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Risk of Criminal Justice System Interactions in Young Adults with Attention-Deficit/Hyperactivity Disorder: Findings From a National Birth Cohort

Risk of Criminal Justice System Interactions in Young Adults with Attention-Deficit/Hyperactivity... Objective: To examine criminal justice system (CJS) interactions and pathways through the justice system for young adults with ADHD compared to young adults without ADHD. Method: Nationwide 3-year birth cohort study using linked health and CJS data. Cox proportional hazards models were employed to examine associations between ADHD and police proceedings, court charges, court convictions, and incarcerations. Results: Young adults with ADHD were significantly more likely to interact with the CJS including police proceedings (hazard ratio [HR], 2.1 95% CI [2.0, 2.2]) court charges (HR, 2.2 95% CI [2.1, 2.3]), court convictions (HR, 2.3 95% CI [2.2, 2.4]), and incarceration (HR, 4.8 95% CI [4.3, 5.4]). Conclusions: Young adults with ADHD are overrepresented at all stages of the CJS. Results highlight the importance of early identification and responsivity to ADHD within the CJS and suggest that the NZ justice system may require changes to both areas to ensure that young individuals with ADHD receive equitable access to, and treatment within, the CJS. (J. of Att. Dis. XXXX; XX(X) XX-XX) Keywords ADHD, criminal justice system interactions, neurodevelopment, integrated data infrastructure would fiddle, be restless. After much consultation, I turned Introduction the essence of the ADHD experience to the positive: aro- Attention-Deficit/Hyperactivity Disorder (ADHD) is clini- reretini, (literally, ‘attention goes to many things’)” (Opai, cally defined as a neurodevelopmental condition character- 2022, p. 1182). ized by the presence of pervasive and developmentally Despite these more positive understandings of ADHD, excessive levels of hyperactivity, impulsivity, and difficul- research has consistently identified people with ADHD as ties in attention (Mehta et al., 2019; Sayal et al., 2018; experiencing high rates of mental health disorders such as Young & Cocallis, 2022). The executive functions impaired in ADHD have been identified as being those of activation, focus, effort, emotion, memory and action (Brown, 2013). University of Auckland, New Zealand Contemporary conceptualizations of ADHD increasingly A Better Start National Science Challenge, New Zealand Nicholson Consulting, Wellington, New Zealand apply a strengths-based lens to explore and explain this het- Donald Beasley Institute, Dunedin, Otago, New Zealand erogenous condition (see e.g., Redshaw & McCormack, University of Sheffield, UK 2022; Sedgwick et al., 2019). In Aotearoa New Zealand University of Otago, Dunedin, New Zealand (NZ), Opai (2022) recently contested negative and medical- Simply Resolution Limited, Wellington, New Zealand ized conceptualizations of ADHD and offered a Te Ao Corresponding Author: Māori (Māori world) perspective on the condition (Māori Nicholas Bowden, Department of Women’s and Children’s Health, The are the indigenous population of NZ). “ADHD has always University of Otago, 201 Great King Street, Dunedin 9016, New Zealand. been seen as a negative term. People could not concentrate, Email: Nick.Bowden@otago.ac.nz 2 Journal of Attention Disorders 00(0) substance use disorders (SUDs), emotional dysregulation, meta-analytic prevalence of ADHD increased to 41.1% of and self-harm. ADHD has also been associated with disrup- the sample (Baggio et al., 2018). tive, defiant, and antisocial behaviors (Cherkasova et al., Regarding associations between ADHD and offense 2022; Erskine et al., 2016; Retz et al., 2021; Sayal et al., types, there is a dearth of research available and existing 2018; Spencer, 2006). People with ADHD often face chal- studies have been limited by small convenience samples or lenges in interpersonal relationships, education, including cross-sectional designs (Fletcher & Wolfe, 2009), and retro- suspensions/expulsion from school and lower tertiary spective, self-report measures of ADHD symptomatology enrollment, and employment (Cherkasova et al., 2022; in childhood (e.g., Román-Ithier et al., 2017; Watts, 2018). Sayal et al., 2018; Zalsman & Shilton, 2016). While, Mohr-Jensen et al. (2019) reported that all recorded While estimates of ADHD prevalence vary due to meth- offenses (except for murder) were significantly higher for odological differences between studies, it is generally those with ADHD than controls, more research employing accepted that the global prevalence among children and large, representative samples is needed to elucidate whether young people is currently around 5-7% (Freckelton, 2019; an association exists between ADHD and certain offense Holland et al., 2023; Retz et al., 2021; Sayal et al., 2018; types. Young & Cocallis, 2022; Zalsman & Shilton, 2016). The Several theories exist on the association between ADHD male to female ratio of ADHD is estimated to be 3:1 and CJS interactions. Some suggest that the symptomatol- (Slobodin & Davidovitch, 2019; Willcutt, 2012; Young ogy of ADHD may lead to crime due to its associations with et al., 2020; Zalsman & Shilton, 2016). low self-control, a widely known criminogenic risk factor A large body of research suggests that ADHD may be a (Pratt et al., 2002; van der Maas et al., 2018). Others sug- risk factor for interactions with the criminal justice system gest that impulsive, cognitive, and behavioral symptoms (CJS). In a meta-analysis of 15,442 children and adoles- may mean that these individuals are more likely to get cents (aged 4–15) with ADHD from nine unique samples, caught for crimes committed due to traces left behind (e.g., ADHD was associated with a two- to threefold increase in DNA) (Mohr-Jensen & Steinhausen, 2016). ADHD may the risk of arrests, convictions, and incarcerations in ado- also be overrepresented in CJS interactions due to its lescence and adulthood compared to controls without comorbidity with other psychiatric conditions linked to ADHD (Mohr-Jensen & Steinhausen, 2016). Significant criminal behaviors, such as conduct disorder, SUDs, and associations between ADHD and both convictions and antisocial personality disorder (ASPD) (Pratt et al., 2002; incarcerations were more recently demonstrated in a Retz et al., 2021; Sibley et al., 2011). It has also been sug- Danish nationwide longitudinal study, though these effects gested that impaired socialization and social bonds during were smaller than previously reported risks due to adjust- development, due to adverse outcomes associated with ment for known individual and familial criminogenic risk ADHD symptomatology, may lead to CJS interactions (van factors (Mohr-Jensen et al., 2019). Research has also der Maas et al., 2018; Watts, 2018). This theorizing is con- reported that, compared to individuals without ADHD, sistent with the social model of disability, which recognizes those with ADHD are more likely to be younger at first that people with impairments are disabled by socially con- arrest and conviction (Philipp-Wiegmann et al., 2018; structed barriers including ableist attitudes, systems, struc- Young & Cocallis, 2022) and tend to have an increased tures, and environments (Oliver, 2013; Shakespeare, 2017). risk of recidivism (Retz et al., 2021), and a higher number It is therefore important to not only understand how of further engagements with the CJS (Philipp-Wiegmann ADHD might lead to interactions with the CJS but also the et al., 2018). ways in which ADHD may shape these interactions and This increased risk of CJS interactions is also reflected affect an individual’s pathway through the justice system. in the disproportionately higher rates of ADHD reported All signatory states to the United Nations Convention on across multiple contact points within the CJS, including the Rights of Persons with Disabilities (UNCRPD) have a police custody/arrests, prison, probation, and forensic men- series of legal obligations to protect disabled people tal health settings (Young & Cocallis, 2022). Compared to (UNCRPD articles 12, 13, 14, and 31). These include ensur- rates of ADHD in the general population, research suggests ing equal recognition before the law and the provision of that there may be around five times the rate of ADHD in effective access to justice, protecting the liberty and secu- youth offender populations and 10 times the rate of ADHD rity of the person (The Office of the High Commissioner for in adult offender populations (Retz et al., 2021; Young & Human Rights, 2006). Cocallis, 2022). In a meta-analysis pooling 102 original However, individuals with ADHD may be at risk from studies including 69,997 participants, Baggio et al. (2018) their moment of first contact with the CJS (e.g., police cus- calculated an ADHD prevalence of 26.2% in adult detention tody and court proceedings) for several reasons. Firstly, populations, corresponding to at least a five-fold over-rep- they may be perceived as uncooperative or less credible as resentation compared to the general population. When ret- they are more likely to respond to questions with “don’t rospectively assessing ADHD rates in childhood, the know” rather than denying suggestions put to them Anns et al. 3 (possibly due to a lack of confidence in their memory) (Mohr-Jensen & Steinhausen, 2016; Young & Cocallis, 2022). Secondly, individuals with ADHD may be at risk of making false confessions or providing false information, due to the use of inappropriate interviewing techniques (Cunial et al., 2020), greater levels of compliance resulting from difficulties with anxiety or low self-esteem, or due to ADHD symptoms (e.g., restlessness, hyperactivity) moti- vating individuals to leave the police station (Gudjonsson et al., 2008; Young & Cocallis, 2022). Signatory states are also required to collect appropriate data to demonstrate they are complying with the obligations set forth in the UNCRPD (Bowden et al., 2022). However, Figure 1. Participant flow chart. Note. All counts have been random rounded to base 3. there are considerable challenges in accessing such data. For example, the NZ government has acknowledged a heavy reliance on international prevalence data to inform died prior to their 17th birthday were excluded. The final national response due to current limitations with data col- sample consisted of 149,076 individuals (see Figure 1). lection (Office for Disability Issues, 2019). Linked population-level health and CJS data from NZ Attention-Deficit/Hyperactivity Disorder provides an opportunity to fill known gaps in the literature ADHD status was determined using an established case iden- regarding ADHD and CJS interactions. In particular, by tification method (Bowden, Thabrew, Kokaua, & Braund, enabling analysis of the pathway through the CJS and 2020; Bowden, Gibb et al., 2020; McLay et al., 2022). This addressing methodological shortcomings in extant research. method uses diagnosis