Prison Psychiatrist: "People with ADHD Commit THESE Crimes!" - Dr Alessandra Cappai

Alex Partridge 0:00 ADHD is so prevalent in the criminal world. Why is it, do you think?

Dr. Alessandra Cappai 0:04 That's definitely a good question. I think-

Alex Partridge 0:06 Dr Alex Cappai is a consultant psychiatrist-

Dr. Alessandra Cappai 0:10 With over 15 years experience

Alex Partridge 0:11 ... and now deals with diagnosing prisoners who have ADHD. Do you see an overlap with ADHD and personality disorders such as BPD, sociopathy, or psychopathy?

Dr. Alessandra Cappai 0:22 Yes. We know that 70% of the people with ADHD have got some sort of comorbidities of some kind, but we need to also distinguish if they are comorbidities or if they've simply been misdiagnosed.

Alex Partridge 0:35 Why do you think so many ADHD women were missed for so long?

Dr. Alessandra Cappai 0:39 Um, well-

Alex Partridge 0:41 What three traits of ADHD do you think are most responsible for breaking the law?

Dr. Alessandra Cappai 0:47 It, the impulsivity, also-

Alex Partridge 0:50 Mm

Dr. Alessandra Cappai 0:50 ... which we have seen is very much related. And then-

Alex Partridge 0:52 Is there a way to redirect those negative traits and turn them into positives?

Dr. Alessandra Cappai 0:59 Um [gentle music]

Alex Partridge 1:03 I'm sure you've heard this a million times on other podcasts, but it really does help if you follow the show or subscribe on YouTube, because it really helps me get bigger and better guests. And if you subscribe, I'll return the favor by promising that I'll never let this podcast be sponsored by Huel. Alex, thank you so much for joining us.

Dr. Alessandra Cappai 1:21 Thank you for inviting

Dr. Alessandra Cappai 1:22 me.

Alex Partridge 1:22 Why is it that you think ADHD is so prevalent in the criminal world?

Dr. Alessandra Cappai 1:26 There have been studies to try and, uh, investigate what the reason may be. What we do know, and, uh, there is plenty of evidence in, uh, in children in the community, you have about 4 or 5% of the population is affected by ADHD. Then in adult, you have a decrease to about 2%, 2.2, 3%. But in prison, for, uh, the studies that we have seen all over the world really, the prevalence is as high as, uh, 20, 40%, so much, much higher. And it doesn't seem that ADHD itself, only ADHD can actually justify criminality, so we need to consider the broader picture. For example, especially if it's, if it... Let's, let's consider a woman with ADHD. Uh, typically, the- there is quite often a very, uh, serious trauma in the background, and then you may have, uh, this person with a early childhood ADHD. Maybe there is trauma. Maybe there was not a family in the background happy to support or also to visualize the difficulties that a child was having. Uh, this may have led to, m- to problems at school, not learning, and possibly even dropping out of school. Also, what happens when you drop out of school early and without no qualification, what happens is that, that the, the regular pathway is that people often end up using drugs-

Alex Partridge 2:59 Mm

Dr. Alessandra Cappai 2:59 ... possibly ending up with the wrong crowd, possibly, uh, starting with a little petty crime, and as soon as you can imagine, they end up in bigger trouble.

Alex Partridge 3:12 Shocking, isn't it? 20, one in four, so 25%.

Dr. Alessandra Cappai 3:15 Yes.

Alex Partridge 3:15 Is that 25% of inmates have ADHD? Is that the same for the female prisons as it is for the male prisons?

Dr. Alessandra Cappai 3:22 What we do know is that in general, the numbers are more or less similar.

Alex Partridge 3:28 If we look at the traits you mentioned that could potentially lead to cr- lead to criminality, so-

Dr. Alessandra Cappai 3:33 Mm

Alex Partridge 3:33 ... the impulsivity, the leaving school early because of ADHD, therefore getting into the wrong crowd, is there a way to redirect those negative traits and turn them into positives?

