Personality and Individual Differences 30 (2001) 1175±1187

www.elsevier.com/locate/paid

The relationship in children between the inattention

and impulsivity components of attention de®cit and
hyperactivity disorder and psychopathic tendencies
E. Colledge, R.J.R. Blair *
University College London, Institute of Cognitive Neuroscience, Alexandra House, 17 Queen Square,
London, WC1N 3AR, UK

Received 27 November 1999; received in revised form 27 March 2000

Abstract
This study investigated the relationship between the inattention and impulsivity components of Atten-
tion-De®cit-Hyperactivity Disorder (ADHD) and psychopathic tendencies in children with emotional and
behavioural diculties. Teachers rated 71 children on the Psychopathy Screening Device (Frick & Hare,
2000: Frick, P. J., & Hare, R. D. (2000). The psychopathy screening device. Toronto: Multi-Health Systems
(in press)), the DuPaul's ADHD rating scale (DuPaul, 1991: DuPaul, G. J. (1991). Parent and teacher
ratings of ADHD symptoms: Psychometric properties in a community-based sample. Journal of Clinical
Child Psychology, 20, 245±253), and the Conners' Abbreviated Symptoms Questionnaire (Conners, 1973:
Conners, C. K. (1973). Rating scales for use in drug studies with children. Pharmacotherapy of children
[Special Issue]. Psychopharmacology Bulletin, 24±84). Signi®cant inter-correlations between teachers' ratings
of children's inattention and impulsivity and psychopathic tendencies were found. There were signi®cant
inter-correlations between teachers' ratings of the inattention and impulsivity components of ADHD and
the Callous and Unemotional (C/UN) and Impulsivity and Conduct (I/CP) problems components of psycho-
pathy. Further analysis revealed that the inter-correlations between these four components were mainly
due to the association between the impulsivity component of ADHD and the antisocial behaviour (I/CP)
component of psychopathy. The inattention component of ADHD was not related to either of the psycho-
pathy risk measures. Equally, the distinguishing factor of the psychopathy (C/UN) was not related to
either of the ADHD measures. A categorical analysis of the data revealed a higher than chance level of co-
morbidity of ADHD and psychopathic tendencies. # 2001 Elsevier Science Ltd. All rights reserved.
Keywords: Psychopathy; Attention-de®cit-hyperactivity disorder (ADHD); Psychopathy Screening Device (PSD)

* Corresponding author. Tel.: +44-20-7679-1162; fax: +44-20-7813-2835.

E-mail address: j.blair@ucl.ac.uk (R.J.R. Blair).

0191-8869/01/$ - see front matter # 2001 Elsevier Science Ltd. All rights reserved.
PII: S0191-8869(00)00101-X
1176 E. Colledge, R.J.R. Blair / Personality and Individual Di€erences 30 (2001) 1175±1187

