Symposia
ADHD - Child
Jessica R. Peters, Ph.D. (she/her/hers)
Assistant Professor
Brown University
Providence, Rhode Island
Shirley Yen, Ph.D.
Associate Professor
Alpert Medical School of Brown University
Providence, RI
Objective: Borderline personality disorder (BPD) has been established as a risk factor for suicide, self-harm, and aggression in adolescents. ADHD is not only comorbid at high rates with BPD but has been proposed as a potential biologically based vulnerability that can contribute to the development of BPD and the spectrum of related impulsive and damaging behavior. The present study examined the overlap between BPD and ADHD in suicidal youth and the relative roles of BPD and ADHD in externalized and self-directed harmful behavior.
Method: A sample of adolescents (age 12-18) hospitalized for suicide risk on an inpatient psychiatric unit was administered semi-structured diagnostic interviews and self- and parent-report measures of aggression and self-injury. Additionally, data on suicide attempts was collected over 6 months of follow up. We computed associations between ADHD diagnosis and both BPD diagnosis and individual BPD criteria and examined differences in aggressive behavior, self-injury, and suicide attempts between patients diagnosed with BPD, ADHD, both (BPD/ADHD), or neither (NDx). For analyses examining self-harm/suicide, BPD dx was calculated/pro-rated without the self-injurious behavior criterion to reduce construct overlap (n = 19).
Results: In our sample of 119, 23 were diagnosed with BPD, 23 with ADHD, 24 with BPD/ADHD, and 49 with NDx. ADHD was also significantly associated with 4 specific BPD criteria: exaggerated anger, affective instability, impulsive behavior, and relationship disturbances. Across parent-reported anger and physical and verbal aggression, both ADHD and BPD/ADHD groups had significantly higher scores than BPD and NDx groups. For hostility, BPD, ADHD, and BPD/ADHD had similarly elevated scores. In contrast, while no group differences were observed for self-injury, predicting suicide attempts over 6-month follow-up, BPD significantly predicted greater likelihood of attempts, but only for those without comorbid ADHD.
Conclusions: Elevated hostility may be a common factor across both BPD and ADHD; however, ADHD specific links with aggression suggest a possible key role of impulse control difficulties in externalized reactions. In contrast, only BPD was linked to future suicide attempt risk, perhaps indicating BPD symptoms less related to ADHD increase suicide risk. Accordingly, certain patterns of symptom expression in those BPD may suggest increased need for ADHD assessment and, if present, treatment. Limitations, further directions, and clinical takeaways will be discussed.