To Örebro University

Attention-deficit/hyperactivity disorder (ADHD) symptoms are associated with myriad adverse outcomes, including interpersonal difficulties, but factors that moderate the developmental course and functional impact of ADHD over time are not well understood. The present study evaluated developmental contributions of the triarchic neurobehavioral traits (boldness, meanness, and disinhibition) to ADHD symptomatology and its subdimensions from adolescence to young adulthood. Participants were twins and triplets assessed at ages 14, 17, and 19 (initial N = 1,185, 51.2% female). Path analyses using negative binomial regression revealed that boldness at age 14 was associated with more ADHD symptoms cross-sectionally (especially hyperactivity/impulsivity), but fewer symptoms (especially inattention) at age 19 in the prospective analysis. Notably, inclusion of interpersonal problems at ages 14 and 17 as covariates reduced the latter effect to nonsignificant. Disinhibition concurrently and prospectively predicted higher levels of ADHD symptoms, including both subdimensions, and the prospective effects were partially mediated by greater social impairment at age 17. Meanness prospectively (but not concurrently) predicted higher levels of hyperactivity/impulsivity symptoms. Sex moderated certain associations of meanness and disinhibition with ADHD symptoms. These findings highlight how fundamental neurobehavioral traits shape both psychopathology and adaptive outcomes in the developmental course of ADHD.

Background: Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) face an elevated risk of criminal convictions compared to those without ADHD. However, understanding this link involves considering sex differences, coexisting psychiatric conditions, and unmeasured familial factors. This study aimed to explore the connection between ADHD and criminal convictions (both violent and non-violent) in males and females, while also assessing the impact of comorbid psychiatric disorders and familial factors.

Methods: Using Swedish national registers, we identified individuals born between 1986 and 1997 (635,391 males and 600,548 females). ADHD was defined through clinical diagnosis and prescribed medications, while criminal convictions were determined based on Swedish lower court records. Unmeasured familial factors were accounted for using a sibling design approach.

Results: Findings revealed that individuals with ADHD had a notably higher absolute and relative risk of both violent and non-violent criminal convictions compared to those without ADHD. While criminal convictions were more frequent among males with ADHD, females with ADHD exhibited higher relative risks (HR violent 10.50, non-violent 4.04) than their male counterparts (HR violent 6.03, non-violent 3.57). Additionally, lower socioeconomic status (SES) in individuals with ADHD was associated with increased relative risks for criminal convictions compared to individuals with ADHD who had higher SES. Adjusting for childhood and internalizing psychiatric disorders partially attenuated these associations, while substance use disorders (SUD) substantially attenuated them. SUD also contributed to an elevated absolute risk of criminal convictions in both male and female individuals with ADHD. Accounting for unmeasured shared familial factors slightly reduced the estimates, but the association between ADHD and criminal convictions persisted.

Conclusion: In conclusion, ADHD remains a potent independent risk factor for criminal convictions, with varying effects based on gender. This underscores the importance of tailored crime prevention strategies and early interventions for individuals with ADHD, especially when comorbid SUD is present.

Purpose: Parental history of criminal offending is a major risk factor for later criminal behavior in children. Extensive research has also shown low resting heart rate (RHR), a moderately heritable biological variable, to be prospectively predictive of criminal behavior. Despite its status as a replicable risk factor, limited research exists on RHR's role in the intergenerational transmission of crime. Specifically, it remains unclear whether parent-child resemblance for biological characteristics such as RHR might play a role in intergenerational crime transmission.

Method: The current study was undertaken to clarify the role of RHR in the intergenerational transmission of crime, and test for moderating effects of socioeconomic status (SES) on its role, in a large Swedish population-based sample of fathers and their sons combined (N similar to 266,000).

Results: Beyond replicating prior work documenting paternal crime history and RHR as predictors of later offspring crime, we show tfhat father-son resemblance for RHR accounts in part for father-to-son crime transmission, and that familial SES does not moderate this transmission.

Conclusions: Our findings have important implications for understanding the role of biological and environmental influences in the intergenerational transmission of crime.