1. Introduction

There are two main diagnoses of childhood disorder that are associated with high levels
of externalising and undercontrolled (i.e., age inappropriate) behaviour: Attention-De®cit-
Hyperactivity Disorder (ADHD), and conduct disorder (CD). ADHD is de®ned as, ``a persistent
pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is
typically observed in individuals at a comparable level of development'' (American Psychiatric
Association DSM-IV, 1994). CD is de®ned as ``a repetitive and persistent pattern of seriously
anti-social behaviour usually criminal in nature'' (American Psychiatric Association DSM-IV,
1994).
The reported prevalence rates for both ADHD and CD vary substantially across studies. Thus,
DuPaul (1991), in a review of the literature, reported rates for ADHD that varied from 1 to 20%.
Factors that can in¯uence prevalence rates include, for example, the speci®c diagnostic criteria
used (Wolraich, Hannah, Baumgaertel & Feurer, 1998) or the age of the participants assessed
(August, Braswell & Thuras, 1998). As regards CD, DSM-IV has suggested prevalence rates
ranging from 6 to 16% for males and 2 to 9% for females. Factors that in¯uence prevalence rates
for CD include social status and risk behaviours, such as class A drug use (Booth & Zhang,
1997).
In addition, to the substantial di€erences in reported prevalence rates for ADHD and CD
across studies, these disorders appear to be highly comorbid. Indeed, there are reports of an
overlap of between 30 and 90% (e.g., Hinshaw, 1987; see also, Biederman, Newcorn & Sprich,
1991; Mannuzza, Klein, Konig & Giampino, 1989; Shapiro & Gar®nkel, 1986; Szatmari, Boyle &
O€ord, 1989; Taylor, Schachar, Thorley & Weiselberg, 1986; Werry, Reeves & Elkind, 1987).
With speci®c reference to antisocial behaviour, Vitelli (1996) examined the prevalence of CD and
ADHD in a juvenile delinquent prison population and found a prevalence rate of 63% for CD,
41% for ADHD and signi®cant comorbidity. However, according to Vitelli, CD was the only
signi®cant predictor of adult criminality.
The reason for the high comorbidity of ADHD and CD has excited considerable empirical and
theoretical work. A number of studies have compared the performance on cognitive tasks of
individuals with ADHD alone, CD alone, comorbid ADHD and CD and comparison popula-
tions without disorder (e.g., Matthys, van Goozen, de Vries, Cohen-Kettenis & van Engeland,
1998; Oosterlaan, Logan & Sergeant 1998; Leung & Connolly, 1996; Schachar & Tannock, 1995).
The ®ndings of these studies have been inconsistent. Some studies have reported that the co-
morbid individuals perform similarly to the individuals with ADHD (e.g., Osterlaan et al., 1998)
while others have reported that the comorbid individuals perform more similarly to the individuals
with CD (e.g., Leung & Connolly, 1996). Schachar and Tannock (1995) found that co-morbid
individuals shared features with both disorders. In a review of the literature, Hinshaw (1987)
argued that ``sucient evidence exists for considering the domains of hyperactivity/attention
de®cits and conduct problems/aggression as partially independent'' (p. 459). A similar position
was backed by Pennington and Ozono€ (1996) who reported that individuals with CD alone did
not show the impairment in executive functioning that is characteristic of individuals with
ADHD. Lynam (1996) focused speci®c attention on the children who are comorbid for ADHD and
CD, considering them a special population that he termed `¯edgling psychopaths'. In addition, he
proposed that the individuals who present with both ADHD and CD might present with more
 E. Colledge, R.J.R. Blair / Personality and Individual Di€erences 30 (2001) 1175±1187 1177

