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

Department of Psychology, University of Windsor, 401 Sunset Ave., Windsor, Ontario, Canada N9B 3P4.
The Journal of Clinical Psychiatry (Impact Factor: 5.14). 10/2008; 69(9):1477-84. DOI: 10.4088/JCP.v69n0916
Source: PubMed

ABSTRACT 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.
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.
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.
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.

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Available from: Carlin Miller, Aug 20, 2015
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    • "A total of 13.5% of the individuals with ADHD had co-occurring BPD in contrast to 1.2% of the control group. The co-occurrence of BPD and ADHD is associated with frequent substance abuse and a higher rate of suicidal behavior [Miller et al., 2008; Ferrer et al., 2010]. "
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    ABSTRACT: Previous research has established the comorbidity of adult Attention-Deficit Hyperactivity Disorder (ADHD) with different personality disorders including Borderline Personality Disorder (BPD). The association between adult ADHD and BPD has primarily been investigated at the phenotypic level and not yet at the genetic level. The present study investigates the genetic and environmental contributions to the association between borderline personality traits (BPT) and ADHD symptoms in a sample of 7,233 twins and siblings (aged 18-90 years) registered with the Netherlands Twin Register and the East Flanders Prospective Twin Survey (EFPTS) . Participants completed the Conners' Adult ADHD Rating Scales (CAARS-S:SV) and the Personality Assessment Inventory-Borderline Features Scale (PAI-BOR). A bivariate genetic analysis was performed to determine the extent to which genetic and environmental factors influence variation in BPT and ADHD symptoms and the covariance between them. The heritability of BPT and ADHD symptoms was estimated at 45 and 36%, respectively. The remaining variance in BPT and ADHD symptoms was explained by unique environmental influences. The phenotypic correlation between BPT and ADHD symptoms was estimated at r = 0.59, and could be explained for 49% by genetic factors and 51% by environmental factors. The genetic and environmental correlations between BPT and ADHD symptoms were 0.72 and 0.51, respectively. The shared etiology between BPT and ADHD symptoms is thus a likely cause for the comorbidity of the two disorders.
    American Journal of Medical Genetics Part B Neuropsychiatric Genetics 12/2011; 156B(7):817-25. DOI:10.1002/ajmg.b.31226 · 3.27 Impact Factor
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    • "The higher than expected rate of co-occurrence between ADHD and bipolar disorder has been previously noted across different ages in clinical samples (Nierenberg et al. 2005; Singh et al. 2006), and is consistent with the documented genetic (Faraone et al. 2001), neuroanatomical (Biederman et al. 2008a) and cognitive-style commonalities between both disorders (Doyle et al. 2005). Previous studies also documented an association between childhood ADHD and cluster B personality disorders (Bernstein et al. 1996 ; Miller et al. 2008). Clinical studies of ADHD adults have documented higher levels of neuroticism (Jacob et al. 2007), novelty seeking and harm avoidance (Jacob et al. 2007 ; "
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    ABSTRACT: The aim of the study was to present nationally representative data on the lifetime independent association between attention deficit hyperactivity disorder (ADHD) and psychiatric co-morbidity, correlates, quality of life and treatment seeking in the USA. Data were derived from a large national sample of the US population. Face-to-face surveys of more than 34 000 adults aged 18 years and older residing in households were conducted during the 2004-2005 period. Diagnoses of ADHD, Axis I and II disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. ADHD was associated independently of the effects of other psychiatric co-morbidity with increased risk of bipolar disorder, generalized anxiety disorder, post-traumatic stress disorder, specific phobia, and narcissistic, histrionic, borderline, antisocial and schizotypal personality disorders. A lifetime history of ADHD was also associated with increased risk of engaging in behaviors reflecting lack of planning and deficient inhibitory control, with high rates of adverse events, lower perceived health, social support and higher perceived stress. Fewer than half of individuals with ADHD had ever sought treatment, and about one-quarter had ever received medication. The average age of first treatment contact was 18.40 years. ADHD is common and associated with a broad range of psychiatric disorders, impulsive behaviors, greater number of traumas, lower quality of life, perceived social support and social functioning, even after adjusting for additional co-morbidity. When treatment is sought, it is often in late adolescence or early adulthood, suggesting the need to improve diagnosis and treatment of ADHD.
    Psychological Medicine 08/2011; 42(4):875-87. DOI:10.1017/S003329171100153X · 5.43 Impact Factor
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    • "Specific associations of ADHD with hyperactivity and BPD were also reported (Rey et al., 1995). More recently, the results of a longitudinal study have again shown individuals diagnosed with childhood ADHD to have an increased risk of personality disorders, specifically the DSM-IV cluster B type of personality disorders in late adolescence (Miller et al., 2008). "
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    ABSTRACT: Attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) are frequently comorbid. To contribute to a better understanding of the associations regularly found between ADHD and BPD, on the one hand, and the developmental pathways for these disorders, on the other hand, latent class analyses (LCA) were undertaken to identify classes differing in profiles of childhood symptoms of ADHD and adult symptoms of ADHD and BPD. Diagnostic interviews with 103 female outpatients meeting the criteria for ADHD and/or BPD were used to assess current DSM-IV symptoms; childhood symptoms of ADHD were assessed in parent interviews. The latent classes were examined in relation to the DSM-IV conceptualizations of ADHD and BPD. And relations between childhood and adult classes were examined to hypothesize about developmental trajectories. LCA revealed an optimal solution with four distinct symptom profiles: only ADHD symptoms; BPD symptoms and only ADHD symptoms of hyperactivity; BPD symptoms and ADHD symptoms of inattention and hyperactivity; BPD symptoms and ADHD symptoms of inattention, hyperactivity and impulsivity. All patients with BPD had some ADHD symptoms in both adulthood and childhood. Hyperactivity was least discriminative of adult classes. Adult hyperactivity was not always preceded by childhood hyperactivity; some cases of comorbid ADHD and BPD symptoms were not preceded by significant childhood ADHD symptoms; and some cases of predominantly BPD symptoms could be traced back to combined symptoms of ADHD in childhood. The results underline the importance of taking ADHD diagnoses into account with BPD. ADHD classification subtypes may not be permanent over time, and different developmental pathways to adult ADHD and BPD should therefore be investigated.
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