Dr. Alessandra Cappai 3:45 I, I firmly believe so. I'm glad that there is, uh, much more awareness. We are starting having so much more awareness with, uh, of neurodiversity and ADHD. You have been diagnosed as an adult, I imagine.

Alex Partridge 3:58 Mm.

Dr. Alessandra Cappai 3:58 Yes. There, there are so many people that, as children, they were not picked up, and, uh, this could be for several reasons that I can probably can discuss during the, during the, the discussion today. Uh, but the reality is that there was probably very little awareness, um, I would say all over Europe. Well, maybe a little bit better in the US, but all over Europe. And this means that unless a child was extremely disruptive and extremely problematic to a level that they would paralyze the whole class, probably they would not be picked up. Uh, because they, because they, the teachers and, uh, and probably parents as well, they just didn't know what to look for. And it was, uh, a common thing to simply label, uh, a, a child, if he was male and naughty-

Alex Partridge 4:50 Mm

Dr. Alessandra Cappai 4:50 ... and, uh, and, uh, hyperactive. Yes, naughty, not disciplined, probably par... Oh, the fault is the pa- the parents are not educating them enough. Or females are probably more often historically labeled as, uh, daydreamers-

Alex Partridge 5:07 Mm

Dr. Alessandra Cappai 5:07 ... lazy. "Oh, she doesn't, uh, she, she just doesn't, she doesn't do enough. She's not trying hard enough." The fact that we have more awareness and there are podcasts and information like this one-

Alex Partridge 5:19 Mm

Dr. Alessandra Cappai 5:19 ... people are talking. My hope is that this is, uh, in fact improving the way in which we can, uh, detect, uh, problems, uh, very early. Um, I would imagine that the best place to do so, it's school.

Alex Partridge 5:35 Mm.

Dr. Alessandra Cappai 5:35 So giving a child the, the attention and the, the right support at the right time, which is, uh, surely, uh, early in school, and also educating not just the child and the teachers, but also families, because also families probably will need some education on how, how to, what to make of the symptoms that they can see presenting in front of their eyes. Uh, that's- All very important because also giving the parents the, the ability to support children the right way and, uh, and in a productive way is actually, actually very important also to support the child to grow up with a better, um, self-awareness, but also self-esteem.

Alex Partridge 6:21 Hmm. I suppose with your work interacting with the prisoners, you, you come across these people, I suppose, when once it's too late-

Dr. Alessandra Cappai 6:29 Yeah

Alex Partridge 6:29 ... once they've offended-

Dr. Alessandra Cappai 6:30 Yeah

Alex Partridge 6:30 ... and they've found themselves in the criminal justice system?

Dr. Alessandra Cappai 6:33 Yeah. Uh, well, it's, it can be seen as a sad, uh, reality, and I would agree probably there, there is some sadness in the realization that it's late, a crime has happened, or a, a path has, uh, has been, uh, is probably has been the kind of wrong path for some time. However, I also see the very much I, I tend to focus on the positive side of things. So for example, in, in prison, um, the prisons I've been working in, uh, we have established, mm, very early interventions in, uh, for ADHD asse- assessments, and this means that people that have been, uh, neglected their whole life from not only at school, at home, but also from the systems, uh, they, they may be sometimes arriving to prisons, to prison maybe sadly the first time they have had access to a care-

Alex Partridge 7:37 Mm

Dr. Alessandra Cappai 7:37 ... professional looking at them and trying to figure out how to improve things in their life.

Alex Partridge 7:44 Do you think all prisoners should get screened for ADHD when they enter the prison system?

