-diagnosis, and it is only more recently that the diagnosis has begun
to be applied to adults. This, K¨
arfve (2006) argues, reflects a general trend
within neuropsychiatry of ‘child’ conditions increasingly being transferred
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2018 The Howard League and John Wiley & Sons Ltd
Published by John Wiley & Sons Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK
The Howard Journal Vol57 No 4. December 2018
ISSN 2059-1098, pp. 453–471
to adult populations, including more extensive use of retrospective di-
agnoses. Though few studies have established any certain findings, the
general adult population prevalence of diagnosis is estimated to be around
4.5% (Faraone et al. 2000). Comparing these figures with criminal justice
specific studies, it soon becomes clear that ADHD is significantly over-
represented within the justice system. This over-representation must, in
turn, be situated in the wider context of a higher prevalence of mental
health disorders experienced by individuals involved with the criminal
justice system generally (Light, Grant and Hopkins 2013), though this is
particularly marked for female offenders (Corston 2007).
In Sweden, recent figures indicate that between 15% and 45% of the
overall prison population fulfils the criteria for ADHD (Kriminalv˚
arden
2013). For women specifically – though under-researched in comparison –
the equivalent figure is suggested to stand at around 29% (Kriminalv˚
arden
2010). While criminological research on ADHD is limited overall, the gaps
about ADHD and women involved with criminal justice are particularly
large, and more research is urgently called for (Konstenius et al. 2012).
This article aims to make a start on addressing this gap, offering first-
hand perspectives on ADHD diagnoses by a small sample of women in
the Swedish criminal justice system. Recognising that wider contexts, both
in terms of criminal justice specifically and society more generally, play a
role in diagnostic experiences and processes (Berger 2015), the broader
socio-economic settings of diagnosis are also given attention.
Following a brief overview of the ADHD literature, with a particular
focus on offending, treatment and responses, suggested functions and
beneficiaries of diagnosis are considered. Produced via a feminist method-
ology, first-hand narratives on diagnosis by a sample of currently desisting
Swedish women are then presented, critically exploring subjective diag-
nostic functions and purposes. Finally, the concluding section, beyond
highlighting the role of ADHD narratives in the women’s account, goes
on to raise wider questions regarding the over-reliance on medicalised
treatments and discourses in current criminal justice contexts. Calls are
also made for more interdisciplinary and critical research in the field.
ADHD and Criminal Justice
Exploring ADHD and offending populations in an international context,
a study by Young et al. (2011), looking at findings from the USA, Canada,
Sweden, Germany, Finland, and Norway, found that, overall, half of the
adult prison population, and two-thirds of young offenders, screen pos-
itive for ADHD. Data thus seem to suggest a link between ADHD and
offending populations; however, the nature of this link remains uncertain.
In fact, the aetiology of ADHD remains unknown (Savolainen et al. 2010),
and although literature suggests that ADHD in childhood is a risk factor
for involvement in offending in later life, it is important to note that no
direct association has been proven (Modre et al. 2011). One major issue
within research around ADHD is that of co-morbidities, including overlaps
with a range of disorders such as autism, dyslexia, personality disorders,
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2018 The Howard League and John Wiley & Sons Ltd
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