ارتباط بین اختلال بیش فعالی با کمبود توجه و مشکلات رفتاری دوران کودکی و اختلالات فکری و روانی بزرگسالان در زندانیان مرد

Two categories of childhood problems frequently implicated in the development of adult psychopathy are conduct problems (CP) and Attention Deficit Hyperactivity Disorder (ADHD). Three perspectives regarding the relationship between childhood symptomatology and adult antisocial outcomes were examined: the conduct-problem mediation, the independent prediction, and the comorbid subtype positions. Relationships between self-report measures of childhood CP and ADHD and interviewer-rated psychopathy scores (PCL-R) were examined for 275 Caucasian and African-American male inmates. Although both childhood CP and ADHD were associated with PCL-R Total and Antisocial Lifestyle (Factor 2) ratings, the influence of ADHD was largely mediated by CP. Although there was evidence for a slight independent contribution of ADHD to the antisocial lifestyle aspects of psychopathy, there was little evidence congruent with the comorbid subtype position: The higher psychopathy ratings of individuals in the comorbid group relative to those of other groups appeared attributable to additive rather than interactive influences of childhood CP and ADHD. Finally, neither set of childhood symptoms was helpful in understanding core emotional/interpersonal aspects of psychopathy (Factor 1).

Whereas 50–80% of felons exhibit the irresponsible and norm-violating behavior diagnostic of antisocial personality disorder (ASPD), psychopathy refers to a narrower constellation of affective, interpersonal, and behavioral characteristics that typify only 15–25% of the incarcerated population (Hare, 1996) and only 30–50% of those with ASPD (Hare, Hart, & Harpur, 1991). The diagnosis of psychopathy is typically based on scores on the PCL-R (Hare, 1991), a behavioral checklist with demonstrated reliability and validity for use with incarcerated male offenders (e.g., Hare, 1999). Factor analyses have reliably identified two correlated dimensions (Hare et al., 1990). Factor 1 of the PCL-R consists of personality traits considered central to psychopathy and summarized as the Callous, Remorseless Exploitation of Others (e.g., shallow affect, glibness/superficial charm). Factor 2 consists of behavioral manifestations of a Chronically Unstable and Antisocial Lifestyle (e.g., irresponsibility, proneness to boredom/need for stimulation: Hare, 1991). Because psychopathy is not included in the Fourth Edition of the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association (APA, 1994), much research into problematic developmental trajectories has focused on predicting ASPD diagnoses. However, individuals with ASPD constitute a heterogeneous population. In fact, only one of two empirically validated dimensions of psychopathy correlates highly with ASPD (Harpur, Hare, & Hakstian, 1989). Further, ASPD has less utility than psychopathy in identifying aberrant cognitive-affective sequelae (Williamson, Harpur, & Hare, 1991) and in predicting severe antisocial outcomes (Harris, Rice, & Cormier, 1991). Psychopathic individuals commit a disproportionate share of all crimes (Hare, 1993). They commit a wider variety of offenses (Hare & McPherson, 1984) and are more recidivistic than other criminals (Serin & Amos, 1995), even compared with ASPD criminals (Cunningham & Reidy, 1998). Given adult psychopaths’ recalcitrance to rehabilitation and treatment efforts (Hemphill, Hare, & Wong, 1998), primary and secondary prevention with youth may provide a more realistic target. However, in contrast to other psychiatric syndromes, few factors are consistently implicated in the developmental trajectory of psychopathy. Antisocial behavior is prevalent, particularly during adolescence, when it can become almost normative (Moffitt, 1993). Even when defiance and rule-breaking begin at an early age (White, Moffitt, Earls, Robins, & Silva, 1990) or are of extreme severity (Robins, 1978), they do not usually lead to persistent and serious antisociality. Two constructs commonly related to adult criminality and psychopathy are childhood symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and childhood conduct problems (CP). Although DSM criteria for ADHD have undergone significant modification over time (Lilienfeld & Waldman, 1990), the essential feature remains a persistent pattern of inattention or hyperactivity/impulsivity that is more frequent and severe than typically seen in children of the same age. ADHD characterizes 3–5% of American youth (Barkley, 1990). Although diagnosis becomes more complex in adulthood (Wender, 1995), ADFID is overrepresented in adult prison populations, with 25–41% of inmates qualifying for this diagnosis (Vitelli, 1996). One of the most common comorbidities of ADHD is conduct disorder, characterizing 30–60% of children with ADHD (Satterfield & Schell, 1997). Conduct Disorder is a repetitive and persistent pattern of childhood antisocial behaviors, including (in DSM-IV) aggression, destruction of property, deceitfulness and theft, and serious rule violations. Conduct problems have also been linked to adult crime (Babinski, Hatsough, & Lambert, 1999), ASPD (APA, 1994), and psychopathy (Vitelli, 1996). Several kinds of evidence suggest etiologic continuity between conduct problems, ADHD, and psychopathy/antisociality (Satterfield, 1978). Both family studies (Cadoret & Stewart, 1991) and longitudinal studies (Hechtman, Weiss, & Perlman, 1984) link ADHD with later conduct problems, persistent criminality (Biederman et al., 1995), and ASPD. ADHD, CP, and psychopathy also share several correlates, including alcohol and substance abuse (Biederman et al., 1995), physiological anomalies in slow wave activity (Costa et al., 2000) and skin conductance (Iaboni, Douglas, & Ditto, 1997), and passive avoidance learning deficits (Oosterlaan, Logan, & Sergeant, 1998). However, despite their substantial overlap, differential correlates have been reported for ADHD and CP. For example, compared with conduct problems, symptoms of ADHD have been associated with lower IQ and poorer academic performance, as well as substantially lower rates of parental psychopathology. Poorer parenting and parental alcohol abuse show a stronger relationship with conduct problems (Reeves, Werry, Elkind, & Zametkin, 1987). However, because most longitudinal studies of ADHD failed to assess for comorbid conduct problems (although see Taylor, Chadwick, Heptinstall, & Danckaerts, 1996), researchers have recently questioned whether ADHD per se is related to serious antisociality. 