The concept of neurodiversity refers to the natural neurological variation of the human species: autism, ADHD, dyslexia, dyspraxia, Tourette's syndrome, acquired brain injuries and intellectual disabilities are not pathologies to be corrected, but cognitive configurations that produce experiences of the world profoundly different from those considered "typical". The term was coined in the late 1990s within the autistic self-advocacy movement and theorised by sociologist Judy Singer, who proposed recognising neurological differences as a new category of minority identity deserving political and civil protection (Singer, 1999). Recognising this variation — and ensuring that it does not translate into exclusion — is a matter of pluralism before it is a matter of health. It is on this premise that Louise Finer, former head of the UK National Preventive Mechanism (2013-2020), published in July 2024 a contribution for Penal Reform International (PRI), an international NGO active in promoting criminal justice systems that respect human rights. The document, entitled Understanding and supporting the needs of neurodivergent people in prisons is a human rights issue, urgently raises a question that has long gone unanswered: why are neurodivergent people so significantly overrepresented in prisons, and why do penitentiary systems continue to ignore this difference?

The available data paint an unequivocal picture, even if the subject of ongoing scientific debate. In England and Wales, the most authoritative estimates suggest that up to half of the prison population may have some form of neurodivergence, a proportion three times higher than in the general population. For ADHD alone, prevalence estimates in the adult prison population range in the literature between 8% and 25% depending on diagnostic criteria and samples used — in any case five to ten times higher than in the general population (Baggio 2018, Fazel 2024, Baggio 2024). That even the measurement of the problem is so contested is itself significant: it testifies to how invisible this population remains to ordinary monitoring tools. In France, the national strategy for neurodevelopmental disorders 2023-2027 explicitly states that 20% of detainees may have ADHD. In Italy, the subject remains largely unexplored at the institutional level: the only available pilot study, conducted by Strada, Tesoro and Vegni at the Milan-Bollate prison and published in 2021 in the Rassegna Italiana di Criminologia, found an ADHD prevalence of 23.7% in a sample of 59 detainees, with high comorbidity with substance abuse and depressive symptoms. The authors emphasise that this is the first Italian study on the subject and that the absence of diagnosis and treatment produces a cumulative negative effect on the functioning of the detained person, increasing the risk of reoffending.

This overrepresentation is not accidental: it is the product of a chain of structural vulnerabilities. The failure to diagnose in childhood — still extremely common today, particularly in women and adults — leaves many people without the tools to understand their own functioning. Early school exclusion, difficulty maintaining stable employment, vulnerability to criminal exploitation and the system's tendency to criminalise distress behaviours arising from unmet needs all combine to create a pathway that leads neurodivergent people into the criminal justice system with disproportionate frequency.

The PRI document identifies the main points of friction between neurodivergence and the prison structure: the sensory environment of a prison — constant noise, unpredictable regimes, forced cohabitation — can be intolerable for autistic people; restricted movement is particularly punishing for those living with ADHD; neurodivergent communication differences are often misunderstood, generating conflicts and bullying dynamics; standard de-escalation techniques can prove counterproductive. Paradoxically, solitary confinement units are sometimes used as a refuge by autistic detainees seeking to escape excessive sensory stimulation, transforming a disciplinary measure into a survival strategy.

At the institutional level, the most systematic process of reflection was launched in 2021 by the Criminal Justice Joint Inspection in England and Wales, whose report Neurodiversity in the Criminal Justice System denounced the absence of systematic screening on entry to prison, the lack of staff training and the non-existence of nationally coordinated strategies. The follow-up published in July 2025 by HM Inspectorate of Prisons notes partial progress — including the introduction of Neurodiversity Support Managers in over a hundred public prison establishments — while finding that the quality of support varies enormously from institution to institution and that neurodivergent people remain largely absent from the design of the services that affect them. Elsewhere in Europe, this level of institutional reflection does not yet exist: no continental European country has produced an equivalent systematic review with policy recommendations.

On the legal front, the question remains open. There are no rulings from the European Court of Human Rights specifically addressing neurodivergence in custodial settings. The case law on Article 3 ECHR in the area of mental health nevertheless offers a potentially extendable framework of reference: in Murray v. the Netherlands (Grand Chamber, 2016), concerning a prisoner serving a life sentence who lacked any adequate therapeutic programme, the Court held that detention without individualised support measures can constitute inhuman and degrading treatment; in Rooman v. Belgium (Grand Chamber, 2019), concerning an interned person with psychiatric disorders who had for years received no treatment in a language he could understand, the Court clarified that the State has a positive obligation to guarantee conditions compatible with the dignity and specific needs of the detained person. If, however, one considers that European States already struggle to uphold this principle for detainees with formally recognised psychiatric conditions — as the abundant case law from Strasbourg attests — extending it to neurodivergent people, whose condition is often undiagnosed and lacks any explicit recognition in international instruments, appears a distant prospect.

The question raised by Penal Reform International is ultimately a question of pluralism: the prison system is built on the implicit norm of the neurologically typical subject, and those who deviate from it are not excluded explicitly, but ignored, misunderstood and sanctioned for behaviours that are an expression of their difference. If European States already struggle to guarantee adequate care for detainees with recognised psychiatric conditions — as the extensive Strasbourg case law demonstrates — for neurodivergent people, often invisible even to themselves before becoming invisible to the system, the road ahead is even longer. No binding international instrument names them explicitly. The PRI document is an invitation to fill this gap. For now, it remains an invitation.

 

(Focus by Oriana Binik)

 

Main sources:

 

L. Finer, Understanding and supporting the needs of neurodivergent people in prisons is a human rights issue, Penal Reform International, July 2024. Go to document

 

Criminal Justice Joint Inspection, Neurodiversity in the Criminal Justice System: A review of evidence, July 2021. Go to document

 

HM Inspectorate of Prisons, Four years on: Neurodiversity in prisons, July 2025. Go to document

 

Gouvernement français, Stratégie nationale pour les troubles du neurodéveloppement 2023-2027, Paris, 2023

 

Selected bibliography:

 

S. Baggio et al., Prevalence of Attention Deficit Hyperactivity Disorder in Detention Settings: A Systematic Review and Meta-Analysis, in Frontiers in Psychiatry, 9/2018, 331

 

S. Baggio et al., Meta-analysis of the prevalence of ADHD in prison: A comment on Fazel and Favril (2024) and reanalysis of the data, in Criminal Behaviour and Mental Health, 34(4)/2024, 385-390

 

S. Fazel, L. Favril, Prevalence of attention-deficit hyperactivity disorder in adult prisoners: An updated meta-analysis, in Criminal Behaviour and Mental Health, 34(3)/2024, 175-184

 

J. Singer, 'Why Can't You Be Normal for Once in Your Life?' From a 'Problem With No Name' to the Emergence of a New Category of Difference, in M. Corker, S. French (eds.), Disability Discourse, Open University Press, Buckingham 1999, 59-67

 

I. Strada, V. Tesoro, E.A.M. Vegni, Studio pilota sulla prevalenza del disturbo da deficit d'attenzione e iperattività (ADHD) nella popolazione detenuta italiana, in Rassegna Italiana di Criminologia, 15(2)/2021, 102-111

 

Cited case law:

 

ECtHR, Rooman v. Belgium [GC], no. 18052/11, 31 January 2019

 

ECtHR, Murray v. the Netherlands [GC], no. 10511/10, 26 April 2016