codes and inference from medication They also provide essential data specific to the NZ-context. dispensing contained within four health datasets managed by The aims of the current study are therefore to: (1) Investigate the NZ Ministry of Health: hospital admissions data from the the benefits of using linked administrative data to contribute National Minimum Dataset (NMDS); specialty mental health to research regarding CJS interactions among young people service use data from the Program for the Integration of with ADHD; (2) Examine CJS interactions and pathways Mental Health Data (PRIMHD); subsidized pharmaceutical through the justice system for young adults with ADHD dispensings from the NZ Pharmaceutical Management compared to young adults without ADHD; and (3) Assess Agency (PHARMAC); and the Ministry of Health’s disability whether associations exist between ADHD and specific support services dataset, Socrates. Codes used to indicate offense types in comparison to individuals without ADHD. ADHD within each of these datasets are provided in the Supplemental Material (Table S1). Individuals were identified Methods with ADHD if they obtained at least one code relating to an ADHD diagnosis in any of the four datasets. As ADHD is Study Design, Population, and Data considered to be a lifetime neurodevelopmental condition, This was a national 3-year birth cohort study using data case identification reviewed diagnosis data from birth through from Statistics New Zealand’s Integrated Data Infrastructure to the end of the study period. (IDI), a large database of linked de-identified administra- tive and survey data about people and households. The IDI Criminal Justice System Measures is a world-leading resource containing population-level data across a range of life domains including health, educa- Four CJS interaction variables of increasing severity were tion, the labor market, housing, social welfare, and the CJS of interest: police proceedings, court charges, court convic- (see Milne et al. (2019) for a detailed description). The tions, and incarcerations. Information on police proceed- study population consisted of all those born in NZ between ings was obtained from NZ police recorded offender data. 1 July 1992 and 30 June 1995, identified using the Court charges and convictions were drawn from Ministry of Department of Internal Affairs birth records. Justice courts data. Incarcerations were obtained from the The observation window for CJS interactions was Department of Corrections dataset. For each CJS interac- between the participants’ 17th and 25th birthdays, as New tion variable, individuals were coded as 1 if they had any Zealanders are subject to the adult court from age 17 and are interaction over an 8-year period from their 17th birthday considered young adults until 25. This age range is also in through to their 25th birthday and 0 for no interaction. Dates keeping with research evidence (Prior et al., 2011). for when each type of interaction occurred were also Individuals who spent two or more years outside of NZ or available. 4 Journal of Attention Disorders 00(0) Offense types for criminal convictions were defined using ADHD status. Observed rates of each of the four CJS inter- the Australian and New Zealand Standard Offense action types and conviction offense types were calculated Classification (ANZSOC), a commonly used method of clas- for those with and without ADHD. Cox proportional haz- sifying offense types in Australia and NZ (Australian Bureau ards models were employed to examine associations of Statistics, 2011). ANZSOC divisions and their descriptions between ADHD and each CJS interaction (proceedings, are provided in the Supplemental Material (Table S2). Specific charges, convictions, and incarcerations). Unadjusted and divisions were combined to create different offense types: adjusted hazard ratios (HRs) for ADHD with 95% confi- offenses against people (ANZSOC divisions 1–6); offenses dence intervals (CIs) were estimated using the robust vari- against property (ANZSOC divisions 6–9, and 12); offenses ance estimator (Lin & Wei, 1989). Adjusted analyses against organizations, government and community (ANZSOC included sex, age, ethnicity, area-level deprivation, and area divisions 10–11, and 13–16); and violent offenses (ANZSOC of residence in the model. Participants were right censored divisions: 2 and 3; ANZSOC subdivisions: murder, attempted if they died, traveled overseas for a period greater than murder, abduction and kidnapping, deprivation of liberty/ 3 consecutive months (92 days) or reached the end of the false imprisonment, robbery; and the ANZSOC group man- study period (i.e., their 25th birthday) without experiencing slaughter [does not include driving causing death]). Each the relevant CJS interaction. Associations between ADHD offense type was treated as a dichotomous variable (con- and conviction for different offense types were also exam- victed/not convicted). First date of conviction for an offense ined, replicating the cox proportional hazards analysis type was also available. described. The decision was made to focus on convictions, The seriousness of offenses was defined using the cate- as this is the first interaction type in the system that appears gorization in the Criminal Procedure Act, § 6 (2011). on an individual’s criminal record. Serious offenses were those punishable by imprisonment of Data management was undertaken in SAS Enterprise two or more years. This was used to create a dichotomous Guide version 7.1 (SAS Institute Inc, 2014) and analyses serious offense indicator. Individuals were coded as 1 if were conducted in Stata MP version 15 (StataCorp, 2017). they were convicted of a serious offense, with all other indi- As per the confidentiality requirements of Statistics New viduals coded as 0. First conviction date for those in the Zealand, raw counts were suppressed if below 20 for CJS serious offense category was also extracted. interactions and below 6 for all other variables. All counts were randomly rounded to base 3. Sociodemographic Variables Results Sociodemographic variables included sex (male/female), age (in years), ethnicity, area of residence, and area-level depri- Participant Population vation. Ethnicity was measured in total response format, Of the 149,076 individuals in our final sample, 2.7% allowing individuals to identify with one or more of the fol- (n = 3,975) were identified as having ADHD. The sociode- lowing ethnic groups: European; Māori; Pacific; Asian; mographic characteristics for those with and without ADHD Middle Eastern, Latin American, African (MELAA); Other. in our sample are presented in Table 1. Those with ADHD Multiple ethnic identification is a common occurrence in NZ were more likely to be male and identify as European, rela- (Statistics New Zealand, 2005). Area-level deprivation and tive to those without ADHD. In contrast, there were fewer area of residence were based on address information at Māori, Pasifika, and Asian individuals amongst those with 17 years of age. Area of residence was categorized into five ADHD relative to those without. Across both ADHD and locations: Auckland; Wellington; rest of the North Island; non-ADHD groups, there was a similar proportion of indi- Canterbury; rest of the South Island. The NZ Deprivation viduals in each deprivation quintile, with a slightly greater Index 2013 (NZDep2013) was used to capture area-level proportion of people without ADHD in the most deprived deprivation. NZDep2013 is based on socioeconomic indica- quintile. The vast majority of participants lived in the North tors from the 2013 NZ Census and includes income, employ- Island of NZ (Auckland, Wellington and Rest of North ment, home ownership, and educational attainment. The Island), 73.1% of those with ADHD and 75.8% of those index is used to assign decile values (ranging from 1 to 10) to without ADHD. The ADHD group had fewer individuals the meshblocks (census areas) that individuals live in. In the residing in Auckland and the rest of the North Island, rela- current study, decile values were collapsed to quintiles with tive to those without ADHD. quintile 1 indicating areas of the least deprivation and quin- tile 5 indicating the greatest deprivation. Criminal Justice System Interactions Data Analysis Observed rates indicate that all CJS interactions were more The sociodemographic characteristics of the participant common in those with ADHD than those without (Figure 2). population were described descriptively, stratified by In those with ADHD, a considerable proportion, 53.4%, Anns et al. 5 Table 1. Sociodemographic Characteristics of Those With and Without ADHD at Baseline (age 17). ADHD n (%) Without ADHD n (%) Sex Male 3,057 (76.9%) 73,680 (50.8%) Female 918 (23.1%) 71,418 (49.2%) Ethnicity European 3,573 (89.9%) 111,126 (76.6%) Māori 1,017 (25.6%) 43,125 (29.7%) Pasifika 174 (4.4%) 16,680 (11.5%) Asian 84 (2.1%) 6,804 (4.7%) MELAA 42 (1.1%) 1,392 (1.0%) Other 21 (0.5%) 1,095 (0.8%) Socioeconomic Deprivation Quintile 1 (least deprived) 747 (18.8%) 28,326 (19.5%) Quintile 2 720 (18.1%) 26,343 (18.2%) Quintile 3 783 (19.7%) 25,764 (17.8%) Quintile 4 828 (20.8%) 26,931 (18.6%) Quintile 5 (most deprived) 876 (22.0%) 34,554 (23.8%) Missing 24 (0.6%) 3,183 (2.2%) Region Auckland 1,020 (25.7%) 41,004 (28.3%) Wellington 510 (12.8%) 15,084 (10.4%) Rest of N. Island 1,377 (34.6%) 53,892 (37.1%) Canterbury 567 (14.3%) 17,415 (12.0%) Rest of S. Island 498 (12.5%) 16,128 (11.1%) Missing S 1,578 (1.1%) Note. All counts have been random rounded to base 3. S indicates suppression due to small counts (<6). MELAA = Middle Eastern, Latin American, African. Figure 2. CJS interactions by ADHD status. Note. CJS = Criminal Justice System. were proceeded against by police by the age of 25 years. Cox proportion hazards analyses indicated that those Court charges were laid against 44.0%, 38.0% had received with ADHD were significantly more likely to interact with a court conviction, and 8.5% were incarcerated. the CJS relative to those without ADHD (Table 2). Comparatively, 28.0% of those without ADHD were pro- Moreover, the likelihood of CJS interactions for those with ceeded against by police, 20.6% were charged in court, ADHD increased through the CJS pathway from an adjusted 16.5% received a conviction, and 1.5% were incarcerated. HR of 2.1 for police proceedings, 2.2 for court charges, 2.3 6 Journal of Attention Disorders 00(0) Table 2. Summary of Hazard Ratios Associated With ADHD for Each Level of CJS Interactions. n Unadjusted HR (95% CI) Adjusted HR (95% CI) Overall Proceeded against by police 2,121 2.34 [2.24, 2.45] 2.07 [1.98, 2.17] Court charge 1,749 2.50 [2.38, 2.62] 2.21 [2.10, 2.32] Court conviction 1,512 2.62 [2.48, 2.76] 2.31 [2.19, 2.43] Incarceration 339 5.51 [4.92, 6.18] 4.81 [4.28, 5.41] Note. All counts have been random rounded to base 3. CJS = Criminal Justice System; HR = Hazard ratio; CI = Confidence interval. Adjusted for gender, ethnicity, deprivation, and area of