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Table 1 Recommendations

From: Identification and treatment of offenders with attention-deficit/hyperactivity disorder in the prison population: a practical approach based upon expert consensus

Identification and Assessment
 1. Prison staff training to develop awareness of ADHD symptoms and co-morbid conditions (including how these may differ by age and gender), treatments, expected outcomes and the potential impact of prison regime on the offender with ADHD (e.g. greater risk of suicide, impact of segregation). This should include recognition that many offender mental health issues are secondary to ADHD.
 2. For youths, adoption of a suitable primary screen (e.g. CHAT) and a clinical diagnostic interview (e.g. ACE). If a rating scale is given (e.g. SNAP-IV, CBRS) this should be sensitive to both inattention and hyperactivity/impulsivity symptoms.
 3. For adults, adoption of a suitable primary screen (e.g. B-BAARS) and a clinical diagnostic interview (e.g. ACE+, CAADID, DIVA-2). If a rating scale is given (e.g. BAARS) this should be sensitive to both inattention and hyperactivity/impulsivity symptoms.
Interventions and Treatment
 4. All treatments should include psychoeducation about ADHD, including symptoms, co-morbidity, pharmacological and non-pharmacological treatments, side-effects of treatment and expected outcomes.
 5. Adoption of appropriate pharmacological and non-pharmacological treatments (see Fig. 1).
 6. Adoption of appropriate educational and occupational programmes designed to increase engagement (see Fig. 1).
 7. Educational and occupational programmes should be prioritised that advance vocational, creative, technical, and/or athletic skills.
Care Management and Multiagency Liaison
 8. There should be close liaison between education and mental health services within the criminal justice system
 9. A care plan coordinator should be assigned to the offender while in prison.
 10. A comprehensive care plan should be established, including a medication management plan, for the offender while in prison (see Additional file 1, online supplementary material).
 11. The care plan should also plan to prepare the offender with ADHD for release from prison (e.g. effecting a seamless transition to ensure continuity of care and uninterrupted treatment with ADHD medication; arranging appropriate links with supportive services and agencies).
 12. A critical time intervention approach should be established for a designated person to support the offender through the release process, support implementation of the care plan and ensure engagement in healthcare.