of the impulsivity component of ADHD and that this `impulsivity' might underpin both the
ADHD and CD. In contrast, he suggested that those individuals only meeting criteria for ADHD
might manifest more of the inattention component of ADHD. In an interesting study in line with
Lynam's position, Babinski, Hartsough and Lambert (1999) examined the relationship between
childhood conduct problems, hyperactivity-impulsivity and inattention in predicting adult criminal
activity. They found that both early conduct problems and hyperactivity-impulsivity were sig-
ni®cant predictors of later criminal involvement. However, a child's level of inattention did not
predict his/her later criminal involvement.
It must be remembered, however, that there are potentially many reasons for why a child
might present with antisocial behaviour (Blair & Frith, 2000; Frick, 1995). These range from
the sociological (e.g., Booth & Zhang, 1997), to `empathic' dysfunction (e.g., Blair, 1995; Blair
& Frith, 2000; Gibbs, 1987) or executive dysfunction (e.g., Mott, 1993; Pennington & Bennetto,
1993). Since ADHD is known to be associated with executive dysfunction (e.g., Pennington &
Ozono€, 1996), it is possible that the comordid cases of ADHD and CD may represent
those individuals with ADHD whose executive dysfunction has prompted the display of
antisocial behaviour. It is certainly clear that the presentation of antisocial behaviour can
follow executive dysfunction (e.g., Blair & Cipolotti, 2000; Burgess & Wood, 1990; Pennington &
Bennetto, 1993). There appear to be other individuals whose antisocial behaviour is due to
`empathic', or other emotional dysfunction (e.g., Blair, 1997; Frick, 1995; Patrick, 1994). A form
of behavioural disorder following `empathic' dysfunction is considered to be psychopathy
(e.g., Blair, 1995; Frick, 1995; Hare, 1991). Individuals with psychopathy form a far more
homogeneous and selective group than those meeting criteria for CD or its adult antisocial
behaviour based equivalent, Antisocial Personality Disorder (APD). Thus, for example, while 50±
80% of inmates meet criteria for APD, only 15±20% meet criteria for psychopathy (Hart & Hare,
1997).
Psychopathy can be indexed behaviourally in children using the Psychopathy Screening Device
(PSD, Frick & Hare, 2000) and in adults by using the Revised Psychopathy Checklist (PCL-R,
Hare, 1991). Both scales index a strikingly similar syndrome. Factor analysis indicates that both
the PSD and PCL-R capture two dimensions present in a psychopathic personality construct. The
Impulsivity/Conduct Problems (I/CP) factor comprises of overt behavioural characteristics such
as impulsivity, poor impulse control (e.g., becomes angry when corrected), and delinquent beha-
viours (e.g., Frick, O'Brien, Wootton & McBurnett, 1994; Harpur, Hare & Hakstian, 1989). This
factor is highly correlated with traditional measures of conduct problems, such as the DSM-IV
de®nition of Conduct Disorder (Frick, 1995). The Callous/Unemotional (C/UN) factor captures
such characteristics as lack of guilt, lack of empathy, and super®cial charm, which are considered
primary in clinical description of psychopathy (Cleckley, 1976; Hare, 1970). Previous studies
using the Psychopathy Screening Device have shown that children with psychopathic tendencies
perform poorly on the same neuro-cognitive tasks that cause adult psychopathic individuals dif-
®culty (e.g., Blair, 1997, 1999; O'Brien & Frick, 1996).
While many studies have shown that ADHD and CD are highly comorbid, no previous study
has examined comorbidity between the inattention and impulsivity components of ADHD and
psychopathic tendencies. The aim of the present study was to investigate measures of ADHD and
psychopathic tendencies in a population of children classi®ed as having Emotional and Beha-
vioural Diculties.
1178 E. Colledge, R.J.R. Blair / Personality and Individual Di€erences 30 (2001) 1175±1187

2. Method

2.1. Design

This experiment involved a correlational design. The measures were the children's verbal IQ
and teacher's ratings of the children's behavioural diculties as indexed by the Psychopathy
Screening device (Frick & Hare, 2000), Dupaul's ADHD rating scale (DuPaul,1991) and the
Abbreviated Symptoms Questionnaire (Conners, 1973).

2.2. Participants

The participants were all male, aged between 9 and 16 years, and attended special schools for
children with Emotional and Behavioral Diculties (EBD schools). The mean age was 13.0 years
(SD=2.3). They all had Statements under the Education Act of 1993 as too problematic for
mainstream education. All the children whose parents did not object for them to participate were
investigated (N=71).

2.3. Procedure and measures

2.3.1. General procedure

Each participant's vocabulary was tested using the British Picture Vocabulary Scale (BPVS; Dunn,
Dunn, Whetton & Burley, 1997). The testing was carried out on an individual basis by the experi-
menter, in a quiet room allocated for the purpose by the school. The BPVS includes a standard format
of verbal instruction and two practice items. Prior to testing the experimenter made sure that the
participant understood the instructions and felt comfortable to go ahead with the testing.
Subsequent to the administration of the BPVS to the child, the Psychopathy Screening Device
(Frick & Hare, 2000), the DuPaul's ADHD rating scale (DuPaul, 1991), and the Conners' Abbre-
viated Symptoms Questionnaire (Conners, 1973) were ®lled in for that child by both that child's form
teacher and another teacher, or in the case of boarding students, by their residential social worker.

