Adult Attention Deficit Hyperactivity Disorder and Violence in the Population of England: Does Comorbidity Matter?

Abstract

BackgroundIt is unclear whether the association between Attention Deficit/Hyperactivity Disorder (ADHD) and violence is explained by ADHD symptoms or co-existing psychopathology. We investigated associations of ADHD and its symptom domains of hyperactivity and inattention, among individuals reporting violence in the UK population.MethodsWe report data from the Adult Psychiatric Morbidity Survey (2007), a representative sample of the household population of England. A randomly selected sample of 7,369 completed the Adult Self-Report Scale for ADHD and the self-reported violence module, including repetition, injury, minor violence, victims and location of incidents. All models were weighted to account for non-response and carefully adjusted for demography and clinical predictors of violence: antisocial personality, substance misuse and anxiety disorders.ResultsADHD was moderately associated with violence after adjustments (OR 1.75, p = .01). Hyperactivity, but not inattention was associated with several indicators of violence in the domestic context (OR 1.16, p = .03). Mild and moderate ADHD symptoms were significantly associated with violence repetition, but not severe ADHD where the association was explained by co-existing disorders. Stratified analyses further indicated that most violence reports are associated with co-occurring psychopathology.ConclusionsThe direct effect of ADHD on violence is only moderate at the population level, driven by hyperactivity, and involving intimate partners and close persons. Because violence associated with severe ADHD is explained by co-existing psychopathology, interventions should primarily target co-existing disorders.

ADHD in Childhood and/or Adulthood as a Risk Factor for Domestic Violence or Intimate Partner Violence: A Systematic Review

“…T. Wymbs et al, 2014), the sample consisted of 100% males; in the study of Crane et al, the percentage of ADHD males was not reported. Gonzalez et al (2013) reported an increased risk for adult ADHD on the outcome of all forms of violence, including DV and IPV. However, when controlled for adult ASPD, the significant effects of adult ADHD and Inattentive (IA) symptoms were lost.…”

“…The other researchers only used a few (one to three) questions regarding frequency of DV/IPV. Fifth, comorbid diagnoses (other than CD/ASPD) were only addressed as a confounder in the study of Crane et al (2014) and Gonzalez et al (2013) and not in the other studies. Finally, in none of the studies, information was provided about medication use.…”

Childhood maltreatment and violence: Mediation through psychiatric morbidity

“…Participants were asked about their violent behavior ("have you been in a physical fight, assaulted or deliberately hit anyone in the past 5 years"), as used in previous UK surveys of violence (Coid et al, 2006;Gonzalez, Kallis, & Coid, 2013). All participants were queried regarding their violent behavior with the initial question: "Have you been in a physical fight, assaulted, or deliberately hit anyone in the past five years?".…”

Adult Attention Deficit Disorder and Aggressive Behaviour: An Exploration of Relationships between Brown Attention-Deficit Disorder Scales and the Aggression Questionnaire

“…Aggression is common in many disorders co-morbid with AD/HD, in particular personality disorders (Dowson, 2006), and it has been argued that the best response to aggression in the context of AD/HD is to treat the comorbid disorders (Gonzalez, Kallis & Coid, 2013).…”