Childhood attention-deficit/hyperactivity disorder and the emergence of personality disorders in adolescence: a prospective follow-up study.

OBJECTIVES Adults with attention-deficit/hyperactivity disorder (ADHD) experience considerable functional impairment. However, the extent to which comorbid Axis II personality disorders contribute to their difficulties and whether such comorbidities are associated with the childhood condition or the persistence of ADHD into adulthood remain unclear. METHOD This study examined the presence of personality disorders in a longitudinal sample of 96 adolescents diagnosed with ADHD when they were 7 through 11 years old, as compared to a matched, never ADHD-diagnosed, control group (N = 85). Participants were between 16 and 26 years old at follow-up. On the basis of a psychiatric interview, the ADHD group was subdivided into those with and without persistent ADHD. Axis II symptoms were assessed by using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Data were analyzed using logistic regression, and odds ratios (ORs) were generated. The study was conducted from 1994 through 1997. RESULTS Individuals diagnosed with childhood ADHD are at increased risk for personality disorders in late adolescence, specifically borderline (OR = 13.16), antisocial (OR = 3.03), avoidant (OR = 9.77), and narcissistic (OR = 8.69) personality disorders. Those with persistent ADHD were at higher risk for antisocial (OR = 5.26) and paranoid (OR = 8.47) personality disorders but not the other personality disorders when compared to those in whom ADHD remitted. CONCLUSION Results suggest that ADHD portends risk for adult personality disorders, but the risk is not uniform across disorders, nor is it uniformly related to child or adult diagnostic status.

[1]  Joseph Biederman,et al.  Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study , 2006, Psychological Medicine.

[2]  J. Gollan,et al.  Developmental psychopathology and neurobiology of aggression , 2005, Development and Psychopathology.

[3]  L. Clark.  Temperament as a unifying basis for personality and psychopathology. , 2005, Journal of abnormal psychology.

[4]  J. Biederman,et al.  Heterogeneity of Irritability in Attention-Deficit/Hyperactivity Disorder Subjects With and Without Mood Disorders , 2005, Biological Psychiatry.

[5]  J. McGough,et al.  Psychiatric comorbidity in adult attention deficit hyperactivity disorder: findings from multiplex families. , 2005, The American journal of psychiatry.

[6]  T. B. Üstün,et al.  Patterns and Predictors of Attention-Deficit/Hyperactivity Disorder Persistence into Adulthood: Results from the National Comorbidity Survey Replication , 2005, Biological Psychiatry.

[7]  L Eugene Arnold,et al.  What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? , 2005, Journal of consulting and clinical psychology.

[8]  K. Herman,et al.  Children with ADHD and Depression: A Multisource, Multimethod Assessment of Clinical, Social, and Academic Functioning , 2005, Journal of attention disorders.

[9]  Avshalom Caspi,et al.  Personality development: stability and change. , 2005, Annual review of psychology.

[10]  R. Kessler,et al.  Costs of attention deficit–hyperactivity disorder (ADHD) in the US: excess costs of persons with ADHD and their family members in 2000 , 2005, Current medical research and opinion.

[11]  J. Paulson,et al.  Social Rejection and ADHD in Young Adults: An Analogue Experiment , 2005, Journal of attention disorders.

[12]  Andrea Bergman,et al.  Adjustment, Social Skills, and Self-Esteem in College Students With Symptoms of ADHD , 2005, Journal of attention disorders.

[13]  Klaus P. Ebmeier,et al.  Predicting schizophrenia: findings from the Edinburgh High-Risk Study , 2005, British Journal of Psychiatry.

[14]  K. Secnik,et al.  Comorbidities and costs of adult patients diagnosed with attention-deficit hyperactivity disorder , 2005, PharmacoEconomics.

[15]  F. Levin,et al.  Adult ADHD and Substance Abuse: Diagnostic and Treatment Issues , 2005, Substance use & misuse.

[16]  T. Wilens,et al.  A clinical perspective of attention-deficit/hyperactivity disorder into adulthood. , 2004, The Journal of clinical psychiatry.

[17]  R. Barkley,et al.  Young adult follow-up of hyperactive children: antisocial activities and drug use. , 2004, Journal of child psychology and psychiatry, and allied disciplines.