2.4. British Picture Vocabulary Scale (BPVS)

The BPVS was used to measure the participant's verbal intelligence quotient (IQ). The BPVS
measures receptive vocabulary for standard English. Vocabulary has been considered to be the
best single measure of academic achievement (Smith, Smith & Dobbs, 1991). Importantly, the
BPVS is not dependent on the child's ability to read. The BPVS was carried out in order to
determine whether there were signi®cant associations between the children's IQ/mental age and
their level of behavioural problems as revealed by teacher's report.

2.5. Teacher questionnaire

A teacher questionnaire based on three sources was administered. The components were: the
Psychopathy Screening Device, (PSD, Frick & Hare, 2000), the ADHD rating scale (DuPaul,
1991) and the Abbreviated Symptoms Questionnaire (ASQ) (Conners, 1973).
 E. Colledge, R.J.R. Blair / Personality and Individual Di€erences 30 (2001) 1175±1187 1179

2.6. Psychopathy screening device

The Psychopathy Screening Device (PSD; Frick & Hare, 2000) is a 20-item scale. Two
teachers completed the PSD for each participating child; the main class teacher and the
school's headteacher. In the case of the residential boys, their form teacher and their resi-
dential social worker completed the PSD. The PSD is designed to measure the characteristics
of psychopathy in a way that is analogous to the Revised Psychopathy Checklist for adults
(PCL-R; Hare, 1991). A study of the PSD revealed a similar two-factor structure to that identi-
®ed by analysis of the PCL-R (Frick et al., 1994). A rapidly burgeoning research literature
attests to the validity of this measure; children with psychopathic tendencies identi®ed by the
PSD, show similar cognitive pro®les to adult psychopathic individuals (e.g., Blair, 1999; Frick et
al., 1994; O'Brien & Frick, 1996). For each of the 20 items on the Psychopathy Screening Device,
the teachers could rate the participants with a score of between 0 and 2. 0 referred to the
fact that the statement was `not true at all', 1 referred to the statement being `sometimes
true', and 2 referred to statements that were `de®nitely true'. Five items were inversely scored
prior to the totalling of each statement to obtain the ®nal PSD score. A ®nal score of up to
40 could be obtained. The participants' score for each item was the average assigned by the
two teachers. Pearson's correlations of the ratings of the two teachers were 0.65 for total PSD
score, 0.62 for the Callous/Unemotional factor and 0.51 for the Impulsiveness/Conduct Problems
factor.

2.7. DuPaul's ADHD Rating Scale

The ADHD rating scale (DuPaul, 1991) consists of 14 items. It is designed to measure the two
components of ADHD: impulsivity coupled with hyperactivity and inattention coupled with
hyperactivity. A study of the ADHD rating scale has indeed revealed a two factor structure
(DuPaul, 1991). A growing research literature attests to the validity of this measure (e.g., Power
et al., 1998; Danforth & DuPaul, 1996; Francis, 1993; DuPaul, 1991). Each item on the ques-
tionnaire can be rated on a scale from 0 to 3 for its applicability to the child (0=`not at all',
1=`just a little', 2=`pretty much', and 3=`very much'). A ®nal score of up to 42 can be obtained.
The participant's score for each item was the average assigned by the two raters. Pearson's
correlations of the ratings of the two teachers (or a teacher and a residential social worker) were
0.55 for total DuPaul score, 0.57 for Factor 1 (Impulsivity/Hyperactivity) and 0.56 for Factor 2
(Inattention/Hyperactivity).

2.8. The Conners Abbreviated Symptom Questionnaire

The Conners Abbreviated Symptom Questionnaire (ASQ; Conners 1973) consists of 10 items.
Each item is rated on a scale from 0 to 3 for its applicability to the child. A maximum score that
can be obtained for this measure is 30. The ASQ is widely regarded as a measure of ADHD and
has been frequently used in the empirical literature (e.g., Buitelaar, van der Gaag, Swaab-Barneveld
& Kuiper, 1996; Zentall & Barack, 1979). The participants' score for each item was the
average assigned by the two teachers. Pearson's correlations of the ratings of the two teachers
were 0.38.
1180 E. Colledge, R.J.R. Blair / Personality and Individual Di€erences 30 (2001) 1175±1187

