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Childhood Attention-Deficit/Hyperactivity Disorder and the Emergence of Personality Disorders in Adolescence: A Prospective Follow-Up Study

Carlin J. Miller, Ph.D.; Janine D. Flory, Ph.D.; Scott R. Miller, Ph.D.; Seth C. Harty, M.A.T.; Jeffrey H. Newcorn, M.D.; and Jeffrey M. Halperin, Ph.D.

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.

(J Clin Psychiatry 2008;69:1477-1484. Online Ahead of Print August 26, 2008.)

Received Aug. 27, 2007; accepted Jan. 29, 2008. From the Department of Psychology, University of Windsor, Ontario, Canada (Drs. C. Miller and S. Miller); the Department of Psychology, Queens College (Drs. Flory and Halperin and Mr. Harty) and the Neuropsychology Doctoral Subprogram, Graduate Center (Dr. Halperin and Mr. Harty), City University of New York; and the Department of Psychiatry, Mount Sinai School of Medicine, New York, N.Y. (Drs. Flory, Newcorn, and Halperin).

This research was supported by National Institute of Mental Health grant #RO1 MH60698.

The authors wish to thank Dana Barowsky, B.A., from Pace University, and Tobey Busch, B.A., an employee of Aid for AIDS, for their assistance in conducting this study. Ms. Barowsky and Mr. Busch report no financial or other relationships relevant to the subject of this article.

Dr. Newcorn is an employee of Mount Sinai School of Medicine; has been a consultant/advisor to Eli Lilly, McNeil, Shire, Novartis, and Sanofi-Aventis; has received grant/research support from Eli Lilly and McNeil; and has served on speakers or advisory boards for Eli Lilly and Novartis. Drs. C. Miller, Flory, S. Miller, and Halperin and Mr. Harty report no additional financial or other relationship relevant to the subject of this article.

Corresponding author and reprints: Carlin J. Miller, Ph.D., Department of Psychology, University of Windsor, 401 Sunset Ave., Windsor, Ontario, Canada N9B 3P4 (e-mail: