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Attention Deficit Hyperactivity Disorder in Prison: A Treatment Protocol

Dr. Appelbaum is Professor of Clinical Psychiatry, and Director, Correctional Mental Health Policy and Research, Center for Health Policy and Research, Commonwealth Medicine, University of Massachusetts Medical School, Shrewsbury, MA. Address correspondence to: Kenneth L. Appelbaum, MD, Center for Health Policy and Research, 13E779, University of Massachusetts Medical School, 333 South Street, Shrewsbury, MA 01545-2732. E-mail: kenneth.appelbaum{at}umassmed.edu

Prescribing controlled substances in correctional settings can create challenges for security, nursing, and psychiatric staff. Some inmates, including those with functionally significant attention deficit hyperactivity disorder (ADHD), however, can benefit from such treatment. This article describes the development of a protocol for the treatment of prison inmates with ADHD that attempted to address a broad range of concerns including disparate diagnostic and treatment standards among prison psychiatrists, conflicts between stakeholders, and medication misuse and substance abuse among inmates. The protocol provides criteria in four main areas: diagnosis, current functional impairment, treatment in general, and treatment with stimulants. Stakeholders had mixed reactions to the protocol.

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