In 1996, despite the fact that up to one per cent of UK schoolchildren had severe hyperaaivity,8 only one in 30 of such children were on medication.' Medication usage must be seen in context of the incidence of the condition. There is therefore very significant under-treatment of this medical condition in the UK.

Conclusion

It is therefore vital that the legal profession has factual knowledge of ADHD. A great deal is already known about ADHD, research is increasing and the current under recognition in the UK means that large numbers of children with problems are overlooked. In children with severe complications, especially those with early onset Oppositional Defiant Disorder and Conduct Disorder, the underlying ADHD may he concealed and thus confuse or delay active treatment.

Those children tend to progress into lifelong criminal activity and antisocial personality disorder, comprising a large proportion of the criminal psychopaths. Those with persistent problems are strongly linked with the 5-10 per cent of offenders who commit 70 per cent of all homicides, rapes and serious assaults. The antisocial activity can range from premeditated acts of aggression through to impulsive actions. The theory that ADHD is a disorder of behavioural inhibition and impulse control with the associated difficulties in self-regulation, in rule-governed behaviour and development of a code of moral conduct is very relevant. Often, short-term memory difficulties mean that the offenders cannot remember what they have done in moments of extreme impulsivity. Being male is by far the strongest factor predisposing to crime. Many criminals are more vulnerable because they have brains that are dysfunctional, especially with regard to problems with impulse control.

The criminal justice, legal, police system and society in general, at the moment, appear to have a low awareness that there may be a genetic or biological basis to some criminal activity. h may well be worth screening prisoners for ADHD, especially those in young offenders' institutions, and as part of their sentence including the institution of effective treatment. It would seem more advantageous to these children and their relatives to identify them at an earlier age, when they are still at school, possibly in the care system, when treatment is more likely to be effective. ADHD may at times justify the consideration of mitigating circumstances; it is a biological explanation for some behaviour or actions, rather than an excuse.

There is a large and well-documented world literature on biological predisposition to crime, and the role of awareness of this in crime prevention. It is important that those involved in crime prevention fully understand the implications of this. Without such understanding, the basic notion that only environmental and social factors cause crime is perpetuated. The causes of crime are multi-factorial, but societal, environmental, economic and cultural factors alone do not yet give the total explanation for crime. Failure to take a wider view enables the high rate of chronic offending to continue and is cost-ineffective. The cast to Britain of juvenile crime is said to be £7 billion per year.

A long-term study from New Zealand has shown that the strongest risk factor for family and adult partner violence was childhood conduct problems and this has been virtually ignored in research and scarcely mentioned in the literature. Adult partners violent towards each other are also at increased risk of abusing their children. Studies suggest that the risk of child abuse is between three to nine times greater in homes where adult partners hit each other. Conduct Disorder also predicts many other undesirable outcomes, including teenage pregnancy (30 per cent of girls with Conduct Disorder) and the fact that 50 per cent of sufferers become involved in a violent intimate relationship.

Understanding the factual reality, and the suffering caused by ADHD and its importance as a public health issue for children and adults is vital, so that rational decisions can he made on the most appropriate provision of help.

Case History - Sam "Sam is now 18. From an early age he was hyperactive, impulsive, noisy and had poor concentration. His life was punctuated by numerous accidents as he had no awareness of danger or of cause and effect and never seemed to learn from his experiences - he broke nearly every bone in his hands during his skate-boarding obsession. Intelligent and quick-witted, Sam is a kind and caring lad with a well developed - if not somewhat excessive - sense of fun. He is an able sportsman and a creative and competent musician. Sam gained a reputation as the class clown and a loveable rogue but his IQ enabled him to achieve well in the more structured environment of junior school.

His work deteriorated in the larger classes in secondary school. His increasing disorganization led to failed homework and assignment deadlines. His self esteem decreased, he became depressed and was rude to teachers, being suspended on two occasions. Repeated detentions meant that his parents were regularly contacted because of his misdemeanours and underachievement. No amount of effort had been spared to give Sam and his older brother a caring and positive upbringing with good moral values. However, being easily led, Sam gravitated towards bad company and had repeated brushes with the law for physical impulsiveness. He began truanting. Friends persuaded him to make a bomb hoax call to his school which was captured on video. Fortunately, his head teacher saw beyond the moment, recognized his potential and prevented the matter being taken further by the authorities.

Unbeknown to his family, Sam had been introduced to drugs at the age of 13 and began to smoke cannabis regularly and steal from his mother to fund this and smoking cigarettes. Needing constant stimulation, entertainment and little sleep, as well as being fidgety and restless meant Sam was always out with friends, sometimes vandalising - often until well into the early hours.

Sam's intelligence, with little effort, gained good GCSE results. He went onto sixth form college. However, the lack of structure and intervals between lectures compounded his growing difficulties. During a free period, Sam was arrested in the local park for possession of a quantity of cannabis with suspected intent to deal - at the age of only 17. He was ' cautioned. This crisis resulted in referral for help which his mother had been abortively seeking for several years - her single parent-status having been blamed for his problems. He was belatedly diagnosed as having severe ADHD with oppositionality and associated substance abuse - a frequent complication of late-diagnosed ADHD - depression and low self-esteem.

Sadly, because of late diagnosis and the very nature of untreated ADHD, Sam could not co-operate with recommended medical and other management of his problems. Police cautioned him but he continued to gravitate downwards personally and socially. Although expected to achieve well in `A' levels, his poor attendance, concentration and other problems, resulted in expulsion just before the exams. Nine months later, Sam's continuing and untreated difficulties led to another arrest. In court his ADHD, good upbringing/environment and academic potential was cited, resulting in a conditional discharge and fine with a warning to stay away from drugs and bad company or face a severe penalty. ' Sam's untreated ADHD prevents him from halting his behaviour or concentrating long enough to consider the gravity of his situation, despite having an obvious high intelligence - or to motivate himself to get a job to pay the fine or support himself. Untreated, he will undoubtedly reoffend and be seen by society as someone who deserves his fate rather than as a victim of a medical condition, needing understanding and support - not punishment. Had Sam's problems been recognized and treated earlier, many of his difficulties could have been prevented. Until such time as he is able to recognize the need for help, his progressive ADHD is increasingly likely to have serious consequences.

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