Biopsychosocial criminological theories suggest that it is important to consider interactions between risk factors from different domains in the prediction of externalizing behavior. Lower resting heart rate is considered the best replicated biological risk factor for externalizing behavior. The psychological construct of empathy has also shown to be predictive of such behavior, but little is known about the potential interaction between these two different risk factors in predicting externalizing behavior. We examined the moderating role of empathy on the association between resting heart rate in childhood and adolescence with externalizing behavior by young adulthood using two subsets of participants from the Longitudinal Risk Factors for Antisocial Behavior project: Subsample 1 (n = 697) at ages 9–10 and 19–20 years and Subsample 2 (n = 394) at ages 14–15 and 19–20 years. Linear and logistic regressions showed that empathy moderated the association between resting heart rate in adolescence and externalizing behavior by young adulthood. Among individuals with low but not high levels of empathy, increased resting heart rate predicted lower levels of externalizing behavior. Interventions enhancing empathic skills in individuals with psychophysiological risk profiles could be beneficial.

BACKGROUND: Lower autonomic arousal is a well-known correlate of criminal offending and other risk-taking behaviors in men, but few studies have investigated this association in women.

AIM: To test associations between autonomic arousal and criminal offending as well as unintentional injuries among female conscripts.

METHODS: All women born 1958-1994 in Sweden who participated in voluntary military conscription (n = 12,499) were identified by linking Swedish population-based registers. Predictors were resting heart rate (RHR) and systolic blood pressure (SBP). Covariates were height, weight, and physical energy capacity. Main outcomes were criminal convictions (any, violent, and non-violent) from the National Crime Register. Secondary outcome was unintentional injuries requiring medical treatment or causing death. We used survival analyses to test for associations between predictors and outcomes.

RESULTS: Low RHR, relative to high RHR, was associated with an increased risk of any criminal conviction, non-violent criminal convictions, and unintentional injuries. Low SBP, relative to high SBP, was associated with an increased risk of violent criminal convictions.

CONCLUSIONS: Results support lower autonomic arousal, particularly lower RHR, as a correlate of criminal offending among women that warrants further examination, as the reported findings have potential implications for the prediction of future female crime.

Low resting heart rate (RHR) is a well-replicated biological correlate of interpersonal violence (i.e., violence against others). However, there is limited research examining the relationship between RHR and intrapersonal violence (i.e., violence against oneself). Using Swedish population-based data, this study examined the relationship between RHR and suicide, an extreme form of intrapersonal violence, among individuals with no convictions (n = 458,785), violent convictions only (n = 8,694), non-violent convictions only (n = 187,138), and both violent and non-violent convictions (n = 37,745). Cox regression analyses indicated that low RHR lowered the risk of suicide by 22% among non-convicted individuals. High RHR increased the risk of suicide by 25% among individuals with non-violent convictions. RHR was not associated with the risk of suicide among individuals with violent convictions only or both violent and non-violent convictions. Research into shared and distinct etiological mechanisms and risk/protective factors for interpersonal and intrapersonal violence may provide valuable insights for treatment and prevention efforts.

Background: Research on the association between depression and crime is limited regarding different types of crime and severity of crime.

Aim: Using Swedish national register data, we explored the association between depression and various crime outcomes and the severity of crime.

Methods: We identified 72,057 individuals with an outpatient depression diagnosis between 2001 and 2013. Individuals with depression were age-, sex-, and socioeconomic status (SES)-matched to undiagnosed population controls (n = 1,080,855). Logistic regression models estimated odds of any, violent, property, drug-related and non-violent crime, as well as the severity of crime.

Results: In fully adjusted models, individuals with depression had significantly higher odds of any conviction (adjusted OR [adjOR] 1.66 [95 % CI 1.60-1.71]). This pattern persisted across all crime types (violent, property, drug-related, non-violent), and for crime severity, including increased odds for longer sentences and multiple convictions.

Conclusions: Individuals with depression had an increased risk for convictions across all crime types and more severe crimes. Our results emphasize the importance of early identification of risk factors and targeted treatments, and the necessity for clarification of the underlying mechanisms of our findings.