1.1. Perspectives relating childhood externalizing behavior to adult psychopathy There are three distinct perspectives regarding the connection between childhood disruptive behavior and adult psychopathy. According to the conduct problem-mediation position (CP-mediation), risk for later antisociality in ADHD children is entirely accounted for by comorbidity between ADHD and CP. ADHD alone does not confer special risk for antisocial outcomes. Indeed, several studies suggest that links between ADHD and adult antisociality depend upon comorbid CP or aggressiveness (e.g., Cadoret & Stewart, 1991). Thus, Lilienfeld and Waldman (1990) conclude that the only influence of ADHD on subsequent criminality is that hyperactive children are at increased risk for developing CP, which in turn places them at risk for later serious antisocial behavior. The independent prediction position argues that ADHD contributes to predicting antisocial outcomes apart from its association with conduct problems. For example, in a 15-year follow-up of 230 clinic-referred males, both hyperactivity-impulsivity and early CP predicted the likelihood of being arrested ( Babinski, Hartsough, & Lambert, 1999). CP predicted involvement in serious offenses; hyperactivity-impulsivity predicted participation in less serious offenses. Similarly, Farrington, Loeber, and Van Kammen (1990), in their sample of 411 males, found that both ADHD and CP were uniquely predictive of later offending. Boys with ADHD were 11% more likely to offend than non-ADHD boys (keeping CP status constant). Further, loglinear analyses revealed no evidence of an interaction between ADHD and CP in the prediction of conviction rate but independent effects for both ADHD and CP. Using a longitudinal epidemiological design, Taylor et al. (1996) noted that childhood hyperactivity (rated at age 6–7) was a unique predictor of later maladjustment (including violence and other antisociality), independent of the influence of conduct problems. Finally, the comorbid subtype position proposes that individuals with both ADHD and CP symptoms are “fledgling psychopaths” ( Lynam, 1996). Lynam reviewed evidence suggesting that only children characterized by both ADHD problems and concurrent CP are characterized by profound neuropsychological, executive, and information processing deficits, including those associated with adult psychopathy. In addition, family studies have revealed greater risk of CP, substance abuse and ASPD in relatives of probands with ADHD+CP than in relatives of probands with ADHD-only ( Stewart, deBlois, & Cummings, 1980), and longitudinal studies have shown more contact with the police ( Farrington et al., 1990) and adult convictions ( Magnusson, 1988) for ADHD+CP boys than for CP-only boys. Moreover, individuals in the comorbid group reportedly exhibit earlier, more versatile, and more serious criminality ( Moffitt, 1990). In summary, because different studies have provided evidence consistent with all three positions, there remains confusion regarding which childhood variables best predict adult psychopathic outcome. Several studies have failed to include concurrent measures of both childhood ADHD and childhood CP. Moreover, no prior studies appear to have included the Revised Psychopathy Checklist (PCL-R), a well-validated measure of psychopathy. 1.2. The current study The current study was designed to clarify the relationship between childhood ADHD, childhood CP, and adult psychopathy. Each of the three positions makes somewhat dissimilar predictions regarding these relationships (see Table 1 for summary of these predictions). To improve upon prior studies, we assessed both conduct problems and attention deficit symptoms retrospectively and employed a reliable and valid measure of psychopathy. Table 1. Predictions/or regression analyses and planned comparisons for CP-mediation, independent prediction, and comorbid subtype hypotheses Type of analysis Variables/groups CP-mediation Independent prediction Comorbid subtype Hierarchical multiple regression CP * * ns ADHD ns * CP X ADHD – – * Planned comparisons Control Low Low Low ADHD Low High Low CP High High Low ADHD+CP High High High PCL-R Total, Factor 1, and Factor 2 ratings serve as the criterion variables in regressions and as the dependent variables in planned comparisons; CP=Childhood conduct problems; ADHD=Childhood Attention Deficit Hyperactivity Disorder symptoms; *Significant predictor; – denotes that prediction for this cell is unclear or not central to the argument of this position. Table options In addition, the present study addressed a logical error in some prior studies. It has been argued that greater prevalence of antisocial outcomes in ADHD/CP groups than in single-disorder groups provides evidence for the comorbid subtype position, but such an outcome could also reflect the additive effects of ADHD and CP. Moreover, Lynam (1996) has argued that, in the absence of the other childhood condition, neither ADHD nor CP should increase the likelihood of adult psychopathy. However, no prior studies have tested this prediction directly. We therefore examined whether childhood ADHD and CP are associated with adult psychopathy individually or interactively via continuous (multiple regression) analyses. We also conducted a priori comparisons using specific groups to test key predictions of the comorbid subtype position: (1) Are adult psychopathy scores higher for the childhood ADHD/CP group than for ADHD-only and CP-only groups? (2) Are psychopathy scores no higher for the ADHD-only and CP-only groups than for adults with neither childhood syndrome? Finally, we explored whether ADHD and/or CP would be equally related to the core personality traits of psychopathy (as measured by PCL-R Factor 1) as well as the antisocial features (as measured by PCL-R Factor 2).