[18]  J. Hektner,et al.  Child and familial pathways to academic achievement and behavioral adjustment: A prospective six-year study of children with and without ADHD , 2003, Journal of attention disorders.

[19]  H. Kraemer,et al.  A new approach to integrating data from multiple informants in psychiatric assessment and research: mixing and matching contexts and perspectives. , 2003, The American journal of psychiatry.

[20]  D. Cicchetti,et al.  Moving research on resilience into the 21st century: Theoretical and methodological considerations in examining the biological contributors to resilience , 2003, Development and Psychopathology.

[21]  P. Shrout,et al.  Accuracy of adult recall of childhood attention deficit hyperactivity disorder. , 2002, The American journal of psychiatry.

[22]  R. Barkley.  Major life activity and health outcomes associated with attention-deficit/hyperactivity disorder. , 2002, The Journal of clinical psychiatry.

[23]  R. Barkley,et al.  Young Adult Follow-Up of Hyperactive Children: Self-Reported Psychiatric Disorders, Comorbidity, and the Role of Childhood Conduct Problems and Teen CD , 2002, Journal of abnormal child psychology.

[24]  A. Fossati,et al.  History of childhood attention deficit/hyperactivity disorder symptoms and borderline personality disorder: a controlled study. , 2002, Comprehensive psychiatry.

[25]  A. Chapman,et al.  Evaluation of DSM-IV personality disorder criteria as assessed by the structured clinical interview for DSM-IV personality disorders. , 2002, Comprehensive psychiatry.

[26]  R. Loeber,et al.  What are adolescent antecedents to antisocial personality disorder? , 2002, Criminal behaviour and mental health : CBMH.

[27]  R. Barkley,et al.  YOUNG ADULTS WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER: SUBTYPE DIFFERENCES IN COMORBIDITY, EDUCATIONAL, AND CLINICAL HISTORY , 2002, The Journal of nervous and mental disease.

[28]  J. Bos,et al.  Personality Characteristics of ADHD Adults Assessed With the Millon Clinical Multiaxial Inventory-II: Evidence of Four Distinct Subtypes , 2000, Journal of personality assessment.

[29]  C. Carlson,et al.  Social Functioning and Emotional Regulation in the Attention Deficit Hyperactivity Disorder Subtypes , 2000, Journal of clinical child psychology.

[30]  J. Brook,et al.  Influence of child and adolescent psychiatric disorders on young adult personality disorder. , 1999, The American journal of psychiatry.

[31]  R. Klein,et al.  Adult psychiatric status of hyperactive boys grown up. , 1998, The American journal of psychiatry.

[32]  P. Lewinsohn,et al.  Axis II psychopathology as a function of Axis I disorders in childhood and adolescence. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[33]  L. Siever,et al.  Serotonin, aggression, and parental psychopathology in children with attention-deficit hyperactivity disorder. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[34]  J. Brook,et al.  Childhood antecedents of adolescent personality disorders. , 1996, The American journal of psychiatry.

[35]  G. Andrews,et al.  Continuities between psychiatric disorders in adolescents and personality disorders in young adults. , 1995, The American journal of psychiatry.

[36]  L. Siever,et al.  Prevalence and stability of the DSM-III-R personality disorders in a community-based survey of adolescents. , 1993, The American journal of psychiatry.

[37]  L. Bellak,et al.  Attention-deficit hyperactivity disorder in adults. , 1992, Clinical therapeutics.

[38]  R. Barkley,et al.  The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study. , 1990, Journal of the American Academy of Child and Adolescent Psychiatry.

[39]  G. Weiss,et al.  Psychiatric status of hyperactives as adults: a controlled prospective 15-year follow-up of 63 hyperactive children. , 1985, Journal of the American Academy of Child Psychiatry.

[40]  L. Siever,et al.  Assessing axis II disorders by informant interview. , 1997, Journal of personality disorders.

[41]  Keiko Nakao,et al.  Updating Occupational Prestige and Socioeconomic Scores: How the New Measures Measure up , 1994 .

[42]  R. Milich,et al.  Hyperactivity, inattention, and aggression in clinical practice , 1982 .