Prevalence of criminal convictions in Norwegian adult ADHD outpatients and associations with ADHD symptom severity and emotional dysregulation

Adult ADHD predicts intimate partner violence perpetration and victimization irrespective of gender and age

Understanding the determinants of intimate partner violence (IPV) from perpetrator and victim perspectives has become a major objective of behavioral science. Empirical evidence suggests that adults at risk for Attention-Deficit/Hyperactivity Disorder (ADHD), compared to the general population, tend to have more conflictual partnerships, and the presence of ADHD increases the risk of aggressive behavior. Possible influences of gender have not been sufficiently investigated yet. Using data from an anonymous online survey, this study examined the relationship between ADHD and IPV in 316 male and female individuals with (n = 131) and without (n = 185) ADHD. Multiple linear regression analyses showed that adults at risk for ADHD had more frequently become both victims and perpetrators of IPV compared to the healthy control group. ADHD achieved significant incremental variance over gender and age. Thus, the presence of ADHD seems to be an important risk factor for IPV irrespective of gender and age. Accordingly, research and treatment approaches focusing on ADHD must not neglect the risk of IPV among patients but should offer specific psychological support.

Psychological Determinants of Conflict with the Law and Susceptibility to Rehabilitation in Relation to the Presence of Symptoms of Attention Deficit Hyperactivity Disorder

Background/Objectives: Many prison-sentenced individuals exhibit symptoms of mental dysfunctions, including attention deficit hyperactivity disorder (ADHD). The presence of co-occurring mental disorders further complicates their rehabilitation and social reintegration efforts. Given these challenges, understanding the role of specific disorders, such as ADHD, is critical for developing targeted interventions tailored to the needs of incarcerated individuals and improving their outcomes. This research aimed to clarify the relationships among hyperactivity, criminal behavior, and psychological functioning to inform preventative and therapeutic strategies. Methods: This study investigated the complex interplay among attention deficit hyperactivity disorder (ADHD) symptoms, criminal behavior, and various psychological factors in a sample of 391 male inmates from low-security Polish prisons and a control group of non-offending men. Principal component analysis (PCA) and Spearman's rank correlation were used to analyze the relationships among ADHD severity, type of crime (no crime, property crime, crime involving aggression), family functioning, childhood trauma, early maladaptive schemas, and mental health disorders. Results: The results revealed that while traumatic experiences were present across all groups, stronger family cohesion and support were associated with the absence of ADHD symptoms and criminal behavior. As ADHD severity and criminal behavior escalated, particularly in cases involving aggression, family support diminished, and maladaptive schemas, including "disconnection and rejection" and "excessive vigilance and inhibition", became more prominent, alongside increased correlations with mental health issues (anxiety and depression). Conclusions: The findings underscore the crucial role of family environment and early intervention in mitigating the risks associated with ADHD and criminal behavior, highlighting the need for comprehensive interventions targeting maladaptive schemas and providing support for both internalizing and externalizing symptoms. Limitations include the retrospective nature of data collection and the exclusive focus on male inmates in low-security facilities.

Inability to start or complete upper secondary school strongly predicts unemployment and psychosocial and psychiatric adversities - A register-based follow-up study from southwestern Sweden

AIM

To study academic, social and psychiatric outcomes among adults in the general population in southwestern Sweden. Groups of individuals born in 1998 and ineligible, eligible but not completed, and eligible and completed upper secondary school were followed in 2020.

METHODS

Data were retrieved from Statistics Sweden, the Swedish National Agency for Education, the Longitudinal Integrated Database for Health Insurance and Labour Market Studies, the Swedish National Crime Register and the National Patient Register. The four adverse outcomes neither engaging in post-secondary studies nor having a regular salary, needing social benefits, having any criminal conviction, and having a psychiatric disorder at age ≥16 were examined.

RESULTS

Of the final sample of 2706 individuals who had attended 9th grade of compulsory school in 2014, 273 (10%) were ineligible for upper secondary school. Of eligible individuals, 82 (3%) never started, 282 (10%) did not complete and 2065 (77%) completed upper secondary school. Compared with completers, the odds ratios for adverse outcomes were markedly increased for all other groups up to 22 years old.

CONCLUSION

Inability to start or complete upper secondary school strongly predicted unemployment and psychosocial and psychiatric adversities. School authorities should consider offering vocational programmes post compulsory school without grade restrictions.

