Objectives: Adults with 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 remains unclear. Methods: This study examined the presence of personality disorders in a longitudinal sample of adolescents diagnosed with ADHD when they were 7 – 11 years-old, as compared to a matched, never-ADHD, control group. Participants were 16-26 years old at follow-up. Based on a psychiatric interview, the ADHD group was subdivided into those with and without persistent ADHD. Axis II symptoms were assessed using the SCID-II. Data were analyzed using logistic regression and odds ratios (OR) were generated. 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 when compared to those in whom ADHD remitted, but not the other personality disorders. 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.
Approximately 3.0% of young Americans have used anabolic-androgenic steroids (AAS). A traditional model of adolescent substance use, the gateway hypothesis, suggests that drug use follows a chronological, causal sequence, whereby initial use of a specific drug leads to an increased likelihood of future drug use. Therefore, the use of illicit appearance and performance enhancing drugs (APED), such as AASs, also follows an analogous progression, whereby legal APEDs, (e.g., nutritional supplements) precedes illicit APED use. We examined the relationship between nutritional supplement use, beliefs about APEDs, and APED use in 201 male (n = 100) and female (n = 101) undergraduates. Participants completed measures of muscle dysmorphia (MDDI), body checking (BCQ, MBCQ), eating disorder symptoms (EDE–Q), perfectionism (FMPS), positive beliefs about the efficacy–safety of AAS use and APED use patterns. A series of covariance structure models (CSM) showed body image disturbance, compulsive exercise, illicit drug use, and perfectionism, independent of gender, were significant predictors of positive beliefs about AAS. Those who used both fat burning and muscle building supplements reported the strongest beliefs in AAS efficacy–safety, which was associated with higher likelihood of current illicit APED use. There was evidence of significant indirect relationships between supplement use and illicit APED use through contact with other AAS users and beliefs about AAS. The potential role for nutritional supplement use in the initiation of illegal APED use is discussed. Future prevention efforts may benefit from targeting legal APED users in youth.
This study examined the self-reported expression of overt aggressive behaviors and covert emotional and cognitive processes in adolescents diagnosed with ADHD and comorbid disruptive behavior disorders (DBDs) during childhood.Methods-Participants were a clinically referred sample of 85 individuals diagnosed with ADHD, initially recruited in the early to mid 1990's when they were 7-11 years of age. At that time, 44 (52%) met criteria for a comorbid diagnosis of ODD and an additional 22 (26%) met criteria for a comorbid diagnosis of CD. Approximately 10 years later, these youth, along with an age-matched comparison sample (n = 83), were re-evaluated to assess a wide array of outcomes including physical and verbal aggression, anger, and hostility.Results-Individuals diagnosed with ADHD+CD in childhood reported elevated levels of physical aggression when compared to Controls and the ADHD-only group. Individuals diagnosed with ADHD+ODD had elevated levels of verbal aggression compared to Controls. Additionally, both comorbid groups experienced significantly greater amounts of anger, but not hostility, as compared to Controls. Importantly, the persistence of ADHD symptoms into adolescence accounted for most group differences in verbal aggression and anger at follow-up, but not physical aggression, which was accounted for by childhood CD.Conclusion-Adolescents diagnosed with ADHD and comorbid disruptive behavior disorders during childhood report high levels of aggression associated with increased emotionality in the form of anger, but not hostile cognitions. These findings suggest that in addition to inattention and hyperactivity/impulsivity, emotional dysregulation may be an important component of ADHD, particularly as it presents in adolescence.
Background and aims-Research has not studied unique impulsivity dimensions as prospective links between childhood attention deficit hyperactivity disorder (ADHD) and alcohol problems. We examined the association between childhood ADHD, 5 facets of impulsivity and alcohol problems in adulthood, and the indirect effects of childhood ADHD-to-impulsivity-toalcohol problems.
Aims To examine the association between developmental trajectories of inattention, hyperactivity-impulsivity, and delinquency through childhood and adolescence (ages 8-16) and subsequent binge drinking and marijuana use in early adulthood (age 21). Design Prospective naturalistic follow-up of children with attention-deficit/hyperactivity disorder (ADHD) previously enrolled in a randomized controlled trial (RCT). Treatment-phase assessments occurred at 3, 9, and 14 months after randomization; follow-up assessments occurred at 24 months, 36 months, and 6, 8, and 12 years after randomization. Setting Secondary analysis of data from the Multimodal Treatment Study of ADHD (MTA), a multi-site RCT comparing the effects of careful medication management, intensive behavior therapy, their combination, and referral to usual community care. Participants 579 children with DSM-IV ADHD combined type, aged 7.0 and 9.9 years old at baseline (M=8.5, SD=.80). Measurements Ratings of inattention, hyperactivity-impulsivity, and delinquency were collected from multiple informants at baseline and through the 8-year follow-up. Self-reports of binge drinking and marijuana use were collected at the 12-year follow-up (M age 21). Findings Trajectories of worsening inattention symptoms and delinquency (and less apparent improvement in hyperactivity-impulsivity) were associated with higher rates of early adult binge drinking and marijuana use, compared with trajectories of stable or improving symptoms and delinquency (of 24 comparisons, 22 p-values <.05), even when symptom levels in stable trajectories were high. Conclusions Worsening inattention symptoms and delinquency during adolescence are associated with increased-levels of early adult substance use; this pattern may reflect a developmental course of vulnerability to elevated substance use in early adulthood.
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