Dr. Alessandra Cappai 7:49 Look, I, I didn't have a, a, a very strong opinion, uh, on this until, until probably a couple of years ago, but evidence, new evidence actually suggests that the, the prevalence of ADHD is so high in the, in the, in the criminal population, which makes it probably pretty straightforward to agree, yes, I think so. Because, because we do... for several reasons. First of all, ADHD is treatable mostly. It's a, it's a treatable problem, uh, differently, uh, as compared to other, uh, mental health problems that have got a worse response. And, uh, and, and also because we want to, to do prev- in prison, I don't see prison mer- merely as a punishment. I see it also as a rehabilitation, so I would imagine that one of the main, uh, uh, reason, one of the main a- aims of going to prison is not to get back-

Alex Partridge 8:51 Hmm

Dr. Alessandra Cappai 8:51 ... to prison. So you want people to learn something from coming to prison, taking something with them, and, uh, make sure that they are not, they're gonna learn not to get back.

Alex Partridge 9:04 Hmm.

Dr. Alessandra Cappai 9:04 And in this also, you need to include the support and the, the treatment when that's, uh, required.

Alex Partridge 9:12 Do you have any particular rehabilitation stories where a prisoner's come in, they've become aware that they're living with ADHD, and then with that new awareness, they've changed the trajectory of their outcomes?

Dr. Alessandra Cappai 9:25 Yeah. Yeah, actually several. Um, I am, uh, particularly fond of, uh, a story. Obviously, I cannot mention names, but I remember, for example, a, a, a female that came to prison. She didn't come with any diagnosis of anything really. Probably occasional depression and anxiety, which was a peculiar way of being anxious and depressed anyway. Very active, extremely active, so she was always like ups and downs, working in the garden and working and, uh, doing all sort of activities, but unable to, um, to, to do coursework, uh, uh, which is sometimes required also for, uh, for the sentence. You know? Uh, it's important. Rehabilitation is also very often being able to sit down in meetings which can last long, probation work and, uh, um, case manager work. So that requires some sort of a ability to, you know, sit down, let other people speak, speak. You know, all those things that were very difficult, um, to her. But anyway, in the time that she was with us, uh, obviously, uh, because of her difficulties, this ADHD was, um, was considered, and she was assessed, and in fact, she did receive a full assessment of a, in fact, a severe ADHD, which was, uh, particularly hyper, still hyperactive, even if we know that, uh... And she, she's, she was around in a f- in her 45, 50s probably at the time. So we know that hyperactivity tends to diminish on, with, with age, but this was not the case with this person. Or probably she was even more hyperactive as a child. But anyway, long story short, she had a very horrible, horrific upbringing, traumatic parents, obviously a lot of violence, a lot of abuse. She didn't man- she didn't manage to, to be in school, or, or better, she was in school, but she didn't take it seriously. She was unable to focus. She's never been able to listen. Uh, dropped out of school very, very early. Ended up doing drugs extremely early, probably started at 12, fif-

Alex Partridge 11:41 Hmm

Dr. Alessandra Cappai 11:41 ... 13, so very, very early. But anyway, she was assessed for ADHD, she got the diagnosis. She responded very well to medications, uh, and she actually made a massive improvement in so many aspects of her life, including being able to engage with probation, with the courses, with the, uh, all the sentence work, but also, um, with her peers.

Alex Partridge 12:06 Mm.

Dr. Alessandra Cappai 12:07 So in reality, something that was not part- it was not probably the major problem before we started realizing was, uh, her emotional instability and, uh, interpersonal problems. But as soon as she was in treatment, there was a massive improvement also in her ability to maintain relationships and friends and be a little bit more moderate in the way she interacts with others without cutting and, uh, and removing-

Alex Partridge 12:36 Mm

Dr. Alessandra Cappai 12:36 ... people, like, uh, straight away from, uh, her radar. And anyway, she, within a year, she was able actually to be released to a supported accommodation with a, with a job already offered, which is obviously the best outcome that you can expect. Already, um, being able to maintain a job and, uh, continue with that.

Alex Partridge 12:59 Mm. It's a strong argument, like, to show how effective a-

Dr. Alessandra Cappai 13:03 Absolutely

Alex Partridge 13:04 ... awareness and diagnosis might be. I'm thinking for someone like that, and j- just generally,

Alex Partridge 13:09 for an ADHD mind, it must be almost literal hell to be behind bars, 'cause you're hyperactive, you're stuck in a cell.