Background: Youth offenders have a high risk of being injured or dying prematurely. However, few studies have considered the role of imprisonment and potential childhood risk factors for these high rates.

Aim: To examine the risk of unintentional injury and premature death in non-imprisoned and imprisoned youth offenders, and to examine the role of parental criminal convictions and psychiatric disorders and own childhood psychiatric disorders.

Methods: All individuals (N = 1,839,711) born in Sweden between 1978 and 1996 were identified using Swedish population-based registers. The exposure was criminal conviction between ages 15-20 years of age.

Results: Imprisoned youth offenders had the highest risk for unintentional injury (HR = 2.29 [2.19-2.40]) and premature death (HR = 10.76 [9.52-12.16]), followed by nonimprisoned youth offenders, compared to non -convicted youth. All childhood risk factors increased the risk for these outcomes among non-imprisoned youth offenders. Among imprisoned youth offenders, parental criminal convictions and parental psychiatric disorders increased the risk for unintentional injury, and parental psychiatric disorders and own childhood psychiatric disorders increased the risk for premature death.

Conclusions: Our study shows there are robust modifiable childhood risk factors for injury and mortality among youth offenders. However, the importance of them to assess risk may differ between non-imprisoned and imprisoned youth offenders.

Background: We examined associations of adverse perinatal events with offspring violent and non-violent criminal convictions in men and women.

Methods: All singleton births between 1973 and 1995 (n = 1,146,570 men, n = 1,085,217 women) were identified through Swedish population-based registers. Information about adverse perinatal events was retrieved from the Medical Birth Register. Outcomes were criminal convictions collected from the National Crime Register. We estimated absolute and relative risks of being convicted of criminal convictions using the Kaplan-Meier method and survival analyses for men and women separately. We also tested for differences in magnitudes of associations for men versus women.

Results: Several adverse perinatal events were associated with an increased risk of violent and non–violent criminal convictions in both men and women. Associations between low birth weight, small nessrelative to gestational age and preterm birth with non–violent criminal convictions were statistically significantly higher for men than for women. There was a dose–dependent association between adverse perinatal events with violent and non–violent criminal convictions for both men and women, indicated by the strengthened magnitude of HR estimates with exposure to an increasing number of adverse perinatal events.

Conclusions: Adverse perinatal events are associated with violent and non-violent criminal convictions in men and women, with some differences in risk estimates between sexes. Findings are compatible with theoretical accounts implicating disruption of the neurodevelopment during the perinatal period.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is associated with an increased risk of poor mental health. However, the understanding of ADHD-related burden and impairments in women during the postpartum period is limited. The aim with the present study was to examine the risk of depression and anxiety disorders during the postpartum period among women with and without an ADHD diagnosis.

METHODS: We used register-based data to identify women who gave birth to their first and/or second child between 2005 and 2013 in Sweden (n = 773,047), of which 0.5 % (n = 3515) had a diagnosis of ADHD prior to pregnancy. Diagnoses of depression and anxiety disorders up to one year after delivery were collected from the national patient register.

RESULTS: A total of 16.76 % of the women with an ADHD diagnosis were also diagnosed with depression disorders in the postpartum period, prevalence ratio (PR) 5.09 (95 % confidence interval (CI), 4.68-5.54). A total of 24.92 % of the women with an ADHD diagnosis were also diagnosed with anxiety disorders in the postpartum period, PR 5.41 (5.06-5.78). Stratified results revealed that having a diagnosis of ADHD increased the risk for both depression and anxiety disorders postpartum, beyond other well-known risk factors.

LIMITATIONS: There is a potential risk of surveillance bias as women diagnosed with ADHD are more likely to have repeated visits to psychiatric care and might have an enhanced likelihood of also being diagnosed with depression and anxiety disorders postpartum, compared to women without ADHD.

CONCLUSIONS: ADHD is an important risk factor for both depression and anxiety disorders postpartum. Therefore, ADHD needs to be considered in the maternal care, regardless of sociodemographic factors and the presence of other psychiatric disorders.