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Journal of Attention Disorders

The Relationship Between ADHD


17(4) 339­–346
© 2012 SAGE Publications
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DOI: 10.1177/1087054711429791
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Self-Reported Offending

Gisli H. Gudjonsson1, Jon Fridrik Sigurdsson2,


Tomas F. Adalsteinsson3, and Susan Young1

Abstract
Objective: To investigate the relative importance of ADHD symptoms, mood instability, and antisocial personality disorder
traits in predicting self-reported offending. Method: A total of 295 Icelandic students completed two scales of offending
behavior and measures of ADHD symptoms, mood instability, and antisocial personality traits. Results: Self-reported
offending from the two independent scales correlated significantly with ADHD symptoms, mood instability, and antisocial
personality traits with medium to large effect size. Multiple regressions showed that ADHD symptoms contributed to
the two outcome measures beyond that of age and gender with a medium effect size. The ADHD effects were only partly
mediated by mood instability and antisocial personality traits for general offending but were almost completely mediated
by the more reactive measure of antisocial behavior. Conclusion: ADHD appears to be a potential risk factor for general
offending in its own right irrespective of the presence of comorbidity, whereas mood instability is more important with
regard to reactive behavior. (J. of Att. Dis. 2013; 17(4) 339-346)

Keywords
ADHD, mood instability, personality disorder traits, self-reported offending

ADHD is a childhood developmental disorder, but one or taking into account comorbid conduct disorder problems in
more of the three core symptoms—inattention, hyperactiv- childhood. She suggests that the offending of adults with
ity, and impulsivity—sometimes persist into young adult- ADHD is likely to be unplanned and opportunistic and
hood (Faraone, 2005). Polanczyk, Silva de Lima, Horta, driven by a high level of impulsivity, need for stimulation,
Biederman, and Rohde (2007) estimated that the world- and mood instability. This is supported by the recent find-
wide-pooled prevalence rate of ADHD among persons ings of Retz and Rosler (2010) who argued that ADHD is
18 years or younger is 5.3%. Mental health problems, more strongly associated with reactive than proactive vio-
delinquency, and antisocial personality disorder are com- lent offending.
monly reported in people who have grown up with ADHD Young et al. (2010) found a younger onset of offending
(Barkley, Fischer, Smallish, & Fletcher, 2004; Barkley, and a significantly higher previous rate of offending
Murphy, & Fischer, 2008; Biederman, Newcorn, & Sprich, among ADHD prisoners compared with nonsymptomatic
1991; Brassett-Grundy & Butler, 2004; Mordre, Groholt, controls. Their total number of previous convictions,
Kjelsberg, Sandstad, & Myhre, 2011; Satterfield et al., determined from official criminal records, showed that
2007; Sibley et al., 2011; Sourander et al., 2006; Unnever, ADHD and heroin addiction were better predictors of the
Cullen, & Pratt, 2003; Young, Gudjonsson, Ball, & Lam, extent of their offending than antisocial personality
2003; Young, Wells, & Gudjonsson, 2011).
It is sometimes assumed that the relationship between 1
King’s College London, United Kingdom
ADHD and offending is substantially mediated by low self- 2
University of Iceland/Landspitali—The National University Hospital of
control with relatively small direct effect (Unnever et al., Iceland, Reykjavik, Iceland
3
2003), although there is some evidence that, regardless of University of Iceland
comorbidity, ADHD alone increases the risk of offending
Corresponding Author:
(Sibley et al., 2011). Young (2007) argued that ADHD is Gisli H. Gudjonsson, King’s College London, Institute of Psychiatry, De
significantly related to early offending, which increases the Crespigny Park, Denmark Hill, London, SE5 8AF, England, United Kingdom.
likelihood of persistent offending into adulthood, even after Email: gisli.gudjonsson@kcl.ac.uk
340 Journal of Attention Disorders 17(4)

