The Association Between ADHD and Antisocial Personality Disorder (ASPD): A Review

Antisocial personality disorder:Failure to balance excitation/inhibition?

While healthy brain function relies on a dynamic but tightly regulated interaction between excitation (E) and inhibition (I), a spectrum of social cognition disorders, including antisocial behavior and antisocial personality disorder (ASPD), frequently ensuing from irregular neurodevelopment, may be associated with E/I imbalance and concomitant alterations in neural connectivity. Technological advances in the evaluation of structural and functional E/I balance proxies in clinical settings and in human cell culture models provide a general basis for identification of biomarkers providing a powerful concept for prevention and intervention across different dimensions of mental health and disease. In this perspective we outline a framework for research to characterize neurodevelopmental pathways to antisocial behavior and ASPD driven by (epi)genetic factors across life, and to identify molecular targets for preventing the detrimental effects of cognitive dysfunction and maladaptive social behavior, considering psychosocial experience; to validate signatures of E/I imbalance and altered myelination proxies as biomarkers of pathogenic neural circuitry mechanisms to determine etiological processes in the transition from mental health to antisocial behavior and ASPD and in the switch from prevention to treatment; to develop a neurobiologically-grounded integrative model of antisocial behavior and ASPD resultant of disrupted E/I balance, allowing to establish objective diagnoses and monitoring tools, to personalize prevention and therapeutic decisions, to predict treatment response, and thus counteract relapse; and finally, to promote transformation of dimensional disorder taxonomy and to enhance societal awareness and reception of the neurobiological basis of antisocial behavior and ASPD.

The Relationship Between Personality Inventory for DSM (PID-5) Domains and Disruptive Behavior Disorders

Introduction

Previous research has demonstrated a strong relationship between personality and psychopathology. However, the relationship between the traits listed in the Alternative Model for Personality Disorders (AMPD) and Disruptive Behavior Disorders (DBD) in adolescents has not been examined in detail. This study aimed to examine the relationship between the Personality Inventory for DSM-5 (PID-5) domains and DBD symptoms in an adolescent inpatient sample.

Methods

A total of 127 adolescents (71% female) aged 12-17 years (M = 15.24, SD = 1.33) were recruited from an inpatient psychiatric hospital. These participants exhibited a wide range of psychiatric disorders unresponsive to prior interventions. They completed the PID-5-Short Form, the Child Behavior Checklist (CBCL), and the Diagnostic Interview Schedule for Children - Computerized Version (DISC-IV).

Results

The antagonism, disinhibition, and psychoticism domains showed significant correlations with DBD scores. Hierarchical regression models predicting total DISC-IV and CBCL scores indicated that the addition of the PID-5 Antagonism and Disinhibition scales did not provide incremental predictive validity over total DBD symptoms.

Conclusion

DBD symptoms are related to psychoticism, antagonism, and disinhibition. However, total Antagonism and Disinhibition scores did not contribute additional predictive power for overall psychopathology beyond DBD scores. These findings highlight questions about the discriminant validity of the PID-5 and suggest further research into the construct validity of these domains.

Longitudinal relations of prematurity and fetal growth restrictions with hyperactivity/inattention and aggression/delinquency

BACKGROUND

It is the aim of this study to analyze the longitudinal relationship between premature birth and low birth weight and the reciprocal influence between hyperactive/inattentive behavior and aggressive/delinquent behavior problems in children from early to late childhood.

METHODS

This study contains data from the German Erlangen-Nuremberg Development and Prevention Study. It applies prospective longitudinal path analyses on data obtained from postnatal pediatric assessments as well as later psychosocial behavior assessments by teachers and parents on N = 667 children, out of which n = 83 children (12.44%) were born preterm/small for gestational age.

RESULTS

The results show direct effects of birth complications at the beginning of preschool on hyperactivity/inattentiveness (teacher rating: ß = 0.28; p = 0.017; parent rating: ß = 0.32; p = 0.005), but not on aggression/delinquency (teacher rating: ß = 0.002; p = 0.427; parent rating: ß = 0.12; p = 0.324). Reciprocal effects between aggression/delinquency and hyperactivity/inattentiveness were stable at the end of elementary school, but not at the end of preschool across informants.

CONCLUSION

Our results support a differentiated view on the potential development of behavior problems after birth complications and the demand for early prevention measures.

IMPACT STATEMENT

Our results extend to the existing body of research by providing insight into the longitudinal effects of prematurity and fetal growth restrictions on hyperactive and aggressive/delinquent behavioral problems throughout a rather long period of development in childhood. The results show direct effects of birth complications on the development of hyperactivity for boys, but not for girls across informants. No direct effects of birth complications on aggression/delinquency are found. Our findings speak against too simple views on behavioral consequences of birth complications and thus can relieve too anxious parents, however close monitoring of the behavioral development of respective children is indicated.

Attention-deficit/hyperactivity disorder combined subtype exacerbates opioid use disorder consequences: Mediation by impulsive phenotypes

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is highly prevalent and associated with opioid use disorder (OUD). Yet, little is known about the mechanisms by which ADHD (which is a heterogeneous construct/diagnosis) might alter the trajectory of OUD outcomes in persons who use heroin.

AIM

We examined whether ADHD subtypes are related to heroin-use consequences and the extent to which the effects of ADHD on lifetime heroin-use consequences are mediated by two impulsivity factors that may be partly independent of ADHD: foreshortened time perspective and drug-use impulsivity.

METHODS

Individuals who reported regular heroin use (N=250) were screened using the Assessment of Hyperactivity and Attention (AHA), Impulsive Relapse Questionnaire (IRQ), Stanford Time Perception Inventory (STPI), and a comprehensive assessment of lifetime and current substance use and substance-related consequences. This secondary analysis examined whether ADHD or intermediate phenotypes predicted heroin-use consequences.

RESULTS

Relative to participants whose AHA scores indicated lifetime absence of ADHD (n=88), those with scores indicating persistent ADHD (childhood and adult, n=62) endorsed significantly more total lifetime heroin-use consequences despite comparable heroin-use severity. Likewise, there was a significant indirect effect of the combined ADHD subtype in childhood on lifetime heroin-use consequences. This effect was mediated by STPI scores indicating less future (and more hedonism in the present) temporal orientation and by IRQ scores indicating less capacity for delaying drug use.

CONCLUSION

The combined ADHD subtype is significantly associated with lifetime heroin-use consequences, and this effect is mediated through higher drug-use impulsivity (less capacity for delay) and lower future temporal orientation.

Trajectory Analysis for Identifying Classes of Attention Deficit Hyperactivity Disorder (ADHD) in Children of the United States

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) is a mental health disorder that affects attention and behavior. People with ADHD frequently encounter challenges in social interactions, facing issues, like social rejection and difficulties in interpersonal relationships, due to their inattention, impulsivity, and hyperactivity.

METHODS

A National Longitudinal Survey of Youth (NLSY) database was employed to identify patterns of ADHD symptoms. The children who were born to women in the NLSY study between 1986 and 2014 were included. A total of 1,847 children in the NLSY 1979 cohort whose hyperactivity/inattention score was calculated when they were four years old were eligible for this study. A trajectory modeling method was used to evaluate the trajectory classes. Sex, baseline antisocial score, baseline anxiety score, and baseline depression score were adjusted to build the trajectory model. We used stepwise multivariate logistic regression models to select the risk factors for the identified trajectories.

RESULTS

The trajectory analysis identified six classes for ADHD, including (1) no sign class, (2) few signs since preschool being persistent class, (3) few signs in preschool but no signs later class, (4) few signs in preschool that magnified in elementary school class, (5) few signs in preschool that diminished later class, and (6) many signs since preschool being persistent class. The sensitivity analysis resulted in a similar trajectory pattern, except for the few signs since preschool that magnified later class. Children's race, breastfeeding status, headstrong score, immature dependent score, peer conflict score, educational level of the mother, baseline antisocial score, baseline anxious/depressed score, and smoking status 12 months prior to the birth of the child were found to be risk factors in the ADHD trajectory classes.