Dr. Alessandra Cappai 13:18 Yeah.

Alex Partridge 13:18 That might breed resentment, anger, maybe even more crime. Is that something you've encountered?

Dr. Alessandra Cappai 13:24 You are absolutely right in terms of, uh, research and statistics. Actually, yes, it is, um, it does happen a lot that people with, uh, ADHD tend to have, um, more incidents whilst in custody. But probably you will know, you will want to know a little bit more about how prison is inside, and I will tell you my experience of, uh, what happens. So this is obviously only my, my experience a- and, uh, not based on, uh, on research or data on, uh, many prisoners. I s- I think that there are two categories of, uh, patients. So there are, it, definitely there is a... With ADHD, I mean. Obviously, there are, there is this problem that, uh, basically being in prison is like, uh, being all in the same house. You don't have privacy. You open your door of your cell, and you are, uh, surrounded by other people. Sometimes it's annoying because they shout, they call you. You may not want interaction, and then you have to go and collect your food together with others. So there are so many things that are, uh, absolutely like, uh, hell for, uh, the mind of a person-

Alex Partridge 14:39 Mm

Dr. Alessandra Cappai 14:39 ... that with neurodiversity and ADHD. However, it's also true that prison is, can be very beneficial for some of these people with ADHD, and I've seen massive improve- improvements, uh, in prison for some of them. Number one is, uh, substance misuse. Well, I'm not saying that you don't, you cannot find substances in prison. In fact, that's not what I'm saying at all. But prison offers a, the possibility to have the support available right there without all the problems that may be there in the community. So in reality, uh, prisoners are often on, uh, re- rehabilitation programs, and they have a structure. So the structure that is, uh, hated and loved by people with ADHD, actually, that's imposed in there. So you have to wake up at a certain time.

Alex Partridge 15:39 Mm.

Dr. Alessandra Cappai 15:39 I mean, don't get me wrong, you can also not get up and not doing anything, and not do anything. You can potentially not do anything. But in reality, that's even more, it's a little bit more miserable than just engaging with, uh, the, the process. So most of the prisoners will have a job, and, uh, you can have active jobs. So my very hyperactive patients with ADHD would all work in the garden, would all be up from early morning until the evening and get super tired. They can all go to the gym, and, uh, some of them may be gym instructors and, uh, walk up and down. Others, uh, enjoy the personal relationships with others, interactions, and they may be peer mentors, for example. So there are many aspects of the prison life that can be negative, but many others actually are very positive.

Alex Partridge 16:34 Mm.

Dr. Alessandra Cappai 16:35 And we have seen a massive improvements in, improvement-

Alex Partridge 16:38 Good

Dr. Alessandra Cappai 16:38 ... in some people, uh, with ADHD.

Alex Partridge 16:40 Do you think there's some prisoners who might slip through the cracks in that sense that they fail to integrate in the ways you've just suggested, and for that neurodiverse person who has a very overactive mind, being in that environment might be inhumane?

Dr. Alessandra Cappai 16:56 Yes. Uh, it could be, it could be. Yeah, that could be the case. That is, uh... Obviously, prison is an im- is an imposed reality, and it's not necessarily, um, what the person would, probably surely is not what the person would choose to do. The environment in prison can be challenging because of the spa- the common space, because of the stimul- the overstimulation at times, the voices, having to... The voices of other people, I mean, uh, which is shouts sometimes.

Alex Partridge 17:26 Mm.

Dr. Alessandra Cappai 17:26 And but also having to integrate and, uh, cooperate.

Alex Partridge 17:30 What three traits of ADHD do you think are most responsible for somebody breaking the law?