3. Results

A correlational analysis was used to observe the relationships between the children's age, IQ,
mental age, teacher's ratings of the children's attentional and hyperactive diculties and psycho-
pathic tendencies (see Table 1). This revealed signi®cant correlations between total ADHD score,
whether measured by the DuPaul or Conners questionnaires, and total PSD score. Moreover,
there were signi®cant correlations between both the Impulsive-Hyperactive and Inattentive-
Hyperactive factors of the DuPaul measure and Factor 1 (Callous/Unemotional; C/U) and Factor
2 (Impulsive/Conduct Problems; I/CP) of the PSD. It should be noted also that there were highly
signi®cant correlations between ratings on the DuPaul's ADHD rating scale, and its constituent
factors, and scores on Conners' ASQ. Neither age nor IQ nor mental age was correlated with any
of the PSD or ADHD scores.
Because of the high inter-correlations between the constituent components of both the ADHD
and PSD measures, we examined the inter-relationships between the constituent factors of the
ADHD rating scale (D.Imp-hyper and D.Inatt-hyper) and the constituent factors of the PSD (C/UN
and I/CP) using partial correlations. Following partialling out the impulsivity-hyperactive com-
ponent of ADHD, the correlations between the inattentive component of ADHD and the C/UN
and I/CP components of the PSD were no longer signi®cant (r=0.002 and r=0.025, n.s.,
respectively; see Table 2a). However, following partialling out the inattentive component of ADHD,
the correlations between the impulsivity-hyperactive component of ADHD and the C/UN and I/CP
factors of the PSD remained signi®cant (r=0.286, p<0.05 and 0.407, p<0.001 respectively; see
Table 2b). These results suggest that the association between the ADHD and PSD measures is
primarily mediated by the ADHD pathology associated with impulsiveness rather than that
associated with inattention.
Following partialling out the I/CP component of the PSD, the correlations between the C/UN
component of the PSD and the impulsive and inattentive components of the ADHD rating scale were

Table 1
A correlational analysis of subject characteristics and the components of ADHD and psychopathic tendenciesa

Age BPVS Mental PSD PSD PSD DuPaul D.Imp-hyper D.Inat-hyper Conners
age total (C/UN) (I/CP) total

Age 0.453 0.046 0.069 0.087 0.062 0.098 0.116 0.051 0.080
BPVS 0.229 0.007 0.077 0.008 0.053 0.032 0.101 0.152
Mental age 0.031 0.018 0.002 0.164 0.129 0.170 0.027
PSD total 0.874 0.952 0.715 0.728 0.673 0.624
PSD (C/UN) 0.726 0.555 0.570 0.513 0.458
PSD (I/CP) 0.706 0.729 0.661 0.635
DuPaul total 0.967 0.975 0.909
D.Imp-hyper 0.904 0.889
D.Inat-hyper 0.884
a
BPVS: Verbal IQ test; PSD total: Score on the Psychopathy Screening Device; C/UN: callous/unemotional factor
score; I/CP: impulsivity/conduct problems factor score; DuPaul total: Total score on the DuPaul ADHD rating scale;
D.Imp-hyper: Impulsive-hyperactive subtype score on DuPaul ADHD rating scale; D.Inat-hyper: Inattentive-hyper-
active subtype score on DuPaul ADHD rating scale, Conners Abbreviated Symptoms Questionnaire score. =sig at
p<0.0001, two-tailed.
 E. Colledge, R.J.R. Blair / Personality and Individual Di€erences 30 (2001) 1175±1187 1181

Table 2
A partial correlational analysis of the components of ADHD and psychopathic tendenciesa

(a) A partial correlational analysis of the Dupaul ADHD ratings and PSD (I/CP) factor controlling for PSD (C/UN)
factor and mental age
PSD (I/CP) D.Imp-hyper D.Inat-hyper

PSD (I/CP) 0.569 0.503

D.Imp-hyper 0.864

(b) A partial correlational analysis of the DuPaul ADHD ratings and PSD (C/UN) factors controlling for PSD (I/CP)
factor and mental age
PSD (C/UN) D.Imp-hyper D.Inat-hyper

