The authors describe personality development and disorders in relation to symptoms of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders.
Consecutive adults referred for neuropsychiatric investigation (N=240) were assessed for current and lifetime ADHD and autism spectrum disorders and completed the Temperament and Character Inventory. In a subgroup of subjects (N=174), presence of axis II personality disorders was also assessed with the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II).
Patients with ADHD reported high novelty seeking and high harm avoidance. Patients with autism spectrum disorders reported low novelty seeking, low reward dependence, and high harm avoidance. Character scores (self-directedness and cooperativeness) were extremely low among subjects with neuropsychiatric disorders, indicating a high overall prevalence of personality disorders, which was confirmed with the SCID-II. Cluster B personality disorders were more common in subjects with ADHD, while cluster A and C disorders were more common in those with autism spectrum disorders. The overlap between DSM-IV personality disorder categories was high, and they seem less clinically useful in this context.
ADHD and autism spectrum disorders are associated with specific temperament configurations and an increased risk of personality disorders and deficits in character maturation.
Childhood-onset neuropsychiatric disorders—which include attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, tic disorders, and learning disabilities—are defined by operational criteria targeting behaviors and deficits in abilities such as attention, empathy, communication, flexibility, and IQ
(1) . Research during the 1990s showed that these disorders are more frequent than previously assumed
(2 –
5) , with severe variants affecting at least 5% of all children and milder phenotypal expressions or “shadow syndromes” frequent in relatives of affected children
(6 –
11) .
Hypothetically, neuropsychiatric diagnoses designate dysfunctional extremes of normally distributed abilities, such as attention and impulse control; adaptive decision-making strategies; adequate perception and control of voice, posture, mimicry, and interpersonal skills; and mentalizing. The variation in such abilities is partly constitutional and may influence personality development to a greater extent than recognized in current personality theory. Patients afflicted by such dysfunctions describe themselves in terms applicable to personality disorders
(12 ,
13) . Subjects with personality disorders demonstrate neurocognitive problems
(14 –
16) , and personality disorders are common in follow-up studies of subjects with neuropsychiatric disorders
(17 ,
18) . These observations suggest that deficits in neurocognitive development during childhood may often lead to personality disorders during adulthood.
In other words, certain childhood temperament profiles may impair healthy character development, producing personality disorders in adulthood.
In the DSM system, personality disorders are assessed on a separate axis from the “major mental disorders” and, analogous with the ICD system, are defined categorically. Both principles are controversial and disputed by most experts, since empirical data lend no support for a sharp delineation of personality disorders from other mental disorders or for a categorical structure for personality traits
(19) . Although the validity of DSM-IV personality disorders seems weak, reliability in assessments by means of structured interviews such as the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) has been demonstrated
(20) .
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