Search

The aim of the study was to investigate predictors of offending among prisoners from official records after controlling for age at first conviction and antisocial personality disorder. The participants were 198 Scottish prisoners, who had completed Diagnostic Statistical Manual IV screens for child and adult attention-deficit hyperactivity disorder (ADHD) symptoms and the Millon Clinical Multiaxial Inventory III for Axis I and Axis II disorders. The ADHD symptomatic group had significantly higher rates of total, acquisitive and violent offending than other prisoners, as well as greater regular heroin use. Hierarchical multiple regressions, using child and adult symptoms as dimensions, showed that frequent use of heroin in the year prior to imprisonment was the single most powerful predictor of the extent of total offending, with ADHD symptoms also adding independently to the variance in offending. In contrast, for violent offending, ADHD symptoms were the strongest predictor followed by alcohol dependence. The findings demonstrate the importance of heroin use and ADHD symptoms in the persistence of offending. There is an urgent need to treat drug addiction and ADHD symptoms in order to reduce offending among the most persistent offenders. Recently, treatment programmes have been developed for adults with ADHD, heroin and crack cocaine addiction which can be applied to this population. [ABSTRACT FROM PUBLISHER]

BACKGROUND: Interrogative suggestibility and compliance are important psychological vulnerabilities during interrogation. The aim of the study was to investigate the relationship of suggestibility and compliance with childhood and current symptoms of attention deficit hyperactivity disorder (ADHD). Compliance has not been studied previously in relation to ADHD. A further aim was to investigate the relationship between ADHD and the reporting of having made a false confession to the police.MethodThe participants were 90 male prisoners, all of whom had completed the Gudjonsson Suggestibility and Compliance Scales (GSS and GCS) within 10 days of admission to the prison. Childhood ADHD symptoms were screened by the Wender Utah Rating Scale (WURS) and current adult symptoms by the DSM-IV Checklist criteria for ADHD. RESULTS: Half of the prisoners (50%) were found on screening to meet criteria for ADHD in childhood and, of those, over half (60%) were either fully symptomatic or in partial remission of their symptoms. ADHD symptoms were found to be significantly associated with compliance, but not with suggestibility. The relationship with compliance was stronger (effect size) in relation to current than childhood symptoms. The ADHD symptomatic groups were significantly more likely to claim that they had made a false confession to the police in the past. CONCLUSIONS: The findings raise important questions about the potential vulnerability of adults with ADHD symptoms in terms of their ability to cope with interrogation. [ABSTRACT FROM AUTHOR]

Objectives. The objective was to evaluate the relationship between self- and informant-rated symptoms of ADHD and performance on neuropsychological tests of attention and impulsivity (Letter Cancellation Test [LCT], Continuous Performance Test [CPT] and Matching Familiar Figures test [MFF]). Design. Participants were clinical referrals for assessment of ADHD in adulthood and healthy controls. Method. ADHD adults were compared with individuals with mild psychiatric disorders (including attention problems), a healthy control group on neuropsychological measures of attention (CPT and LCT) and on impulsivity (MFF). Secondly, the scores obtained on these measures were correlated with the Young ADHD Questionnaire-S (YAQ-S) and Young ADHD Questionnaire-I (YAQ-I) self- and informant-reported scales of ADHD symptomatology, emotional problems, delinquency, and social functioning. Results. The ADHD group were more impaired than the healthy controls on neuropsychological measures, but only the MFF differentiated them from the psychiatric controls. Tests of attentional control positively correlated with the self-reported functioning of the ADHD group but not among the psychiatric or normal controls. There was a positive correlation between tests of attention (but not impulsivity) and self-ratings of ADHD symptomatology for the ADHD group, suggesting that ADHD adults are better at recognizing attentional problems than impulse control. A positive correlation was found between the Delinquency scale and a test of impulsivity for the ADHD group only. Conclusions. The findings suggest that there are neuropsychological underpinnings of the ADHD syndrome but neuropsychological tests may discriminate poorly between ADHD and mild psychiatric disorders. ADHD adults may be more reliable informants of adult functioning than their parents, although they may underreport impulsive behaviour. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate whether personality tests could differentiate between alcohol and drug users among juvenile offenders. The subjects were 108 Icelandic juvenile offenders who had been given conditional discharge. The Eysenck Personality Questionnaire (EPQ) and the Gough Socialisation Scale were administered to all subjects. The results indicate that the subjects who were classified as drug users or frequent alcohol users scored significantly lower than the other juveniles on the Gough Socialisation Scale and significantly higher on the EPQ lie scale. [ABSTRACT FROM AUTHOR]

Wrongful conviction databases have shed light on the fact that innocent people can be induced to confess to crimes they did not commit. Drawing on police practices, core principles of psychology, and forensic studies involving multiple methodologies, this article updates the original Scientific Review Paper (Kassin et al., 2010) on the causes, consequences, and remedies for police-induced false confessions. First, we describe the situational and personal risk factors that lead innocent people to confess and the collateral consequences that follow-including the corruptive effects of confession on other evidence, the increased likelihood of conviction at trial, the increased tendency to plead guilty despite innocence, the stigma that shadows false confessors even after exoneration, and the failure of Miranda to serve as a safeguard. Next, we propose the following remedies: (1) mandate the video recording of all suspect interviews and interrogations in their entirety and from a neutral camera angle; (2) require that police have an evidence-based suspicion as a predicate for commencing interrogation; (3) impose limits on confrontational interrogations, namely with regard to detention time, presentations of false evidence, and minimization themes that imply leniency; (4) adopt a science-based model of investigative interviewing; (5) protect youthful suspects and vulnerable adults by mandating the presence of defense attorneys during interrogation, and a suitable appropriate adult where required; (6) shield lay witnesses and forensic examiners from confessions to ensure the independence of their judgments; and (7) abolish contributory clauses from compensation statutes that penalize innocent persons who were induced to confess and/or plead guilty. These recommendations should help to prevent confession-based wrongful convictions and improve the administration of justice for all concerned. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

In the past decade, there have been substantial changes in diagnostic nomenclature. This study investigated sex differences in attention-deficit/hyperactivity disorder (ADHD) symptom severity based on Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV, DSM-IV(TR), and DSM-5 criteria, separating rating scale and clinical interview data in children and adults with ADHD. PubMed, PsycINFO, and Scopus were searched for published studies (1996-2021) reporting severity of attention, and hyperactivity/impulsivity in males and females. We compared data: (1) across the entire lifespan aggregating rating scale and clinical interview data (51 studies), (2) drawing solely on rating scale data (18 studies), and (3) drawing solely on clinical interview data (33 studies). Fifty-two studies met inclusion criteria comparing data for females ( n = 8423) and males ( n = 9985) with ADHD across childhood and/or adulthood. In total, 15 meta-analyses were conducted. Pooled data across the lifespan aggregating both rating scale and clinical diagnostic interview data, showed males had significantly more severe hyperactivity/impulsivity symptoms than females. Rating scale data were similar; boys had significantly more severe hyperactivity/impulsivity than girls. In adulthood, men were rated to have significantly more severe inattention than women with no difference in the hyperactivity/impulsivity dimension. All significant differences were of small effect size. No significant sex differences in the severity of symptoms emerged for clinical interview data for children or adults, in contrast. Possible reasons for the discrepancy in findings between rating scales and clinical diagnostic interviews are discussed.