Differential neurocognitive profiles in adult attention-deficit/hyperactivity disorder subtypes revealed by the Cambridge Neuropsychological Test Automated Battery

Adult attention-deficit/hyperactivity disorder (aADHD) represents a heterogeneous entity incorporating different subgroups in terms of symptomatology, course, and neurocognition. Although neurocognitive dysfunction is generally associated with aADHD, its severity, association with self-reported symptoms, and differences between subtypes remain unclear. We investigated 61 outpatients (65.6% male, mean age 31.5 ± 9.5) diagnosed using DSM-5 criteria together with age-, sex-, and education-matched healthy controls (HC) (n = 58, 63.8% male, mean age 32.3 ± 9.6). Neurocognitive alterations were assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and compared between groups using the generalized linear model (GLM) method. Multivariate effects were tested by principal component analysis combined with multivariate pattern analysis. Self-reported symptom severity was tested for correlations with neurocognitive performance. GLM analyses revealed nominally significant differences between the aADHD and HC groups in several domains, however, only the Rapid Visual Information Processing measures survived correction, indicating impaired sustained attention and response inhibition in the aADHD group. Comparison of the predominantly inattentive and the hyperactive-impulsive/combined subtypes yielded nominally significant differences with higher levels of dysfunction in the inattentive group. In the stepwise discriminant analysis aADHD and HC groups were best separated with 2 factors representing sustained attention and reaction time. We found only weak correlations between symptom severity and CANTAB factors. aADHD patients are neuropsychologically heterogeneous and subtypes show different neurocognitive profiles. Differences between the aADHD and HC groups were driven primarily by the inattentive subtype. Sustained attention and its factor derivative showed the most significant alterations in aADHD patients.

Self-control in criminology: we need a broader conceptualization and links to psychiatric diagnoses

Background

Poor self-control is a strong correlate of criminal propensity. It is conceptualized and operationalized differently in criminology than in other scientific traditions.

Aims

(1) To verify the dimensionality of the criminological Grasmick self-control items, other self-regulation items and morality ones. (2) To re-interpret the dimensions using a clinical perspective, a taxonomic/diagnostic model and references to possible "biological underpinnings." (3) Validate the dimensions by associations with crime.

Method

Population: all persons born 1995 in Malmö and living there at age 12. A random sample (N = 525) filled in a comprehensive self-report questionnaire on themes like personality, crime/abuse and social aspects at age 15, 16 and 18. Age 18 data were analysed: 191 men and 220 women.

Results

Self-regulation items were 4-dimensional: ADHD problems (Behavior control and Executive skills) and two Aggression factors. Morality items formed a fifth dimension. Negative Affect and Social interaction factors covered the rest of the variance. The validity of these factors was backed up by correlations with similar items/factors. Self-regulation subscales predicted crimes better than the Grasmick scale; an interaction with morality improved prediction still further. Sex differences were over-all small with three exceptions: Aggression, Morality and Negative affect.

Conclusion

We identified four dimensions of the 20-item Grasmick instrument: Cognitive action control (impulsiveness/sensation seeking, response inhibition), Executive skills/future orientation, Affective/aggression reactivity and Aggression control. All should be possible to link to brain functional modules. Much can be gained if we are able to formulate an integrated model of self-regulation including distinct brain functional modules, process-and trait-oriented models, relevant diagnoses and clinical experiences of individual cases.

Effect of Pharmacological Treatment of Attention-Deficit/Hyperactivity Disorder on Criminality

OBJECTIVE

Criminality rates are higher among persons with attention-deficit/hyperactivity disorder (ADHD), and evidence that medication reduces crime is limited. Medication rates between clinics vary widely even within universal health care systems, partly because of providers' treatment preferences. We used this variation to estimate causal effects of pharmacological treatment of ADHD on 4-year criminal outcomes.

METHOD

We used Norwegian population-level registry data to identify all unique patients aged 10 to 18 years diagnosed with ADHD between 2009 and 2011 (n = 5,624), their use of ADHD medication, and subsequent criminal charges. An instrumental variable design, exploiting variation in provider preference for ADHD medication between clinics, was used to identify causal effects of ADHD medication on crime among patients on the margin of treatment, that is, patients who receive treatment because of their provider's preference.

RESULTS

Criminality was higher in patients with ADHD relative to the general population. Medication preference varied between clinics and strongly affected patients' treatment. Instrumental variable analyses supported a protective effect of pharmacological treatment on violence-related and public-order-related charges with numbers needed to treat of 14 and 8, respectively. There was no evidence for effects on drug-, traffic-, sexual-, or property-related charges.

CONCLUSION

This is the first study to demonstrate causal effects of pharmacological treatment of ADHD on some types of crimes in a population-based natural experiment. Pharmacological treatment of ADHD reduced crime related to impulsive-reactive behavior in patients with ADHD on the margin of treatment. No effects were found on crimes requiring criminal intent, conspiracy, and planning.