PSD (C/UN) 0.099 0.074

D.Imp-hyper 0.814

(c) A partial correlational analysis of the PSD ratings and the D.Imp-hyper component of DuPaul's ADHD rating
scale, controlling for D.Inat-hyper component and mental age
PSD (C/UN) PSD (I/CP) D.Imp-hyper

PSD (C/UN) 0.579 0.286

PSD (I/CP) 0.407

(d) A partial correlational analysis of the PSD ratings and the D.Inat-hyper component of DuPaul's ADHD rating
scale, controlling for D.Imp-hyper component and mental age
PSD (C/UN) PSD (I/CP) D.Inat-hyper

PSD (C/UN) 0.528 0.002

PSD (I/CP) 0.025
a
C/UN: callous/unemotional factor score; I/CP: impulsive/conduct problem factor score; D. Imp-hyper: Impulsive-
hyperactive subtype score on DuPaul ADHD rating scale; D. Inat-hyper: Inattentive-hyperactive subtype score on
DuPaul ADHD rating scale. =sig at p<0.05, two-tailed, =sig at p<0.001, two-tailed, =sig at p<0.0001, two-tailed.

no longer signi®cant (r=0.099 and r=0.074, n.s., respectively; see Table 2c). However, following
partialling out the C/UN component of the PSD, the correlations between the I/CP component
of the PSD and the impulsive and inattentive components of the ADHD rating scale remained
signi®cant (r=0.569 and 0.503, p<0.0001, see Table 2d). These results suggest that the association
between the ADHD and PSD measures is primarily mediated by the pathology linked to impulsive-
ness that is associated with both disorders. However, the association between these measures does
not seem to be due to an association between ADHD and the a€ective interpersonal disturbance
(the C/UN factor) linked to psychopathy.
Following the correlational analyses presented above, we also conducted a categorical analysis
to investigate prevalence rates for the disorders and the level of comorbidity within our study
population. This revealed that 27/71 children reached criteria for a diagnosis of ADHD according
1182 E. Colledge, R.J.R. Blair / Personality and Individual Di€erences 30 (2001) 1175±1187

to DuPaul's (1991) ADHD rating scale while 22/71 children scored high (25+) on the PSD. Out
of the 33 children who reached criteria for either ADHD or psychopathic tendencies, 16 reached
criteria for both disorders (i.e., there were 11 children who only met the criteria for ADHD and 6
children who only met the criteria for psychopathic tendencies). Two chi square analyses were
attempted to identify whether there were signi®cantly larger numbers of individuals who were
comorbid for both disorders than would be expected by chance. These revealed that the incidence
of comorbidity compared to psychopathy alone was greater than would be expected by chance 2
(1df)=5.167, p<0.025. However, the incidence of comorbidity compared to ADHD alone was
not signi®cantly greater than would be expected by chance 2 (1df)<1; n.s.