residence. Table 3. Summary Statistics and Hazard Ratios Associated With ADHD Status for Offense Types. ADHD (N = 3,975) Non-ADHD Unadjusted HR Adjusted HR n % (N = 145,098) n % (95% CI) (95% CI) Serious offenses 882 (22.2%) 8,541 (5.9%) 4.02 [3.74, 4.33] 3.51 [3.26, 3.78] Offenses against the person 999 (25.1%) 11,256 (7.8%) 3.47 [3.25, 3.70] 2.79 [2.62, 2.98] Violent offenses 627 (15.8%) 5,847 (4.0%) 4.16 [3.83, 4.52] 3.65 [3.35, 3.97] Offenses against property 861 (21.6%) 8,094 (5.6%) 4.16 [3.88, 4.47] 3.78 [3.52, 4.06] Offenses against organizations, 1,296 (32.6%) 20,463 (14.1%) 2.57 [2.43, 2.72] 2.24 [2.12, 2.37] government and community Note. All counts have been random rounded to base 3. HR = Hazard ratio; CI = Confidence interval. Adjusted for gender, ethnicity, deprivation, and area of residence. for court convictions, and a substantial increase to 4.8 for between two to almost four times as likely to be convicted incarceration. compared to those without ADHD. Our finding of an increased risk of being proceeded against by police, being charged or convicted in court, and Offenses Types being incarcerated amongst those with ADHD is consistent Observed rates for conviction offense type by ADHD status with prior research in this area (Erskine et al., 2016; Mohr- and unadjusted and adjusted HRs are presented in Table 3. Jensen & Steinhausen, 2016; Mohr-Jensen et al., 2019). Individuals with ADHD had higher observed rates for all However, in contrast to previous studies, we also observed a offense types relative to those without ADHD. Likewise, clear pattern of increasing risk of CJS interactions as indi- cox proportional hazard analyses indicated that ADHD was viduals with ADHD proceeded through the system. More associated with significantly increased likelihood of all specifically, while the effect sizes we observed for the risk of offense types relative to those without ADHD. The adjusted police proceedings, court charges and court convictions fall hazards of conviction for serious offenses (HR 3.5), violent within the range of those previously reported for people with offenses (HR 3.7), and offenses against property (HR 3.8) ADHD, for incarcerations we report a substantially higher were particularly high. risk (Mohr-Jensen & Steinhausen, 2016; Mohr-Jensen et al., 2019). The greater effect size for incarceration observed in our study may be due to the lack of control for comorbid Discussion conditions such as CD, which are known criminogenic risk The current study utilized linked population-level health factors (Pratt et al., 2002), or the possibility of the case iden- and CJS data to examine interactions with, and pathways tification method used in the current study capturing more through, the CJS for young adults with and without ADHD severe cases of ADHD (Bowden, Gibb et al., 2020). The in NZ. Findings revealed that over half of young adults with sharp increase in the risk of incarceration observed may also ADHD interacted with the CJS by their 25th birthday. signal differences in the NZ justice system’s approach to Moreover, when controlling for important sociodemo- ADHD, which may be less responsive to the condition than graphic factors, individuals with ADHD were over two other nations, particularly the steps in the justice system times as likely to be proceeded against by police and between conviction and sentence. This would suggest that charged or convicted in court and almost five times as likely the UNCRPD obligations of equal recognition before the to be incarcerated than those without ADHD. Analyses also law and the elimination of discrimination on the basis of dis- revealed that for all offense types, those with ADHD were ability are not being met for individuals with ADHD in NZ. Anns et al. 7 The finding indicating that ADHD is associated with an during sentencing the potential for incarceration to exacer- increased risk across the spectrum of conviction offense bate symptoms, increase the risk of mistreatment, or be a types is consistent with the limited research to date (Retz more difficult experience than for people without ADHD et al., 2021). Our findings that the largest effect sizes were may need to be considered (Freckelton, 2019). The failure observed for serious offenses, violent offenses, and offenses of any CJS to screen for or respond appropriately to ADHD against property broadly reflect those of Mohr-Jensen et al. may therefore have serious implications such as causing a (2019). These findings may support the idea of an associa- subjectively more painful and less productive experience tion between ADHD and more impulsive crimes (e.g., bur- for a reasonable proportion of offenders (Pratt et al., 2002). glary and theft), particularly for individuals with higher A recent NZ justice system initiative has emerged in recog- levels of impulsivity (Fletcher & Wolfe, 2009). Symptoms nition of the need to respond more quickly and more effec- of impulsivity may also explain associations between tively to neurodivergence (Walker & Doogue, 2019). At this ADHD and violent crimes such as assault but only when stage, there is no mechanism within the initiative to screen these crimes occur in a reactive and not proactive/premedi- for specific neurodiverse conditions, including ADHD tated context (Retz & Rösler, 2009). Retz and Rösler (2009) (Clasby et al., 2022). suggest that a relationship between ADHD and reactive The current study also provides NZ data on ADHD in the aggression may be feasible due to the psychopathological CJS for the first time and demonstrates an ability to use characteristics of ADHD. Reactive aggression tends to be linked administrative data to help NZ meet its UNCRPD driven by affective outbursts and impulsivity. It is not pre- obligation of collecting disability data (Article 31). Such meditated but arises spontaneously, generally as a reaction methodology could be periodically replicated and expanded to conflict or provocation with the sole aim of reducing ten- upon both in NZ and abroad for better monitoring of States sion and agitation (Retz & Rösler, 2009). This may explain Parties progress toward meeting their obligations under the a link between violent crime at least in a reactive context UNCPRD in relation to the CJS. In particular, the use of and the hyperactive-impulsive symptoms of ADHD (Retz integrated data to enable analysis of the pathway through & Rösler, 2009). the CJS at a population level is novel and provides more nuanced insights into the disabling experiences of young adults with ADHD in the CJS. Implications The overrepresentation of individuals with ADHD at each Strengths and Limitations stage of the CJS suggests that the NZ CJS is failing to iden- tify individuals with ADHD either before or during their The current study has a number of strengths. Firstly, we interactions with the legal system, or that the legal system is were able to establish a large, 3-year national birth cohort, correctly identifying these individuals but failing to respond tracking participants until their 25th birthday. The use of to and make appropriate accommodations. The identifica- linked data allowed us to identify those with and without tion and consideration of ADHD is important because due ADHD and examine their interactions with the CJS at mul- to the symptoms of the condition, these individuals may be tiple contact points including police, courts, and correc- at risk from their moment of first contact with the CJS. tions. We were also able to explore differences in the types Moreover, it has been suggested that individuals with of offending for those with compared to those without ADHD may find the nature of incarceration more difficult ADHD, which allowed us to investigate how their pathways than those without the condition (Baggio et al., 2018; might differ from one another. Additionally, the use of Freckelton, 2019). Compared to offenders without ADHD, linked data meant that we were able to control for various individuals with ADHD have been shown to be more likely sociodemographic factors and account for early exits during to engage in misconduct in prison such as verbal or physical the observation period (e.g., emigration and death). aggression, damage to property, and incidents involving There are several limitations to the current study that self-injury (e.g., self-harm or suicidal behaviors) (Baggio should be noted. We did not control for the effects of condi- et al., 2018; Retz et al., 2021; Young & Cocallis, 2022). tions highly comorbid with ADHD such as CD and SUDs, This may be due to symptoms such as hyperactivity or which may be associated with an increased risk of delin- impulsivity impairing an individual’s ability to effectively quency and crime (Pratt et al., 2002; Retz et al., 2021; cope with the structure and demands of imprisonment Sibley et al., 2011). While some studies have shown an which may lead to disciplinary infractions, the prevention independent effect of ADHD on offending when controlling of early release, and even further convictions and extended for comorbid conditions (e.g., Sibley et al., 2011), other sentences (Young & Cocallis, 2022). As such, it has been research has shown no independent effect of ADHD on suggested that punishment via incarceration may not be crime when controlling for comorbidities (e.g., Mordre effective in preventing recidivism in those with ADHD et al., 2011; Retz et al., 2021). This was considered out of (Mohr-Jensen et al., 2019). It has also been suggested that scope for the present study in part because the data source 8 Journal of Attention Disorders 00(0) used (the IDI) is not effective in capturing co-occurring in criminality (Philipp-Wiegmann et al., 2018; Retz et al., conditions of interest such as CD (Bowden, Gibb et al., 2021) and a significant risk reduction for convictions and 2020). However, we note that by focusing on what we know incarcerations (Mohr-Jensen et al., 2019). This may also we can capture in the IDI, it allows us to consider whether disrupt any pathways that may exist from ADHD to the approaches can be developed based on a screening for development of SUDs. It has been suggested that multi- ADHD, regardless of the presence of co-occurring modal interventions may be most effective, with medication conditions. reducing the symptoms of ADHD to increase engagement The use of administrative data for identifying ADHD with the non-pharmacological side of treatment (e.g., CBT) likely undercounts, and may falsely identify, cases. For (Retz et al., 2021). More research is needed to examine the example, the method relies on health service use and will efficacy of early intervention and treatment for ADHD on not capture individuals with ADHD who are not accessing CJS outcomes in a NZ context. It would also assist policy treatments (Milne et al., 2022). Alternatively, the use of makers to understand how various participants in the CJS pharmaceuticals as indications of ADHD may falsely cap- become aware of information on ADHD and whether legal ture individuals