disorder. ADHD was a better predictor of violent offences, traits of acting out behavior, but the reverse will be true of
even above prior drug use. Using the same data set, Young general offending (Young et al., 2009, 2011).
et al. (2009) found that ADHD was a much better predictor
of the number of critical incidents within the prison than
antisocial personality disorder. Similar findings have been Method
reported among persons detained in forensic mental health Participants
facilities (Young et al., 2003). Investigating predictors of
institutional disturbance, critical incidents with the institu- The participants were 295 students from four educational
tion, and previous offending in the community among ado- establishments in Iceland. There were 136 (46.4%) males
lescent offenders, Young, Misch, Collins, and Gudjonsson and 157 (53.6%) females (two did not reveal their sex).
(2011) found that ADHD symptoms were more important Most of the participants (80.1%) were 16 to 18 years. A
in predicting institutional behavioral disturbance than con- further 27 participants declined to take part in the study,
duct disorder, whereas substance misuse and violent cog- which represented 8.4% of the total sample approached.
nitions were the best predictors of delinquency in the
community. The findings from these studies suggest that
ADHD is important in predicting behavioral disturbance Instruments
and critical incidents within an institution. Gudjonsson, Self-Reported Delinquency Scale. This 34-item scale (Mak,
Sigurdsson, Young, Newton, and Peersen (2009) showed 1993) records different kinds of delinquent acts and has been
that mood instability is an important comorbid problem shown to have good reliability and validity (Gudjonsson
associated with ADHD, which may exacerbate existing et al., 2006). These range from minor antisocial acts (e.g.,
propensities for poor behavioral inhibition and result in cheating at games or exams, truancy from school, drinking
offending. In contrast, ADHD may be a less important pre- alcohol under age in a public place, consuming soft drugs)
dictor of offending in the community than antisocial per- to more serious acts of delinquency (e.g., theft, using a
sonality disorder, but this has not been investigated in weapon in a fight, fire setting, physical assault, driving a
community samples. The preceding review raises impor- vehicle while intoxicated, and sexual assault). The partici-
tant questions about the role of ADHD symptoms and pants indicate whether they had engaged in any of the delin-
mood instability in offending and how the nature of the quent acts in the past 12 months. In the current study, the
offending (general offending versus more dynamic acting formula devised by Sankey and Huon (1999) was used to
out behavior) influences this relationship. determine the extent of delinquency in terms of the range
The purpose of the present study was to investigate the and seriousness of delinquent activities. The mean serious-
relationship between self-reported offending, ADHD symp- ness score for each item is multiplied by the participant’s
toms, mood instability, and antisocial personality disorder response to each item, giving a Mak Total Offending Score
traits in a community sample of college students. It was ranging from 0 to 474.
anticipated that an antisocial personality disorder trait is the RATE-S. This is a 32-item self-report questionnaire
best predictor of self-reported offending among a community (Young & Ross, 2007) of behaviors during the previous
sample (Gudjonsson, Einarsson, Bragason, & Sigurdsson, month. It comprises four subscales: (a) RATE-ADHD
2006), but that ADHD symptoms and mood instability add a Symptoms (i.e., measuring attentional difficulties, impul-
unique variance beyond that of an antisocial personality trait siveness, and disorganization); (b) RATE-Emotional Con-
(Young, 2007). Self-reported offending behavior was mea- trol (i.e., items relate to emotional volatility and include
sured by two different scales: The Mak Self-Reported worries, anxieties, depressed mood, anger, loss of temper,
Delinquency Scale, Total Offending Score (Mak, 1993), and and poor self-esteem); (c) RATE-Antisocial Behavior (i.e.,
the RATE-Antisocial Behavior Scale (Young & Ross, 2007). involvement in a range of delinquent behaviors such as
The former is a direct measure of the extent of delinquent fighting, theft, damage to property, vandalism, reckless
acts during the previous 12 months and thus a measure of behavior, verbal threats to others, and being arrested and
general offending, whereas the latter is a more dynamic mea- questioned by police); and (d) RATE-Social Functioning
sure of acting out and reckless behavior (e.g., getting into a (i.e., items focus on social participation and confidence in
fight, threatening behavior, causing damage to property, social activities). Each item is rated on an 8-point Likert-
reckless behavior, police contact) during the previous month. type scale, ranging from “not at all” to “most of the time.”
Hypothesis 1 is that self-reported offending is correlated The possible score for each scale ranges between 8 and 64,
with antisocial personality traits, ADHD symptoms, and with the possible total score ranging between 32 and 256.
mood instability. Hypothesis 2 is that ADHD symptoms and The RATE-S has been shown to have good reliability and
mood instability are better predictors than antisocial personality validity (Gudjonsson, Sigurdsson, Eyjolfsdottir, Smari, &
Gudjonsson et al. 341

