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Themenschwerpunkt/Theme Articles

ADHS, Antisoziale Persönlichkeitsstörung und Delinquenz

1Prof. Dr. med. Dr. jur. R. Luthe zum 75. Geburtstag gewidmet

Welche Zusammenhänge sind erkennbar?

Published Online:April 17, 2008https://doi.org/10.1024/1661-4747.56.2.121

Abstract

Die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) kann im Erwachsenenalter mit erheblichen Einschränkungen im Lebensalltag vergesellschaftet sein. In Straftäterpopulationen kommt ADHS sowohl bei Männern wie auch Frauen überdurchschnittlich häufig vor. In der Regel ist dabei ADHS mit einer Conduct Disorder (CD) assoziiert. Bei der Kombination ADHS mit CD handelt es sich um Personen, bei denen in der Kindheit und Jugend delinquente Verhaltensstile zu beobachten sind. Bei diesem Personenkreis, nicht aber bei isolierter ADHS, besteht ein hohes Risiko für die Entwicklung einer Antisozialen Persönlichkeitsstörung (ASP) oder von anhaltendem kriminellem Verhalten im Erwachsenenalter. Etwa die Hälfte aller Kinder mit ADHS entwickelt eine CD. Eine ASP tritt später in 20–25 % der Fälle ein. Auf welche Weise ADHS mit CD oder ASP pathogenetisch assoziiert ist, konnte bisher nicht eindeutig geklärt werden. Gemeinsame genetische Faktoren, Gen × Gen Interaktionen sowie Gen × Umwelt Interaktionen sind wahrscheinlich. Straftäter mit ADHS beginnen in jüngerem Alter mit delinquenten Verhaltensstilen und sind häufiger Rezidivtäter als Täter ohne ADHS. Die Prävalenz von ADHS ist nicht in allen Tätergruppen gleichmäßig erhöht. Bei Betrügern ist die ADHS Prävalenz normal. Signifikant mehr ADHS findet man bei Sexualstraftätern (ca. 30 %) und bei Personen, die reaktive Gewalttaten verübt haben. Bei proaktiver Gewalttätigkeit ist die Prävalenz für ADHS eher niedrig. Auch unter den BTM Delinquenten findet man eine relativ hohe ADHS Prävalenz. Die im Rahmen der ADHS auftretende Antisozialität lässt keine wesentlichen Querverbindungen zur Kerngruppe der Psychopathen nach Hare erkennen und kann damit als eigenständige Subgruppe innerhalb der ASP angesehen werden.


On the Relations Between Attention Deficit-/Hyperactivity Disorder, Antisocial Personality Disorder, and Delinquency

The adult attention deficit-/hyperactivity disorder (ADHD) can lead to important impairments in social adaptation and activities of daily living. The prevalence of ADHD in offender populations has been found increased. Due to methodical differences and different legal conditions the prevalence rates vary remarkably from 4 % to 72 %. In prison and forensic populations ADHD is almost always associated with conduct disorder (CD). This is about a population of children and adolescents demonstrating varies types of delinquent and rule braking behaviour. Exclusively patients with ADHD and CD and not those with ADHD solely are at risk to develop later Antisocial Personality Disorder (ASP) or criminality. Approximately 50 % of all ADHD children show later comorbid CD. Nearly one half of the individuals with ADHD and CD are suffering from ASP during adulthood. Regarding shared pathogenetic mechanisms of ADHD and CD not much is known. Common genes, gen × gen and gene × environment interactions are under discussion. When comparing offenders with and without ADHD it is apparent that individuals with ADHD start their crimes in earlier age. ADHD persons are more often offenders with recidivistic crimes. The prevalence of ADHD in different offender populations is not increased in general. The prevalence of ADHD is low in cheating and some types of property crime and relatively high in sexual offences, drug crimes and reactive violence but not in proactive violence. There is no common psychopathologic structure between ADHD and psychopathy (Hare). The antisociality of individuals with ADHD seems to be a distinct subgroup of the comprehensive field of ASP as defined according to DSM-IV.

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