who may be accessing these medications processes and procedures are altered in response to such for other conditions (D’Souza et al., 2020). The level of information. undercount is reflected in the relatively low prevalence of Further research is necessary to understand why the risk ADHD found in our sample at 2.7% compared with world- of CJS interactions increases so sharply from conviction to wide prevalence estimates typically in the 5-7% range sentence for young persons with ADHD. A better under- (Freckelton, 2019; Holland et al., 2023; Retz et al., 2021; standing of how young persons with ADHD experience that Young & Cocallis, 2022). The effect that any misclassifica- pathway will inform how best to mitigate this disabling tion bias may have had on our findings is unknown. As our experience. This could present a significant opportunity for case identification method may also capture more complex NZ and other countries to innovate, including by allowing or severe cases of ADHD, this may partly explain the for supports, accommodation, and alternative pathways increasing risk of CJS interactions observed as individuals (e.g., restorative justice) in order to ensure obligations with ADHD moved through the justice system. Lastly, as under the UNCRPD are met. our cohort excludes migrants to NZ who make up almost one-third of young people between 20 and 24 years of age Conclusion living in the country (Statistics New Zealand, 2013), it is only representative of those born in NZ and not the popula- Our findings revealed that not only were individuals with tion as a whole. ADHD overrepresented at all stages of the CJS and offense types examined, there was also a pattern of increasing risk for CJS interactions as these individuals moved through the Further Research system. These results highlight the importance of early To fully elucidate and understand the relationship between identification and responsivity to ADHD within the CJS ADHD and CJS interactions, there is a need for more and suggest that the NZ justice system may require changes research employing large, representative samples with lon- to both of these areas to ensure that young individuals with gitudinal rather than cross-sectional designs. The impor- ADHD receive equitable access to, and treatment within, tance of controlling for co-occurring psychiatric conditions the CJS. The current study has also revealed the utility of such as CD and SUDs has been highlighted by a number of effective data linkage in better understanding the pathways previous studies, due to their independent associations with of individuals with ADHD through the CJS. crime, and the extent to which this impacts CJS interactions among individuals with ADHD in NZ needs to be deter- Declaration of Conflicting Interests mined. Future research could also benefit from exploring The author(s) declared no potential conflicts of interest with the role of other risk and protective factors for CJS interac- respect to the research, authorship, and/or publication of this tions among those with ADHD in NZ. For example, research article. has noted that while co-occurring autism may be a protec- tive factor against crime in those with ADHD (Mohr-Jensen Funding et al., 2019), adverse outcomes across schooling and The author(s) disclosed receipt of the following financial support employment that are associated with ADHD may interact for the research, authorship, and/or publication of this article: The and exacerbate one another, increasing the likelihood of authors acknowledge the New Zealand Law Foundation and the delinquency (Erskine et al., 2016). The potential benefits of Michael and Suzanne Borrin Foundation who jointly funded a early intervention and treatment of ADHD have also been project on neurodevelopmental impairment and the criminal jus- highlighted with evidence that active periods of treatment tice system. This study details findings related to one aspect of this with ADHD medication may be associated with reductions wider project. D’Souza and Bowden’s time was funded by A Anns et al. 9 Better Start National Science Challenge, in turn funded by the courtroom: A brief evaluation of environmental accommo- New Zealand Ministry of Business, Innovation and Employment, dations to increase procedural fairness. Criminal Behaviour grants UOAX1511 and UOAX1901. and Mental Health, 32(3), 197–211. https://doi.org/10.1002/ cbm.2239 Criminal Procedure Act, § 6. (2011). https://www.legislation.govt. Disclaimer nz/act/public/2011/0081/latest/DLM3360039.html These results are not official statistics. They have been created for Cunial, K. J., Casey, L. M., Bell, C., & Kebbell, M. R. research purposes from the Integrated Data Infrastructure (IDI) (2020). Investigative interviewing of youth with ADHD which is carefully managed by Stats NZ. For more information about – Recommendations for detective training. Psychiatry the IDI please visit https://www.stats.govt.nz/integrated-data/. Psychology and Law, 27(5), 797–814. https://doi.org/10.1080 /13218719.2020.1742241 ORCID iD D’Souza, S., Bowden, N., Gibb, S., Shackleton, N., Audas, R., Hetrick, S., Taylor, B., & Milne, B. (2020). Medication dis- Francesca Anns https://orcid.org/0009-0006-7276-0211 pensing for attention-deficit/hyperactivity disorder to New Zealand youth. The New Zealand Medical Journal, 133, Supplemental Material 84–95. Supplemental material for this article is available online. Erskine, H. E., Norman, R. E., Ferrari, A. J., Chan, G. C. K., Copeland, W. E., Whiteford, H. A., & Scott, J. G. (2016). References Long-term outcomes of attention-deficit/hyperactivity disorder and conduct disorder: a systematic review and Australian Bureau of Statistics. (2011). Australian and New meta-analysis. Journal of the American Academy of Child Zealand standard offence classification (ANZSOC) (3rd ed.). and Adolescent Psychiatry, 55(10), 841–850. https://doi. 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Neuroscience and Biobehavioral Zealand. https://www.districtcourts.govt.nz/assets/Uploads/ Anns et al. 11 Proposal-for-a-trial-of-Young-Adult-List-in-Porirua-District- Zealand. He is passionate about analyzing data in ways that lead to Court-pdf.pdf better outcomes for people and toward a more equitable Aotearoa. Watts, S. J. (2018). ADHD symptomatology and criminal behav- Brigit Mirfin-Veitch is the Director of the Donald Beasley ior during adolescence: Exploring the mediating role of Institute and an Associate Professor (Research) with the Centre for school factors. International Journal of Offender Therapy Postgraduate Nursing, University of Otago. Brigit is a sociologist and Comparative Criminology, 62(1), 3–23. https://doi. and her research is strongly focused on equitable access to justice org/10.1177/0306624X16639970 for all disabled people. She has a particular interest in understand- Willcutt, E. G. (2012). The prevalence of DSM-IV attention- ing how neurodivergent young people experience the criminal jus- Deficit/Hyperactivity Disorder: A meta-Analytic Review. tice system. Neurotherapeutics, 9, 490–499. https://doi.org/10.1007/ s13311-012-0135-8 Betony Clasby is a doctoral researcher with the Department of Young, S., Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, Sociological Studies at the University of Sheffield, United M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, Kingdom. Betony takes a multidisciplinary approach that encom- G., Hill, P., Hollingdale, J., Kilic, O., Lloyd, T., Mason, P., passes the fields of neuropsychology, social policy, criminology, Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., . . . and education. Her research seeks to counter systemic disadvan- Woodhouse, E. (2020). Females with ADHD: An expert con- tages faced by those with neurological differences within educa- sensus statement taking a lifespan approach providing guid- tional and criminal justice settings, from screening and identifica- ance for the identification and treatment of attention-deficit/ tion to intervention and policy. hyperactivity disorder in girls and women. BMC Psychiatry, Nathan Hughes is Professor of Adolescent Health and Justice in 20(1), 1–27. https://doi.org/10.1186/s12888-020-02707-9 the Department of Sociological Studies at the University of Young, S., & Cocallis, K. (2022). Attention-Deficit/Hyperactivity Sheffield, UK. His research focuses on experiences of neurodevel- Disorder (ADHD) and Offending. In C. Garofalo & J. J. opmental conditions, with a particular emphasis on processes of Sijtsema (Eds.), Clinical Forensic Psychology: Introductory criminalization and opportunities for policy and practice reform. Perspectives on Offending (pp. 303–319). Springer To achieve the latter, he is co-chair of the Global Law and Public International Publishing. https://doi.org/10.1007/978-3-030- Health Association’s Neurodisability and Neurodiversity group, 80882-2_16. and the Acquired Brain Injury Justice Forum. Zalsman, G., & Shilton, T. (2016). Adult ADHD: A new disease? International Journal of Psychiatry in Clinical Practice, Warren Forster is the Director of Simply Resolution Limited. 20(2), 70–76. https://doi.org/10.3109/13651501.2016.11491 Warren is a barrister and researcher. His research interests include a focus on innovations to improve accesses to justice, particularly for disabled people. He is interested to develop a deeper under- Author Biographies standing of how disabled people experience the formal and infor- mal components of the justice system and how this system can be Francesca Anns is a Research Assistant with the Centre of co-designed to remove access barriers and the resulting disabling Methods and Policy Application in the Social Sciences experiences. (COMPASS) and is currently studying toward her PhD in Psychology at the University of Auckland, New Zealand. She has Eden Tuisaula is a research assistant at the Donald Beasley a particular interest in the use of population-level data to investi- Institute in Dunedin, New Zealand. Eden is completing her Master gate outcomes relating to health and well-being. of Arts Psychology at Massey University and holds a Bachelor of Applied Science majoring in Psychology. Eden has ADHD, which Stephanie D’Souza is a Senior Lecturer with the School of Social underpins her interest in disability rights, social justice and Sciences and Centre of Methods and Policy Application in the research informed by lived experience. Social Sciences (COMPASS) at the University of Auckland, New Zealand. Her research involves applying quantitative methods to Nicholas Bowden is a Research Fellow with the Department of understand social, health, and wellbeing outcomes over the lifes- Women’s and Children’s Health at the University of Otago, New pan using survey and administrative data. Zealand. He is a quantitative social scientist specializing in the use of population-level linked health and non-health data. His research Conrad MacCormick is an Analytics Lead at Nicholson interests include mental health and neurodevelopmental conditions Consulting. He has more than 12 years’ experience in data and with a focus on reducing inequities and improving well-being. statistics roles across both the public and private sectors in New http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Attention Disorders SAGE