Young, 2009; Gudjonsson, Sigurdsson, Gudmundsdottir, & for the study was granted by the National Bioethics
Sigurjonsdottir, 2010; Young & Gudjonsson, 2006). Committee in Iceland.
Barkley Current Symptoms Scale to screen for ADHD
(BCS). This is an 18-item self-report questionnaire (Barkley,
1998) that corresponds with the Diagnostic and Statistical Results
Manual of Mental Disorders (4th ed.; American Psychi- Sex Effect
atric Association, 1994) criteria. In all, 9 items measure
problems with attention and 9 measure symptoms of To test for possible sex differences on the psychological
hyperactivity/impulsiveness. Each item was scored on a tests, MANOVA was performed on the measures with sex
4-point rating scale of frequency of symptoms from as the independent (fixed) variable. There was a significant
“never” to “very often.” The participants completed the overall sex effect (Pillai’s Trace = .169; F = 4.8, p < .01;
questionnaire for symptoms they had experienced during partial η2 = .169).
the previous 6 months. Scores ranged between 0 and 27 for The mean test scores on the Mak Total Offending Score,
each of the two subscales (Inattention and Hyperactivity/ RATE, BCS-ADHD, and Gough Socialization Scale were
Impulsivity) and 0 to 54 for the Total scale. Magnusson et calculated separately for males and females. Independent t
al. (2006) reported the measure had good psychometric tests were conducted between males and females on the psy-
properties and correlated well with informants’ ratings of chological tests and effect sizes (Cohen’s d) obtained on the
symptoms and interview-based diagnoses in childhood three scales where significant difference emerged. The
and adulthood in an Icelandic sample. The same measure findings showed that males scored significantly higher
has been used successfully in research into ADHD symp- on all three offending/socialization scales (Mak Total
toms among Icelandic college students (Gudjonsson et Offending Score, RATE-Antisocial Behavior Scale, and
al., 2010; Gudjonsson, Sigurdsson, Eyjolfsdottir, et al., Gough Socialization Scale). The effect sizes were large for
2009). the two offending outcome measures (Mak Total Offending
Gough Socialization Scale. This is a 54-item scale from the Score, RATE-Antisocial Behavior Scale; Cohen’s d = 0.58
California Personality Inventory, which measures the extent and 0.61, respectively) and medium for the Gough
to which individuals have internalized the values of society Socialization Scale (Cohen’s d = 0.43). Alpha reliability
(Megargee, 1972). The lower the score the more likely the coefficients showed acceptable reliability for all the scales
person is to possess antisocial personality traits (Gudjonsson ranging between .73 and .91 (see Table 1).
& Roberts, 1985). It is a good measure of proneness to anti-
social behavior (Blackburn, 1993), self-reported offending
(Gudjonsson et al., 2006), reoffending (Sigurdsson, Gud- Correlations
jonsson, & Peersen, 2001), and reconviction after being Table 2 shows the Pearson’s correlations between the self-
released from prison (Peersen, Sigurdsson, Gudjonsson, & reported measures, antisocial personality traits, ADHD
Gretarsson, 2004). Young and Gudjonsson (2006) found symptoms, and mood instability. The correlations are given
that the scale discriminated extremely well between patients separately for males and females. The correlations were
clinically diagnosed with ADHD and normal controls with generally larger for the female than male sample. BCS-
a large effect size (Cohen’s d = 2.6). ADHD symptoms, the Gough Socialization Scale, and the
RATE-Emotional Control Scale all correlated significantly
with the Mak Total Offending Score and the RATE-
Procedure Antisocial Behavior Scale with low to large effect sizes.
The colleges selected were from three of the most heavily The BCS-ADHD total symptom score correlated signifi-
populated areas of Iceland. The questionnaires were cantly with the Gough Socialization Scale (negative correla-
administered to students in class in the presence of their tions) and the RATE-Emotional Control Scale with medium
teacher and the researcher during the first semester of the to large effect sizes. The table shows that the RATE-
academic year. The researcher explained that the purpose Emotional Control Scale is more highly correlated with the
of the study was to investigate the relationship between RATE-Antisocial Scale (large effect size) than with the Mak
delinquency, ADHD, anxiety, and depression. It was fur- Total Offending Score (low to medium effect size).
ther explained that participation was voluntary and that
those who did not wish to take part were free to leave the
class at any time. Those who remained in class, which Multiple Regressions
comprised 91.6% of the total sample, completed the With regard to the psychological variables, there was
unmarked questionnaires anonymously and placed them no violation of linearity, but there was violation of nor-
into a sealed box held by the researcher. Ethical approval mality regarding the Mak Total Offending Score and the
342 Journal of Attention Disorders 17(4)