Background: Trait compliance involves people reacting favorably to demands made by others across different situations. This may lead to susceptibility to external pressures, exploitation, and manipulation. Moreover, trait compliance was found to correlate with various mental health outcomes, such as depression and anxiety. The Gudjonsson Compliance Scale (GCS) is an efficient tool for assessing trait compliance in Western contexts. To date, no study has validated the psychometric properties of the GCS in Chinese populations., Methods: Two college student samples from China were recruited. The first sample (N = 4,276) was used to conduct exploratory factor analysis. The second (N = 4,356) was used to perform a confirmatory factor analysis. The reliability, measurement invariance, and correlational tests were conducted on the two combined samples., Results: The Chinese GCS showed a 3-factor structure, with two items deleted. Reliability was supported by moderate-to-good internal consistency of the three-factor scales and good internal consistency on the full scale. Strong measurement invariance across sex, ethnicity, and group recruitment was supported. Scores of the total scale and factor scales were found to significantly associated with several mental health problems., Conclusions: The Chinese version of the GCS appears to be a valid and reliable instrument for measuring trait compliance and could promote both the assessment and research on compliance in Chinese population., (© 2024. The Author(s).)

Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with substance use (SU) and/or substance use disorder (SUD). Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment. This can be further complicated by the context in which services are delivered. Also, when working with young people and adults with co-existing ADHD and SU/SUD, there is uncertainty among healthcare practitioners on how best to meet their needs. In February 2022, the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues. Following presentations providing attendees with an overview of the literature, group discussions were held synthesizing research evidence and clinical experience. Topics included: (1) A review of substances and reasons for use/misuse; (2) identification, assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services; and (3) identification, assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services. Dis-cussions highlighted inter-service barriers and fragmentation of care. It was concluded that a multimodal and multi-agency approach is needed. The consensus group generated a table of practice recommendations providing guidance on: identification and assessment; pharmacological and psychological treatment; and multi-agency interventions., Competing Interests: Conflict-of-interest statement: Young S, Abbasian C, Cubbin S, Branney P, Colley B, Deeley Q, Hill P, Hollingdale J, Judge D, Lewis A, Mason P, Johnson J and Woodhouse E are affiliated with consultancy firms/private practices. Over the past five years Young S has received honoraria for consultancy and educational talks years from Janssen, Medice and Takeda. She is author of the ADHD Child Evaluation (ACE) and ACE+ for adults; and lead author of R&R2 for ADHD Youths and Adults. Hill P received honoraria for consultancy and educational talks from Takeda and Flynn Pharma. Cortese S declares honoraria and reimbursement for travel and accommodation expenses for lectures from the following non-profit associations: Association for Child and Adolescent Central Health (ACAMH), Canadian ADHD Alliance Resource (CADDRA), British Association of Pharmacology (BAP), and from Healthcare Convention for educational activity on ADHD. Mason P has received honoraria for consultancy and educational talks from Takeda, Flynn Pharma and Lily. Nutt D has received honoraria for educational talks from Takeda and Janssen. Lewis A has received honoraria for consultancy to the Association for Child & Adolescent Mental Health (ACAMH) and Takeda and for educational talks to Forensic Treatment Division, Ministry of Justice, Republic of Korea. Mukherjee R has received honoraria for consultancy and talks related to ADHD from Takeda, Flynn Pharma and Janssen. Johnson J has received honoraria for consultancy and educational talks for Flynn Pharma, Takeda and Janssen. The remaining authors (Gudjonsson GH, Cocallis K, Roberts J, Al-Attar Z, Robinson F) declare that the meeting was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity and impulsivity. A dearth of studies have investigated psychosexuality in this population, often with few (predominantly male) participants. We recruited individuals with and without ADHD via an anonymous online survey distributed electronically by ADHD support organizations and social media. We investigated sexual history; interests and practices; and relationships. Of 1392 respondents, we classified an 'ADHD' group ( n = 541; 30.5% male) and compared them to individuals of similar ages without ADHD, ('Other' group; n = 851; 37.6% male). The ADHD group (both males and females) had a significantly higher preference for same-sex or either-sex partners; and higher rates of electronic sexual exchanges, masturbation, and sexually transmitted diseases. They were more adventurous in sexual interests and practices and substantially less satisfied with their partners, both sexually and generally. Within the ADHD group, significant sex differences emerged: females had younger onset of sexual activities, used contraception less frequently, had more sexual partners and practiced more infidelity. Sexual interests differed between the sexes, but females more commonly acted on them, whereas males did not. Findings suggest both sexes engage in risky sexual behaviors, perhaps driven by impulsivity, but risk is substantially greater for females with ADHD.

Although alcohol-intoxicated witnesses to violent crimes are common, research on how alcohol affects witnesses' perception of aggression is sparse. In the present study, it was investigated whether different levels of intoxication altered how severe witnesses perceived aggression displayed by involved parties in an intimate partner violence (IPV) scenario to be. An experimental mixed-groups design 3 (sober vs. moderate vs. high breath alcohol concentration [BAC]) x 2 (immediate vs. one week delayed interview) was used. Socially drinking men and women ( n = 137; 67 and 70, respectively) were randomized to an alcohol condition (0.8 g/kg adjusted to 0.75 g/kg for women, divided into two intoxication groups: moderate ≤0.08 and high ≥0.08) or a control condition (juice). They were also randomized into a direct interview condition or a delayed interview condition. In a laboratory setting, they consumed drinks and viewed an IPV scenario on film. During their interview, the participants rated how severe they perceived the involved parties' aggression to be. Inter alia, participants in the high BAC group perceived both parties' physically aggressive behavior as comparatively less severe than the sober and moderately intoxicated witnesses did. The high BAC group also perceived the IPV scenario as less unpleasant than the other two groups, and they maintained this perception over time and repeated interviews. A BAC level of ≥0.08 was required to significantly lower witnesses' perceived severity of physical aggression, possibly caused by alcohol's anxiety-dampening effect as well as its impairing effect on cognitive processing capacity over this level of intoxication. That alcohol intoxication at (or over) such a BAC level makes witnesses perceive physical aggression as less severe and less unpleasant, and also that such an altered perception holds over time and repeated interviews, is important for legal practitioners to be aware of when handling intoxicated witnesses to violence. Therefore, this issue warrants further investigation.