STUDY PREREGISTRATION INFORMATION

The ADHD controversy project: Long-term effects of ADHD medication; https://www.isrctn.com/; 11891971.

The cognitive neuroscience of self-awareness: Current framework, clinical implications, and future research directions

Self-awareness, the ability to take oneself as the object of awareness, has been an enigma for our species, with different answers to this question being provided by religion, philosophy, and, more recently, science. The current review aims to discuss the neurocognitive mechanisms underlying self-awareness. The multidimensional nature of self-awareness will be explored, suggesting how it can be thought of as an emergent property observed in different cognitive complexity levels, within a predictive coding approach. A presentation of alterations of self-awareness in neuropsychiatric conditions will ground a discussion on alternative frameworks to understand this phenomenon, in health and psychopathology, with future research directions being indicated to fill current gaps in the literature. This article is categorized under: Philosophy > Consciousness Psychology > Brain Function and Dysfunction Neuroscience > Cognition.

Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review

Attention Deficit Hyperactivity Disorder (ADHD) is a developmental disorder, with an onset in childhood, that accompanies the person throughout their life, with prevalence between 3 and 5% in adults. Recent studies point towards a fourth core symptom of the disorder related to the emotional information processing that would explain the repercussions that ADHD has on the social, academic, and professional life of the people affected. This review aims to describe emotion dysregulation features as well as the brain activity associated in adults with ADHD. A search of the scientific literature was launched in specialized databases: PsycInfo, Medline, Eric, PsycArticle, Psicodoc and Scopus, following PRISMA guidelines. Twenty-two articles met the inclusion criteria: (a) an ADHD clinical diagnosis, (b) participants over 18 years old, (c) emotion regulation measurement, (d) empirical studies, and (c) in English. Due to the heterogeneity of the studies included, they were classified into three sections: measures and features of emotion regulation (ER) in people with ADHD, neurological and psychophysiological activity related to ER, and treatments. The studies found that meet the selection criteria are scarce and very heterogeneous both in aims and in sample features. Adults with ADHD show a more frequent use of non-adaptive emotion regulation strategies compared to people without ADHD symptoms. Moreover, emotion dysregulation was associated with symptom severity, executive functioning, psychiatric comorbidities, and even with criminal conviction. Different patterns of brain activity were observed when people with and without ADHD were compared. These results may suggest that psychopharmacological treatments as well as behavioral therapies could be useful tools for improving emotional difficulties in adult ADHD.

"Jing-Ning Granules" Can Alleviate Attention Deficit Hyperactivity Disorder in Rats by Modulating Dopaminergic D2/D1-Like Receptor-Mediated Signaling Pathways

Background

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by attention deficit, hyperactivity, and impulsivity. Jing-Ning Granules (JNG) is a traditional Chinese medicine (TCM) that can alleviate ADHD. Although JNG is commonly used for the effective treatment of ADHD and has obtained the national invention patent, the exact mechanism of action remains unclear.

Objective

In this study, we examined the effect and mechanism of JNG in spontaneously hypertensive rats (SHRs). We hypothesized that JNG affects dopaminergic D2/D1-like receptors and related pathways.

Materials and Methods

Six rat groups were used in the experiment: Wistar-Kyoto rats (WKY, control group) and five SHR groups, including a model group; atomoxetine (ATX, positive control) group; and low, medium, and high-dose JNG groups. The corresponding treatments were daily administered to each group for 6 weeks. A behavioral test, including a step-down test and open field test (OFT), was carried out at the end of treatment. After the behavioral test, all animals were sacrificed, and the brain tissue was collected and analyzed ex vivo; histopathological analysis was performed to assess the pathological changes of the hippocampus; expression of D1-like and D2-like receptors, sensor protein calmodulin (CaM), protein kinase A (PKA), and calcium/calmodulin-dependent serine/threonine protein kinase (CaMKII) in the striatum and hippocampus was measured by western blot and real-time quantitative PCR (RT-PCR); cyclic adenosine monophosphate (cAMP) levels in the striatum were analyzed using an enzyme-linked immunosorbent assay (ELISA), while the level of Ca2+ in the striatum was analyzed by a calcium kit.

Results

Our results showed that ATX or JNG could ameliorate the hyperactive/impulsive behavior and cognitive function of ADHD by promoting neuroprotection. Mechanistically, ATX or JNG could prompt the expressions of Dl-like and D2-like receptors and improve the mRNA and protein levels of cAMP/PKA and Ca2+/CAM/CAMKII signaling pathways.

Conclusion

These results indicate that JNG can produce therapeutic effects by regulating the balance of D2/D1-like receptor-mediated cAMP/PKA and Ca2+/CaM/CaMKII signaling pathways.