Table 1. Sex Differences on the Psychological Measures.

Males Females

Measures M (SD) n M (SD) n t-value α


Mak Total Offending Score 72.7 (71.9) 135 38.5 (41.8) 157 5.04* .86
RATE Total Score 99.6 (26.1) 110 96.4 (28.1) 118 0.88 .87
  RATE-ADHD Symptoms Scale 30.1 (9.8) 127 28.4 (11.0) 140 1.32 .83
  RATE-Emotional Control Scale 24.3 (10.0) 130 26.9 (12.3) 141 −1.88 .88
  RATE-Antisocial Behavior Scale 18.4 (9.5) 130 13.3 (6.9) 148 5.18* .86
  RATE-Social Functioning Scale 27.0 (9.7) 125 28.3 (9.2) 140 −1.08 .73
BCS-ADHD Total Score 12.7 (9.6) 125 12.6 (9.3) 145 −0.14 .91
 BCS-Inattention 6.8 (5.1) 126 6.7 (4.9) 148 0.26 .84
 BCS-Hyperactivity/Impulsivity 6.0 (5.0) 128 6.0 (5.1) 151 0.00 .84
Gough Socialization Scale 32.2 (6.5) 110 34.9 (6.1) 121 −3.28* .75
Note: BCS = Barkley Current Symptoms Scale.
*p < .001.

Table 2. Intercorrelations Between the Psychological Scales for Males (Above the Diagonal) and Females (Below the Diagonal).

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
  1. Mak Total Offending Score — .31*** .25** .20* .54*** −.08 .41*** .41*** .35*** −.45***
  2. RATE Total Score .50*** — .73*** .81*** .74*** .33*** .52*** .56*** .43*** −.55***
  3. RATE-ADHD .47*** .83*** — .58*** .42*** −.09 .53*** .59*** .41*** −.42***
  4. RATE-Emotional Control .42*** .91*** .73*** — .50*** .05 .47*** .49*** .41*** −.43***
  5. RATE-Antisocial Behavior .64*** .73*** .67*** .60*** — .04 .32*** .32*** .29*** −.43***
  6. RATE-Social Functioning −.01 .36*** −.01 .25** .00 — .10 .16 .03 −.17
  7. BCS-ADHD Total Score .48*** .69*** .70*** .62*** .61*** .12 — .93*** .94*** −.53***
  8. BCS-Inattention .46*** .72*** .71*** .66*** .60*** .15 .94*** — .76*** −.52***
  9. BCS-Hyperactivity .46*** .59*** .62*** .54*** .56*** .09 .95*** .78*** — −.48***
10. Gough Socialization Scale −.59*** −.60*** −.57*** −.58*** −.62*** −.15 −.59*** −.60*** −.53*** —
Note: BCS = Barkley Current Symptoms Scale.
*p < .05. **p < .01. ***p < .001.