CONCLUSION

The trajectory classes findings obtained in the current study can (a) assist a researcher in evaluating an intervention (or combination of interventions) that best decreases the long-term impact of ADHD symptoms and (b) allow clinicians to better assess as to which class a child with ADHD belongs so that appropriate intervention can be employed.

Cocaine Effect Expectancies among Patients with Cocaine Use Disorder with and without Adult Attention Deficit Hyperactivity Disorder: Are There Any Relevant Differences?

Cocaine use could be modulated by drug expectancies based on previously experienced subjective effects. Some patients perceive a paradoxical calming effect after cocaine use. This study was performed to explore cocaine effect expectancies in patients diagnosed with cocaine use disorder, with and without co-occurring adult attention deficit hyperactivity disorder (ADHD). Secondly, we sought to empirically determine the presence of this paradoxical calming effect after cocaine use in patients with co-occurring adult ADHD to identify the individuals most at risk of cocaine use and relapse. Cross-sectional study using a consecutive sampling method of patients diagnosed with cocaine use disorder (n = 221) treated at public therapeutic communities in Andalusia (Spain). Participants completed a battery of instruments to assess the following variables: cocaine effect expectancies, paradoxical calming effect, adult ADHD, and other co-occurring psychiatric disorders. A multivariate binary logistic regression analysis showed that two variables, the paradoxical calming effect and antisocial personality disorder (ASPD), were independently associated with the probability of being diagnosed with adult ADHD (OR = 3.43, 95% CI = 1.88-6.26 and OR = 3.42, 95% CI = 1.30-8.95, respectively). The presence of a paradoxical calming reaction to cocaine and/or a diagnosis of ASPD in patients with cocaine use disorder increases the diagnostic suspicion of co-occurring adult ADHD.

Real-life instability in ADHD from young to middle adulthood: a nationwide register-based study of social and occupational problems

BACKGROUND

Studies using self-reports indicate that individuals with ADHD are at increased risk for functional impairments in social and occupational settings, but evidence around real-life instability remains limited. It is furthermore unclear if these functional impairments in ADHD differ across sex and across the adult lifespan.

METHOD

A longitudinal observational cohort design of 3,448,440 individuals was used to study the associations between ADHD and residential moves, relational instability and job shifting using data from Swedish national registers. Data were stratified on sex and age (18-29 years, 30-39 years, and 40-52 years at start of follow up).

RESULTS

31,081 individuals (17,088 males; 13,993 females) in the total cohort had an ADHD-diagnosis. Individuals with ADHD had an increased incidence rate ratio (IRR) of residential moves (IRR 2.35 [95% CI, 2.32-2.37]), relational instability (IRR = 1.07 [95% CI, 1.06-1.08]) and job shifting (IRR = 1.03 [95% CI, 1.02-1.04]). These associations tended to increase with increasing age. The strongest associations were found in the oldest group (40-52 years at start of follow). Women with ADHD in all three age groups had a higher rate of relational instability compared to men with ADHD.

CONCLUSION

Both men and women with a diagnosis of ADHD present with an increased risk of real-life instability in different domains and this behavioral pattern was not limited to young adulthood but also existed well into older adulthood. It is therefore important to have a lifespan perspective on ADHD for individuals, relatives, and the health care sector.

Exploring the psychometric properties of the externalizing spectrum inventory-brief form in a Swedish forensic psychiatric inpatient sample

BACKGROUND

The Externalizing Spectrum Inventory-Brief Form (ESI-BF) [1] is a 160-item self-report instrument designed for the assessment of externalizing psychopathology, yet few studies to date have evaluated its psychometric properties, structural fit, and criterion validity in forensic psychiatric settings.

METHODS

Here, we investigated these aspects in a sample of forensic psychiatric inpatients (n = 77) from a maximum-security forensic psychiatric hospital in Sweden. We firstly investigated the reliability. Secondly, using confirmatory factor analysis, the structure of the ESI-BF. And thirdly, using a Bayesian approach, assessed how the three ESI-BF subfactors relate to criterion measures of antisocial behaviors, substance use, and lifetime externalizing spectrum diagnoses.

RESULTS

The ESI-BF demonstrated good to adequate reliability and internal consistency, with all but four facet scales exhibiting α and ω values ≥ 0.80. Average inter-item correlations for the facet scales ranged from 0.31 to 0.74. However, all structural models exhibited poor to mediocre fit, with model fit values for the CFI being 0.66, 0.79 and 0.87 and RMSEA values of 0.14, 0.12 and 0.09. for the unidimensional correlated factors and bifactor model, respectively. Regarding criterion validity, all subscales of the item-based ESI-BF three-factor model exhibited robust correlations with the Life History of Aggression total, aggression and antisocial/consequences subscales, with correlations ranging from 0.29 to 0.55. All ESI-BF subfactors demonstrated robust associations, yet with different externalizing outcomes, lending tentative support to its criterion validity.

CONCLUSION

Despite remaining ambiguities regarding its structural fit, the ESI-BF may be promising for assessing externalizing psychopathology in forensic psychiatric populations. However, further investigation of the ESI-BF is needed before any firm conclusions can be drawn about its appropriateness in forensic psychiatric settings.

A Comparative Study of Prison Inmates With and Without ADHD: Which Neuropsychological and Self-Report Measures are Most Effective in Detecting ADHD Within Correctional Services?

OBJECTIVE

In this study we aimed to investigate the screening and diagnostic properties of various self-report instruments to identify measures which most effectively detect ADHD in a correctional sample.

METHOD

The sample consisted of 193 male high security prisoners in Sweden. We investigated if measures of ADHD symptoms, executive functioning, impulsivity, estimated IQ and working memory could differentiate participants with ADHD from those with ASPD or no diagnosis.

RESULTS

Participants with ADHD obtained significantly higher total scores on all included measures. Although we found that some of the measures were more efficient in differentiating ADHD, mean values were generally elevated in the sample.

CONCLUSION

Results demonstrate the importance of investigating psychometric properties in relevant samples to assure a measurement's usefulness in different contexts, in this case a correctional setting, where the high influence of unspecific behavioral indicators in these measurements might negatively affect their validity.

Brief report: Free-living physical activity levels and cognitive control in multi-problem young adults

Previous studies indicate a positive association between physical activity and cognitive control in sedentary but healthy adults, yet not much is known about physical activity levels in multi-problem young adults. We examined the level of self-reported free-living physical activity (i.e., MET minutes per week) in an ecologically valid sample of young adults facing multiple problems, including unemployment, lack of education, frequent substance use, and history of delinquency. We compared cognitive control with an age- and sex-matched control sample. Additionally, the association between physical activity and cognitive control (i.e., response inhibition, error processing, interference effect) in the multi-problem group was examined. Physical activity and cognitive control were measured with the International Physical Activity Questionnaire-Long Form and three cognitive control experiments (i.e., Flanker, Go/NoGo, Stroop), respectively. With M = 4428 Metabolic Equivalents (METs), our multi-problem sample (n = 63) showed physical activity levels similar to the age- and sex-matched control sample from the general population (n = 62). The multi-problem young adults also showed impaired cognitive control indexed as decreased response inhibition and decreased Flanker correctness effect compared to their peers. We could not find an association between self-reported physical activity and cognitive control in the multi-problem sample. Due to the small sample size, results should be interpreted with caution. However, future dose-response studies could still use these results to further examine if within-individual increased physical activity may possibly lead to improved cognitive control in (already relatively active) multi-problem young adults.