Objective: To investigate salient predictors of self-reported false confessions. The conditions included mild intellectual disability (ID), autism spectrum disorder (ASD), ADHD, conduct disorder (CD), psychiatric symptoms, and compliance. Method: The sample consisted of 386 male Scottish prisoners, who completed a diagnostic ADHD interview, psychometric tests, and a questionnaire about false confessions they had given to police over their lifetime. Results: There was a high rate of reported false confessions (33.4%); the reason for the majority (62.2%) being to "cover up for somebody else." CD, ADHD, psychological distress and psychiatric symptoms, and compliance were all significant predictors of false confession. When examining the influence of underlying domains of ADHD, it was found that hyperactivity/impulsivity drove the association with false confession after adjusting for coexisting CD. Conclusion: CD and ADHD were the two most powerful predictors of false confessions, with CD mediating some of the effects of ADHD.

This review shows that there is now a solid scientific evidence base for the "expert" evaluation of disputed confession cases in judicial proceedings. Real-life cases have driven the science by stimulating research into "coercive" police questioning techniques, psychological vulnerabilities to false confession, and the development and validation of psychometric tests of interrogative suggestibility and compliance. Mandatory electronic recording of police interviews has helped with identifying the situational and personal "risk factors" involved in false confessions and how these interact. It is the combination of a detailed evaluation and analysis of real-life cases, experimental work, and community (and prison/police station) studies that have greatly advanced the science over the past 40 years. In this review, the story of the development of the science during this "golden era" is told through the three established error pathways to false confessions and wrongful convictions: misclassification, coercion, and contamination. A case study of a major miscarriage of justice is used to highlight the key issues at each stage of the error pathways and it shows the continued resistance of the judiciary to admit mistakes and learn from them. Science is a powerful platform from which to educate the police and the judiciary., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Gudjonsson.)

Objective: The objective of the study is to quantify the extent of specific polysubstance use, drug transitions to current substances, and describe the association with alcohol use disorders among inmates with ADHD. We also examined health risk behaviors and patterns of offending in relation with ADHD. Method: A total of 387 male British prison inmates were screened and interviewed via the Diagnostic Interview for ADHD in Adults 2.0 (DIVA-2). Results: Male prisoners with ADHD endorse more methadone and amphetamine use. There was a significantly higher linear trend among those with ADHD for the number of substances ever used. ADHD was positively associated with increasing levels of alcohol use disorder severity, and with alcohol dependence. Transition along the pathways of substance misuse and persistence of drug misuse was better explained by the presence of conduct disorder/antisocial personality traits. Conclusion: Higher rates of alcohol dependence and stimulant-cocaine misuse suggest these inmates have maladaptive coping mechanisms, such as self-medication behaviors.

Background: Attention-deficit hyperactivity disorder (ADHD) is highly prevalent amongst prison inmates and the criminal justice system (CJS) likely bears considerable costs for offenders with ADHD. We aimed to examine the relationship between ADHD and health-related quality of life (HRQoL) and quality-adjusted life years (QALY) amongst imprisoned adults; and to estimate the annual expenditure associated with ADHD status in prison., Methods: An observational study was performed in 2011-2013, at Porterfield Prison, Inverness, United Kingdom (UK). The all male sample included 390 adult prison inmates with capacity to consent and no history of moderate or severe intellectual disability. Participants were interviewed using the Diagnostic Interview for ADHD in Adults 2.0. The Health Utilities Index Mark 3 (HUI3) was used to measure health status, and to calculate attribute specific HRQoL scores and QALY. Health service utilisation was obtained through inspection of medical prison records. Inmates with ADHD were compared with inmates without ADHD., Results: Inmates with ADHD had significantly lower QALYs, with a clinically significant adjusted difference of 0.13. Psychiatric co-morbidity accounted for the variation of ADHD on the HUI3 emotion domain only. Medical costs for inmates with ADHD were significantly higher; and behaviour-related prison costs were similar to prisoners without ADHD, reflecting a low frequency of recorded critical incidents., Conclusions: ADHD may directly contribute to adverse health and quality of life through cognitive and executive function deficits, and co-morbid disorders. The extrapolation of conservative cost estimates suggests that the financial burden of medical and behavior-related prison care for inmates with ADHD in the UK is approximately £11.7 million annually. The reported cost estimates are conservative as there is great variability in recorded critical incidents in prisons. In turn, for some prison establishments the prison care costs associated with prisoners with ADHD may be considerably greater.

Background: Attention-deficit hyperactivity disorder (ADHD) and head injury (including traumatic brain injury (TBI)) manifest in high levels across prison samples and guidance from the National Institute for Health and Care Excellence notes that people with acquired brain injury may have increased prevalence of ADHD. We aimed to examine the association of ADHD with TBI and the impact of the association upon health-related quality of life (HRQoL) and service use among imprisoned adults., Methods: An observational study was performed in 2011-2013, at Porterfield Prison, Inverness, United Kingdom (UK). The all male sample included 390 adult prison inmates with capacity to consent and no history of moderate or severe intellectual disability. Head injury was measured with a series of self-reported questions, addressing history of hits to the head: frequency, severity, loss of consciousness (LOC), and sequelae. Participants were interviewed using the Diagnostic Interview for ADHD in Adults 2.0. The Health Utilities Index Mark 3 was used to measure health status, and to calculate attribute specific HRQoL and Quality-Adjusted Life Year (QALY) scores., Results: 72% of prisoners sampled reported at least one head injury in their lifetime. Among those, 70% of head injuries occurred before age 16 and 70% experienced LOC. Prisoners with ADHD were nearly twice more likely to have TBI. Prisoners with ADHD-only and ADHD with co-morbid TBI had significantly lower scores in several HRQoL attributes, compared with TBI only or the absence of either condition. Adjusted logistic regression models indicated an average reduction of 0.20 QALYs in inmates with ADHD-only and 0.30 QALY loss in those with ADHD with co-morbid TBI compared with inmates with neither condition., Conclusions: There is a robust association between ADHD and TBI, and ADHD with co-morbid TBI confers significantly greater impairment in terms of HRQoL. Managing the short and long-term consequences of TBI is essential to improving care for prisoners and to addressing the criminogenic factors related to them.