RATE-Antisocial Behavior Scale. Violation of normality is symptoms on offending behavior and the extent to which the
not uncommon when large samples are used (Field, 2009). effects were mediated by poor emotional control and antiso-
The collinearity statistics were acceptable (i.e., no variable cial personality traits.
had Variance Inflation Factor (VIF) greater than 1.0). The predictor variables accounted for 34.2% and 42.1% in
To investigate how much the BCS-ADHD total symp- “general” offending (Mak Total Offending Score) and antiso-
toms, the RATE-Emotional Control Scale, and the Gough cial behavior (RATE-Antisocial Behavior Scale), respectively.
Socialization Scale (i.e., the predictor variables of ADHD For “general” offending, poor emotional control made no sig-
symptoms, mood instability, and antisocial personality nificant contribution to the outcome variable. The extent of
traits) contributed to the variance in past offending (Mak offending was predicted by a combination of being a young
Total Offending Score) and more current antisocial behavior male with antisocial personality traits and ADHD symptoms.
(RATE-Antisocial Behavior Scale), hierarchical multiple Antisocial personality traits (i.e., a low score on the Gough
regressions were carried out using a forced entry method. Socialization Scale) were the single best predictor (β = −.408),
Separate analyses were carried out for the two outcome and these partly mediated the effects of ADHD symptoms.
(dependent) variables, and the findings are summarized in Importantly, ADHD symptoms remained significant in the
Tables 3 and 4. The predictor variables were entered in four final step (β = .206) and had a stronger effect than being a male
steps with gender (male = 1, female = 2) and age being (β = .176) and of a younger age (β = −.137).
entered first to adjust for their possible effects, followed in With regard to the RATE-Antisocial Behavior Scale
Step 2 by the BCS-ADHD symptoms, RATE-Emotional (Table 4), poor emotional control and antisocial personality
Control Scale in Step 3, and the Gough Socialization Scale traits almost fully mediated the effect of ADHD symp-
in Step 4. This allowed us to investigate the effects of ADHD toms (β value reduced from .418 to .075 and became
Gudjonsson et al. 343

Table 3. Summary of Multiple Regression Analysis (Hierarchical) for Mak Total Offending Score.

Step 1 Step 2 Step 3 Step 4

  β/t-value β/t-value β/t-value β/t-value


Gender .261/3.9*** .254/4.2*** .261/4.3*** .176/3.0**
Age −.104/−1.5 −.118/−1.9 −.132/−2.1* −.137/−2.37*
BCS-ADHD Total Score .416/6.8*** .373/5.1*** .206/2.8**
RATE-Emotional Control Scale .080/1.1 −.034/−0.5
Gough Socialization Scale −.408/−5.6***
F value (2, 203) = 9.0*** (3, 202) = 23.0*** (4, 201) = 17.5*** (5, 200) = 22.3***
Adjusted R2 .073 .243 .244 .342
Note: BCS = Barkley Current Symptoms Scale. Step 1: Δ R2 = .082, p < .001; Step 2: Δ R2 = .172, p < .001; Step 3: Δ R2 = .004, ns; Step 4: Δ R2 = .099,
p < .001.
*p < .05. **p < .01. ***p < .001.

Table 4. Summary of Multiple Regression Analysis (Hierarchical) for the RATE-Antisocial Behavior Scale.

Step 1 Step 2 Step 3 Step 4

  β/t-value β/t-value β/t-value β/t-value


Gender .270/3.9*** .275/4.4*** .310/5.5*** .253/4.5**
Age −.078/−1.1 −.096/−1.5 −.169/−3.0** −.177/−3.2*
BCS-ADHD Total Score .418/67*** .182/2.7** .075/1.1
RATE-Emotional Control Scale .446/6.6*** .374/5.5***
Gough Socialization Scale −.270/3.9***
F value (2, 196) = 8.6*** (3, 195) = 22.3*** (4, 194) = 31.1*** (5, 193) = 29.8***
Adjusted R2 .072 .244 .378 .421
Note: BCS = Barkley Current Symptoms Scale. Step 1:Δ R2 = .081, p < .001; Step 2:Δ R2 = .174, p < .001; Step 3:Δ R2 = .133, p < .001; Step 4:Δ R2 = .045,
p < .001.
*p < .05. **p < .01. ***p < .001.

