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.