Dr. Alessandra Cappai 17:38 I would say probably i- the impulsivity is, uh, surely a, a big one. Also, w- well, obviously, one of the main issues that can, uh, drive someone, uh, to, to break the laws is often connected to, uh, substance misuse-

Alex Partridge 17:54 Mm

Dr. Alessandra Cappai 17:54 ... which we have seen is very much related. That's not really a trait, but it's very much related to ADHD. And, uh, and then they probably, the cognitive functioning-

Alex Partridge 18:05 Mm-hmm

Dr. Alessandra Cappai 18:05 ... which is, uh, which may be as li- a little bit, um, deficient in, uh, in people with ADHD, especially when it's severe, could be also that they're non- that non-planning, not seeing the consequences.

Alex Partridge 18:19 Hmm.

Alex Partridge 18:20 Is there a particular crime that you see people committing when they have ADHD?

Dr. Alessandra Cappai 18:25 Um, e- especially in males-

Alex Partridge 18:26 Hmm

Dr. Alessandra Cappai 18:26 ... I think, I guess it's, uh, probably a assault, which is probably related to impulsivity-

Alex Partridge 18:31 Hmm

Dr. Alessandra Cappai 18:32 ... uh, of- often. Uh, also drug-related offenses often. I guess also driving offenses are, uh, pretty o- frequent, but not necessarily they are indictable or they're gonna lead to a prison sentence. But still, if you were considering the crimes, it's themselves. I guess that also the s- speeding is probably extremely frequent, and it can go wrong. Driving under the effect of substances, they are, uh, possibly things that can happen, yeah.

Alex Partridge 19:02 And women with ADHD, are they committing similar crimes to the men with ADHD?

Dr. Alessandra Cappai 19:06 Women are such a different chapter because in reality, women are, uh, if you, if you consider the UK, um, women are only 5% of the UK prison population. So they, they, it's a very minimal, minimal number, and what we know in terms of the offenses of women's, women's offenses are they, they are not violent. If, if you take the percentage of, uh, of offenses, 95% of, uh, of assaults or, uh, serious assaults are actually by men. Um, mo- the vast majority of sexual offenses are, have been done by m- by men. Women do, tend to commit more, uh, less, uh, violent offenses n- normally.

Alex Partridge 19:50 Such as?

Dr. Alessandra Cappai 19:51 Uh, like, um, could be burglary, for example, which is not necessarily, um, which is not violent.

Alex Partridge 19:58 Hmm.

Dr. Alessandra Cappai 19:59 Uh, could be like, uh, fraud.

Alex Partridge 20:01 Do you see an overlap with ADHD and personality disorders such as BPD, sociopathy, or psychopathy?

Dr. Alessandra Cappai 20:09 Yes. Actually, uh, again, this is, uh, well, yes, we know that first of all, uh, all, uh, people with ADHD have much more comorbidity, and when we say in psychiatry, we say comorbidity, we mean the co-presence of, uh, another diagnosis. So this happens much more, um, in, uh, people with ADHD. In fact, probably 70% of the people with ADHD have got some sort of comorbidities of some kind. So it's very frequent. Um, but yes, for some of these comorbidities, sometimes we at, at, at, at current, we are, uh, we need to also distinguish if they are comorbidities or if they are, they've simply been, uh, misdiagnosed, misdiagnosed. So for example, this is the case of a woman that, um, until probably honestly until 10, 15 years ago, they were, it, it is very frequent to misdiagnose women as, uh, suffering with emotionally unstable or borderline personality disorder-

Alex Partridge 21:15 Hmm

Dr. Alessandra Cappai 21:15 ... which is the same disorder, which is a personality dis- personality disorder. Um, more difficult to treat. Uh, statistically responds much less to medications and in fact, uh, medications are not the first-line treatment to treat emotionally unstable personality disorder, and in fact, uh, psychological therapies are. Um, but because of the mood instabilities that characterize personality disorders and, uh, particularly borderline personality disorder, often people, f- females with ADHD have been labeled, uh, as, uh, emotionally unstable, but I would say mislabeled. I have reassessed many people that end up, many women that have, um, come to prison and, uh, I could not see at all, uh, traits of emotionally unstable personality disorders. So whilst on one side I can say, yes, there is a comorbidity and there is a lot, and we do know that there is a, a lot of comorbidity with anxiety, depression, personality disorders, autism. Sometimes we also need to consider that, uh, some people may have been misdiagnosed in the past.

Alex Partridge 22:30 Hmm. Why do you think so many ADHD women were missed for so long?

Dr. Alessandra Cappai 22:35 Because they are silent. Because they were not that loud as, uh, as children, isn't it? That's the thing. Uh, um, you don't miss a child that is, uh, hyperactive and, uh, a difficult to manage ... From a, from a, from a, a school teacher point of view, difficult to manage.

Alex Partridge 22:52 Hmm.

Dr. Alessandra Cappai 22:52 Uh, uh, probably impossible to manage. You don't miss that one because, uh, simply it travels the whole, uh, the whole system. It just stops you from teaching, it stops the whole ... It an- annoys you, annoys the, the other children, probably is, uh, disruptive and then other people, other children follow, so it becomes impossible as for a teacher in primary school to actually continue doing their job. But females, in females, ADHD is, uh, more often, not always, but more often, rather than hyperactive is inattentive. So you have the classical daydreamer, uh, distracted, uh, not very precise, not very good in maths probably, or spelling sometimes, and, uh, forgetful or, uh, also in general, like in, like in a little bit, in a little bit of a bubble, isn't it?

Alex Partridge 23:45 Hmm.

Dr. Alessandra Cappai 23:46 And they don't create problems. They are silent. They're n- not, not necessarily, they may be even shy and not, and kind of com- Even if they don't f- they, they have difficulties being attentive, they are not disruptive. They not necessarily are making a big deal of this.

Alex Partridge 24:04 Hmm.

Dr. Alessandra Cappai 24:06 There is another thing, I think, that culture, that probably there is also a cultural aspect in which in reality I, I, uh, I think, I think f- females are, um, in many cultures actually have been, uh, are, are more penalized for, uh, expressing, for example, expressing difficulties. So it's more eas- it's easier-

Alex Partridge 24:28 Mm

Dr. Alessandra Cappai 24:28 ... to, uh, label a girl as, um, a girl that is, for example, ups and downs with the moods as, oh, it's, that's the hormones.

Alex Partridge 24:39 Mm.

Dr. Alessandra Cappai 24:39 Or, um, inattentive and not able to, to do maths, oh, she's not very clever, or, uh, you know, just labeling rather than, uh, actually considering a real, a, a, addressing a real problem.

Alex Partridge 24:55 Was it the injustice that women have faced that made you want to specialize in ADHD?

Dr. Alessandra Cappai 25:00 I think that's a part of it. Also, I, I like the fact that, um, that there is a, it's, it's, there is so much that can be improved with not so much... I mean, you can really make little adjustments to improve a lot. ADHD is a, is a really very treatable condition and, um, one of the things that probably I am, uh, um, that I would like to see more, es- especially in the NHS, because at the moment in the NHS, it's, um, most of the services are offering medications, like a pharmacological treatment. But in reality, we also know that there are more treatments, and we do know that sometimes you have to address more. So even like with, uh, coaching for ADHD, which is simply trying to be, to improve your awareness of a structure routine and the what to do to, to have this in place. I like the fact that you can work with, uh, some simple concepts and actually make a difference, and, uh, I feel that we are, uh, far behind in what we sh- where, to the level where we should be-

Alex Partridge 26:09 Mm

Dr. Alessandra Cappai 26:10 ... and I, um, I will be part of this improvement, driving the improvement.

Alex Partridge 26:15 Is there anything particular that you find interesting about the criminal mind-

Dr. Alessandra Cappai 26:20 Mm

Alex Partridge 26:20 ... that's different from the mind of someone who abides by the law?