Risk of Criminal Justice System Interactions in Young Adults with Attention-Deficit/Hyperactivity Disorder: Findings From a National Birth Cohort

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SAGE
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©The Author(s) 2023
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1087-0547
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1557-1246
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10.1177/10870547231177469
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Abstract

Objective: To examine criminal justice system (CJS) interactions and pathways through the justice system for young adults with ADHD compared to young adults without ADHD. Method: Nationwide 3-year birth cohort study using linked health and CJS data. Cox proportional hazards models were employed to examine associations between ADHD and police proceedings, court charges, court convictions, and incarcerations. Results: Young adults with ADHD were significantly more likely to interact with the CJS including police proceedings (hazard ratio [HR], 2.1 95% CI [2.0, 2.2]) court charges (HR, 2.2 95% CI [2.1, 2.3]), court convictions (HR, 2.3 95% CI [2.2, 2.4]), and incarceration (HR, 4.8 95% CI [4.3, 5.4]). Conclusions: Young adults with ADHD are overrepresented at all stages of the CJS. Results highlight the importance of early identification and responsivity to ADHD within the CJS and suggest that the NZ justice system may require changes to both areas to ensure that young individuals with ADHD receive equitable access to, and treatment within, the CJS. (J. of Att. Dis. XXXX; XX(X) XX-XX) Keywords ADHD, criminal justice system interactions, neurodevelopment, integrated data infrastructure would fiddle, be restless. After much consultation, I turned Introduction the essence of the ADHD experience to the positive: aro- Attention-Deficit/Hyperactivity Disorder (ADHD) is clini- reretini, (literally, ‘attention goes to many things’)” (Opai, cally defined as a neurodevelopmental condition character- 2022, p. 1182). ized by the presence of pervasive and developmentally Despite these more positive understandings of ADHD, excessive levels of hyperactivity, impulsivity, and difficul- research has consistently identified people with ADHD as ties in attention (Mehta et al., 2019; Sayal et al., 2018; experiencing high rates of mental health disorders such as Young & Cocallis, 2022). The executive functions impaired in ADHD have been identified as being those of activation, focus, effort, emotion, memory and action (Brown, 2013). University of Auckland, New Zealand Contemporary conceptualizations of ADHD increasingly A Better Start National Science Challenge, New Zealand Nicholson Consulting, Wellington, New Zealand apply a strengths-based lens to explore and explain this het- Donald Beasley Institute, Dunedin, Otago, New Zealand erogenous condition (see e.g., Redshaw & McCormack, University of Sheffield, UK 2022; Sedgwick et al., 2019). In Aotearoa New Zealand University of Otago, Dunedin, New Zealand (NZ), Opai (2022) recently contested negative and medical- Simply Resolution Limited, Wellington, New Zealand ized conceptualizations of ADHD and offered a Te Ao Corresponding Author: Māori (Māori world) perspective on the condition (Māori Nicholas Bowden, Department of Women’s and Children’s Health, The are the indigenous population of NZ). “ADHD has always University of Otago, 201 Great King Street, Dunedin 9016, New Zealand. been seen as a negative term. People could not concentrate, Email: Nick.Bowden@otago.ac.nz 2 Journal of Attention Disorders 00(0) substance use disorders (SUDs), emotional dysregulation, meta-analytic prevalence of ADHD increased to 41.1% of and self-harm. ADHD has also been associated with disrup- the sample (Baggio et al., 2018). tive, defiant, and antisocial behaviors (Cherkasova et al., Regarding associations between ADHD and offense 2022; Erskine et al., 2016; Retz et al., 2021; Sayal et al., types, there is a dearth of research available and existing 2018; Spencer, 2006). People with ADHD often face chal- studies have been limited by small convenience samples or lenges in interpersonal relationships, education, including cross-sectional designs (Fletcher & Wolfe, 2009), and retro- suspensions/expulsion from school and lower tertiary spective, self-report measures of ADHD symptomatology enrollment, and employment (Cherkasova et al., 2022; in childhood (e.g., Román-Ithier et al., 2017; Watts, 2018). Sayal et al., 2018; Zalsman & Shilton, 2016). While, Mohr-Jensen et al. (2019) reported that all recorded While estimates of ADHD prevalence vary due to meth- offenses (except for murder) were significantly higher for odological differences between studies, it is generally those with ADHD than controls, more research employing accepted that the global prevalence among children and large, representative samples is needed to elucidate whether young people is currently around 5-7% (Freckelton, 2019; an association exists between ADHD and certain offense Holland et al., 2023; Retz et al., 2021; Sayal et al., 2018; types. Young & Cocallis, 2022; Zalsman & Shilton, 2016). The Several theories exist on the association between ADHD male to female ratio of ADHD is estimated to be 3:1 and CJS interactions. Some suggest that the symptomatol- (Slobodin & Davidovitch, 2019; Willcutt, 2012; Young ogy of ADHD may lead to crime due to its associations with et al., 2020; Zalsman & Shilton, 2016). low self-control, a widely known criminogenic risk factor A large body of research suggests that ADHD may be a (Pratt et al., 2002; van der Maas et al., 2018). Others sug- risk factor for interactions with the criminal justice system gest that impulsive, cognitive, and behavioral symptoms (CJS). In a meta-analysis of 15,442 children and adoles- may mean that these individuals are more likely to get cents (aged 4–15) with ADHD from nine unique samples, caught for crimes committed due to traces left behind (e.g., ADHD was associated with a two- to threefold increase in DNA) (Mohr-Jensen & Steinhausen, 2016). ADHD may the risk of arrests, convictions, and incarcerations in ado- also be overrepresented in CJS interactions due to its lescence and adulthood compared to controls without comorbidity with other psychiatric conditions linked to ADHD (Mohr-Jensen & Steinhausen, 2016). Significant criminal behaviors, such as conduct disorder, SUDs, and associations between ADHD and both convictions and antisocial personality disorder (ASPD) (Pratt et al., 2002; incarcerations were more recently demonstrated in a Retz et al., 2021; Sibley et al., 2011). It has also been sug- Danish nationwide longitudinal study, though these effects gested that impaired socialization and social bonds during were smaller than previously reported risks due to adjust- development, due to adverse outcomes associated with ment for known individual and familial criminogenic risk ADHD symptomatology, may lead to CJS interactions (van factors (Mohr-Jensen et al., 2019). Research has also der Maas et al., 2018; Watts, 2018). This theorizing is con- reported that, compared to individuals without ADHD, sistent with the social model of disability, which recognizes those with ADHD are more likely to be younger at first that people with impairments are disabled by socially con- arrest and conviction (Philipp-Wiegmann et al., 2018; structed barriers including ableist attitudes, systems, struc- Young & Cocallis, 2022) and tend to have an increased tures, and environments (Oliver, 2013; Shakespeare, 2017). risk of recidivism (Retz et al., 2021), and a higher number It is therefore important to not only understand how of further engagements with the CJS (Philipp-Wiegmann ADHD might lead to interactions with the CJS but also the et al., 2018). ways in which ADHD may shape these interactions and This increased risk of CJS interactions is also reflected affect an individual’s pathway through the justice system. in the disproportionately higher rates of ADHD reported All signatory states to the United Nations Convention on across multiple contact points within the CJS, including the Rights of Persons with Disabilities (UNCRPD) have a police custody/arrests, prison, probation, and forensic men- series of legal obligations to protect disabled people tal health settings (Young & Cocallis, 2022). Compared to (UNCRPD articles 12, 13, 14, and 31). These include ensur- rates of ADHD in the general population, research suggests ing equal recognition before the law and the provision of that there may be around five times the rate of ADHD in effective access to justice, protecting the liberty and secu- youth offender populations and 10 times the rate of ADHD rity of the person (The Office of the High Commissioner for in adult offender populations (Retz et al., 2021; Young & Human Rights, 2006). Cocallis, 2022). In a meta-analysis pooling 102 original However, individuals with ADHD may be at risk from studies including 69,997 participants, Baggio et al. (2018) their moment of first contact with the CJS (e.g., police cus- calculated an ADHD prevalence of 26.2% in adult detention tody and court proceedings) for several reasons. Firstly, populations, corresponding to at least a five-fold over-rep- they may be perceived as uncooperative or less credible as resentation compared to the general population. When ret- they are more likely to respond to questions with “don’t rospectively assessing ADHD rates in childhood, the know” rather than denying suggestions put to them Anns et al. 3 (possibly due to a lack of confidence in their memory) (Mohr-Jensen & Steinhausen, 2016; Young & Cocallis, 2022). Secondly, individuals with ADHD may be at risk of making false confessions or providing false information, due to the use of inappropriate interviewing techniques (Cunial et al., 2020), greater levels of compliance resulting from difficulties with anxiety or low self-esteem, or due to ADHD symptoms (e.g., restlessness, hyperactivity) moti- vating individuals to leave the police station (Gudjonsson et al., 2008; Young & Cocallis, 2022). Signatory states are also required to collect appropriate data to demonstrate they are complying with the obligations set forth in the UNCRPD (Bowden et al., 2022). However, Figure 1. Participant flow chart. Note. All counts have been random rounded to base 3. there are considerable challenges in accessing such data. For example, the NZ government has acknowledged a heavy reliance on international prevalence data to inform died prior to their 17th birthday were excluded. The final national response due to current limitations with data col- sample consisted of 149,076 individuals (see Figure 1). lection (Office for Disability Issues, 