Last week we explored the high prevalence and underdiagnosis of ADHD among incarcerated individuals. As correctional nurses, we frequently interact with patients whose behaviors—impulsivity, restlessness, difficulty with authority—are often misunderstood. When these behaviors stem from untreated ADHD, they can contribute to negative outcomes like infractions, segregation, and disengagement from care. In this post, we’ll turn to treatment options and practical management strategies that nurses can use in their day-to-day practice.

Medications

While stimulant medications (like methylphenidate or amphetamine salts) are considered first-line treatments for ADHD, they are rarely prescribed in corrections due to their abuse potential and contraband value. This makes non-stimulant pharmacologic and non-pharmacologic options especially important in the correctional setting. Non-stimulant medications for ADHD include:

• Atomoxetine (Strattera): A norepinephrine reuptake inhibitor approved for adult ADHD. Less risk of misuse, but slower onset of effect.
• Guanfacine (Intuniv) and Clonidine: Alpha-agonists often used off-label; may help with impulsivity and sleep.
• Bupropion (Wellbutrin): May be helpful for patients with co-occurring depression or substance use disorders.

These alternatives require careful monitoring, patient education, and time to assess effectiveness, but they can offer symptom relief with lower security risk.

The Correctional Nurse’s Role in Behavioral Support

Even without medication, behavioral interventions can make a meaningful difference. Correctional nurses can use several strategies to help patients with ADHD manage symptoms and function more effectively in the correctional environment.

Structure and Routine
Patients with ADHD often struggle with executive functioning—things like planning, prioritizing, and managing time. Encouraging routines and helping patients understand the facility’s daily structure can improve functioning and reduce anxiety.

Clear, Concise Communication
Use brief instructions and confirm understanding. Repeating directions, using written reminders (when feasible), and offering one step at a time can be very helpful.

Emotional Regulation Support
Impulsivity and mood swings are common. Nurses can model calm, respectful interactions and teach grounding techniques (deep breathing, counting, mindfulness prompts) when a patient is escalating.

Advocacy for Program Access
Many individuals with ADHD struggle in group settings or structured programs like GED classes or substance abuse treatment. They may be removed for “disruptive” behavior. Nurses can advocate for modified participation or mental health support so patients aren’t excluded from rehabilitative services.

Collaborative Approach
Work with mental health professionals, security staff, and medical providers to promote a shared understanding of ADHD-related behaviors. This reduces labeling patients as “manipulative” or “noncompliant” and supports more trauma-informed, individualized care.

Final Thoughts

Managing ADHD in correctional settings requires clinical awareness, creative problem-solving, and compassionate communication. As correctional nurses, we are often the first to notice patterns that point to undiagnosed or undertreated ADHD. Through thoughtful screening, consistent documentation, and behavioral support, we can help our patients experience fewer disciplinary actions and better engagement in care—key steps toward rehabilitation and success beyond incarceration.

Please take a moment and share your thoughts about ADHD in corrections in the comments section below.