nonsignificant). Poor emotional control remained the single contributed to the two offending outcome measures beyond
best predictor (β = .374), followed by antisocial personality that of age and gender with a medium effect size, but, impor-
traits on the Gough Socialization Scale (β = −.270) and tantly, ADHD symptoms and mood instability had differen-
being a male (β = .253). tial effects on offending behavior depending on outcome
measure used. For “general” offending, antisocial personal-
ity traits proved to be the single most powerful predictor,
Discussion followed by ADHD symptoms. Entering mood instability
Hypothesis 1 was supported by showing that self-reported into the regression had no significant incremental effect, but
offending (with the Mak Total Offending Score and RATE- entering antisocial personality traits mediated almost half of
Antisocial Behavior Scale) correlated significantly with the effect of ADHD symptoms on offending. Therefore, for
ADHD symptoms (BCS), mood instability (the RATE- “general” offending, ADHD symptoms still had some sig-
Emotional Control Scale), and antisocial personality traits nificant direct effect on offending. This appears to support
(the Gough Socialization Scale). The effect sizes were the recent findings of Sibley et al. (2011) that ADHD is a
mostly medium to large. The Mak Total Offending and the potential risk factor for offending in its own right, irrespec-
RATE-Antisocial Behavior Scale were highly correlated tive of the presence of comorbidity.
with large effect sizes (r = .54 and .64 for males and In contrast to “general” offending, the more dynamic
females, respectively). acting out and reckless antisocial behavior measured by
In spite of the considerable overlap between the two out- the RATE-Antisocial Behavior Scale was best predicted by
come measures, multiple regression analyses showed that mood instability, followed by antisocial personality traits.
Hypothesis 2 was also supported. ADHD symptoms The marked and significant effects found for ADHD in
344 Journal of Attention Disorders 17(4)

Step 2 were largely mediated by mood instability. This References


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Gudjonsson, G. H., Wells, J., & Young, S. (2011). Motivation for of male criminality: A prospective population-based follow-up
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Sankey, M., & Huon, G. F. (1999). Offence seriousness in adoles- Author Biographies
cent delinquent behavior. Legal and Criminological Psychol- Gisli H. Gudjonsson, CBE, obtained a PhD from the University
ogy, 4, 253-264. of Surrey, England, in 1981. He is a professor of forensic psychol-
Satterfield, J. H., Faller, K. J., Crinella, F. M., Schell, A. M., ogy at the Institute of Psychiatry, King’s College, London, and a
Swanson, J. M., & Homer, L. D. (2007). A 30-year prospective head of clinical and forensic psychology in the Lambeth Forensic
346 Journal of Attention Disorders 17(4)

Services at the South London and Maudsley NHS Foundation Thomas Frey Adalsteinsson obtained an MA in sport psychology
Trust. His main research interests are in the areas of forensic psy- from John F. Kennedy University, California, in 2011 and a BA in
chology, including police interrogation, false confessions, and psychology from the University of Iceland in 2007. He works inde-
motivation for offending. In 2009, the British Psychological pendently as a sport psychology consultant in the San Francisco
Society granted him a Lifetime Achievement Award for his excep- Bay Area, coaches soccer and golf, and works with the sport
tional and sustained contribution to the practice of psychology. He psychology program at John F. Kennedy University. His main
was appointed a Commander of the Order of the British Empire research interests are in sport and performance psychology, espe-
(CBE) in the Queen’s Birthday 2011 Honours List for services to cially interventions to enhance performance and talent
clinical psychology. development.

Jon Fridrik Sigurdsson obtained a PhD in psychology from Susan Young obtained a doctorate in clinical psychology from
King’s College, University of London, in 1998. He is a professor University College London in 1999 and a PhD in psychology
at the University of Iceland and Reykjavik University and the from King’s College, University of London, in 1999. She is a
head of the Clinical Psychology Service at the Mental Health senior lecturer in forensic clinical psychology at the Institute of
Services, Landspitali—The National University Hospital of Psychiatry, King’s College, London, and Honorary Consultant
Iceland in Reykjavik, Iceland. His main research interests are in clinical and forensic psychologist at Broadmoor Hospital. Her
clinical and forensic psychology, including understanding the main research interests are in the areas of ADHD and forensic
behavioral problems of young people. psychology.

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