Neurodevelopmental disorders in the Albanian penitentiary system: findings from the first systematic screening study

Background:

Neurodevelopmental disorders (NDDs) such as attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and specific learning disorders are reported with a higher prevalence in the penitentiary system compared to the general population. Recent meta-analyses report prevalence estimates ranging from 8.3 to 22.2 (depending on the inclusion criteria) for ADHD [1, 2]. These disorders are linked to earlier criminal onset, higher rates of adversities in the penitentiary system, and pose a higher risk of recidivism [3]. However, they still remain highly underdiagnosed and untreated, especially in overcrowded institutions and with a great lack of resources, like prisons in Albania.

The aim of this study was to determine the prevalence of screen-positive NDD symptoms in residents from two Albanian penitentiaries and to evaluate the concordance between screening findings and existing clinical records.

Methods:

A cross-sectional study was conducted in two Albanian penitentiaries. The study was approved by the Ethics Committee of the University of Medicine, Tirana, and the General Prison Directorate in Albania. Written informed consent was obtained from all participants. Structured interviews were performed with 112 individuals, residents in the two institutions (85 males at the “Mine Peza” Penitentiary in Tirana and 27 females at the “Pojska” Penitentiary).

Instruments included: Adult ADHD Self Report Scale v1.1, Wender Utah Rating Scale, Autism Quotient, Adult Dyslexia Checklist, Adverse Childhood Experiences, Suicide Behaviors Questionnaire-Revised-SBQ-R, and Drug History Questionnaire-DHQ. Instruments were adapted into Albanian through forward-backward translation and pilot testing.

Data analysis was performed using SPSS v.26 and the PROCESS Macro v.5.0. Due to non-normality, non-parametric analyses were employed, including Mann-Whitney U and Kruskal-Wallis tests for group comparisons and Spearman’s rho for correlations.

Results:

Screening results revealed that 32.1% of participants screened positive for childhood ADHD symptoms, while 16.1% for current ADHD symptoms. 24.1% presented above-threshold scores for dyslexia symptoms and 2.7% for autistic traits. Notably, none of the individuals had ever received a diagnosis or been evaluated for neurodevelopmental disorders. 18.8% had a documented psychiatric history, with mood disorders accounting for the highest percentage, and 8.9% displayed significant suicidal risk. 17% of the entire sample was currently under medication. High rates of lifetime substance use was documented (including alcohol, cannabis and cocaine).

Conclusions:

The findings show a profound discrepancy between the highly present symptoms and the clinical recognition of neurodevelopmental disorders in the Albanian prison population. While we have learned to diagnose and treat major psychiatric disorders, it seems that we are neglecting the ones that directly impact the early onset of the criminal course and the stagnation in its vicious circle. Routine screening combined with adequate neuro-psycho-pharmacological interventions has been shown to reduce recidivism and increase rehabilitation in prison settings [4]. It is time for such approaches to be incorporated into the Albanian penitentiary system.

Keywords: Forensic Psychiatry, Neurodevelopmental Disorders, criminality, Psychiatric comorbidities, recidivism, penitentiary rehabilitation

References

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