Dr. Alessandra Cappai 26:24 The biology of the lack of empathy, which is basically, uh, particularly prevalent, uh, in psychopathy. So that's something that, uh, and also in, uh, in the trying and imagining how it is to, to live that way, and, uh, and yes, that's, that's a, I, I guess it's an attractive point for, uh, many, uh, for many researchers that are trying to-

Alex Partridge 26:49 Mm

Dr. Alessandra Cappai 26:49 ... scan, uh, and to, to see what's different. We know something, we know there, but it's a lot about the amygdala, but we don't know exactly how all of this works and how is, how really it is, the life experience of a person with that low or absent em- emotional regulation and, uh, empathy.

Alex Partridge 27:13 Shall we do the Washing Machine Of Woes?

Dr. Alessandra Cappai 27:15 Yeah, let's go.

Alex Partridge 27:15 Every week, I put an ADHD woe into this machine, and I read it out to see if there's some advice and relatability from the guest, and this week in the Washing Machine Of Woes: During COVID lockdown, I grew so bored that I turned to alcohol and spiraled into a depression. At some points, I wanted to take my own life, but since things have returned to normal, those darker thoughts have lifted. Do you think I should still seek help, or was this just a circumstantial depression caused by a lack of stimulation?

Dr. Alessandra Cappai 27:48 Okay, and this person, and this is the only thing we know, so we don't know if this person, um, has got ADHD as well as depression.

Alex Partridge 27:59 Um, I think it's coming... Well, I think we can probably assume that they probably do-

Dr. Alessandra Cappai 28:03 Okay

Alex Partridge 28:03 ... um, coming from the community.

Dr. Alessandra Cappai 28:05 Okay.

Alex Partridge 28:06 But it doesn't say it, so yeah, I, I would assume yes.

Dr. Alessandra Cappai 28:09 Yes. I, I... Well, COVID was a very difficult time for, uh, I think for all of us, uh, myself included. Um, things have been hard, and probably many people have suffered either an, what we call an adjustment disorder, which is a, uh, basically similar to depression, a little bit less serious, but, and very, very situational to the problem. But other people also suffered from depression afterwards when, uh, the stress of, uh, the adrenaline basically ceased to be there. Um, first of all, I think that it's a very personal choice, uh, whether to seek, whether you feel about seeking help or not. But if I, if you have the doubt, maybe that suggests to me that there are some things that you may, that have remained probably unexplained or you are unsure of, and, uh, I cannot see any reason why not to explore this in therapy. Um, I'm not necessarily suggesting that there, there needs to be a pharmacological treatment for something that was there in the past and is not creating any problem nowadays. Obviously, I'm not, I'm not saying that COVID is gonna happen again, and, uh, and we're gonna get bored, and, uh, we're gonna live the, in the same way, but trying to explore, uh, what happened and, uh, why possibly boredom affected you so badly, uh, actually probably could be something important to do because we want to think and receive treatment not only when we are in the, in the really, the, the very lower bottom, but when we are a little bit better, to be able to actually work on, uh, prevention strategies and how not to end up being so unwell again and, uh, improving our- ... strategies, coping strategies. So for example, probably alcohol was not necessarily, which is something that many people have done. Um, it, it's a normal coping mechanism, but maybe not the most functional one. And, uh, it can, it could be good to discuss with a therapist, um, a little bit more, uh, in depth

Alex Partridge 30:37 As well as alcohol, do you think crime can be a means to occupy a bored mind?

Dr. Alessandra Cappai 30:45 That, I, I wouldn't consider that the mechanism is, um, the mechanism is as simple as, "Oh, I'm bored. I want to do crime." I think you end up doing crime in a, in a more, uh, like, uh, in a less direct way. So for i- for example, you start doing things that are more and more risky. It could be, for example, investments or, uh, some businesses that are, you know, can carry some sort of risk for yourself and other people. Or, uh, again, we were discussing earlier, uh, speeding with a car or, uh, assaulting someone that comes out of impulse- impulsivity. So all of this is, uh, yes, I'm bored and I'm reacting to something, but it's not that I want to... It's not that linear-

Alex Partridge 31:30 Mm

Dr. Alessandra Cappai 31:30 ... that I go into crime. Plus, getting into crime is often also not justifiable only from, uh, um, by the ADHD symptoms themselves. There is always something more. Previous trauma has always been, uh, is, is, is an important, um, aspect to consider, that not everybody with, that has got ADHD, even serious ADHD, are gonna go into trauma. And, uh, substance misuse and alcohol. Obviously, they are a, a big predictor or... of violence and, uh, involvement with the criminal justice system as well.

