REVIEW OF: Balázs J et al, BMC Psychiatry 2018;18(1):34

What is the relationship between ADHD and self-harm and what can we do about it? ADHD is quite common, affecting 4%–6% of children and adolescents, and non-suicidal self-injury (NSSI) is also common, affecting about 5% of all people in the community and up to 80% of people with psychiatric diagnoses. Furthermore, about two-thirds of patients with ADHD have comorbid psychiatric disorders, often mood and anxiety disorders. This study explores factors that might mediate the association between ADHD and NSSI.

Researchers interviewed 202 psychiatric inpatient adolescents (99 boys and 103 girls) ages 13–18 at a facility in Hungary. To assess for DSM-IV psychiatric conditions, they used a structured diagnostic interview via the modified Mini International Neuropsychiatric Interview for Children and Adolescents (MINI Kid). For NSSI, researchers used the 17-item Deliberate Self-Harm Inventory (DSHI), which contains questions related to the frequency, severity, and duration of self-harm.

The authors found that 25% of adolescents had ADHD (n = 52; 23% of boys and 28% of girls) and another 38% scored at subthreshold level for ADHD symptoms (n = 77; 40% of boys and 36% of girls). An astounding 86% of girls (n = 25) and 43% of boys (n = 10) with ADHD had NSSI. Statistical analysis showed that ADHD and NSSI were not directly related. Instead, the likelihood of having both ADHD and NSSI could be explained by comorbidities. The most significant of these comorbidities included affective disorders, psychotic disorders, an independent state of suicidality, and (for girls) alcohol abuse or dependence.

CCPR’s Take:
Since inpatient treatment is generally reserved for adolescents who have suicidal ideation or NSSI, it is no surprise that ADHD and NSSI track together in these patients. However, the gem in this study is that it points us toward prioritizing treatment of comorbid conditions to reduce NSSI rather than being too distracted [sic] by the ADHD.