Maladaptive Personality Traits in a Group of Patients with Substance Use Disorder and ADHD

Background and Objectives: the comorbidity of personality disorders in patients who use psychoactive substances is common in psychiatric practice. The epidemiology of disharmonious personality traits in patients with ADHD and addictions in adulthood is still insufficiently researched. The study investigated the typology of personality traits in a group of adult patients consuming psychoactive substances, in whom symptoms of ADHD were identified. Materials and Methods: the study evaluates a group of 104 patients with chronic psychoactive substances abuse, in whom symptoms of ADHD were identified in early adulthood, in terms of comorbid personality traits. Results: statistically significant data have been obtained regarding the presence of clinical traits characteristic for cluster B personality disorders, the patients presenting lower levels of self-control, self-image instability, difficulties in the areas of social relationships and own identity integration. Conclusions: ADHD symptomatology precedes the clinical traits of personality disorders in patients with addictions, negatively influencing chronic evolution and quality of life.

A Systematic Review of Longitudinal Studies Investigating the Association Between Early Life Maternal Depression and Offspring ADHD

OBJECTIVE

The systematic review sought to understand the relationship between maternal depression and later ADHD in children.

METHOD

Three databases were used to identify the studies (Medline, Web of Science and PsychInfo) resulting in 1,223 studies being screened and 14 articles being included in the review.

RESULTS

The majority of studies (N = 11) reported a significant relationship between maternal depression (across both prenatal and postnatal periods) and ADHD symptoms in children. This relationship remained significant when temperament, or past ADHD symptoms were controlled for. Several methodological issues were identified including; overreliance on maternal report and parental ADHD not being accounted for in most studies.

CONCLUSION

The review adds to the literature regarding the temporal relationship between maternal depression and the development of ADHD in children, and thus supports the case for improving access to mental health services for mothers as a preventative strategy in the development of child psychopathology.

Neural signatures of the development of antisocial behaviours and callous-unemotional traits among youth: The moderating role of parental support

Comorbidity of antisocial behaviours (AB) and callous-unemotional (CU) traits characterizes a subgroup of youth at risk for chronic and severe AB in adulthood. Although aberrant neural response to facial emotion confers heightened risk for AB and CU traits, the behavioural effect of this neural response varies by family context. The present study examines the effects of neural response to emotional faces, parental support and the interaction between the two as predictors of AB and CU traits in a longitudinal sample of preadolescents (Nbaseline  = 11,883; Mage  = 9.5; 47.8% female). Low CU youth who evinced attenuated response to fearful faces within the left superior temporal sulcus and fusiform gyrus showed smaller decreases of AB over time; these associations did not extend to high CU youth. Among high CU youth reporting low parental support, blunted response to fearful faces within the bilateral inferior parietal sulcus predicted smaller decreases of AB. Study findings highlight neurobehavioural differences between youth with high and low CU traits, as well as the interacting roles of negative face processing and parental support in the development of AB.

ADHD symptom profiles, intermittent explosive disorder, adverse childhood experiences, and internalizing/externalizing problems in young offenders

Attention-deficit/hyperactivity disorder (ADHD) and co-existing psychiatric/psychological impairments as well as adverse childhood experiences (ACEs) are common among young offenders. Research on their associations is of major importance for early intervention and crime prevention. Intermittent explosive disorder (IED) warrants specific consideration in this regard. To gain sophisticated insights into the occurrence and associations of ADHD, IED, ACEs, and further psychiatric/psychological impairments in young (male and female) offenders, we used latent profile analysis (LPA) to empirically derive subtypes among 156 young offenders who were at an early stage of crime development based on their self-reported ADHD symptoms, and combined those with the presence of IED. We found four distinct ADHD subtypes that differed rather quantitatively than qualitatively (very low, low, moderate, and severe symptomatology). Additional IED, ACEs, and further internalizing and externalizing problems were found most frequently in the severe ADHD subtype. Furthermore, females were over-represented in the severe ADHD subtype. Finally, ACEs predicted high ADHD symptomatology with co-existing IED, but not without IED. Because ACEs were positively associated with the occurrence of ADHD/IED and ADHD is one important risk factor for on-going criminal behaviors, our findings highlight the need for early identification of ACEs and ADHD/IED in young offenders to identify those adolescents who are at increased risk for long-lasting criminal careers. Furthermore, they contribute to the debate about how to best conceptualize ADHD regarding further emotional and behavioral disturbances.

Attention-Deficit/Hyperactivity Disorder Symptoms and Externalizing Progression in the LAMS Study: A Test of Trait Impulsivity Theory

OBJECTIVE

To test differential prospective prediction of growth in externalizing behavior, including oppositional defiant disorder, conduct disorder, and substance use disorders, by earlier hyperactive-impulsive (HI) vs inattentive (IN) symptoms of attention-deficit/hyperactivity disorder (ADHD).

METHOD

Participants in the Longitudinal Assessment of Manic Symptoms (LAMS) Study (N = 685 at study entry), including 458 boys and 227 girls ages 6-12, completed full parent report and self-report assessments every year for 8 years on the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Three sets of analyses were conducted. First, hierarchal regression (block entry) was used to test independent associations between HI symptoms and later externalizing outcomes, controlling for IN symptoms, and IN symptoms and later externalizing outcomes, controlling for HI symptoms. Second, logistic regression was used to test progression of DSM externalizing disorders. Third, tests of mediation were used to assess potentiation of externalizing progression through environmental risk mediators (eg, family environment, neighborhood violence).

RESULTS

Consistent with hypotheses derived from trait impulsivity theories of externalizing behavior, HI symptoms of ADHD were associated independently with long-term externalizing outcomes, whereas IN symptoms were not. Between months 48 and 96, ADHD-HI/combined symptom subtype diagnoses predicted later oppositional defiant disorder diagnoses, oppositional defiant disorder diagnoses predicted later conduct disorder diagnoses, and conduct disorder diagnoses predicted later substance use disorder diagnoses. Evidence for environmental risk mediation (eg, parental monitoring, neighborhood violence) was also found.

CONCLUSION

Findings support trait impulsivity models of externalizing progression, whereby ADHD-HI/combined symptoms subtypes predispose to increasingly severe externalizing behaviors, which are magnified in contexts of environmental risk.

Screening for ADHD Symptoms among Criminal Offenders: Exploring the Association with Clinical Features

Background: Attention-deficit/hyperactivity disorder (ADHD) is a disabling disorder. High rates of ADHD have been consistently reported among prisoners. The main objectives were (1) to estimate the prevalence of ADHD symptoms in a sample of male inmates and (2) to investigate the relationship between ADHD symptoms and socio-demographic/clinical features. According to the high prevalence of childhood trauma among inmates, we assessed whether exposition to childhood trauma can be related to the presence of ADHD symptoms. Methods: A total of 159 male prisoners admitted to Monza prison between January 2020 and June 2021 were included. Both Wender Utah ADHD rating scale and adult ADHD self-report scale were administered to assess ADHD symptoms. Moreover, inmates completed the childhood trauma questionnaire. Results: Data were available for 108 inmates. Thirty-five prisoners (32.4%) were found on screening to meet the criteria for symptoms of ADHD. Cocaine use disorder, prescription of mood stabilizers and a history of emotional abuse significantly increased the likelihood of having clinically significant ADHD symptoms. Furthermore, patients who experienced physical neglect resulted in meeting the criteria for ADHD symptoms. Conclusions: ADHD symptoms are widespread among inmates and are associated with specific risk factors. Screening for ADHD should be done to provide appropriate intervention strategies.

