Familial Patterns in Criminal Conviction Risk Observed Among Individuals with ADHD

A largescale, comprehensive study has found that individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of being convicted of crimes compared to those without ADHD, and that this association extends to their relatives, suggesting shared familial factors such as genetics and environmental conditions. The new study in Biological Psychiatry, published by Elsevier, emphasizes the need for timely support to help reduce impulsive or risky behaviors that might otherwise escalate. It suggests that understanding familial patterns encourages clinicians to be more attentive to ADHD symptoms in relatives, thereby helping to interrupt cycles across generations.

ADHD affects 5% to 7% of children and adolescents worldwide, and about 2.5% of adults. Characterized by impaired attention, hyperactivity/impulsivity, or both, ADHD is associated with adverse outcomes, including elevated risk of crime. Meta-analyses show that individuals with ADHD are 2-3 times more likely to be arrested, convicted, or incarcerated, often at a younger age and with higher rates of reoffending. Additionally, about 25% of incarcerated individuals meet diagnostic criteria for ADHD, far exceeding general population rates. However, the link between ADHD and criminality remains poorly understood.

John Krystal, MD, Editor of Biological Psychiatry, comments, “We have long known that ADHD puts people at risk for risky, impulsive behaviors, including crime. We have also been aware that ADHD risk has a genetic component. This important paper now brings these threads together to show that families that carry ADHD risk also are at risk for having family members who engage in criminal activity. These data highlight the importance of early identification and treatment of ADHD in high-risk families to mitigate this risk.”

Using Swedish national registry data, investigators followed more than 1.5 million people born between 1987 and 2002, linking medical diagnoses of ADHD to official crime records. They then compared risks of criminal convictions both within individuals and across multiple degrees of relatedness: twins, siblings, half-siblings, and cousins.

“We found that individuals with ADHD were several times more likely to have criminal convictions for both violent and non-violent crimes. Importantly, relatives of individuals with ADHD also showed increased risk, even if they themselves did not have ADHD, pointing to shared familial liability. The associations were to some extent stronger among women than men, indicating possible sex-specific factors in how ADHD relates to criminal outcomes,” explains lead investigator Sofi Oskarsson, PhD, School of Behavioural, Social and Legal Sciences, Örebro University, Sweden. “Because ADHD may be underdiagnosed or mischaracterized in females, the higher relative risk among women may indicate that when ADHD does occur, it reflects a more severe or concentrated set of underlying risk factors.”

The researchers point out that this study was conducted in Sweden, a high-income Western country with universal healthcare and relatively low incarceration rates. Cultural, legal, and healthcare system differences may influence both ADHD detection and conviction likelihood. However, a systematic review of worldwide ADHD prevalence suggests that rates are relatively consistent across regions when comparable diagnostic criteria are applied. “This indicates that our findings may extend beyond Western context, although studies in underrepresented regions are clearly warranted to confirm the generalizability of co-aggregation patterns,” says Dr. Oskarsson.

The findings of the study highlight that preventive and intervention strategies should be implemented for both sexes, while also addressing potential sex-specific mechanisms and the additional challenges faced by females with ADHD, including stigma and late detection. Early identification and treatment of ADHD, especially in families with a history of ADHD, could play a critical role in mitigating associated risks.

Dr. Oskarsson concludes, “At a time when awareness of ADHD is increasing, understanding the broader familial patterns helps us recognize ADHD not only as an individual challenge but also as part of a family-level risk profile. These insights are critical for informing early intervention and support strategies that could reduce negative outcomes like criminality.”

Notes for editors

The article is "The Familial Co-Aggregation of ADHD and Criminal Convictions: A Register-Based Cohort Study,” by Sofi Oskarsson, PhD, Ralf Kuja-Halkola, PhD, Anneli Andersson, PhD, Catherine Tuvblad, Isabell Brikell, Brian D’Onofrio, Zheng Chang, PhD, and Henrik Larsson, PhD (https://doi.org/10.1016/j.biopsych.2025.10.007). It appears online in Biological Psychiatry, published by Elsevier.

The article is openly available at https://www.biologicalpsychiatryjournal.com/article/S0006-3223(25)01527-6/fulltext.

Copies of the full text and additional information are also available to credentialed journalists upon request; please contact Rhiannon Bugno at [email protected]. Journalists wishing to interview the authors should contact Sofi Oskarsson, PhD, at +46 19303016 or [email protected].

The authors’ affiliations and disclosures of financial relationships and conflicts of interests are available in the article.

John H. Krystal, MD, is Chairman of the Department of Psychiatry at the Yale University School of Medicine, Chief of Psychiatry at Yale-New Haven Hospital, and a research psychiatrist at the VA Connecticut Healthcare System. His disclosures of financial relationships and conflicts of interests are available here.

About Biological Psychiatry

Biological Psychiatry is the official journal of the Society of Biological Psychiatry, whose purpose is to promote excellence in scientific research and education in fields that investigate the nature, causes, mechanisms, and treatments of disorders of thought, emotion, or behavior. In accord with this mission, this peer-reviewed, rapid-publication, international journal publishes both basic and clinical contributions from all disciplines and research areas relevant to the pathophysiology and treatment of major psychiatric disorders.

The journal publishes novel results of original research which represent an important new lead or significant impact on the field, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Reviews and commentaries that focus on topics of current research and interest are also encouraged.

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