title: Personality disorders and Axis I comorbidity in adolescent outpatients with ADHD.
abstract: Attention deficit hyperactivity disorder (ADHD) is a lifelong condition which carries great cost to society and has an extensive comorbidity. It has been assumed that ADHD is 2 to 5 times more frequent in boys than in girls. Several studies have suggested developmental trajectories that link ADHD and certain personality disorders. The present study investigated the prevalence of ADHD, common Axis I disorders, and their gender differences in a sample of adolescent outpatients. We also wanted to investigate the relationship between ADHD and personality disorders (PDs), as well as how this relationship was influenced by adjustment for Axis I disorders, age and gender.
  
  
  
  We used a sample consisting of 153 adolescents, aged 14 to 17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. ADHD, conduct disorder (CD) and other Axis I conditions were assessed using the Mini International Neuropsychiatric Interview (MINI). PDs were assessed using the Structured Interview for DSM-IV Personality (SIDP-IV).
  
  
  
  13.7 % of the adolescents met diagnostic criteria for ADHD, with no significant gender difference. 21.6 % had at least one PD, 17.6 % had CD, and 4.6 % had both ADHD and a PD. There was a significantly elevated number of PD symptoms in adolescents with an ADHD diagnosis (p = 0.001), and this relationship was not significantly weakened when adjusted for age, gender and other Axis I disorders (p = 0.026). Antisocial (χ (2) = 21.18, p = 0.002) and borderline (χ (2) = 6.15, p = 0.042) PDs were significantly more frequent in girls than in boys with ADHD.
  
  
  
  We found no significant gender difference in the prevalence of ADHD in a sample of adolescents referred to a general mental health outpatient clinic. Adolescent girls with ADHD had more PDs than boys, with antisocial and borderline PDs significantly different. The present study suggests that ADHD in girls in a general outpatient population may be more prevalent than previously assumed. It especially highlights the importance of assessing antisocial and borderline personality pathology in adolescent girls presenting with ADHD symptoms.
authors.affiliation: Department for Child and Adolescent Mental Health (The Nic Waal Institute), Lovisenberg Diakonale Hospital, P.O. Box 4970, Nydalen, N-0440, Oslo, Norway. hansole.korsgaard@tele5.no.
authors.forename: Hans Ole
authors.initials: HO
authors.lastname: Korsgaard
authors.affiliation: Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.|Department of Psychology, University of Oslo, Oslo, Norway.
authors.forename: Svenn
authors.initials: S
authors.lastname: Torgersen
authors.affiliation: Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.|Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
authors.forename: Tore
authors.initials: T
authors.lastname: Wentzel-Larsen
authors.affiliation: Vestfold Hospital Trust, Tønsberg, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Randi
authors.initials: R
authors.lastname: Ulberg
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D019955:Conduct Disorder / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D010045:Outpatients / Q000523:psychology* / Q000706:statistics & numerical data*; D010554:Personality Disorders / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D017678:Sex Distribution
keywords: ADHD; Adolescent; Axis I; Comorbidity; Conduct disorder; Outpatient; Personality disorder