Treating ADHD may reduce criminality
Pharmaceutical treatment of attention deficit-hyperactivity disorder (ADHD) is associated with reduced criminality according to a study published yesterday in the New England Journal of Medicine. The study of over 25,000 Swedish adults with the disorder found that men undergoing pharmaceutical treatments had a 51% chance of committing at least one crime in a 4-year period compared to 63% for those not in treatment. The risk of criminality for women with ADHD was 25% for those taking medication, and 31% for those not in treatment. It’s possible, of course, that the reduction in criminality associated with treatment was due not to the treatment itself, but to other factors, such as desire to improve behaviour, which could have both motivated treatment and reduced criminality. However, even when the investigators adjusted for likely confounders, they found that treatment was associated with significantly reduced criminal offending. Thus, their findings are at least suggestive of a causal relationship between medication and reduced crime.
It will be interesting to see how such a relationship, if it can be further supported, will be viewed by the general public and medical profession. Will it be seen as strengthening or weakening the case for ADHD treatment?
One the one hand, crime reduction is a widely valued social goal. If an educational or social work intervention was found to reduce crime rates to same degree that ADHD treatments appeared to in this study, most would take this as powerful reason to implement those interventions.
On the other hand, we know that medical and social interventions are not always viewed similarly even when their effects are similar. For example, many people believe that medical interventions capable or improving cognitive performance should be used only to treat intellectual disability, not to enhance the cognition of normal people, yet few would take the same view regarding education programmes that improve cognition in similar ways.
Moreover, there is a reluctance, particularly within the medical profession, but also more widely, to accept that social objectives might be relevant to prescription practices or medical decisions more generally. Presumably this reluctance stems from humanity’s atrocious track record in this area: historical attempts to implement medical solutions to social problems have tended to end in disaster, as in the case of the frontal lobotomy to control aggression and early and mid-20th century eugenics. There is a legitimate fear that we cannot trust ourselves to use medicine for social goals without winding up grossly violating the rights of individuals. And, of course, crime prevention is a social goal par excellence.
My (amateur sociological) observation is that when medical interventions serve a clear social purpose but also treat an established disease or disorder, they tend to gain wide acceptance, perhaps because the social goal can then be seen as playing only a secondary or accessory role in justifying intervention. Thus, forced treatment for severely psychotic patients who pose a danger to others is fairly well accepted in many jurisdictions However, when interventions serve no orthodox medical goal but only a social purpose, they tend not to be well-accepted. Thus, forced medical interventions in individuals who pose a danger to others but suffer from no psychiatric disorder are generally not widely accepted.
I wonder, then, whether reaction to findings such as those published in the New England Journal yesterday might depend to a large extent on whether ADHD is now regarded as a bona fide medical disorder or simply a medical label for what is really a social problem.
Of course, whether this ought to make a difference to how we view these findings is another matter altogether.