2019). Linked population-level health and CJS data from NZ Attention-Deficit/Hyperactivity Disorder provides an opportunity to fill known gaps in the literature ADHD status was determined using an established case iden- regarding ADHD and CJS interactions. In particular, by tification method (Bowden, Thabrew, Kokaua, & Braund, enabling analysis of the pathway through the CJS and 2020; Bowden, Gibb et al., 2020; McLay et al., 2022). This addressing methodological shortcomings in extant research. method uses diagnosis codes and inference from medication They also provide essential data specific to the NZ-context. dispensing contained within four health datasets managed by The aims of the current study are therefore to: (1) Investigate the NZ Ministry of Health: hospital admissions data from the the benefits of using linked administrative data to contribute National Minimum Dataset (NMDS); specialty mental health to research regarding CJS interactions among young people service use data from the Program for the Integration of with ADHD; (2) Examine CJS interactions and pathways Mental Health Data (PRIMHD); subsidized pharmaceutical through the justice system for young adults with ADHD dispensings from the NZ Pharmaceutical Management compared to young adults without ADHD; and (3) Assess Agency (PHARMAC); and the Ministry of Health’s disability whether associations exist between ADHD and specific support services dataset, Socrates. Codes used to indicate offense types in comparison to individuals without ADHD. ADHD within each of these datasets are provided in the Supplemental Material (Table S1). Individuals were identified Methods with ADHD if they obtained at least one code relating to an ADHD diagnosis in any of the four datasets. As ADHD is Study Design, Population, and Data considered to be a lifetime neurodevelopmental condition, This was a national 3-year birth cohort study using data case identification reviewed diagnosis data from birth through from Statistics New Zealand’s Integrated Data Infrastructure to the end of the study period. (IDI), a large database of linked de-identified administra- tive and survey data about people and households. The IDI Criminal Justice System Measures is a world-leading resource containing population-level data across a range of life domains including health, educa- Four CJS interaction variables of increasing severity were tion, the labor market, housing, social welfare, and the CJS of interest: police proceedings, court charges, court convic- (see Milne et al. (2019) for a detailed description). The tions, and incarcerations. Information on police proceed- study population consisted of all those born in NZ between ings was obtained from NZ police recorded offender data. 1 July 1992 and 30 June 1995, identified using the Court charges and convictions were drawn from Ministry of Department of Internal Affairs birth records. Justice courts data. Incarcerations were obtained from the The observation window for CJS interactions was Department of Corrections dataset. For each CJS interac- between the participants’ 17th and 25th birthdays, as New tion variable, individuals were coded as 1 if they had any Zealanders are subject to the adult court from age 17 and are interaction over an 8-year period from their 17th birthday considered young adults until 25. This age range is also in through to their 25th birthday and 0 for no interaction. Dates keeping with research evidence (Prior et al., 2011). for when each type of interaction occurred were also Individuals who spent two or more years outside of NZ or available. 4 Journal of Attention Disorders 00(0) Offense types for criminal convictions were defined using ADHD status. Observed rates of each of the four CJS inter- the Australian and New Zealand Standard Offense action types and conviction offense types were calculated Classification (ANZSOC), a commonly used method of clas- for those with and without ADHD. Cox proportional haz- sifying offense types in Australia and NZ (Australian Bureau ards models were employed to examine associations of Statistics, 2011). ANZSOC divisions and their descriptions between ADHD and each CJS interaction (proceedings, are provided in the Supplemental Material (Table S2). Specific charges, convictions, and incarcerations). Unadjusted and divisions were combined to create different offense types: adjusted hazard ratios (HRs) for ADHD with 95% confi- offenses against people (ANZSOC divisions 1–6); offenses dence intervals (CIs) were estimated using the robust vari- against property (ANZSOC divisions 6–9, and 12); offenses ance estimator (Lin & Wei, 1989). Adjusted analyses against organizations, government and community (ANZSOC included sex, age, ethnicity, area-level deprivation, and area divisions 10–11, and 13–16); and violent offenses (ANZSOC of residence in the model. Participants were right censored divisions: 2 and 3; ANZSOC subdivisions: murder, attempted if they died, traveled overseas for a period greater than murder, abduction and kidnapping, deprivation of liberty/ 3 consecutive months (92 days) or reached the end of the false imprisonment, robbery; and the ANZSOC group man- study period (i.e., their 25th birthday) without experiencing slaughter [does not include driving causing death]). Each the relevant CJS interaction. Associations between ADHD offense type was treated as a dichotomous variable (con- and conviction for different offense types were also exam- victed/not convicted). First date of conviction for an offense ined, replicating the cox proportional hazards analysis type was also available. described. The decision was made to focus on convictions, The seriousness of offenses was defined using the cate- as this is the first interaction type in the system that appears gorization in the Criminal Procedure Act, § 6 (2011). on an individual’s criminal record. Serious offenses were those punishable by imprisonment of Data management was undertaken in SAS Enterprise two or more years. This was used to create a dichotomous Guide version 7.1 (SAS Institute Inc, 2014) and analyses serious offense indicator. Individuals were coded as 1 if were conducted in Stata MP version 15 (StataCorp, 2017). they were convicted of a serious offense, with all other indi- As per the confidentiality requirements of Statistics New viduals coded as 0. First conviction date for those in the Zealand, raw counts were suppressed if below 20 for CJS serious offense category was also extracted. interactions and below 6 for all other variables. All counts were randomly rounded to base 3. Sociodemographic Variables Results Sociodemographic variables included sex (male/female), age (in years), ethnicity, area of residence, and area-level depri- Participant Population vation. Ethnicity was measured in total response format, Of the 149,076 individuals in our final sample, 2.7% allowing individuals to identify with one or more of the fol- (n = 3,975) were identified as having ADHD. The sociode- lowing ethnic groups: European; Māori; Pacific; Asian; mographic characteristics for those with and without ADHD Middle Eastern, Latin American, African (MELAA); Other. in our sample are presented in Table 1. Those with ADHD Multiple ethnic identification is a common occurrence in NZ were more likely to be male and identify as European, rela- (Statistics New Zealand, 2005). Area-level deprivation and tive to those without ADHD. In contrast, there were fewer area of residence were based on address information at Māori, Pasifika, and Asian individuals amongst those with 17 years of age. Area of residence was categorized into five ADHD relative to those without. Across both ADHD and locations: Auckland; Wellington; rest of the North Island; non-ADHD groups, there was a similar proportion of indi- Canterbury; rest of the South Island. The NZ Deprivation viduals in each deprivation quintile, with a slightly greater Index 2013 (NZDep2013) was used to capture area-level proportion of people without ADHD in the most deprived deprivation. NZDep2013 is based on socioeconomic indica- quintile. The vast majority of participants lived in the North tors from the 2013 NZ Census and includes income, employ- Island of NZ (Auckland, Wellington and Rest of North ment, home ownership, and educational attainment. The Island), 73.1% of those with ADHD and 75.8% of those index is used to assign decile values (ranging from 1 to 10) to without ADHD. The ADHD group had fewer individuals the meshblocks (census areas) that individuals live in. In the residing in Auckland and the rest of the North Island, rela- current study, decile values were collapsed to quintiles with tive to those without ADHD. quintile 1 indicating areas of the least deprivation and quin- tile 5 indicating the greatest deprivation. Criminal Justice System Interactions Data Analysis Observed rates indicate that all CJS interactions were more The sociodemographic characteristics of the participant common in those with ADHD than those without (Figure 2). population were described descriptively, stratified by In those with ADHD, a considerable proportion, 53.4%, Anns et al. 5 Table 1. Sociodemographic Characteristics of Those With and Without ADHD at Baseline (age 17). ADHD n (%) Without ADHD n (%) Sex Male 3,057 (76.9%) 73,680 (50.8%) Female 918 (23.1%) 71,418 (49.2%) Ethnicity European 3,573 (89.9%) 111,126 (76.6%) Māori 1,017 (25.6%) 43,125 (29.7%) Pasifika 174 (4.4%) 16,680 (11.5%) Asian 84 (2.1%) 6,804 (4.7%) MELAA 42 (1.1%) 1,392 (1.0%) Other 21 (0.5%) 1,095 (0.8%) Socioeconomic Deprivation Quintile 1 (least deprived) 747 (18.8%) 28,326 (19.5%) Quintile 2 720 (18.1%) 26,343 (18.2%) Quintile 3 783 (19.7%) 25,764 (17.8%) Quintile 4 828 (20.8%) 26,931 (18.6%) Quintile 5 (most deprived) 876 (22.0%) 34,554 (23.8%) Missing 24 (0.6%) 3,183 (2.2%) Region Auckland 1,020 (25.7%) 41,004 (28.3%) Wellington 510 (12.8%) 15,084 (10.4%) Rest of N. Island 1,377 (34.6%) 53,892 (37.1%) Canterbury 567 (14.3%) 17,415 (12.0%) Rest of S. Island 498 (12.5%) 16,128 (11.1%) Missing S 1,578 (1.1%) Note. All counts have been random rounded to base 3. S indicates suppression due to small counts (<6). MELAA = Middle Eastern, Latin American, African. Figure 2. CJS interactions by ADHD status. Note. CJS = Criminal Justice System. were proceeded against by police by the age of 25 years. Cox proportion hazards analyses indicated that those Court charges were laid against 44.0%, 38.0% had received with ADHD were significantly more likely to interact with a court conviction, and 8.5% were incarcerated. the CJS relative to those without ADHD (Table 2). Comparatively, 28.0% of those without ADHD were pro- Moreover, the likelihood of CJS interactions for those with ceeded against by police, 20.6% were charged in court, ADHD increased through the CJS pathway from an adjusted 16.5% received a conviction, and 1.5% were incarcerated. HR of 2.1 for police proceedings, 2.2 for court charges, 2.3 6 Journal of Attention Disorders 00(0) Table 2. Summary of Hazard Ratios Associated With