Co-occurring Mental Disorders in Transitional Aged Youth With Substance Use Disorders - A Narrative Review

Adolescence and emerging adulthood are often referred to as youth. Transitional psychiatry addresses this target group, which considers patients between 15 and 25 years of age. Substance use usually begins and peaks at this stage of life. Psychiatric disorders, foremost attention-deficit/hyperactivity disorder, and affective disorders, conduct disorders, and first-episodes psychosis frequently appear in early life stages. This review aims to provide a broad overview of transitional-aged youth's most common psychiatric comorbidities with substance use disorders. A literature search was conducted in Embase and Pubmed, and the main findings are described narratively. We present main findings for the following comorbidities: attention-deficit/hyperactivity disorder, conduct disorder, personality disorders, affective disorders, psychotic disorders, and the phenomena of overdose and suicidality. In conclusion, co-occurring mental health disorders are common and appear to facilitate the development of substance use disorders and exacerbate their overall course. Substance use also affects the severity and course of comorbid psychiatric disorders. Overall, data on transition-age youth with substance use disorders are highly inconsistent. Universal screening and treatment guidelines do not yet exist but should be aimed for in the future.

Internalizing-externalizing comorbidity and regional brain volumes in the ABCD study

Despite nonoverlapping diagnostic criteria, internalizing and externalizing disorders show substantial comorbidity. This comorbidity is attributable, at least in part, to transdiagnostic neuroaffective mechanisms. Both unipolar depression and externalizing disorders are characterized by structural and functional compromises in the striatum and its projections to the anterior cingulate cortex (ACC) and other frontal regions. Smaller volumes and dampened reward responding in these regions are associated with anhedonia and irritability - mood states that cut across the internalizing and externalizing spectra. In contrast, smaller amygdala volumes and dampened amygdala function differentiate externalizing disorders from internalizing disorders. Little is known, however, about associations between internalizing-externalizing comorbidity and brain volumes in these regions, or whether such patterns differ by sex. Using a transdiagnostic, research domain criteria (RDoC)-informed approach, we evaluate associations between heterotypic (Internalizing × Externalizing) symptom interactions and striatal, amygdalar, and ACC volumes among participants in the Adolescent Brain Cognitive Development study (N = 6,971, mean age 9.9 years, 51.6% female). Heterotypic symptoms were associated with ACC volumes for both sexes, over and above the main effects of internalizing and externalizing alone. However, heterotypic comorbidity was associated with larger ACC volumes for girls, but with smaller ACC volumes for boys. These findings suggest a need for further studies and transdiagnostic assessment by sex.

U.S. national, regional, and state-specific socioeconomic factors correlate with child and adolescent ADHD diagnoses pre-COVID-19 pandemic

Attention-deficit/hyperactivity disorder (ADHD), the most diagnosed emerging neurodevelopmental disorder in children, is a growing health crisis in the United States. Due to the potential increase in ADHD severity during and post the COVID-19 pandemic, we analyzed recent national and two state-specific ADHD data distribution among U.S. children and adolescents by investigating a broad range of socioeconomic status (SES) factors. Child and adolescent ADHD diagnosis and treatment data were parent-reported via National Survey of Children's Health (NSCH). The nationwide childhood prevalence of ADHD is 8.7%, and 62.1% of diagnosed children are taking medication. Louisiana (15.7%) has the highest percentage of children diagnosed with ADHD and California (5.6%) has the lowest, followed by Nevada (5.9%). Multiple correspondence analysis (MCA, n = 51,939) examining 30 factors highlights four areas of interest at the national and state level: race/ethnicity, financial status, family structure, and neighborhood characteristics. Positive correlations between ADHD diagnosis and unsafe school, unsafe neighborhood, and economic hardship are evident nationally and statewide, while the association between a lack of ADHD diagnosis and higher urban neighborhood amenities are evident nationally, but not in two opposing outlier states-Louisiana or Nevada. National and state-specific hierarchical analyses demonstrate significant correlations between the various SES factors and ADHD outcomes. Since the national analysis does not account for the demographic heterogeneity within regions or individual states, the U.S. should rely on comprehensive, county-specific, near real-time data reporting to effectively model and mitigate the ADHD epidemic and similar national health crises.

Early onset externalizing behaviors among forensic psychiatric patients: Identification in child and adolescent psychiatric services

Forensic psychiatric patients constitute a heterogeneous patient group, with common comorbidity within the externalizing spectrum. Increased knowledge on early antecedents in the pathway to severe mental illness and criminality is needed. In this study, we investigated early onset externalizing behaviors in three groups of forensic psychiatric patients 1) patients without contact with child and adolescent psychiatry (CAP), 2) patients with CAP contact, and 3) patients with both CAP contact and institutional placement. Participants (N = 98) were consecutively recruited from a cohort of forensic psychiatric patients in Sweden between 2016 and 2020. Data were collected through file information and semi-structured interviews and analyzed with a Bayesian approach. A history of CAP together with an institutional placement during childhood or adolescence was associated with more externalizing disorders, a higher number of convictions over the lifetime, a lower age at first conviction, and a lower age at first self-reported crime. Our findings provide further insight into the importance of early-onset adverse behaviors in the development of later externalizing behaviors, and may be of particular use for practitioners within social services and CAP services.

Identifying Associated Factors for Illegal Acts among Patients with Gambling Disorder and ADHD

Illegal behaviors have been reported in gambling disorder (GD) as well as in individuals with attention deficit hyperactivity disorder (ADHD). Likewise, ADHD symptomatology has been observed in patients with GD. We aimed to examine the association between ADHD symptomatology, personality traits and impulsivity in a sample of treatment-seeking patients with GD (n = 204) with and without a criminal report. The subjects were evaluated before starting treatment using different self-administered instruments. Among those who had committed an illegal act, two groups were made depending on whether or not the criminal conduct had legal repercussions (n = 64 without legal consequences; n = 32 with legal consequences). Structural equation modeling (SEM) was used to explore the interrelationships between personality traits, ADHD, impulsivity levels, gambling-related criminal behavior and other gambling-related factors. Greater ADHD symptomatology was found in patients with reported illegal behaviors, as well as higher impulsivity levels. Those individuals who presented legal consequences due to the criminal behavior showed higher impulsivity levels and harm avoidance and lower persistence and cooperativeness. Our findings uphold that patients with GD and ADHD symptomatology have greater impulsivity and are more vulnerable to committing an illegal act. Therefore, specific harm-prevention interventions and treatment approaches are needed for this population.

Callous-unemotional traits in Chinese preschool children with attention-deficit/hyperactivity disorder

BACKGROUND

Children with early onset of Callous-Unemotional (CU) traits are at a higher risk for long-term, persistent psychosocial problems. The current study aimed to explore the characteristics of CU in preschool children with Attention Deficit Hyperactivity Disorder (ADHD) and the diagnostic significance of CU traits in ADHD.

METHODS

A total of 176 preschool children (89 with ADHD and 87 Typically Developing Children [TDC]) aged 4-5 years old were recruited to the study. The participants were assessed for CU traits, emotional and behavioral problems, and how their executive functioning was associated with ADHD using multiple assessment scales. Multiple linear regression analysis was performed to assess the incremental validity of the Inventory of Callous-Unemotional Traits (ICU), adjusting for possible covariates by child's sex, conduct problems, and oppositional defiant symptoms.

RESULTS

The results showed that there was a significant difference of ICU scores between the ADHD and TDC groups (F = 30.12, P < 0.001). In terms of callousness, ADHD + Oppositional Defiant Disorder (ODD) group showed a significant high score, and the ADHD only group scored significantly higher than the TDC group (F = 20.42, P < 0.001). The ICU was negatively associated with the prosocial behaviour subscale (γ = - 0.57, P < 0.01) and showed low to moderate positive correlations with emotional and behavioural problems, as well as executive function (γ = 0.24-0.67, P < 0.05). The ICU scores explained 6% of the incremental validity in ADHD symptoms. The diagnostic value of the ICU for ADHD was medium and acceptable.

