ADHD in adults and criminal behavior: The role of psychiatric comorbidities and clinical and sociodemographic factors in a clinical sample

Abstract

Introduction

ADHD is a neurodevelopmental disorder associated with functional, behavioral, and relational difficulties. Its onset is in childhood, before the age of 12, and it often persists into adulthood. This study investigates the link between ADHD in adulthood, psychiatric comorbidities, and the risk of criminal behavior, analyzing the impact of clinical and sociodemographic variables.

Methods

This cross-sectional study included a sample of 308 patients diagnosed with ADHD, treated at the ADHD Outpatient Clinic of SS Gonfalone Hospital in Monterotondo between 2019 and 2024. Diagnoses and comorbidities were assessed through structured interviews and standardized diagnostic tools (ASRS, DIVA-5). Information on legal status and types of crimes was collected through individual interviews. Statistical analysis was performed using t-tests, chi-square tests, and stepwise logistic regression models.

Results

In the sample, 8.1 % of patients with ADHD had committed crimes, with a male prevalence (92 %). Significant predictors of criminal behavior included male gender (OR = 1.899, p = 0.004) and alcohol use disorder (OR = 4.59, p = 0.002). Additionally, oppositional defiant disorder, ADHD diagnosis before the age of 18, and unemployment showed a potential association with risky criminal behavior. Lifetime prescription of antipsychotics (61.4 %) and antiepileptics (48.7 %) was more frequent among participants who committed crimes, while no significant differences were found in the use of atomoxetine and methylphenidate.

Conclusions

Adult ADHD, particularly in males, with combined presentation and in the presence of comorbidities such as oppositional defiant disorder and alcohol use disorder, is associated with an increased risk of criminal behavior. The findings highlight the need for personalized and multimodal interventions to mitigate these risks. Future studies should adopt longitudinal designs to explore causal dynamics and evaluate the effectiveness of therapeutic strategies in forensic contexts.