Symptoms of Attention Deficit and Hyperactivity Disorder (ADHD) affect up to 11 percent of children (Visser et al., 2013). There is strong empirical evidence that an ADHD diagnosis puts children at higher risk for significant academic impairment, weaker ties to pro-social institutions, increased risk of delinquency, and negative impacts on social functioning and job attainment and retention as adults (Kent et al., 2011; Kuriyan et al., 2013; Sibley et al., 2011). For children who are already vulnerable to school discipline, poor education outcomes, and justice-system involvement due to their race or socio-economic status (Education, 2014), ADHD likely magnifies these risks. This study used qualitative interviews with 21 racially diverse, out-of-school, justice-system-involved young men to explore the ways ADHD shapes young people’s prosocial bonds and school experiences.
Methods
In-depth interviews were conducted with 21 young men (ages 18-24) enrolled in a program provided by a non-residential, non-profit organization devoted to serving young men with justice involvement who are disconnected from school and employment in Massachusetts. These young men are frequently referred to the program as an alternative to incarceration while under community supervision, and are at high risk for future incarceration.
The 21 young men identified as Latino (10), as Black (African-American, Afro-Caribbean, or Afro-Latino) (4), white (3), multi-racial (3), and Asian (1). Twelve had a diagnosis of ADHD and seven had a co-occurring learning or other disorder. Five did not have ADHD but had been diagnosed with other neurodevelopmental or mental health disorders. Four had no diagnosis.
Findings
School was a challenging place for most of the young men, but particularly those with ADHD. Young men without ADHD diagnoses seemed to have fewer disciplinary problems in school and were punished less severely. Most young men with ADHD reported having an individualized education program (IEP). Consistent with the literature, the young men had varying experiences with IEP implementation. None of them reported having any legal advocates in IEP meetings or negotiations, and for those who had been removed from their homes or involved with the Department of Children and Families (DCF), there was little continuity for their accommodations. Some young men felt singled out by the IEP process and felt it differentiated them from other students. Several expressed shame or stigma at having their IEP publicly revealed and expressed defensiveness about what having an IEP meant about their intelligence or abilities:
I used to hate those [IEP] meetings cause my mom had to come to school… I’m sitting in class and I’m getting called down out of a lot…nobody knew what an IEP was…I had special education written all over me.
All the young men reported disciplinary issues at school, and most reported experiencing exclusionary discipline, including out-of-school suspension and, more rarely, in-school suspension. Suspensions were employed repeatedly for some young men, sometimes paradoxically as a response for not coming to school. However, the young men did not report that suspensions had any impact on their behavior. For some, suspension was a desired outcome leading to out-of-school time that was often unsupervised and unstructured. For others, suspension was part of escalating behavior that was designed to get a reaction from school officials. Young men described schools that seemed ill-equipped to deal with disciplinary problems, which resulted in discipline that was both exclusionary and poorly communicated to students. Several young men reported having to spend time alone in a dean’s or principal’s office for entire school days after an incident without contact with other students. Others reported not knowing or understanding that they were suspended or in trouble, leading to disorientation and disengagement:
I got suspended one time but I was never told that I got suspended. So I tried to go back to school not knowing that I was suspended. I got to the front door but the teacher, the principal just came through the front door and told me I was suspended. So since that day I just never went back.
For young people already tenuously attached to school, being overtly told you are not allowed in presents a barrier that is difficult to overcome.
Consistent with the literature (Skiba et al., 2014), several young men described a trajectory that began with exclusionary discipline in earlier grades and escalated to expulsion and transition to an alternative school, ultimately ending in dropout. School transitions for young men with ADHD were problematic. Several young men dropped out between middle school and high school, and in frustration when moving from one school to another when their school records were not transferred or received.
Young men also had considerable difficulty returning to school after criminal-legal-system-related attrition or incidents that resulted in expulsion due to miscommunication, embarrassment, frustration about having to repeat grades, or lack of support. Angel, who has ADHD, depression, and anxiety, described his attempt to return to school to finish his senior year after a period of not attending. He came to the first day of school but was not sure who his teachers would be, and was directed to a classroom for attendance. Since his name did not appear on the roster, he was sent to the dean, who told him she had disenrolled him from school.
Other young men felt pushed out by school, even when there was no formal expulsion. Alternative schools seemed to serve as an “off-ramp” for young men with ADHD. Some, like Noah, believed they would have an opportunity to return to their traditional school, and were frustrated when that opportunity didn’t materialize:
My IEP worker would always tell me finish this year off good and next year we’ll try to see if we can get you into a public school. I don’t think she ever even tried to be honest. I don’t think she cared.
All young men interviewed had some experience with law enforcement. Young men with ADHD seemed to become involved with police at an earlier age than those without ADHD. For most young men, police contact was not initiated by school authorities or resource officers, but several reported arrests that were related to incidents at school, primarily fighting or bullying, where police came to their house later to arrest them or inform them of a restraining order. Most young men said they had been held by police many more times than they had been arrested. For young men with ADHD, staying out of trouble while incarcerated could be a struggle. For instance, Alejandro described how his initial 12-month Department of Youth Services (DYS) sentence extended to 24 months:
I kept messing it up… they were letting me go to a step down, but I just kept messing it up. I’d be like fighting somebody at a step down… And so they indicted me, they gave me one more time on top of my time and I couldn’t have good time then. Then they just gave me the full time I was supposed to serve. I was supposed to serve like a 12 or 24, and I ended up serving like the 24 months.
It was unclear whether ADHD symptoms made it difficult to follow rules when under correctional supervision. For some, like John, incarceration brought structure and order to an otherwise chaotic life, demonstrating how complex young mens’ relationships to institutions may be when their pro-social relationships have broken down. As he described it, “I lived a good life in jail”. This does not mean jail was a positive influence for John, but instead shows how difficult his life outside of jail has been, and how the many systems involved in John’s life have failed him.
Discussion
Schools, widely documented as a pro-social protective factor for young people at risk of justice-system involvement, were sources of disconnection and stigma for young men in this study struggling with ADHD and other disorders. Though study participants had serious behavioral challenges that were difficult for schools to manage, these interviews suggest that these are the students who need more protection and intervention from school officials than their peers. Young men with ADHD may be less able to navigate the complexities of remaining in school while under correctional supervision than those without the diagnosis. Aptitude and impairment appeared to influence how young men were treated by institutions, especially schools. Young men with learning disorders (with or without ADHD) reported experiencing little to no encouragement to stay in school, and several even felt pushed out. Even less-impaired students with ADHD felt stigma associated with their special education status. Young men with ADHD also seemed to experience more persistent and escalating discipline relative to those without ADHD, even before their criminal legal system involvement.
Recommendations
This study was small and the conclusions we can draw are limited. However, the findings contribute to a growing body of work that documents how the health care system, the school system, and the justice system are linked by policy failures that differentially harm children of color (Annamma et al., 2014; Sussman, 2011). By damaging family institutions, limiting access to protective institutions, and diminishing the complement of choices available early in childhood or adolescence, institutions both fail to prevent — and ultimately reinforce — negative outcomes for children. The policy response should be clear: bolster in-school support for children with ADHD, especially those who have disciplinary issues, to prevent school detachment and possible criminal legal system involvement. Behavioral health policy must recognize that children with the most precarious attachments to family, school, and community would also potentially benefit the most from inclusive policies that keep them attached to school and other support services.
Sarah Jalbert, PhD, is Executive Director of the Institute for Community Health. Holly Swan, PhD, is Senior Policy and Implementation Manager at the Massachusetts Office of the Child Advocate.
References
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