THURSDAY NOVEMBER 02 2000

Medical Briefing

ADHD and the link to crime

DR THOMAS STUTTAFORD

LORD WOOLF, the Lord Chief Justice, summed up the difficulty in settling the length of sentence which Robert Thompson and John Venables should serve for the murder of James Bulger when he said that “further detention would not serve any constructive purpose”.

Lord Woolf wished to give the two boys, who had expressed remorse, the opportunity to reform and thereby escape the destructive influence of life in a young offenders’ unit.

Some experts believe that we are born as little angels until corrupted by society. Others agree that William Golding, the author of Lord of the Flies, is correct in his portrayal of children as savages — unless tamed by social rules and pressures. The truth lies between these two extreme points of view.

What is certain is that when dealing with aberrant children, their unacceptable behaviour should not be dismissed as a passing phase. Such extreme behaviour is invariably present in those children who grow up to become psychopaths. Part of the official definition of antisocial personality disorder, the current term for psychopathy, is that there is evidence of conduct disorder before the age of 15.

These symptoms of conduct disorder in childhood, which may later lead to psychopathy, include the frequent initiation of physical fights, the use of weapons, arson and stealing. Thompson and Venables, in their torture and murder of James Bulger, showed all the other features that are frequently seen in children who later become psychopaths — their actions displayed skilled lying, physical cruelty to animals, physical cruelty to other children, deliberate destruction of property and sexual assault.

More than 90 per cent of children with conduct disorder have evidence of attention deficit hyperactivity disorder (ADHD). There is convincing evidence that Venables was destructively hyperactive.

The reverse, of course, is not true: all children with ADHD are difficult to live with, but most are law-abiding, and one large group with this personality disorder is exceptionally gifted.

One of the difficulties in separating nature from nurture as a cause of the delinquency, which is a forerunner of psychopathy in adult life, is that the parents of the child have many of the same genes as their children — genes that are unlikely to make for good parenting.

The treatment of severe conduct disorder includes a revolution in the lifestyle of the whole family — a therapy easier to prescribe than achieve. Dr Robert Andry, a clinical psychologist who has specialised in the treatment of antisocial personality disorders in adolescents and young adults, has shown that although many are beyond salvation, an appreciable minority can be taught to conform to the rules of society.

Not, however, by kindliness, but by inflicting on them, while incarcerated, a life of such austerity and discipline — but not cruelty — that they resolve at all costs to avoid re-incarceration.

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