The identification and management of inmates with neurodevelopmental disorders (ND) has been insufficiently addressed in the literature. We estimated the proportion of cases with Attention deficit/hyperactivity disorder (ADHD), Autism spectrum disorder (ASD) and Intellectual disability (ID) in prison, their comorbidity, and associations with disruptive behaviours and with psychiatric symptoms. Further, we examined the role of coexisting ND on psychiatric symptoms and attitudes toward violence. All 390 male inmates underwent an assessment that included the Diagnostic Interview for ADHD in Adults 2.0, the Autism Quotient, the Learning Disability Screening Questionnaire, the Brief Symptom Inventory (BSI), and measures of disruptive behaviours and attitudes towards violence. The percentage of cases with ADHD, ASD and ID were 25%, 9% and 9%. Inmates with ADHD and those with ID had significantly higher levels of disruptive behaviours. The combined ADHD/ASD group had significantly higher scores on global severity symptoms than either ADHD or ASD only. Meanwhile, the combined ADHD/ID group had significantly higher scores of behavioural disturbance than the ADHD-only group. Our findings show the extent of ND in prison, their inter-relations and associations with further mental health problems. Vulnerabilities conferred by ND within the criminal justice system should be addressed via interventions and preventative strategies., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Purpose: To examine the role of family conflict in the relationship between attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD)., Methods: A cross-sectional national population survey was carried out among 10,838 14-16 year old students in all secondary schools in Iceland. Three latent measures, financial status, ADHD and CD, and one observed measure, family structure, were included in the study. A structural equation model was used to evaluate direct effects between ADHD and CD for four different groups; females and males, experiencing family conflict and those not experiencing family conflict., Results: ADHD was significantly and positively associated with CD for all groups. When controlling for financial status and family structure it was found that ADHD was positively and significantly associated with CD for adolescent females and males not experiencing family conflict as well as for those experiencing family conflict. The link between ADHD and CD was significantly stronger for those adolescents who had experienced family conflict compared to those who had not experienced family conflict. These results suggest that family conflict moderates the association between ADHD and CD for both girls and boys., Conclusions: The results of this study indicate that family environment and ADHD symptoms are important when predicting CD among adolescent youth. Most notably, family conflict exacerbates the effects of ADHD symptoms on CD among both females and males.

Objective: There is a reasonable theoretical base for understanding the possible causes and motivations behind substance misuse and its dependency. There is a need for a reliable and valid measure that delineates the markers of substance use from its initiation and identifies different motivations for drug use transitioning, maintenance, and dependency. We addressed this gap in the United Kingdom by examining and validating the Substance Transitions in Addiction Rating Scale (STARS)., Methods: For this review, 390 male prisoners were screened for conduct disorder and assessed with a clinical diagnostic interview for attention deficit/hyperactivity disorder (ADHD). They completed the four STARS subscales regarding their substance use. Exploratory structural equation modeling was performed to assess the STARS structure and to derive factors to assess validity against ADHD and conduct disorder diagnostic categories., Results: Each of the subscales produced meaningful and reliable factors that supported the self-medication and behavioral disinhibition hypotheses of substance use motivation. The findings robustly show that ADHD is significantly associated with the need for coping as a way of managing primary and comorbid symptoms, but not conduct disorder. The findings were strongest for the combined ADHD type., Discussion: STARS has a great potential to further the understanding of the motivation behind substance use and its dependency in different populations.

Aim: To investigate factors predicting treatment completion and treatment outcome of the Reasoning and Rehabilitation Mental Health Programme (R&R2MHP) cognitive skills programme for mentally disordered offenders., Methods: Secondary analysis of data previously obtained from 97 male patients who were sectioned and detained under the United Kingdom Mental Health Act in low, medium and high security hospitals and who had completed R&R2MHP. Predictors of treatment completion included background variables and five outcome measures: Four self-reported measures of violent attitudes, social problem-solving skills, reactive anger and locus of control and an objective measure of behaviour on the ward that was completed by staff. Completion of the 16 session programme, which was delivered on a weekly basis, was classified as ≥ 12 sessions., Results: It was found that the R&R2MHP is appropriate for delivery to participants of different ages, ethnic background, and at different levels of security without the completion rate or treatment effectiveness being compromised. Participants taking oral typical psychotropic medication were over seven times more likely to complete the programme than other participants. Behavioural disturbance on the ward prior to commencing the programme predicted non-completion (medium effect size). As far as treatment completion was concerned, none of the background factors predicted treatment effectiveness (age, ethnic background, level of security, number of previous convictions and number of previous hospital admissions). The best predictor of treatment effectiveness was attitude towards violence suggesting that this should be the primary outcome measure in future research evaluating outcomes of the R&R2MHP cognitive skills program., Conclusion: The findings suggest that a stable mental state is a key factor that predicts treatment completion., Competing Interests: Conflict-of-interest statement: SY has received fees for consultancy, travel and educational talks from Janssen, Eli Lilly, Shire, Novartis, HB Pharma, Flynn Pharma and Shire. She has received research funding from Eli Lilly, Shire and Janssen. She is a consultant at the Cognitive Centre of Canada and co-author of the R&R2 program for mentally disordered offenders. GHG has received fees for consultancy from Eli Lilly and educational talks from Janssen and Shire. MD has no conflicts of interest to declare.

Background: The association of attention deficit/hyperactivity disorder (ADHD) and fetal alcohol spectrum disorders (FASD) results in a complex constellation of symptoms that complicates the successful diagnosis and treatment of the affected individual. Current literature lacks formal guidelines, randomized control trials, and evidence-based treatment plans for individuals with ADHD and associated FASD. Therefore, a meeting of professional experts was organized with the aim of producing a consensus on identification and treatment guidelines that will aid clinicians in caring for this unique patient population., Methods: Experts from multiple disciplines in the fields of ADHD and FASD convened in London, United Kingdom, for a meeting hosted by the United Kingdom ADHD Partnership (UKAP; www.UKADHD.com ) in June 2015. The meeting provided the opportunity to address the complexities of ADHD and FASD from different perspectives and included presentations, discussions, and group work. The attendees worked towards producing a consensus for a unified approach to ADHD and associated FASD., Results: The authors successfully came to consensus and produced recommended guidelines with specific regards to identification and assessment, interventions and treatments, and multiagency liaisons and care management, highlighting that a lifespan approach to treatment needs to be adopted by all involved. Included in the guidelines are: 1) unique 'red flags', which when identified in the ADHD population can lead to an accurate associated FASD diagnosis, 2) a treatment decision tree, and 3) recommendations for multiagency care management., Conclusions: While clinically useful guidelines were achieved, more research is still needed to contribute to the knowledge base about the diagnosis, treatment, and management of those with ADHD and associated FASD.