4. Discussion

This present study is, as far as we are aware, the ®rst to investigate the relationship between the
inattentive and impulsivity components of ADHD and psychopathic tendencies in children. This
study revealed signi®cant inter-correlations between teacher's ratings of children's ADHD and
psychopathic tendencies. In addition, there were signi®cant inter-correlations between teacher's
ratings of the attentional and impulsivity components of ADHD and the Callous and Unemotional
(C/UN) and Impulsive and Conduct Problems (I/CP) components of Psychopathy. Interestingly,
partial correlations revealed that the intercorrelations between these four components were princi-
pally due to the association between the impulsivity impairment associated with ADHD and the
antisocial behaviour (I/CP) component of psychopathy. Finally, a categorical analysis revealed a
higher than would have been predicted by chance level of comorbidity of ADHD and psycho-
pathic tendencies.
The highly signi®cant inter-correlation between teacher's ratings of children's inattention and
impulsivity and psychopathic tendencies was in line with previous work investigating the comorbidity
of ADHD and Conduct Disorder (CD). This work has reported comorbidity rates for ADHD and
CD of between 30 and 90% (e.g., Hinshaw, 1987; see also, Biederman et al., 1991; Mannuzza et
al., 1989; Shapiro & Gar®nkel, 1986; Szatmari et al., 1989; Taylor et al., 1986; Werry et al., 1987).
The DSM de®nition of CD is highly correlated with the I/CP component of psychopathy (Frick,
1995).
While there were signi®cant intercorrelations between ADHD and psychopathic tendencies in
the current study, the partial correlational analyses conducted on the components of ADHD and
Psychopathy revealed that the relationship between these two disorders may be complex. They
indicated that the association between ADHD and psychopathic tendencies was primarily due to
the intercorrelation of the impulsivity component of ADHD and the I/CP component of psy-
chopathy. It should be noted that this intercorrelation is not simply due to an overlap of items for
the two components. These items are listed in Table 3. While both components make reference to
engaging in risky activities all the other items are somewhat di€erent.
The ®nding of an intercorrelation of the impulsivity component of ADHD and the I/CP com-
ponent of psychopathy is interesting because it is both in line with, and extends, previous
research. Thus, for example, Babinski et al. (1999) found that both early conduct problems and
hyperactivity-impulsivity were signi®cant predictors of later criminal involvement, both alone and
in combination. However, the symptoms of inattention did not seem to contribute to the risk for
 E. Colledge, R.J.R. Blair / Personality and Individual Di€erences 30 (2001) 1175±1187 1183

Table 3
Comparison of impulsivity items in DuPaul's ADHD rating scale and psychopathy screening device

Imp/Ha DuPaul I/CP PSD

Often ®dgets or squirms in seat Brags about accomplishments

Has diculty remaining seated Becomes angry when corrected
Has diculty waiting for turn in groups Thinks he/she is more important than others
Often blurts out answers to questions Acts without thinking
Has diculty playing quietly Blames others for mistakes
Often talks excessively Teases other people
Often interrupts or intrudes on others Does not keep same friends
Often engages in physically dangerous activities without Engages in risky or dangerous activities
considering consequences
Gets bored easily

criminal involvement. The current study complements this work by indicating that the impulsivity
component of ADHD was associated with the I/CP component of psychopathy (i.e., the anti-
social behavior component). In contrast, the inattentive component of ADHD, independent of its
association with the impulsivity component of ADHD, was not associated with the I/CP com-
ponent of PSD. Moreover, the current study extends the preceding work by indicating that the
a€ective C/UN component of psychopathy was not associated with the components of ADHD
independently of their association with the I/CP component of Psychopathy.
The ®ndings of the partial correlations support previous suggestions that there are multiple
developmental routes to the display of antisocial behaviour (e.g., Blair & Frith, 2000; Frick,
1995); see Fig. 1. They do not suggest that there is a common pathological basis to the two dis-
orders or even to the impulsivity component of ADHD and the I/CP component of psychopathy.
Rather they are consistent with the suggestion that one developmental route, perhaps associated
with executive dysfunction (cf. Mott, 1993), involves a syndrome of impulsivity that is a risk
factor for both ADHD and antisocial behavior (Route 1 in Fig. 1). A second route would involve
disturbance to the neural systems that mediate empathy and fear (Blair, 1995; Frick, 1995; Route
2 in Fig. 1a). Such disturbance predisposes the individual to the callous and unemotional a€ective
component of psychopathy and is also a risk factor for antisocial behaviour. In addition, it
should be noted that these ®ndings augment those of Babinski et al. (1999), in suggesting that the
pathology that underpins the inattention component of ADHD is not a risk factor for the display
of antisocial behaviour and conduct problems.
In the current study, 16/22 individuals who met criteria for psychopathic tendencies on the
PSD (cut-o€ score=25; Blair, 1997), also met criteria for ADHD according to the DuPaul
ADHD rating scale (1991). This is a signi®cantly higher comorbidity than would be expected by
chance. Of course, given the selected nature of the present sample, this comorbidity could re¯ect a
selection bias in the decision to send these particular children to Special Schools. But it is perhaps
interesting to brie¯y consider a potential reason for the signi®cant comorbidity between ADHD
and psychopathic tendencies and to place the above results in the context of recent anatomical
®ndings related to the pathologies of ADHD and psychopathy. It has been suggested that the
impulsivity component of ADHD may be due to early dysfunction in a neural circuit that
includes anterior cingulate (Swanson et al., 1998). In contrast, the inattention component of
1184 E. Colledge, R.J.R. Blair / Personality and Individual Di€erences 30 (2001) 1175±1187

Fig. 1. A causal model of the potential relationship between ADHD and psychopathic tendencies.

