ADHD and Conduct Disorder: Delinquency in teens with ADHD and other conditions

By Nestor Lopez-Duran PhD

Given the high rates of ADHD diagnoses in the USA, and recent discussions about the likely misdiagnoses of tens of thousands of children, it is easy for some to dismiss ADHD as jus a term used by zealous clinicians to label kids who just want to be kids. But such an attitude ignores the real struggles that kids with true ADHD experience as compared to their non-affected peers.

For example, this week I read a study just published in the prestigious Journal of Abnormal Child Psychology that examined the association between ADHD and delinquency. Specifically, the study explored whether kids diagnosed with ADHD in early childhood were more likely than their peers to engage in criminal behavior in adolescence. Likewise, given the high co-occurrence of ADHD and other behavioral disorders, such as conduct disorder and oppositional defiant disorder, the study also explored whether the combination of ADHD and these disorders put these kids at an even higher risk for committing violent and/or criminal acts in adolescence.

The study included over 400 boys who were followed from early childhood into adolescence. In early childhood, 209 of the participants did not have any diagnosis (control group), 47 were diagnosed with ADHD only, 135 were diagnosed with ADHD and oppositional defiant disorder (ODD), and 106 were diagnosed with ADHD and conduct disorder (CD). Once the kids reached adolescence 8 years later, the researchers examined the kids participation in delinquent acts (e.g., theft, assault, arson, etc).

The results:

In the graphic above you can see the percentage of children in each of the 4 groups (1. controls; 2. ADHD only; 3. ADHD/ODD; 4. ADHD/CD) that first engaged in severe delinquent acts (e.g., assault with a weapon, arson, rape, etc) at specific ages. As you can see, the group with comorbid ADHD and conduct disorder were the most at risk, with 20% committing a severe act by age 13 and over 40% by age 18. We could dismiss this as simply reflecting the role of conduct disorder. That is, we could argue that it is not the ADHD but the conduct disorder that is leading to more severe criminal acts. But take a look at the two lines in the middle. Virtually identical, these lines represent the kids with ADHD and oppositional defiant disorder as well as the kids with ADHD only. Both groups were significantly more at risk than their control peers. Specifically, the study found that both of these groups were more likely to offend earlier, commit a greater variety of crimes, and initiate severe delinquency than comparison participants, and by comparison the authors mean those without a diagnosis of ADHD.

The research then suggests that kids with ADHD, even those who do not show serious conduct problems in early childhood (the ADHD only group), are at a high risk for engaging in severe delinquent behavior in adolescence. This finding is even more upsetting when you consider that the participants in this study received outstanding care during early childhood. Specifically, these kids had taken part in a large treatment study that involved intensive intervention, including parent management training and medication when necessary. The particular intervention used in that study is known as one of the most effective intervention for kids with ADHD. So the disturbing aspect of the findings is that these kids were at such high risk for severe delinquent behavior DESPITE receiving proper intervention. This highlights two issues: 1) the need to develop more effective interventions focused on preventing future delinquency among kids with ADHD, and 2) the need for parents, educators, and clinicians to closely monitor these kids in an effort to prevent severe delinquency.

The authors stated:

For children with ADHD, an elevated risk for nonnormative delinquency is just one of a slew of probable negative life outcomes, including school drop-out, interpersonal difficulties, substance use, and unemployment (Barkley et al. 2007; Mannuzza et al. 1993; Molina et al. 2007b; Weiss and Hechtman 1993). These outcomes highlight the intense need for treatment in individuals diagnosed with ADHD. All PALS probands participated in an 8-week intensive Summer Treatment Program and their parents received a standard course of behavioral parent training (Pelham and Hoza 1996). They also received an average of 6 years of pharmacological intervention. However, the findings of this study and others from this same sample (Molina et al. 2007b; Kent et al. 2010) suggest that these interventions were not sufficient to prevent the negative outcomes that are common for children with ADHD.

The reference:
Sibley, M., Pelham, W., Molina, B., Gnagy, E., Waschbusch, D., Biswas, A., MacLean, M., Babinski, D., & Karch, K. (2010). The Delinquency Outcomes of Boys with ADHD with and Without Comorbidity Journal of Abnormal Child Psychology DOI: 10.1007/s10802-010-9443-9