Background: Attention deficit hyperactivity disorder (ADHD) is overrepresented in prison, making it imperative to identify a screening tool that can be quickly applied to efficiently detect the disorder. We explored the discrimination ability of a widely used ADHD screen, the Barkley Adult ADHD Rating Scale (BAARS-IV), against a clinical diagnostic interview. A brief version of the screen was then developed in order to simplify its use in the prison context, and maximize its diagnostic properties., Method: A cross-sectional study of 390 male prison inmates was performed in the UK, all participants were screened and interviewed via the Diagnostic Interview for ADHD in Adults 2.0 (DIVA-2)., Results: A total of 47 (12.1%) inmates screened positive for ADHD using the full BAARS-IV, and 96 (24.6%) were clinically diagnosed, for a sensitivity of 37.9 and a specificity of 96.3. Our models identified the six items that most predicted ADHD diagnosis, with adjusted odds ratios ranging from 2.66 to 4.58. Sensitivity, specificity and accuracy were 0.82, 0.84 and 0.84, respectively, for the developed brief scale, and 0.71, 0.85 and 0.81 for its validation. Weighted probability scores produced an area under the curve of 0.89 for development, and 0.82 for validation of the brief scale., Conclusions: The original BAARS-IV performed poorly at identifying prison inmates with ADHD. Our developed brief scale substantially improved diagnostic accuracy. The brief screening instrument has great potential to be used as an accurate and resource-effective tool to screen young people and adults for likely ADHD in the criminal justice system.

Objective: The aim of this study was to examine the role of emotional distress as well as ADHD symptomatology in explaining (a) recidivism, (b) behavioral disturbances in prison, and (c) violent and nonviolent offending., Method: In all, 196 male prisoners from Aberdeen prison completed the Symptom Checklist-90, which examines various clinical symptoms and emotional distress. Current adult symptoms were assessed by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria for ADHD., Results: Emotional distress and ADHD explained the variance in prison records of behavioral disturbance above and beyond antisocial personality (ASP) traits; however, much of the effect of emotional distress was mediated by ADHD symptoms. Only ADHD symptoms were significantly associated to history of violent offending, whereas ASP and age mostly explained nonviolent offenses and overall recidivism., Conclusion: Our results provide support for the conceptual association between ADHD and its related emotional dimension with behavioral disturbance in prison, suggesting a link to reactive violence., (© The Author(s) 2013.)

Purpose: The principal aims of this study are to identify risk factors associated with police arrest and false confessions and to investigate whether the severity of the ADHD condition/symptoms increases the risk., Methods: 22,226 young persons in Iceland anonymously completed self-report questionnaires screening for conduct disorder and ADHD. In addition, they stated whether they had a diagnosis of ADHD and had received ADHD medication, and their history of offending, police interrogation and false confession. Participants were stratified into two age groups, 14-16 and 17-24 years., Results: The older group was significantly more likely to have been interrogated by the police but the younger group were much more vulnerable to false confession during interrogation. Males were more likely to be at risk for both than females. The severity of the ADHD condition increased the risk of both interrogation and false confession. Negative binomial regressions showed that age, gender, conduct disorder, offending, and ADHD symptoms were all significant predictors of both interrogations and number of false confessions. Conduct disorder was the single best predictor of police interrogation, but the findings were more mixed regarding false confessions. Young people presenting with a combination of severe ADHD and comorbid conduct disorder had the worst outcome for both interrogation and false confessions., Conclusions: The findings endorse the need for support of persons with ADHD to be put in place to ensure fair due process and to prevent miscarriages of justice.

This study aimed to evaluate the acceptability and efficacy of delivering the Reasoning and Rehabilitation Mental Health Program (R&R2MHP) to female mentally disordered offenders detained in medium and low secure hospital settings. Group treatment participants (N = 18) and control participants receiving treatment as usual (N = 20) completed self-report measures pre- and post-group. An informant measure of ward behavior was also completed by staff. Violent attitudes and locus of control were assessed at 3-month follow-up. Program completion was excellent (89%). A conservative intention-to-treat analysis found significant treatment effects post-group for positive problem-solving orientation, rational problem-solving style, and locus of control (medium-large effect), but no treatment effect for violent attitudes, anger, and ward behavior. At follow-up, a large treatment effect was found for locus of control. Ad hoc per protocol analyses found a large treatment effect for ward behavior. The findings provide preliminary support for the feasibility and utility of delivering R&R2MHP to females in secure psychiatric settings., (© The Author(s) 2013.)

There are very few, if any, valid and victim-specific situation empathy measures available at present for use with mentally disordered offenders. The aim of this study was to validate a modified version (VERA-2) of the Victim Empathy Response Assessment (VERA) tool which was developed earlier (Young et al., 2008) to enable victim-specific situation empathy measurement in offenders. A total of 55 mentally disordered in-patients residing in a maximum security hospital were assessed on VERA-2 as well as on measures of antisocial personality traits, global affective empathy, violent cognitions, and reported remorse for the index offence. The VERA-2 cognitive and affective empathy scales were negatively correlated with antisocial personality traits and violent cognitions, and positively related to remorse for the index offence. Global affective empathy was positively related to VERA-2 affective empathy. Participants with a history of sexual offending had significantly higher cognitive empathy than other offenders. Acceptance of violence and remorse for the index offence were the best predictors of both cognitive and affective empathy. The findings suggest that the VERA-2 is a valid instrument for measuring victim empathy among mentally disordered offenders, and may prove useful in the context of future risk assessment and outcomes in this population., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Compared with general population rates, prevalence rates of ADHD have been consistently reported to be higher in both male and female offender populations, the latter estimated to range between 10-29%. Research in forensic institutional settings has reported that aggressive behaviour is a particularly prominent source of impairment among men with ADHD. However there is a paucity of research investigating the type of behavioural incidents that may arise in female offenders with ADHD. This pilot study therefore aimed to further our understanding of ADHD within a cohort of female mentally disordered offenders by ascertaining estimated rates of ADHD and associated functional disturbance presenting in this population. Fifty female offenders completed the Barkley ADHD rating scales. Data on aggressive and self-harming behaviours were obtained from patients' clinical records. Almost one-third of patients (28%) screened positive for ADHD, most commonly hyperactive/impulsive and combined subtypes. They were significantly younger than their peers and there were no significant differences in behavioural disturbance records between groups. When controlling for age, hyperactive/impulsive symptoms and combined symptoms were significantly and positively correlated with measures of behavioural disturbance. ADHD symptoms correlated more strongly with self-harm than outward aggression, which is a novel finding. This pilot study has contributed to the knowledge base about the rate and functional problems of female offenders with ADHD. Future research should replicate the study using a larger sample and explore the effect of treatment (pharmacological and psychological) on the reduction of ADHD symptoms, behavioural disturbance, length of stay and quality of life., Competing Interests: Conflict of interest: SY, GG and PA have received honoraria for consultancy, travel, educational talks and/or research from Janssen-Cilag, Eli-Lilly, Shire, Flynn-Pharma, Novatis and/or HB Pharma. All honoraria for PA are paid to Kings College London. SY and PA were members of the NICE guideline development group for ADHD. Other authors have no conflicts of interest in this paper.