CONCLUSIONS

The current study indicated that early identification of CU traits may help clinicians better understand symptoms and behavioural problems in children with ADHD. CU traits therefore could be considered as a useful assessment tool for ADHD.

Callous-Unemotional Traits among Adolescents with Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, or Typical Development: Differences between Adolescents' and Parents' Views

This study examined parent-adolescent agreement on the callous, uncaring, and unemotional dimensions of callous-unemotional (CU) traits and the differences in adolescent-reported and parent-reported CU traits among 126 adolescents with autism spectrum disorder (ASD), 207 adolescents with attention-deficit/hyperactivity disorder (ADHD), and 203 typically developing (TD) adolescents. Adolescent-reported and parent-reported CU traits on the three dimensions of the Inventory of Callous and Unemotional Traits were obtained. The strength of CU traits and the differences between adolescent-reported and parent-reported traits were compared among the three groups using analysis of covariance. Parent-adolescent agreement was examined using intraclass correlation. The results reveal that both adolescent-reported and parent-reported callousness and uncaring traits in the ASD and ADHD groups were significantly stronger than those in the TD group. Parent-adolescent agreement on the uncaring trait was fair across the three groups, whereas that on callousness was poor across all three groups. Parent-adolescent agreement on unemotionality was fair in the TD group but poor in the ADHD and ASD groups. ASD and ADHD groups had significantly greater differences in scores reported by parents and adolescents on the callousness trait than the TD group. The parent-adolescent score differences in the uncaring trait were also larger in the ASD group than in the TD group. Thus, these results support the application of a multi-informant approach in CU trait assessment, especially for adolescents with ASD or ADHD.

Association of ADHD and hypersexuality and paraphilias

Subjects with ADHD suffer from inattention, hyperactivity, and impulsivity. Clinicians often assume that specific symptoms of ADHD are bound to affect sexual desire by increasing the frequency of hypersexuality. There is a lack of knowledge about the comorbidity between ADHD, hypersexuality, and paraphilias. The aim of this article was to provide a review of the literature on the association of ADHD and hypersexuality and paraphilias and to discuss the screening and the management of these syndromes when associated with ADHD. A systematic review of the literature was performed in PubMed, PsychInfo, and Embase databases. The studies reviewed show that some individuals who suffer from ADHD report hypersexuality and paraphilias, but no clear data emerged supporting the idea that hypersexuality and paraphilias are more frequent in an ADHD population. On the other hand, some studies showed a high prevalence of ADHD in hypersexual and paraphilic subjects. This is the first systematic review of hypersexuality and paraphilias in individuals with ADHD. However, the results are limited by differences in the methodology and measurement instruments for hypersexuality and paraphilias as well as by the small number of studies and the small sample sizes of many studies.

Individual differences, ADHD, adult pathological demand avoidance, and delinquency

BACKGROUND

Pathological Demand Avoidance (PDA) is a developmental disorder involving challenging behaviour clinically linked to Autism Spectrum Disorder (ASD). Many of the problematic features of PDA are often seen in persons with attention deficit hyperactivity disorder and impulsivity. ADHD and impulsivity are also common in the backgrounds of offenders.

AIMS

Method and procedure: We examined if self-reported ASD, ADHD, impulsivity, and general personality traits such as low conscientiousness and low emotional stability predicted self-reported PDA scores, and which constructs contributed to the prediction of delinquency, recruiting 132 participants (mean age 34.6 years, SD = 10.9, range 18-68), of whom 126 cases had complete data.

OUTCOMES AND RESULTS

Many of these constructs, but particularly ADHD (r = 0.71, p < 0.001) were significant correlates of PDA, the correlation between ASD and PDA was small, and did not predict PDA. Multiple regression indicated that a combination of higher attention deficit, antagonism, and lower emotional stability predicted 65 % of an individual's PDA score, but that their PDA score did not contribute to the prediction of delinquency.

CONCLUSIONS AND IMPLICATIONS

This research indicates that, for community adult populations, self-reported individual differences in ADHD, emotional instability, and antagonism appear to better predict PDA than ASD. The association PDA has with delinquency may reflect these constructs, which are also correlates of offending.

Lifetime co-occurring psychiatric disorders in newly diagnosed adults with attention deficit hyperactivity disorder (ADHD) or/and autism spectrum disorder (ASD)

BACKGROUND

Co-occurring psychiatric disorders in adults with Attention Deficit Hyperactivity Disorder (ADHD) and/or Autism Spectrum Disorder (ASD) contribute to the burden of the healthcare and possibly to the delay of diagnosis. Aim of the study was to clinically assess the prevalence and compare lifetime co-occurring psychopathology in a sample of newly diagnosed ADHD and/or ASD adults and discuss the diagnostic challenges they pose.

METHODS

The lifetime prevalence rates of ten of the most frequently co-occurring psychiatric diagnoses was registered in 336 adults of normal intelligence who underwent a thorough clinical evaluation for the diagnosis of ADHD and/or ASD for the first time in their lives. Four study groups were formed: the ADHD (n = 151), the ASD (n = 58), the ADHD+ASD (n = 28) and the nonADHD/nonASD (NN) (n = 88) group.

RESULTS

At least one co-occurring psychopathology was found in 72.8% of the ADHD group, in 50% of the ASD group, in 72.4% of the ADHD+ASD group and in 76.1% of the NN group (p = 0.004). In all groups the most frequent psychiatric disorder was depressive disorder. The only significant difference regarding the patterns of psychiatric co-occurrence between the ADHD and the nonADHD groups (ASD and NN groups) was found for SUD (p = 0.001). Also, the proportion of subjects with Bipolar Disorder was significantly greater in the NN group as compared to those with ASD (p = 0.025).

CONCLUSIONS

Our results support the high prevalence of co-occurring psychiatric disorders in adults with ADHD and/or ASD with the ASD group presenting the lowest rate. The most marked difference between the ADHD and the nonADHD groups was found for SUD. Moreover, our findings highlight the need for a thorough clinical assessment of all referred patients both in the presence and absence of ADHD and/or ASD.

Welfare consequences for people diagnosed with attention deficit hyperactivity disorder (ADHD): A matched nationwide study in Denmark

There is insufficient data regarding the excess direct and indirect costs associated with attention deficit hyperactivity disorder (ADHD). Using the Danish National Patient Registry (2002-2016), we identified 83,613 people of any age with a diagnosis of ADHD or who were using central-acting medication against ADHD (primarily methylphenidate, with at least two prescriptions) and matched them to 334,446 control individuals. Additionally, 18,959 partners of patients aged ≥18 years with ADHD were identified, and compared with 74,032 control partners. Direct costs were based on data from the Danish Ministry of Health. Information about the use and costs of drugs were obtained from the Danish Medicines Agency. The frequencies of visits and hospitalizations, and costs of general practice were derived from data from the National Health Security. Indirect costs were obtained from Coherent Social Statistics. The average annual health care costs for people with ADHD and their partners were, respectively, €2636 and €477 higher than those of the matched controls. A greater percentage of people with ADHD and their partners compared with respective control subjects received social services (sick pay or disability pension). Those with ADHD had a lower income from employment than did controls for equivalent periods up to five years before the first diagnosis of ADHD. The additional direct and indirect annual costs (for those aged ≥18 years) including transfers of ADHD compared with controls were €23,072 for people with ADHD and €7,997 for their partners. ADHD has substantial socioeconomic consequences for individual patients, their partners and society.

Effects of Childhood and Adult Persistent Attention-Deficit/Hyperactivity Disorder on Risk of Motor Vehicle Crashes: Results From the Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

To determine motor vehicle crash (MVC) risk in adults with a history of childhood attention-deficit/hyperactivity disorder (ADHD) and persistent ADHD symptoms.

