Attention-Deficit/Hyperactivity Disorder, Racial Disparities, and Involvement in the Juvenile Justice System: A Narrative Review

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition associated with adverse behavioral, social, and legal outcomes across childhood and adolescence. Untreated ADHD is associated with increased involvement in the criminal justice system, while racial and ethnic disparities in diagnosis and treatment may contribute to inequitable outcomes among minority youth. This narrative review examines the relationships among ADHD, pharmacologic treatment, juvenile justice involvement, and racial/ethnic disparities affecting minority youth. A targeted review of peer-reviewed literature published between 2000 and 2026 was conducted using PubMed and Google Scholar, including cohort studies, longitudinal analyses, meta-analyses, and nationally representative datasets, to assess ADHD prevalence, associations with delinquency and criminal justice outcomes, treatment effects, and disparities in diagnosis and care. Across studies, ADHD is consistently associated with increased rates of police contact, court involvement, criminal convictions, incarceration, and shorter time to re-offense. Pharmacologic treatment is associated with reduced rates of criminal convictions and substance-related problems. Nevertheless, racial and ethnic disparities persist, with minority youth significantly less likely to receive a diagnosis or treatment despite a similar symptom burden. ADHD is also substantially overrepresented in justice-involved populations, with approximately 25-30% of individuals meeting diagnostic criteria. ADHD represents a potentially modifiable factor along pathways to juvenile justice involvement, although outcomes are shaped by both clinical and structural determinants. Expanding equitable screening, improving access to longitudinal pharmacologic and behavioral care, strengthening coordination among healthcare, educational, and community systems, and integrating mental health services within juvenile justice settings may reduce downstream justice system involvement among vulnerable youth populations.