Research has indicated that, compared with the general population, the prevalence of offenders with ADHD in prison is high. The situation for offenders managed in the community by the Probation Service is unknown. This study aimed to bridge the gap in our knowledge by (1) surveying the awareness of probation staff about ADHD and (2) screening the rate of offenders with ADHD managed within the service. In the first study, a brief survey was circulated to offender managers working in 7 Probation Trusts in England and Wales asking them to estimate the prevalence of offenders with ADHD on their caseload, the presenting problems of these offenders and challenges to their management, and the training received on the treatment and management of offenders with ADHD. The survey had a return rate of 11%. Probation staff perceived that 7.6% of their caseload had ADHD and identified this group to have difficulties associated with neuropsychological dysfunction, lifestyle problems and compliance problems. They perceived that these problems hindered meaningful engagement with the service and rehabilitation. Challenges to their management were perceived to be due to both internal processes (motivation and engagement) and external processes (inadequate or inappropriate interventions). Few respondents had received training in the management of offenders with ADHD and most wanted more support. In the second study, a sub-sample of 88 offenders in one Probation Trust completed questionnaires to screen for DSM-IV ADHD in childhood and current symptoms. The screen found an estimated prevalence of 45.45% and 20.51% for childhood and adulthood ADHD respectively and these were strongly associated with functional impairment. Thus probation staff considerably underestimated the likely rate, suggesting there are high rates of under-detection and/or misdiagnosis among offenders with ADHD in their service. The results indicate that screening provisions are needed in probation settings, together with training for staff., Competing Interests: Conflict of Interest: SY, GG and MA have received honoraria for consultancy, travel, educational talks and/or research from Janssen-Cilag, Eli-Lilly, Shire, Flynn-Pharma, Novatis and/or HB Pharma. SY was a member of the NICE guideline development group for ADHD. She is co-author of R&R2 ADHD and a consultant at the Cognitive Centre of Canada. Other authors have no conflicts of interest in this paper. No financial support was received to conduct and publish this study.

Objective: Antisocial personality disorder (ASPD) and schizophrenia, as well as childhood abuse, are associated with violent behaviour and show marked volumetric reduction in the anterior cingulate (AC), a brain region implicated in regulation of violence through its involvement in decision making, empathy, impulse control, and emotion regulation. The present study examined, for the first time to the authors' knowledge, the grey matter volume of the AC in relation to seriously violent behaviour and childhood psychosocial deprivation (including physical and sexual abuse) in the context of a mental disorder (schizophrenia or ASPD)., Methods: Fifty-seven men [14 with ASPD and a history of serious violence; 13 with schizophrenia and a history of serious violence (VSZ); 15 with schizophrenia without a violence history (SZ); 15 nonviolent healthy participants] underwent whole-brain magnetic resonance imaging and were rated on the presence of physical abuse, sexual abuse, neglect, extreme poverty, foster home placement, criminal parent, severe family conflict, and broken home (collectively 'psychosocial deprivation'). Stereological volumetric ratings of the AC were examined for group differences and their association with childhood psychosocial deprivation., Results: A higher proportion of ASPD and VSZ patients had suffered psychosocial deprivation as children, in particular severe physical abuse, relative to SZ patients and healthy participants. ASPD and VSZ, but not SZ, patients had significantly lower AC volume relative to healthy participants. AC volumes correlated negatively with (total) psychosocial deprivation as well as physical and sexual abuse ratings. Group differences in AC volume became nonsignificant when psychosocial deprivation ratings were covaried for., Conclusions: Violent mentally disordered individuals with ASPD or schizophrenia suffer from a significant AC volume loss and this deficit, at least in part, is explained by their histories of stressful childhood experiences. Current and future therapies aiming to reduce violence in such populations would benefit by attending to biological (and other) correlates of childhood abuse.

Objective: The objective was to disentangle the relationship between offending, ADHD, and comorbid risk factors., Method: A total of 11,388 students in further education completed a questionnaire, which measured nonviolent and violent delinquency, current ADHD symptoms, conduct disorder, substance use, association with delinquent peers, emotional lability, anger problems, violent attitudes, and low self-esteem., Results: The nonviolent and violent delinquency measures correlated significantly with all the predictor measures, with small to large effect sizes. Multiple regressions showed that after controlling for age and gender, ADHD contributed 8.2% and 8.8% to the variance in nonviolent and violent delinquency, respectively, but these effects were largely mediated by the comorbid measures, particularly substance use, association with delinquent peers, and conduct disorder., Conclusion: The relationship between ADHD symptoms and offending among young people is largely explained indirectly by comorbid factors. A key prevention is to address substance use problems and association with delinquent peers.

Based on a sample of 9085 16- to 19-year-old students attending all high schools in Iceland in 2004, the current study examines depressed mood and anger as potential mediators between family conflict/violence and sexual abuse, on the one hand, and suicidal ideations and suicide attempts on the other. Agnew's general strain theory provides the theoretical framework for the study. Structural equation modelling (SEM) was conducted allowing explicit modelling of both direct and mediating effects using observed and latent variables. The findings showed that both depressed mood and anger mediated the relationship between family conflict/violence and sexual abuse and suicidal attempts. However, when testing the mediating pathways between sexual abuse and family conflict/violence and suicidal ideations, only depressed mood but not anger turned out to be a significant mediator. The authors discuss how these finding may inform and facilitate the design and development of interventions to reduce the likelihood of suicide attempts among young people., (Copyright © 2013 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Background: Intellectual Disabilities (ID) and Attention Deficit Hyperactivity Disorder (ADHD) are recognized psychological vulnerabilities in police interviews and court proceedings in England and Wales. The aims of this study were to investigate: (a) the prevalence of ID and/or ADHD among suspects detained at a large London metropolitan police station and their relationship with conduct disorder (CD), (b) the impact of their condition on police staff resources, (c) the effectiveness of current custody assessment tools in identifying psychological vulnerabilities, and (d) the use of 'Appropriate Adults' in interviews., Method: A total of 200 individuals in a police custody suite were interviewed and screened for ID, ADHD (current symptoms) and CD., Results: The screening rates for these three disorders were 6.7%, 23.5% and 76.3%, respectively. ADHD contributed significantly to increased requests being made of staff after controlling for CD and duration of time in custody. This is a novel finding. Reading and writing difficulties and mental health problems were often identified from the custody risk assessment tools, but they were not used effectively to inform on the need for the use of an Appropriate Adult. The frequency with which Appropriate Adults were provided to support detainees in police interviews (4.2%) remains almost identical to that found in a similar study conducted 20 years previously., Conclusions: The current findings suggest that in spite of reforms recently made in custodial settings, procedures may not have had the anticipated impact of improving safeguards for vulnerable suspects. Detainees with ID and ADHD require an Appropriate Adult during police interviews and other formal custody procedures, which they commonly do not currently receive. The findings of the current study suggest this may be due, in large part, to the ineffective use of risk-assessment tools and healthcare professionals, which represent missed opportunities to identify such vulnerabilities.