METHOD

Participants with (n = 441) and without (n = 239; local normative comparison group) childhood ADHD from the Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder (MTA) Study were included. Participants provided self-reports on total number of MVCs they had been involved in and the time of licensure. Driving experience was estimated as the number of months since licensure. Total number of MVCs by adulthood was regressed on baseline ADHD status adjusting for sex, age at follow-up, driving experience, baseline oppositional defiant disorder/conduct disorder comorbidity, baseline household income level, adult oppositional defiant disorder/conduct disorder symptoms, adolescent and adult substance use, and adult antisocial personality disorder symptoms. We repeated the analysis using adult ADHD status (persistent versus desistant versus local normative comparison group) and symptom level as the predictor variables. Results are presented as incidence rate ratio (IRR) and CI.

RESULTS

Childhood ADHD was associated with a higher number of MVCs (IRR = 1.45, CI = 1.15-1.82), and adult ADHD symptom persistence was associated with more MVCs than desistance (IRR = 1.46, CI = 1.14-1.86). ADHD desistance was not associated with a significantly increased risk for MVCs compared with the local normative comparison group (IRR = 1.24, CI = 0.96-1.61). Concurrent symptoms of inattention and hyperactivity/impulsivity predicted MVC risk.

CONCLUSION

Persistence of ADHD into adulthood is a stronger predictor of MVC risk than childhood-limited ADHD.

CLINICAL TRIAL REGISTRATION INFORMATION

Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study; https://clinicaltrials.gov; NCT00000388.

Cognitive-motivational, interpersonal, and behavioral functioning in relationship to treatment and research engagement in forensic patients with ADHD

Objectives

To provide more insight into treatment and research responsivity in offenders with attention‐deficit hyperactivity disorder (ADHD).

Method

Via self‐reports and patients' scores on cognitive computer tasks, it was examined whether poorer cognitive‐motivational, interpersonal, and behavioral functioning were related to treatment no‐shows, longer treatment time duration intervals, and no‐show at the research appointment in 52 forensic outpatients with ADHD (M_age = 35.3, SD = 9.38). Treatment adherence was tracked for 10 appointments after research participation.

Results

Regression analyses showed that higher self‐reported impulsivity was associated with research no‐show, and more alcohol use with longer treatment time intervals. Yet, self‐reported delay aversion was associated with fewer treatment no‐shows, and, uncontrolled for alcohol use, impulsivity was associated with shorter treatment time intervals in a subsample of patients.

Conclusions

These preliminary results indicate that externalizing behaviors increase the risk for nonadherence in forensic ADHD patients, but that cognitive‐motivational problems also motivate patients to be more engaged.

Adolescent-Parent Agreement on Callous-Unemotional Traits in Adolescents with Attention-Deficit/Hyperactivity Disorder

This study examined the levels of agreement between the reports of 207 adolescents with attention-deficit/hyperactivity disorder (ADHD) and their parents regarding the adolescents' callous-unemotional (CU) traits and investigated the factors influencing adolescent-parent agreement. Adolescent-parent agreement about CU traits in three dimensions according to the Chinese version of the Inventory of Callous and Unemotional Traits was examined. The influence of demographic characteristics, comorbid conduct disorder (CD), oppositional defiant disorder (ODD), and ADHD symptoms on adolescent-parent agreement was also examined. The results indicated that adolescent-parent agreement on the CU trait of uncaringness was moderate, whereas agreement on the CU traits of callousness and unemotionality was poor. Adolescent-parent agreement on the three dimensions of CU traits varied depending on the adolescents' sex and comorbid CD and ODD symptoms as well as parental age. Therefore, multiple sources of information are required when assessing the severity of CU traits in adolescents with ADHD. The factors influencing the levels of the agreement should also be considered.

Borderline personality disorder and attention deficit/hyperactivity disorder in adolescence: overlap and differences in a clinical setting

BACKGROUND

With increased consensus regarding the validity and reliability of diagnosing Borderline Personality Disorder (BPD) in adolescents, clinicians express concern over the distinction between BPD and Attention-Deficit/Hyperactivity Disorder (ADHD), and its co-morbidity in clinical settings. The goal of this study was to evaluate differences between BPD, ADHD and BPD + ADHD in terms of co-morbid psychiatric disorders and a range of self-reported behavioral problems in adolescents.

METHODS

Our sample consisted of N = 550 inpatient adolescents with behavioral and emotional disorders that have not responded to prior intervention. We took a person-centered approach (for increase clinical relevance) and compared adolescents with ADHD, BPD and ADHD+BPD in terms of co-occurring psychiatric disorders and behavioral problems. We performed a regression analysis to test whether BPD symptoms make an incremental contribution to the prediction of psychiatric symptoms over ADHD symptoms.

RESULTS

The severity of almost all co-occurring disorders, aggression, self-harm, suicidal thoughts, and substance use, were higher in the ADHD+BPD group. Borderline symptoms made an incremental contribution to the prediction of psychiatric symptoms beyond the contribution of ADHD.

CONCLUSION

Severity and co-morbidity may be helpful factors in distinguishing between ADHD and BPD in clinical practice and the co-morbidity of these two disorders may indicate a worse clinical outcome.

Distinct brain structure and behavior related to ADHD and conduct disorder traits

Attention-Deficit/Hyperactivity Disorder (ADHD) and conduct disorder (CD) exemplify top-down dysregulation conditions that show a large comorbidity and shared genetics. At the same time, they entail two different types of symptomology involving mainly non-emotional or emotional dysregulation. Few studies have tried to separate the specific biology underlying these two dimensions. It has also been suggested that both types of conditions consist of extreme cases in the general population where the symptoms are widely distributed. Here we test whether brain structure is specifically associated to ADHD or CD symptoms in a general population of adolescents (n = 1093) being part of the IMAGEN project. Both ADHD symptoms and CD symptoms were related to similar and overlapping MRI findings of a smaller structure in prefrontal and anterior cingulate cortex. However, our regions of interest (ROI) approach indicated that gray matter volume (GMV) and surface area (SA) in dorsolateral/dorsomedial prefrontal cortex and caudal anterior cingulate cortex were negatively associated to ADHD symptoms when controlling for CD symptoms while rostral anterior cingulate cortex GMV was negatively associated to CD symptoms when controlling for ADHD symptoms. The structural findings were mirrored in performance of neuropsychological tests dependent on prefrontal and anterior cingulate regions, showing that while performance on the Stop Signal test was specifically related to the ADHD trait, delayed discounting and working memory were related to both ADHD and CD traits. These results point towards a partially domain specific and dimensional capacity in different top-down regulatory systems associated with ADHD and CD symptoms.

Attention Deficit Hyperactivity Disorder Increases Nicotine Addiction Severity in Adults Seeking Treatment for Substance Use Disorders: The Role of Personality Disorders

AIMS

To examine the role of attention deficit/hyperactivity disorder (ADHD) and impulsive personality disorders in nicotine addiction severity among treatment-seeking substance use disorder (SUD) patients.

METHODS

In a cross-sectional study, we examined data from the second International ADHD in Substance Use Disorders Prevalence Study (IASP-2) on 402 adults in SUD treatment from Puerto Rico, Hungary, and Australia using diagnostic interviews for ADHD, antisocial (ASP) and borderline (BPD) personality disorders, and the self-report Fagerström Test of Nicotine Dependence (FTND). We compared SUD patients with and without ADHD on nicotine addiction severity. We tested direct and indirect pathways from ADHD to nicotine addiction and mediation through ASP and BPD.

RESULTS

Overall, 81.4% of SUD patients reported current cigarette smoking. SUD patients with ADHD had higher FTND scores and smoked more cigarettes than those without ADHD, with an earlier onset and more years of smoking. ASP mediated the effect of ADHD on all aspects of nicotine addiction severity, whereas BPD did so only on some aspects of nicotine addiction severity.

