The Impact of ADHD Treatment on Intimate Partner Violence in a Forensic Psychiatry Setting

Functional Impairments Associated With ADHD in Adulthood and the Impact of Pharmacological Treatment

OBJECTIVE

Among untreated adults, functional impairments associated with ADHD are widespread and cumulative, and can include social, educational, and professional impairments, increased risk of accidents and mortality, and reduced quality of life. Here, we review the most prominent functional impairments in adults with ADHD and summarize evidence describing the potential role of medication in improving outcomes.

METHOD

Articles related to the search terms "ADHD," "adult," and functional impairments were identified through Google Scholar and PubMed and selected for inclusion based on four criteria: strength of evidence, relevance to current challenges in adult ADHD, impact on the field, and recency of the results.

RESULTS

We identified 179 papers to support the conclusions on the relationship between ADHD and functional impairments, and the impact of pharmacological therapy on functional impairments.

CONCLUSION

This narrative review provides evidence that pharmacological treatment can be effective in minimizing not only the symptoms of ADHD, but its functional consequences as well.

Cognitive-motivational, interpersonal, and behavioral functioning in relationship to treatment and research engagement in forensic patients with ADHD

Objectives

To provide more insight into treatment and research responsivity in offenders with attention‐deficit hyperactivity disorder (ADHD).

Method

Via self‐reports and patients' scores on cognitive computer tasks, it was examined whether poorer cognitive‐motivational, interpersonal, and behavioral functioning were related to treatment no‐shows, longer treatment time duration intervals, and no‐show at the research appointment in 52 forensic outpatients with ADHD (M_age = 35.3, SD = 9.38). Treatment adherence was tracked for 10 appointments after research participation.

Results

Regression analyses showed that higher self‐reported impulsivity was associated with research no‐show, and more alcohol use with longer treatment time intervals. Yet, self‐reported delay aversion was associated with fewer treatment no‐shows, and, uncontrolled for alcohol use, impulsivity was associated with shorter treatment time intervals in a subsample of patients.

Conclusions

These preliminary results indicate that externalizing behaviors increase the risk for nonadherence in forensic ADHD patients, but that cognitive‐motivational problems also motivate patients to be more engaged.

Alexithymia as a Predictor of Arousal and Affect Dysregulations when Batterers with Attention Deficit Hyperactivity Disorder Cope with Acute Stress

Empirical research has stated that Attention Deficit Hyperactivity Disorder (ADHD) might underlie intimate partner violence against women (IPVAW) perpetration. Even though there is a clear relationship between these two variables, it is still unknown how ADHD facilitates violence proneness. In this regard, psychophysiological variables such as skin conductance levels (SCL) might offer information about emotional regulation when individuals cope with stress. Furthermore, alexithymia traits might be a strong candidate in explaining the above-mentioned emotional dysregulations. Hence, we compared the SCL response to acute cognitive stress in IPVAW perpetrators with and without ADHD symptoms to that of controls (non-violent and unaffected), and we also assessed the presence of alexithymia traits and their role in emotional regulation. Our data point out that ADHD IPVAW perpetrators presented higher SCL and negative affect than controls, particularly during the recovery period. Moreover, ADHD IPVAW perpetrators showed higher self-reported alexithymia, and this variable was a good predictor of autonomic and psychological state dysregulations, even after controlling for the effects of alcohol and drug misuse. Therefore, our study reinforces the need to consider psychophysiological measurements when screening the therapeutic needs of IPVAW perpetrators, due to their relatively low cost and the significant contents of their results. Finally, we also highlight the key role of alexithymia in this violent population, which should be considered when designing cognitive intervention training coadjutant to current psychotherapies for IPVAW perpetrators.