Background: The growing popularity of offending behavior programs has led to the interest of whether such programs are effective with mentally disordered offenders. This study aimed to evaluate the effectiveness of the Reasoning and Rehabilitation program adapted for offenders with severe mental illness (R&R2 MHP)., Methods: A sample of 59 adult high risk males detained in a high secure hospital completed questionnaires at baseline and post treatment to assess violent attitudes, anger, coping processes and social problem-solving. An informant measure of social and psychological functioning, including disruptive behavior, was completed by staff at the same time. The data of 30 patients who participated in the group condition were compared using intention to treat analysis with 29 controls who received treatment as usual., Results: 80% of group participants completed the program. In contrast to controls, significant medium-large treatment effects were found at outcome on self-reported measures of violent attitudes, social problem-solving and coping processes. Improvements were endorsed by informant ratings of disruptive behavior, social and psychological functioning., Conclusions: The R&R2MHP had a comparatively low dropout rate and was effective in a sample of high risk mentally disordered offenders requiring detention in high security. Future research should use a randomized controlled design., Trial Registration: Current Controlled Trials ACTRN12613000216718.

Objective: To investigate the relative importance of ADHD symptoms, mood instability, and antisocial personality disorder traits in predicting self-reported offending., Method: A total of 295 Icelandic students completed two scales of offending behavior and measures of ADHD symptoms, mood instability, and antisocial personality traits., Results: Self-reported offending from the two independent scales correlated significantly with ADHD symptoms, mood instability, and antisocial personality traits with medium to large effect size. Multiple regressions showed that ADHD symptoms contributed to the two outcome measures beyond that of age and gender with a medium effect size. The ADHD effects were only partly mediated by mood instability and antisocial personality traits for general offending but were almost completely mediated by the more reactive measure of antisocial behavior., Conclusion: ADHD appears to be a potential risk factor for general offending in its own right irrespective of the presence of comorbidity, whereas mood instability is more important with regard to reactive behavior.

Objective: Violent behaviour has been associated with presence of certain mental disorders, most notably antisocial personality disorder (ASPD) and schizophrenia, childhood abuse, and multiple brain abnormalities. This study examined for the first time, to the authors' knowledge, the role of psychosocial deprivation (PSD), including childhood physical and sexual abuse, in structural brain volumes of violent individuals with ASPD or schizophrenia., Methods: Fifty-six men (26 with ASPD or schizophrenia and a history of serious violence, 30 non-violent) underwent magnetic resonance imaging and were assessed on PSD. Stereological volumetric brain ratings were examined for group differences and their association with PSD ratings. PSD-brain associations were examined further using voxel-based-morphometry., Results: The findings revealed: reduced thalamic volume in psychosocially-deprived violent individuals, relative to non-deprived violent individuals and healthy controls; negative association between thalamic volume and abuse ratings (physical and sexual) in violent individuals; and trend-level negative associations between PSD and hippocampal and prefrontal volumes in non-violent individuals. The voxel-based-morphometry analysis detected a negative association between PSD and localised grey matter volumes in the left inferior frontal region across all individuals, and additionally in the left middle frontal and precentral gyri in non-violent individuals., Conclusions: Violent mentally-disordered individuals with PSD, relative to those with no or minimal PSD, suffer from an additional brain deficit, i.e., reduced thalamic volume; this may affect sensory information processing, and have implications for management, of these individuals. PSD may have a stronger relationship with volumetric loss of stress-linked regions, namely the frontal cortex, in non-violent individuals., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Objective: The main objective of this article is to investigate the type of personality disorders and clinical syndromes (CSs) that were best related to ADHD symptoms among prisoners., Method: The authors screened for childhood and adult ADHD symptoms and administered the Millon Clinical Multiaxial Inventory-III (MCMI-III) to 196 serving prisoners., Results: Childhood and adult ADHD symptoms were most strongly related to the compulsive (negative relationship) and borderline (positive relationship) scales on the MCMI-III with large and medium effect sizes, respectively. Hierarchical multiple regressions revealed that the absence of compulsive personality disorder traits (i.e., a low score as a dimension) was the single best Axis II predictor of childhood and adult ADHD symptoms. CSs did not add significantly to the variance in childhood ADHD beyond that of the personality disorder dimensions, but it did so for current ADHD symptoms in relation to alcohol dependence., Conclusion: The findings demonstrate the relative absence of compulsive personality disorder traits in prisoners with ADHD symptoms as core maladaptive traits involving disorganization.

Background: This study investigates the relationship between attention deficit hyperactivity disorder (ADHD) symptoms and cigarette smoking, alcohol use and illicit drug use., Method: The participants were 10,987 pupils in the final three years of their compulsory education in Iceland (ages 14-16 years). The participants completed questionnaires in class relating to anxiety, depression and antiestablishment attitudes, ADHD symptoms, smoking, alcohol consumption and illicit drug use., Results: Of the total sample, 5.4% met screening criteria for ADHD. Smoking, alcohol and illicit drug use were significantly related to ADHD symptoms. In addition, the number of different illicit drugs consumed was significantly higher among the ADHD symptomatic than the nonsymptomatic participants, including the illicit use of sedatives. The main distinguishing illicit drug substances were lysergic acid diethylamide (odds ratio or OR = 8.0), cocaine (OR = 7.5), mushrooms (OR = 7.1) and amphetamines (OR = 6.5). Logistic multiple regressions showed that after controlling for gender and school grade, ADHD symptoms predicted smoking, alcohol use and illicit drug use independent of anxiety, depression and antiestablishment attitudes. In addition, poly-substance use was linearly and incrementally related to ADHD symptoms with a large effect size., Conclusions: The findings underscore the vulnerability of young persons with ADHD symptoms to smoking, alcohol and illicit drug use, possibly as a means of self-medication, and emphasize a need for early identification and treatment to reduce the risk of escalation., (© 2011 The Authors. Journal of Child Psychology and Psychiatry © 2011 Association for Child and Adolescent Mental Health.)

