Association of ADHD with reactive and proactive violent behavior in a forensic population.

ADHD is associated with social problems and aggressive behavior. As hyperactive-impulsive traits are core symptoms of ADHD, it has been hypothesized that reactive-impulsive violence is more likely related to ADHD psychopathology than proactive-instrumental violence. One hundred and twenty-seven adult violent offenders participated in the study. Diagnosis of ADHD and ratings of reactive and proactive features of the committed crimes were performed using standardized instruments. According to DSM-IV, 16.5% subjects fulfilled diagnostic criteria for ADHD, 23.6% were diagnosed as ADHD in partial remission, and 59.8% had no ADHD. Univariate analyses revealed higher reactive violence ratings in both ADHD groups when compared to subjects without ADHD, whereas the opposite was found regarding proactive violence ratings. Using multivariate analyses of variance controlled for age, gender and comorbid substance use disorders, childhood ADHD psychopathology and current ADHD significantly increased the risk of reactive violence and decreased the risk of proactive violence. Significant impact of male gender on proactive violence was found. The findings suggest that ADHD is associated with reactive but not proactive violence in aggressive offenders.