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.
Highlights
Attention deficit-hyperactivity disorder (ADHD) is associated with criminality [1], including violent crime [2] and externalizing behaviours [3,4]
Attention Deficit/Hyperactivity Disorder (ADHD) is often diagnosed as a unitary construct [7], factor analytic studies consistently confirm a two-dimensional structure of inattention and hyperactivity/impulsivity [8,9], each associated with distinct correlates and executive dysfunction
Because violence is increasingly recognized as a major public health problem [23] requiring intervention from healthcare professionals, and the potential impact on violence from neurodevelopmental psychopathology has not been systematically studied at the population level [19], we investigated associations between ADHD and violence in the adult household population of England in a representative survey carried out in 2007 [24]
Summary
Attention deficit-hyperactivity disorder (ADHD) is associated with criminality [1], including violent crime [2] and externalizing behaviours [3,4]. Inattention is associated with low educational achievement [13,14], and cognitive compromise related to working memory, monitoring, and executive difficulties [11], which may impair regulation of interpersonal interactions in certain circumstances, leading to violent altercations. It 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. Because violence associated with severe ADHD is explained by co-existing psychopathology, interventions should primarily target co-existing disorders
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