Alex Partridge 32:05 Mm. Fascinating.

Alex Partridge 32:07 I'm thinking about your ADHD item now, and, uh, I ask all my guests-

Dr. Alessandra Cappai 32:13 [laughs]

Alex Partridge 32:14 ... to tell me an item that most represents ADHD in their life and, or for you, and you said a clock.

Dr. Alessandra Cappai 32:20 Yes.

Alex Partridge 32:21 And I think people will know where we're going with this-

Dr. Alessandra Cappai 32:24 [laughs]

Alex Partridge 32:24 ... but you explain why you chose a clock.

Dr. Alessandra Cappai 32:26 Uh, it's because there's a, um, kind of paranormal, uh, relationship with time.

Alex Partridge 32:33 [laughs]

Dr. Alessandra Cappai 32:34 A few people ADHD, with ADHD have a very complicated relationship with time, where time can be, at the same time, so slow because everything is so boring and just never, like, uh, you never get done with something that is so boring and it lasts, a, a second could last for hours. But also so fast when you're getting ready.

Alex Partridge 32:58 Mm.

Dr. Alessandra Cappai 32:58 It's just, uh, such a, like a, yeah, just this inability to, to, to prioritize a one task and finish that task and at the time that you are expected to finish and to be on time for a certain appointment.

Alex Partridge 33:13 Mm.

Dr. Alessandra Cappai 33:13 And, uh, also, this, um, I don't know if it is, uh, about underestimating or overestimate- underestimating the task length or overestimating your, your ability to be quick with a task. But this thing of, uh, people with ADHD, if they know that they have two hours between now and the appointment, in those two hours, even if they are ready, they're not gonna get ready. They're gonna start doing hundreds of things.

Alex Partridge 33:40 [laughs]

Dr. Alessandra Cappai 33:41 And they're gonna manage to get late because they... I don't know. Afra- They may be, um, overestimating-

Alex Partridge 33:46 Mm

Dr. Alessandra Cappai 33:46 ... themselves maybe. I don't know. But yes, it's time, I think it's a big, big one. You were just discussing earlier about the, the clothes, uh, in the washing machine. Also, you remember that-

Alex Partridge 33:57 Yeah, yeah, yeah

Dr. Alessandra Cappai 33:57 ... we were just discussing that some people forget clothes. And that's, again, I think it's, could be also that related to the time, isn't it? Because you just forget about the passing of the prog- the passing time of the program that is there, which probably would a- alert most of the non-neurodivergent people-

Alex Partridge 34:15 Mm

Dr. Alessandra Cappai 34:15 ... isn't it?

Alex Partridge 34:16 Yes. Yeah. I've started reframing five minutes-

Dr. Alessandra Cappai 34:18 [laughs]

Alex Partridge 34:18 ... as 300 seconds. 'Cause if you say you've got five minutes, you think you've got enough time to have a shower, get ready-

Dr. Alessandra Cappai 34:23 [laughs]

Alex Partridge 34:23 ... brush your teeth. But in reality, you definitely never do. But 300 seconds makes it seem a lot more urgent.

Dr. Alessandra Cappai 34:29 Yes.

Alex Partridge 34:29 That's a good little hack.

Dr. Alessandra Cappai 34:31 And I kind of approve, yeah. That's a good one.

Alex Partridge 34:33 Thank you so much, Alex. This has been really fascinating.

Dr. Alessandra Cappai 34:36 Thank you. Thank you for inviting me. [upbeat music]