ADHD for Each Level of CJS Interactions. n Unadjusted HR (95% CI) Adjusted HR (95% CI) Overall Proceeded against by police 2,121 2.34 [2.24, 2.45] 2.07 [1.98, 2.17] Court charge 1,749 2.50 [2.38, 2.62] 2.21 [2.10, 2.32] Court conviction 1,512 2.62 [2.48, 2.76] 2.31 [2.19, 2.43] Incarceration 339 5.51 [4.92, 6.18] 4.81 [4.28, 5.41] Note. All counts have been random rounded to base 3. CJS = Criminal Justice System; HR = Hazard ratio; CI = Confidence interval. Adjusted for gender, ethnicity, deprivation, and area of residence. Table 3. Summary Statistics and Hazard Ratios Associated With ADHD Status for Offense Types. ADHD (N = 3,975) Non-ADHD Unadjusted HR Adjusted HR n % (N = 145,098) n % (95% CI) (95% CI) Serious offenses 882 (22.2%) 8,541 (5.9%) 4.02 [3.74, 4.33] 3.51 [3.26, 3.78] Offenses against the person 999 (25.1%) 11,256 (7.8%) 3.47 [3.25, 3.70] 2.79 [2.62, 2.98] Violent offenses 627 (15.8%) 5,847 (4.0%) 4.16 [3.83, 4.52] 3.65 [3.35, 3.97] Offenses against property 861 (21.6%) 8,094 (5.6%) 4.16 [3.88, 4.47] 3.78 [3.52, 4.06] Offenses against organizations, 1,296 (32.6%) 20,463 (14.1%) 2.57 [2.43, 2.72] 2.24 [2.12, 2.37] government and community Note. All counts have been random rounded to base 3. HR = Hazard ratio; CI = Confidence interval. Adjusted for gender, ethnicity, deprivation, and area of residence. for court convictions, and a substantial increase to 4.8 for between two to almost four times as likely to be convicted incarceration. compared to those without ADHD. Our finding of an increased risk of being proceeded against by police, being charged or convicted in court, and Offenses Types being incarcerated amongst those with ADHD is consistent Observed rates for conviction offense type by ADHD status with prior research in this area (Erskine et al., 2016; Mohr- and unadjusted and adjusted HRs are presented in Table 3. Jensen & Steinhausen, 2016; Mohr-Jensen et al., 2019). Individuals with ADHD had higher observed rates for all However, in contrast to previous studies, we also observed a offense types relative to those without ADHD. Likewise, clear pattern of increasing risk of CJS interactions as indi- cox proportional hazard analyses indicated that ADHD was viduals with ADHD proceeded through the system. More associated with significantly increased likelihood of all specifically, while the effect sizes we observed for the risk of offense types relative to those without ADHD. The adjusted police proceedings, court charges and court convictions fall hazards of conviction for serious offenses (HR 3.5), violent within the range of those previously reported for people with offenses (HR 3.7), and offenses against property (HR 3.8) ADHD, for incarcerations we report a substantially higher were particularly high. risk (Mohr-Jensen & Steinhausen, 2016; Mohr-Jensen et al., 2019). The greater effect size for incarceration observed in our study may be due to the lack of control for comorbid Discussion conditions such as CD, which are known criminogenic risk The current study utilized linked population-level health factors (Pratt et al., 2002), or the possibility of the case iden- and CJS data to examine interactions with, and pathways tification method used in the current study capturing more through, the CJS for young adults with and without ADHD severe cases of ADHD (Bowden, Gibb et al., 2020). The in NZ. Findings revealed that over half of young adults with sharp increase in the risk of incarceration observed may also ADHD interacted with the CJS by their 25th birthday. signal differences in the NZ justice system’s approach to Moreover, when controlling for important sociodemo- ADHD, which may be less responsive to the condition than graphic factors, individuals with ADHD were over two other nations, particularly the steps in the justice system times as likely to be proceeded against by police and between conviction and sentence. This would suggest that charged or convicted in court and almost five times as likely the UNCRPD obligations of equal recognition before the to be incarcerated than those without ADHD. Analyses also law and the elimination of discrimination on the basis of dis- revealed that for all offense types, those with ADHD were ability are not being met for individuals with ADHD in NZ. Anns et al. 7 The finding indicating that ADHD is associated with an during sentencing the potential for incarceration to exacer- increased risk across the spectrum of conviction offense bate symptoms, increase the risk of mistreatment, or be a types is consistent with the limited research to date (Retz more difficult experience than for people without ADHD et al., 2021). Our findings that the largest effect sizes were may need to be considered (Freckelton, 2019). The failure observed for serious offenses, violent offenses, and offenses of any CJS to screen for or respond appropriately to ADHD against property broadly reflect those of Mohr-Jensen et al. may therefore have serious implications such as causing a (2019). These findings may support the idea of an associa- subjectively more painful and less productive experience tion between ADHD and more impulsive crimes (e.g., bur- for a reasonable proportion of offenders (Pratt et al., 2002). glary and theft), particularly for individuals with higher A recent NZ justice system initiative has emerged in recog- levels of impulsivity (Fletcher & Wolfe, 2009). Symptoms nition of the need to respond more quickly and more effec- of impulsivity may also explain associations between tively to neurodivergence (Walker & Doogue, 2019). At this ADHD and violent crimes such as assault but only when stage, there is no mechanism within the initiative to screen these crimes occur in a reactive and not proactive/premedi- for specific neurodiverse conditions, including ADHD tated context (Retz & Rösler, 2009). Retz and Rösler (2009) (Clasby et al., 2022). suggest that a relationship between ADHD and reactive The current study also provides NZ data on ADHD in the aggression may be feasible due to the psychopathological CJS for the first time and demonstrates an ability to use characteristics of ADHD. Reactive aggression tends to be linked administrative data to help NZ meet its UNCRPD driven by affective outbursts and impulsivity. It is not pre- obligation of collecting disability data (Article 31). Such meditated but arises spontaneously, generally as a reaction methodology could be periodically replicated and expanded to conflict or provocation with the sole aim of reducing ten- upon both in NZ and abroad for better monitoring of States sion and agitation (Retz & Rösler, 2009). This may explain Parties progress toward meeting their obligations under the a link between violent crime at least in a reactive context UNCPRD in relation to the CJS. In particular, the use of and the hyperactive-impulsive symptoms of ADHD (Retz integrated data to enable analysis of the pathway through & Rösler, 2009). the CJS at a population level is novel and provides more nuanced insights into the disabling experiences of young adults with ADHD in the CJS. Implications The overrepresentation of individuals with ADHD at each Strengths and Limitations stage of the CJS suggests that the NZ CJS is failing to iden- tify individuals with ADHD either before or during their The current study has a number of strengths. Firstly, we interactions with the legal system, or that the legal system is were able to establish a large, 3-year national birth cohort, correctly identifying these individuals but failing to respond tracking participants until their 25th birthday. The use of to and make appropriate accommodations. The identifica- linked data allowed us to identify those with and without tion and consideration of ADHD is important because due ADHD and examine their interactions with the CJS at mul- to the symptoms of the condition, these individuals may be tiple contact points including police, courts, and correc- at risk from their moment of first contact with the CJS. tions. We were also able to explore differences in the types Moreover, it has been suggested that individuals with of offending for those with compared to those without ADHD may find the nature of incarceration more difficult ADHD, which allowed us to investigate how their pathways than those without the condition (Baggio et al., 2018; might differ from one another. Additionally, the use of Freckelton, 2019). Compared to offenders without ADHD, linked data meant that we were able to control for various individuals with ADHD have been shown to be more likely sociodemographic factors and account for early exits during to engage in misconduct in prison such as verbal or physical the observation period (e.g., emigration and death). aggression, damage to property, and incidents involving There are several limitations to the current study that self-injury (e.g., self-harm or suicidal behaviors) (Baggio should be noted. We did not control for the effects of condi- et al., 2018; Retz et al., 2021; Young & Cocallis, 2022). tions highly comorbid with ADHD such as CD and SUDs, This may be due to symptoms such as hyperactivity or which may be associated with an increased risk of delin- impulsivity impairing an individual’s ability to effectively quency and crime (Pratt et al., 2002; Retz et al., 2021; cope with the structure and demands of imprisonment Sibley et al., 2011). While some studies have shown an which may lead to disciplinary infractions, the prevention independent effect of ADHD on offending when controlling of early release, and even further convictions and extended for comorbid conditions (e.g., Sibley et al., 2011), other sentences (Young & Cocallis, 2022). As such, it has been research has shown no independent effect of ADHD on suggested that punishment via incarceration may not be crime when controlling for comorbidities (e.g., Mordre effective in preventing recidivism in those with ADHD et al., 2011; Retz et al., 2021). This was considered out of (Mohr-Jensen et al., 2019). It has also been suggested that scope for the present study in part because the data source 8 Journal of Attention Disorders 00(0) used (the IDI) is not effective in capturing co-occurring in criminality (Philipp-Wiegmann et al., 2018; Retz et al., conditions of interest such as CD (Bowden, Gibb et al., 2021) and a significant risk reduction for convictions and 2020). However, we note that by focusing on what we know incarcerations (Mohr-Jensen et al., 2019). This may also we can capture in the IDI, it allows us to consider whether disrupt any pathways that may exist from ADHD to the approaches can be developed based on a screening for development of SUDs. It has been suggested that multi- ADHD, regardless of the presence of co-occurring modal interventions may be most effective, with medication conditions. reducing the symptoms of ADHD to increase engagement The use of administrative data for identifying ADHD with the non-pharmacological side of treatment (e.g., CBT) likely undercounts, and may falsely identify, cases. For (Retz