ADHD-ASPD Developmental Trajectory — MRCPsych Paper B MCQ
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Correct answer: C — Childhood ADHD predicts an increased risk of later antisocial personality disorder both with and without childhood conduct disorder, although conduct problems identify an important high-risk pathway.
Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D
B is correct. ADHD is a childhood-onset neurodevelopmental disorder and prospectively predicts an increased risk of later antisocial personality disorder. This association has been demonstrated both in children with comorbid conduct disorder and in those without it. Conduct problems remain especially important because they mark a prominent developmental pathway towards persistent adult antisocial behaviour, but they are not an absolute prerequisite for the association. The relationship is probabilistic rather than inevitable and does not imply that antisocial personality disorder causes ADHD. Substance misuse and social adversity may amplify or mediate adverse outcomes but do not fully account for the longitudinal association. Although ADHD medication has been associated with lower criminality, this should not be overstated as proof that treatment prevents antisocial personality disorder.
Reference: Storebø OJ, Simonsen E. The Association Between ADHD and Antisocial Personality Disorder (ASPD): A Review. Journal of Attention Disorders. 2016;20(10):815–824. https://pubmed.ncbi.nlm.nih.gov/24284138/