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Trajectories of Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder Symptoms as Precursors of Borderline Personality Disorder Symptoms in Adolescent Girls

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Abstract

Little empirical evidence exists regarding the developmental links between childhood psychopathology and borderline personality disorder (BPD) in adolescence. The current study addresses this gap by examining symptoms of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) as potential precursors. ADHD and BPD share clinical features of impulsivity, poor self-regulation, and executive dysfunction, while ODD and BPD share features of anger and interpersonal turmoil. The study is based on annual, longitudinal data from the two oldest cohorts in the Pittsburgh Girls Study (N = 1,233). We used piecewise latent growth curve models of ADHD and ODD scores from age 8 to 10 and 10 to 13 years to examine the prospective associations between dual trajectories of ADHD and ODD symptom severity and later BPD symptoms at age 14 in girls. To examine the specificity of these associations, we also included conduct disorder and depression symptom severity at age 14 as additional outcomes. We found that higher levels of ADHD and ODD scores at age 8 uniquely predicted BPD symptoms at age 14. Additionally, the rate of growth in ADHD scores from age 10 to 13 and the rate of growth in ODD scores from 8 to 10 uniquely predicted higher BPD symptoms at age 14. This study adds to the literature on the early development of BPD by providing the first longitudinal study to examine ADHD and ODD symptom trajectories as specific childhood precursors of BPD symptoms in adolescent girls.

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Notes

  1. The fit statistics for the alternative forms of growth were as follows: linear models of ADHD [χ 2 (16, N = 1,220) = 69.50, p < 0.001; CFI = 0.98; RMSEA = 0.052] and ODD symptom scores [χ 2 (16, N = 1,220) = 72.08, p < 0.001; CFI = 0.98; RMSEA = 0.054]; quadratic models of ADHD [χ 2 (12, N = 1,220) = 11.91, p = 0.45; CFI = 0.99; RMSEA = 0.030] and ODD symptom scores [χ 2 (12, N = 1,220) = 15.01, p = 0.24; CFI = 0.98; RMSEA = 0.034].

  2. Even without significant growth in the unconditional model in ADHD scores from age 10–13, including covariates and outcomes can influence the slope so that it may vary as a function of these additional variables (c.f. Fisher and Kim 2007). Specifically, we were able to demonstrate the significant predictive effect of the development trajectory of ADHD from age 10–13 on BPD symptoms at age 14. These seemingly contradictory results may be due to increased power to detect slope variability when covariates and outcomes are included in the model.

  3. To determine the effect of the covariates on the final model of interest, we ran additional analyses without the covariates negative emotionality, conduct disorder symptoms, and depression symptoms at age 8. The pattern of results remained the same. The ADHD (β = 0.16, p = 0.003) and ODD (β = 0.13, p = 0.020) intercepts, as well as the ODD slope from 8–10 years (β = 0.22, p = 0.022) and the ADHD slope from 10–13 years (β = 0.16, p = 0.037) predicted BPD symptoms at age 14.

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Acknowledgements

This research was supported by grants from the National Institute of Mental Health (MH056630), the National Institute on Drug Abuse (DA012237), and by funding from the Office of Juvenile Justice and Delinquency Prevention, the FISA Foundation and the Falk Fund. Dr. Burke’s effort was supported by K01 MH074148. Dr. Hipwell’s effort was supported by K01 MH07179. Dr. Stepp’s effort was supported by K01 MH086713.

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  1. Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O’Hara St., Pittsburgh, PA, 15213, USA

    Stephanie D. Stepp, Jeffrey D. Burke, Alison E. Hipwell & Rolf Loeber

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Stepp, S.D., Burke, J.D., Hipwell, A.E. et al. Trajectories of Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder Symptoms as Precursors of Borderline Personality Disorder Symptoms in Adolescent Girls. J Abnorm Child Psychol 40, 7–20 (2012). https://doi.org/10.1007/s10802-011-9530-6

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