et al., 2021). More research is needed to examine the example, the method relies on health service use and will efficacy of early intervention and treatment for ADHD on not capture individuals with ADHD who are not accessing CJS outcomes in a NZ context. It would also assist policy treatments (Milne et al., 2022). Alternatively, the use of makers to understand how various participants in the CJS pharmaceuticals as indications of ADHD may falsely cap- become aware of information on ADHD and whether legal ture individuals who may be accessing these medications processes and procedures are altered in response to such for other conditions (D’Souza et al., 2020). The level of information. undercount is reflected in the relatively low prevalence of Further research is necessary to understand why the risk ADHD found in our sample at 2.7% compared with world- of CJS interactions increases so sharply from conviction to wide prevalence estimates typically in the 5-7% range sentence for young persons with ADHD. A better under- (Freckelton, 2019; Holland et al., 2023; Retz et al., 2021; standing of how young persons with ADHD experience that Young & Cocallis, 2022). The effect that any misclassifica- pathway will inform how best to mitigate this disabling tion bias may have had on our findings is unknown. As our experience. This could present a significant opportunity for case identification method may also capture more complex NZ and other countries to innovate, including by allowing or severe cases of ADHD, this may partly explain the for supports, accommodation, and alternative pathways increasing risk of CJS interactions observed as individuals (e.g., restorative justice) in order to ensure obligations with ADHD moved through the justice system. Lastly, as under the UNCRPD are met. our cohort excludes migrants to NZ who make up almost one-third of young people between 20 and 24 years of age Conclusion living in the country (Statistics New Zealand, 2013), it is only representative of those born in NZ and not the popula- Our findings revealed that not only were individuals with tion as a whole. ADHD overrepresented at all stages of the CJS and offense types examined, there was also a pattern of increasing risk for CJS interactions as these individuals moved through the Further Research system. These results highlight the importance of early To fully elucidate and understand the relationship between identification and responsivity to ADHD within the CJS ADHD and CJS interactions, there is a need for more and suggest that the NZ justice system may require changes research employing large, representative samples with lon- to both of these areas to ensure that young individuals with gitudinal rather than cross-sectional designs. The impor- ADHD receive equitable access to, and treatment within, tance of controlling for co-occurring psychiatric conditions the CJS. The current study has also revealed the utility of such as CD and SUDs has been highlighted by a number of effective data linkage in better understanding the pathways previous studies, due to their independent associations with of individuals with ADHD through the CJS. crime, and the extent to which this impacts CJS interactions among individuals with ADHD in NZ needs to be deter- Declaration of Conflicting Interests mined. Future research could also benefit from exploring The author(s) declared no potential conflicts of interest with the role of other risk and protective factors for CJS interac- respect to the research, authorship, and/or publication of this tions among those with ADHD in NZ. For example, research article. has noted that while co-occurring autism may be a protec- tive factor against crime in those with ADHD (Mohr-Jensen Funding et al., 2019), adverse outcomes across schooling and The author(s) disclosed receipt of the following financial support employment that are associated with ADHD may interact for the research, authorship, and/or publication of this article: The and exacerbate one another, increasing the likelihood of authors acknowledge the New Zealand Law Foundation and the delinquency (Erskine et al., 2016). The potential benefits of Michael and Suzanne Borrin Foundation who jointly funded a early intervention and treatment of ADHD have also been project on neurodevelopmental impairment and the criminal jus- highlighted with evidence that active periods of treatment tice system. This study details findings related to one aspect of this with ADHD medication may be associated with reductions wider project. D’Souza and Bowden’s time was funded by A Anns et al. 9 Better Start National Science Challenge, in turn funded by the courtroom: A brief evaluation of environmental accommo- New Zealand Ministry of Business, Innovation and Employment, dations to increase procedural fairness. Criminal Behaviour grants UOAX1511 and UOAX1901. and Mental Health, 32(3), 197–211. https://doi.org/10.1002/ cbm.2239 Criminal Procedure Act, § 6. (2011). https://www.legislation.govt. Disclaimer nz/act/public/2011/0081/latest/DLM3360039.html These results are not official statistics. They have been created for Cunial, K. J., Casey, L. M., Bell, C., & Kebbell, M. R. research purposes from the Integrated Data Infrastructure (IDI) (2020). Investigative interviewing of youth with ADHD which is carefully managed by Stats NZ. For more information about – Recommendations for detective training. Psychiatry the IDI please visit https://www.stats.govt.nz/integrated-data/. 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Neuroscience and Biobehavioral Zealand. https://www.districtcourts.govt.nz/assets/Uploads/ Anns et al. 11 Proposal-for-a-trial-of-Young-Adult-List-in-Porirua-District- Zealand. He is passionate about analyzing data in ways that lead to Court-pdf.pdf better outcomes for people and toward a more equitable Aotearoa. Watts, S. J. (2018). ADHD symptomatology and criminal behav- Brigit Mirfin-Veitch is the Director of the Donald Beasley ior during adolescence: Exploring the mediating role of Institute and an Associate Professor (Research) with the Centre for school factors. International Journal of Offender Therapy Postgraduate Nursing, University of Otago. Brigit is a sociologist and Comparative Criminology, 62(1), 3–23. https://doi. and her research is strongly focused on equitable access to justice org/10.1177/0306624X16639970 for all disabled people. She has a particular interest in understand- Willcutt, E. G. (2012). The prevalence of DSM-IV attention- ing how neurodivergent young people experience the criminal jus- Deficit/Hyperactivity Disorder: A meta-Analytic Review. tice system. Neurotherapeutics, 9, 490–499. https://doi.org/10.1007/ s13311-012-0135-8 Betony Clasby is a doctoral researcher with the Department of Young, S., Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, Sociological Studies at the University of Sheffield, United M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, Kingdom. Betony takes a multidisciplinary approach that encom- G., Hill, P., Hollingdale, J., Kilic, O., Lloyd, T., Mason, P., passes the fields of neuropsychology, social policy, criminology, Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., . . . and education. Her research seeks to counter systemic disadvan- Woodhouse, E. (2020). Females with ADHD: An expert con- tages faced by those with neurological differences within educa- sensus statement taking a lifespan approach providing guid- tional and criminal justice settings, from screening and identifica- ance for the identification and treatment of attention-deficit/ tion to intervention and policy. hyperactivity disorder in girls and women. BMC Psychiatry, Nathan Hughes is Professor of Adolescent Health and Justice in 20(1), 1–27. https://doi.org/10.1186/s12888-020-02707-9 the Department of Sociological Studies at the University of Young, S., & Cocallis, K. (2022). Attention-Deficit/Hyperactivity Sheffield, UK. His research focuses on experiences of neurodevel- Disorder (ADHD) and Offending. In C. Garofalo & J. J. opmental conditions, with a particular emphasis on processes of Sijtsema (Eds.), Clinical Forensic Psychology: Introductory criminalization and opportunities for policy and practice reform. Perspectives on Offending (pp. 303–319). Springer To achieve the latter, he is co-chair of the Global Law and Public International Publishing. https://doi.org/10.1007/978-3-030- Health Association’s Neurodisability and Neurodiversity group, 80882-2_16. and the Acquired Brain Injury Justice Forum. Zalsman, G., & Shilton, T. (2016). Adult ADHD: A new disease? International Journal of Psychiatry in Clinical Practice, Warren Forster is the Director of Simply Resolution Limited. 20(2), 70–76. https://doi.org/10.3109/13651501.2016.11491 Warren is a barrister and researcher. His research interests include a focus on innovations to improve accesses to justice, particularly for disabled people. He is interested to develop a deeper under- Author Biographies standing of how disabled people experience the formal and infor- mal components of the justice system and how this system can be Francesca Anns is a Research Assistant with the Centre of co-designed to remove access barriers and the resulting disabling Methods and Policy Application in the Social Sciences experiences. (COMPASS) and is currently studying toward her PhD in Psychology at the University of Auckland, New Zealand. She has Eden Tuisaula is a research assistant at the Donald Beasley a particular interest in the use of population-level data to investi- Institute in Dunedin, New Zealand. Eden is completing her Master gate outcomes relating to health and well-being. of Arts Psychology at Massey University and holds a Bachelor of Applied Science majoring in Psychology. Eden has ADHD, which Stephanie D’Souza is a Senior Lecturer with the School of Social underpins her interest in disability rights, social justice and Sciences and Centre of Methods and Policy Application in the research informed by lived experience. Social Sciences (COMPASS) at the University of Auckland, New Zealand. Her research involves applying quantitative methods to Nicholas Bowden is a Research Fellow with the Department of understand social, health, and wellbeing outcomes over the lifes- Women’s and Children’s Health at the University of Otago, New pan using survey and administrative data. Zealand. He is a quantitative social scientist specializing in the use of population-level linked health and non-health data. His research Conrad MacCormick is an Analytics Lead at Nicholson interests include mental health and neurodevelopmental conditions Consulting. He has more than 12 years’ experience in data and with a focus on reducing inequities and improving well-being. statistics roles across both the public and private sectors in New

Journal

Journal of Attention Disorders – SAGE

Published: Oct 1, 2023

Keywords: ADHD; criminal justice system interactions; neurodevelopment; integrated data infrastructure

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