CONCLUSIONS

SUD patients with comorbid ADHD show more severe nicotine addiction than those without, which is largely explained by comorbid impulsive personality disorders. In SUD patients, it is important to screen for adult ADHD and other psychiatric disorders, especially those with impulse control deficits such as ASP and BPD.

Assessing phenotypic and polygenic models of ADHD to identify mechanisms of risk for longitudinal trajectories of externalizing behaviors

BACKGROUND

Children with ADHD frequently engage in higher rates of externalizing behaviors in adulthood relative to children without. However, externalizing behaviors vary across development. Little is known about how this risk unfolds across development. Phenotypic and polygenic models of childhood ADHD were used to predict individual differences in adult externalizing trajectories. Supportive parenting, school connectedness, and peer closeness were then examined as causal mechanisms.

METHODS

Data were from the National Longitudinal Study of Adolescent to Adult Health (N = 7,674). Externalizing behavior was measured using data from age 18 to 32 and modeled using latent class growth analysis. Child ADHD was measured using retrospective self-report (phenotypic model) and genome-wide polygenic risk scores (polygenic model). Multiple mediation models examined the direct and indirect effects of the phenotypic and polygenic models (separately) on externalizing trajectories through the effects of adolescent supportive parenting, school connectedness, and peer closeness.

RESULTS

Phenotypic and polygenic models of ADHD were associated with being in the High Decreasing (3.2% of sample) and Moderate (16.1%) adult externalizing trajectories, but not the severe Low Increasing trajectory (2.6%), relative to the Normal trajectory (78.2%). Associations between both models of ADHD on the High Decreasing and Moderate trajectories were partially mediated through the effects of school connectedness, but not supportive parenting or peer closeness.

CONCLUSIONS

Findings shed light on how childhood ADHD affects downstream psychosocial processes that then predict specific externalizing outcomes in adulthood. They also reinforce the importance of fostering a strong school environment for adolescents with (and without) ADHD, as this context plays a critical role in shaping the development of externalizing behaviors in adulthood.

The Role of the Gut-Brain Axis in Attention-Deficit/Hyperactivity Disorder

Genetic and environmental factors play a role in the cause and development of attention-deficit/hyperactivity disorder (ADHD). Recent studies have suggested an important role of the gut-brain axis (GBA) and intestinal microbiota in modulating the risk of ADHD. Here, the authors provide a brief overview of the clinical and biological picture of ADHD and how the GBA could be involved in its cause. They discuss key biological mechanisms involved in the GBA and how these may increase the risk of developing ADHD. Understanding these mechanisms may help to characterize novel treatment options via identification of disease biomarkers.

Executive function, attention, and memory deficits in antisocial personality disorder and psychopathy

Antisocial personality disorder (ASPD) and psychopathy attempt to represent individuals demonstrating callousness and disregard for others. ASPD has been criticized for capturing a heterogeneous population whilst missing the essence of the diagnosis by neglecting interpersonal/affective deficits which measures of psychopathy include. This heterogeneity in operationalizations has led to diverse findings without clear understanding of what characterizes this broader population. This study sought to clarify the neuropsychological profiles of ASPD and psychopathy. The Cambridge Neuropsychological Test Assessment Battery was administered to 85 adult male offenders in a personality disorder secure service and to 20 healthy controls. Of patients with ASPD, 46% met criteria for psychopathy. Of those with psychopathy, 89% met criteria for ASPD. There were two sets of comparisons: ASPD versus other personality disorders versus controls and psychopathy versus other personality disorders versus controls. ASPD showed deficits across executive functions, visual short-term and working memory, and attention (compared with controls). Psychopathy showed deficits limited to attention, complex planning, inhibitory control, and response reversal. Response reversal and visual search deficits appeared specific to ASPD and psychopathy versus other personality disorders and may underpin antisocial traits. Additional deficits in inhibitory control and working memory appeared to distinguish ASPD from other personality disorders.

The etiology of antisocial personality disorder: The differential roles of adverse childhood experiences and childhood psychopathology

Antisocial Personality Disorder (ASPD) is a severe personality disorder with robust associations with crime and violence, but its precise etiology is unknown. Drawing on near-population of federal correctional clients in the Midwestern United States, the current study examined antecedent background factors spanning adverse childhood experiences and childhood psychopathology. Greater adverse childhood experiences were associated with ASPD diagnosis with physical abuse showing associations with ASPD symptoms and sexual abuse with lifetime diagnosis for ASPD. Conduct Disorder was strongly linked to ASPD; however, Oppositional Defiant Disorder and ADHD had null associations. Given the role of environmental factors in the development of ASPD, greater criminological attention should be devoted to understanding how assorted forms of abuse and neglect coupled with childhood psychopathology contribute to ASPD especially given its linkages to severe criminal offending.

Treatment of Adult ADHD without Stimulants: Effectiveness in A Dually Diagnosed Correctional Population

Adult ADHD has received increased attention in the past two decades. There is a complex relationship between ADHD and substance use disorders, with ADHD being a risk factor for and a moderator in the treatment of addiction. ADHD is also a risk factor for the development of antisocial personality disorder. As a result, ADHD is prevalent in a correctional dually diagnosed population. This retrospective chart review reports on the effectiveness of the treatment for ADHD in a population with substance use disorders, residing in a correctional community center for treatment and reintegration purposes. Only patients with a primary diagnosis of ADHD were included and only nonstimulants were used. After an average of four visits, or approximately four months, patient showed a moderate response with a pretreatment to posttreatment effect size of 1.4. Sixty-four percent of patients responded and 35% remitted, according to the Clinical Global Index Severity Scale as the primary outcome measure. While stimulants are considered the first-line treatment for ADHD, they clearly present challenges in certain populations, especially in patients with significant antisocial and addiction histories. It does appear that non-stimulants are effective in this population. It is speculated that the response and remission rate could be improved by adding ADHD specific psychosocial interventions.

Police perceptions of the impact that ADHD has on conducting cognitive interviews with youth

Attention deficit hyperactivity disorder (ADHD) in youth witnesses, victims and suspects can significantly impact the investigative interviewing process. In this study, 102 Child Protection Investigation Unit (CPIU) detectives were asked to read four vignettes of adolescents being interviewed by police, two as witnesses and two as suspects, in which one witness and one suspect display ADHD-type behaviour. The detectives rated the degree to which the behaviour in each vignette would impact the interviewer's ability to use the 10 key components of the cognitive interview (CI). They perceived ADHD-type interviewee behaviour as significantly hampering the use of all 10 CI components. There is also a significant difference between the detectives' rated severity of each CI component; they rated Encourage Concentration, Mentally Recreate and Change Order as exerting the strongest impact on the interview process. Implications for police perceptions of training options, needs and preferences regarding interviewing youth with ADHD are discussed.

Childhood serotonergic function and early adult outcomes in youth with ADHD: A 15-year follow-up study

Longitudinal studies have shown that clinical precursors of antisocial personality disorder (ASPD) include attention-deficit/hyperactivity disorder (ADHD) and more notably comorbid ADHD and conduct disorder (CD). Despite existing evidence for the purported role of abnormal serotonergic function in aggressive youth and adults, little evidence exists on the role of serotonin in the progression from childhood disruptive behavior disorders to adult psychopathology, including ASPD. This study examined the relation between serotonergic function in children diagnosed with ADHD and the development of ASPD in early adulthood. We hypothesized that low serotonin response to a pharmacological probe in childhood would predict the development of adult ASPD. Towards this goal we divided 40 adults (M = 37, F = 3), ages 23-26 (m-24.57, sd-2.33) diagnosed with childhood ADHD into 2 groups: participants with (n = 21) and without (n = 19) ASPD. We used logistic regression to assess whether serotonergic measures in childhood assessed via prolactin and cortisol responses to a fenfluramine challenge, would selectively predict the development of ASPD in early adulthood. Logistic regression models showed that low central serotonergic response in childhood indexed by cortisol response significantly predicted adult ASPD (Wald = 4.427, p = .035) but not ADHD diagnosis in adulthood. Adults without ASPD had the highest serotonergic response whereas adults with adolescent ASPD (i.e. early onset ASPD) had the lowest response. Thus we provide new evidence of the link between low serotonergic function in childhood and the development of ASPD in adulthood, particularly for boys with adolescent onset of ASPD. These findings are relevant for understanding the contribution of childhood neurobiology to risk for later ASPD.

Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan

Attention-deficit/hyperactivity disorder (ADHD) is highly heritable and the most common neurodevelopmental disorder in childhood. In recent decades, it has been appreciated that in a substantial number of cases the disorder does not remit in puberty, but persists into adulthood. Both in childhood and adulthood, ADHD is characterised by substantial comorbidity including substance use, depression, anxiety, and accidents. However, course and symptoms of the disorder and the comorbidities may fluctuate and change over time, and even age of onset in childhood has recently been questioned. Available evidence to date is poor and largely inconsistent with regard to the predictors of persistence versus remittance. Likewise, the development of comorbid disorders cannot be foreseen early on, hampering preventive measures. These facts call for a lifespan perspective on ADHD from childhood to old age. In this selective review, we summarise current knowledge of the long-term course of ADHD, with an emphasis on clinical symptom and cognitive trajectories, treatment effects over the lifespan, and the development of comorbidities. Also, we summarise current knowledge and important unresolved issues on biological factors underlying different ADHD trajectories. We conclude that a severe lack of knowledge on lifespan aspects in ADHD still exists for nearly every aspect reviewed. We encourage large-scale research efforts to overcome those knowledge gaps through appropriately granular longitudinal studies.

Attention-Deficit/Hyperactivity Disorder and Transitional Aged Youth

PURPOSE OF REVIEW

Extensive research has been conducted on attention-deficit/hyperactivity disorder (ADHD) in children and adults; however, less is known about ADHD during the transition from childhood to adulthood. Transitional aged youth (TAY) with ADHD represents a particularly vulnerable population as their newfound independence and responsibility often coincides with the development of comorbid disorders. The purpose of this review is to provide an update on the evaluation, diagnosis, and treatment of TAY-ADHD.

RECENT FINDINGS

Recent studies discovering ADHD symptoms emerging in TAY call the classification of ADHD as a disorder necessarily developing in childhood into question. TAY-ADHD are also shown to be vulnerable to academic and social impairments, increased risky behavior, and comorbid psychiatric disorders. Due to the risk of stimulant diversion in TAY, providers are advised to take precaution when prescribing medication to this population. Recent studies demonstrating the efficacy of psychotherapy in conjunction with non-stimulant or extended release stimulant medication provide a feasible alternative. This review highlights research on the course and evaluation of ADHD, impairments and comorbidities specific to TAY, and treatments tailored to address the unique challenges associated with TAY-ADHD.

Childhood ADHD and treatment outcome: the role of maternal functioning

BACKGROUND

Relatively little is known about the role of maternal functioning in terms of attention deficit hyperactivity disorder (ADHD) symptoms, attachment style and resilience as predictive factors for treatment outcome when offspring are diagnosed with ADHD.

OBJECTIVE

To investigate whether maternal functioning is associated with treatment outcome in children with ADHD.

METHODS

The study formed part of a larger naturalistic observational study of children with ADHD. A battery of self-report measures was used to assess selected factors in maternal functioning at the point of referral (baseline data); adult ADHD-symptoms, adult attachment style and adult resilience. Associations between these domains and child treatment response were subsequently examined in a 1-year follow up.

RESULTS

Maternal ADHD-symptoms and degree of resilience were significantly correlated to symptom reduction in offspring diagnosed with ADHD. However, the association between maternal attachment style and child treatment response as measured by the ADHD-RS did not reach statistical significance.

CONCLUSION

To our knowledge, this is the first study to consider potential protective factors along with risk factors in maternal functioning and the impact on child treatment outcome. The study contributes to our knowledge of the potential role of maternal functioning in treatment outcome for children with ADHD.

Monoamine Oxidase-A Genetic Variants and Childhood Abuse Predict Impulsiveness in Borderline Personality Disorder

Objective

Impulsivity is a core feature of borderline personality disorder (BPD) and antisocial personality disorder (ASPD) that likely arises from combined genetic and environmental influences. The interaction of the low activity variant of the monoamine oxidase-A (MAOA-L) gene and early childhood adversity has been shown to predict aggression in clinical and non-clinical populations. Although impulsivity is a risk factor for aggression in BPD and ASPD, little research has investigated potential gene-environment (G×E) influences impacting its expression in these conditions. Moreover, G×E interactions may differ by diagnosis.

Methods

Full factorial analysis of variance was employed to investigate the influence of monoamine oxidase-A (MAO-A) genotype, childhood abuse, and diagnosis on Barratt Impulsiveness Scale-11 (BIS-11) scores in 61 individuals: 20 subjects with BPD, 18 subjects with ASPD, and 23 healthy controls.

Results

A group×genotype×abuse interaction was present (F(2,49)=4.4, p=0.018), such that the interaction of MAOA-L and childhood abuse predicted greater BIS-11 motor impulsiveness in BPD. Additionally, BPD subjects reported higher BIS-11 attentional impulsiveness versus ASPD participants (t(1,36)=2.3, p=0.025).

Conclusion

These preliminary results suggest that MAOA-L may modulate the impact of childhood abuse on impulsivity in BPD. Results additionally indicate that impulsiveness may be expressed differently in BPD and ASPD.

Symptom covariance accounts for behavioral approach associations across impulse control disorders

Behavioral approach system (BAS) dysfunction has been identified as a correlate of and a potential mechanism for attention-deficit/hyperactivity disorder (ADHD) and comorbid disorders. This study examined the role of symptom covariation in the relations among BAS dysfunction, ADHD symptoms, and comorbid impulsive personality disorder features. Undergraduates (N = 207) completed measures of BAS functioning, ADHD symptoms, and borderline and antisocial personality disorder symptoms, and associated features (i.e., relational aggression). Hierarchical regression suggested that age, impulsive ADHD symptoms, and relational aggression were associated with BAS functioning. Adding other ADHD symptom dimensions (inattention, hyperactivity) and antisocial and borderline scores to the model did not increase variance accounted for beyond that accounted for by ADHD impulsivity scores. Results highlight a role of symptom covariance in the previously demonstrated relation between BAS, impulsive presentations of ADHD, and comorbid impulsive personality pathology. Implications for etiological models of ADHD and its co-occurrence with other disorders are discussed.

Trait Impulsivity and the Externalizing Spectrum

This article reviews evidence that trait impulsivity-expressed early in life as the hyperactive-impulsive and combined presentations of attention-deficit/hyperactivity disorder (ADHD)-is a bottom-up, subcortically mediated vulnerability to all externalizing disorders. This vulnerability arises from deficient mesolimbic dopamine responding, which imbues psychological states (irritability, discontentment) that motivate excessive approach behavior (hyperactivity, impulsivity). Through complex interactions with (a) aversive motivational states that arise from largely independent subcortical systems, (b) emotion regulatory mechanisms that arise from top-down, cortical modulation of subcortical neural function, and (c) environmental risk factors that shape and maintain emotion dysregulation, trait impulsivity confers vulnerability to increasingly severe externalizing behaviors across development. This perspective highlights the importance of identifying transdiagnostic neural vulnerabilities to psychopathology; dovetails with the hierarchical, latent structure of psychopathology; and suggests that progression along the externalizing spectrum is an ontogenic process whereby a common, multifactorially inherited trait interacts with endogenous and exogenous influences to yield increasingly intractable externalizing behaviors across development.