This paper investigates the relationship between physical activity and depressed mood, under conditions of family conflict. We analyze data from a representative sample of 7,232 Icelandic adolescents. Analysis of variance was carried out to test for main and interaction effects. The study shows that while family conflict increases the likelihood of depressed mood, among adolescents, physical activity decreases the likelihood of depressed mood. Furthermore, physical activity plays a more important role among those adolescents living in aversive circumstances, than other adolescents, as family conflict and physical activity interact in the effect on depressed mood for adolescents living in such circumstances. The findings highlight the role of physical activity in decreasing mental distress among adolescents, especially those living in aversive circumstances at home., (Copyright © 2011 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Objective: To examine whether depressed mood and anger mediate the effects of sexual abuse and family conflict/violence on self-injurious behavior and substance use., Methods: A cross-sectional national survey was conducted including 9,085 16-19 year old students attending all high schools in Iceland in 2004. Participants reported frequency of sexual abuse, family conflict/violence, self-injurious behavior, substance use, depressed mood, and anger., Results: Sexual abuse and family conflict/violence had direct effects on self-injurious behavior and substance use among both genders, when controlling for age, family structure, parental education, anger, and depressed mood. More importantly, the indirect effects of sexual abuse and family conflict/violence on self-injurious behavior among both males and females were twice as strong through depressed mood as through anger, while the indirect effects of sexual abuse and family conflict/violence on substance use were only significant through anger., Conclusions: These results indicate that in cases of sexual abuse and family conflict/violence, substance use is similar to externalizing behavior, where anger seems to be a key mediating variable, opposed to internalizing behavior such as self-injurious behavior, where depressed mood is a more critical mediator., Practice Implications: Practical implications highlight the importance of focusing on a range of emotions, including depressed mood and anger, when working with stressed adolescents in prevention and treatment programs for self-injurious behavior and substance use., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Little is known about expert psychiatric and psychological evidence in appeal cases., Aims: To review the frequency, nature and impact of expert psychiatric and psychological evidence in the Supreme Court in Iceland over a 7-year period where all appeals in Iceland are heard., Method: All cases listed on the Supreme Court's Website between 2001 and 2007 were identified. The judgements were carefully screened for relevant information. Details of the nature of the criminal offences for the sample were obtained from official records., Results: 3367 cases were identified. Psychiatric and psychological evidence was considered in 213 (6.3%) cases (2.7% and 4.2% for the two disciplines, respectively), with only 10% cases involving reports from both disciplines. Psychiatrists focused primarily on assessing violent offenders, diminished responsibility issues, restraining orders, and mental state examinations and diagnosis, whereas psychologists were more commonly involved in custody disputes and credibility assessments of victims of sexual offending. No oral expert evidence was heard in the Supreme Court. Psychiatric and psychological evidence was typically that previously presented in the District Courts., Conclusions: This is the first comprehensive study to investigate the contribution of forensic psychiatry and psychology in appeal cases. Psychiatrists and psychologists have complementary skills for the assessment of court referrals. Their evidence and recommendations in appeal cases in Iceland are accepted by the Supreme Court in the great majority (78%) of cases.

Reviewing the literature on police-induced confessions, we identified suspect characteristics and interrogation tactics that influence confessions and their effects on juries. We concluded with a call for the mandatory electronic recording of interrogations and a consideration of other possible reforms. The preceding commentaries make important substantive points that can lead us forward-on the effects of videotaping of interrogations on case dispositions; on the study of non-custodial methods, such as the controversial Mr. Big technique; and on an analysis of why confessions, once withdrawn, elicit such intractable responses compared to statements given by child and adult victims. Toward these ends, we hope that this issue provides a platform for future research aimed at improving the diagnostic value of confession evidence.

An open forensic rehabilitation ward provides an important link bridging the gap between secure and community provisions. This paper provides an audit of such a service by examining the records of an open forensic rehabilitation ward over a five-year period from 1 June 2000 until 31 May 2005. During the audit period there were 51 admissions, involving 45 different patients, and 50 discharges. The majority of the patients came from secure unit facilities, acute psychiatric wards or home. Thirty-nine patients were discharged either into hostels (66%) or their home (12%). The majority of patients (80%) had on admission a primary diagnosis of either schizophrenia or schizoaffective disorder. Most had an extensive forensic history. The focus of their admission was to assess and treat their mental illness/disorder and offending behaviour and this was successful as the majority of patients were transferred to a community placement after a mean of 15 months. It is essential that there is a well-integrated care pathway for forensic patients, involving constructive liaison with generic services and a well-structured treatment programme which integrates the key principles of the 'recovery model' approach to care.

Objective: To ascertain whether ADHD symptoms, and associated problems, are negatively related to subjective well-being., Method: The Satisfaction With Life Scale (SWLS) was completed by 369 university students, along with the Reasoning & Rehabilitation (R&R) ADHD Training Evaluation (RATE), the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Scale for current ADHD symptoms, and the Depression Anxiety Stress Scales (DASS)., Results: The SWLS was negatively correlated with all the other measures, and the strongest correlations were with the Total RATE score. A multiple regression analysis showed that the variables in the study accounted for 22% and 25% of the variance of the SWLS among males and females, respectively. Among males poor social functioning was the best predictor of dissatisfaction with life, whereas among females it was poor emotional control., Conclusion: Both ADHD symptoms and associated problems are significantly related to poorer satisfaction with life.

Attention-deficit hyperactivity disorder (ADHD) is a developmental disorder, which is associated with a number of psychiatric conditions, mostly personality disorder, substance misuse, anxiety and depression. The aim of the present study was to investigate the relationship between ADHD symptoms and associated psychiatric conditions among prisoners. The participants were 90 male prisoners in Iceland who were assessed within 10 days of admission to the prison. The Mini International Neuropsychiatric Interview (MINI) and the Standardised Assessment of Personality-Abbreviated Scale (SAPAS) were administered. Childhood ADHD symptoms were screened by the Wender-Utah Rating Scale and current adult symptoms by the DSM-IV Checklist for ADHD. Half of the prisoners (50%) were found on screening to have met criteria for ADHD in childhood and of those over half (60%) were either fully symptomatic or in partial remission of their symptoms. A logistic regression analysis revealed that the MINI Antisocial Personality Disorder scale was the single best predictor of current ADHD symptoms. Many prisoners are either fully symptomatic or in partial remission of their ADHD symptoms and have serious co-morbid problems, primarily associated with antisocial personality disorder and substance dependence. Prisoners should routinely undergo screening for ADHD in order to identify those who would benefit from a comprehensive assessment to determine who may have ADHD and associated problems.

Aims: The aim of the study was to examine trends in adolescent depression and anxiety symptoms from 1997 to 2006, using four time-points (1997, 2000, 2003, and 2006), and adolescent mental health service use in the same period, using three time-points (1997, 2000, and 2006)., Methods: Four cross-sectional population-based samples of 14- and 15-year-old students, attending the compulsory 9th and 10th grades of the Icelandic secondary school system, completed questionnaires relating to mental health. In total, 21,245 students participated in the four studies., Results: Anxiety symptoms increased significantly for both boys and girls, throughout the period from 1997 to 2006. Depressive symptoms increased significantly for girls, while there were no significant changes in depression among boys. During the same time period, the proportion of adolescents who visited healthcare specialists, i.e. psychiatrists, psychologists and social workers, increased significantly. The results revealed that regular visits (six times or more during 1 year) to psychiatrists and psychologists increased significantly over the same period among girls but not among boys., Conclusions: The findings show that symptoms of depression and anxiety have increased among adolescents in Iceland. Future work would benefit from further research into the trends in risk and protective factors associated with these outcomes. The findings call particular attention to the increasing risk for depression and anxiety symptoms among girls.