At intake, you may encounter a patient who seems impatient, fidgety, or easily distracted. They may interrupt, lose track of questions, or appear agitated without an obvious trigger. These behaviors are often attributed to anxiety, substance use, or defiance, but they could also be symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), an often underrecognized and undertreated condition in incarcerated populations.

Understanding ADHD in Adults

Although commonly associated with children, ADHD persists into adulthood in up to 60% of cases. Adult presentations often differ, with less hyperactivity, more inattention, impulsivity, disorganization, and difficulty regulating emotions. These traits can impair functioning in social, occupational, and legal contexts. In fact, ADHD is associated with higher rates of substance use, academic failure, employment instability, and legal troubles.

Incarcerated adults have significantly higher rates of ADHD compared to the general population. While about 4–5% of adults in the community meet diagnostic criteria, studies estimate that 15–25% of incarcerated individuals may have ADHD.

Challenges in Correctional Settings

Diagnosing ADHD in corrections is complex. Many individuals arrive without a formal diagnosis. Others may carry misdiagnoses (e.g., bipolar disorder, conduct disorder, or antisocial personality disorder) due to overlapping symptoms or behavioral interpretations. Additionally, the structured environment of incarceration can sometimes mask symptoms, while at other times, stress and lack of autonomy may amplify them.

Medication management is a particular challenge. While stimulant medications are considered first-line treatment, they are often restricted or avoided in correctional settings due to their abuse potential and high value as contraband. Non-stimulant alternatives like atomoxetine or guanfacine may be safer but are underutilized. Without treatment, patients with ADHD are at increased risk for disciplinary infractions, time in segregation, and failure to engage in rehabilitative programs.

The Role of the Correctional Nurse

Correctional nurses are in a unique position to identify, support, and advocate for patients with ADHD. Here’s how:

Screening at Intake: Ask about prior diagnoses, school difficulties, behavioral challenges, past medication use, and symptoms like restlessness, disorganization, or chronic lateness.

Observe Patterns: Difficulty following routines, repeated rule violations, or impulsive behavior may be clues.

Education and Support: Many patients are unaware that their behaviors may stem from an underlying condition. Education about ADHD may foster self-awareness and openness to treatment.

Advocate for Evaluation: If ADHD is suspected, referral for psychiatric evaluation may be appropriate. Advocacy includes encouraging access to evidence-based, safe, and non-stigmatizing treatment plans.

Document Clearly: Behavioral observations and patient-reported history should be thoroughly documented to support continuity of care and clinical decision-making.

Final Thoughts

ADHD is more than a behavioral issue—it’s a neurodevelopmental disorder with serious implications for health, safety, and rehabilitation. Correctional nurses can help shift the narrative by recognizing symptoms, supporting evaluation and care, and treating patients with dignity and compassion. In doing so, we not only reduce stigma but also contribute to better outcomes—both behind the wall and beyond it.

In the second post in this series, we will discuss Treatment and management strategies that Correctional Nurses can use to support their patients with ADHD.