ADHD has been attributed to dysfunction to a neural circuit that includes right frontal cortex
(Swanson et al., 1998). Psychopathy has been related to dysfunction within a neural circuit that
includes either the amygdala, orbitofrontal cortex or both (e.g., Blair, Morris, Frith, Perret &
Dolan, 1999; Blair & Frith, 2000; Damasio, 1994; Hare, 1998). Interestingly, anterior cingulate,
amygdala and orbitofrontal cortex are all richly interconnected (e.g., Amaral, Price, Pitkanen &
Carmichael, 1992; Rolls, 1996). It could be expected that dysfunction in any one of these neural
systems might disrupt the development of the connecting systems (see Karmilo€-Smith, 1998). In
addition, it should be noted that a particular polymorphism of the dopamine 4 receptor gene has
been linked to the development of ADHD (Swanson, Sunohara, Kennedy et al., 1998). Both
anterior cingulate and amygdala are particularly rich in dopamine 4 receptors (Seeman & Van
Tol, 1994). Thus, both the evidence on the interconnections of anterior cingulate and amygdala
and the rich presence of dopamine 4 receptors in both regions might be linked to the high levels of
comorbidity of ADHD, potentially particularly the impulsive form of ADHD, and CD/psychopathy.
Interestingly, the inattention component of ADHD is associated with right frontal cortex. Right
frontal cortex is not directly connected to the amygdala. Moreover, right frontal cortex is also not
particularly rich in dopamine 4 receptors. The lack of association between this component of
ADHD and CD/psychopathy may be linked to this relative independence of pathology. Fig. 1
represents this tentative speculation.
We want to note that as the population studied was highly selected, co-morbidity with other
problems is also likely. For example, ADHD is highly comorbid with emotional disorders and
pervasive developmental disorders (e.g., dyslexia; Boetsch, Green & Pennington, 1996). In addition,
ADHD is often associated with reduced verbal and performance IQ (Taylor, 1994). We cannot
address co-morbidity with other disorders with the data available. While the presence of dyslexia
is unlikely to in¯uence the results and we controlled for mental age in the analyses, it is possible
that co-morbidity with anxiety disorders may have a€ected the results. However, it should be
 E. Colledge, R.J.R. Blair / Personality and Individual Di€erences 30 (2001) 1175±1187 1185

noted that if this is the case, our observations of an association between the impulsivity components
of ADHD and psychopathic tendencies are an underestimate of the situation outside of the special
school setting. The presence of anxiety should be inversely related to psychopathic tendencies
(Hare, 1991).
In conclusion, the present paper examined the relationship between the attentional and impul-
sivity impairments associated with ADHD and the C/UN and I/CP components of psychopathy
in children with Emotional and Behavioural Diculties. In line with previous work showing
substantial comorbidity between ADHD and Conduct Disorder (e.g., Hinshaw, 1987), the current
study showed that an individual child's level of impulsivity diculties was a signi®cant predictor
of the conduct problem component of psychopathy. In line with suggestions that there are multiple
developmental routes to conduct problems (e.g., Frick, 1995), the conduct problem component of
psychopathy appeared to be independently related to both the impulsivity component of ADHD
as well as the callous/ empathic component of psychopathy.

Acknowledgements

This work was supported by a Medical Research Council grant [ref. G9716841] and the
Department of Health [Virtual Institute for Personality Disorders]. We thank the sta€ and pupils
at Boxmoor House, Falconer, and Larwood schools.

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