Summary of findings

This study provides longitudinal evidence showing that prospectively identified childhood ADHD traits are associated with a higher risk of experiencing IPV by midlife in a large population-based birth cohort study. Higher ADHD traits at age 10 years were associated with 23% higher odds of reporting IPV experiences by age 51 years, after adjusting for gender, ethnicity and childhood social class. In addition, ADHD traits were associated with a greater number of different IPV experiences by age 51 years, and with higher odds of reporting all domains of IPV included in this study (harassment, economic abuse, physical violence, threats/coercive control and sexual violence). Effect sizes observed are modest, but meaningful on a population scale. In adults without high ADHD traits, the predicted probabilities of experiencing IPV after adjustment for covariates were around one in seven (14%) for men, and one in four (24%) for women. In adults with high ADHD traits, probabilities increased to approximately one in five (20%) for men, and one in three (33%) for women. Although there were no sex interactions observed in this study, because of the higher prevalence of IPV experiences in women in general, women with ADHD traits are more likely than men with ADHD traits to experience IPV. Findings should be interpreted as relating to dimensional ADHD traits, rather than clinically diagnosed ADHD.

These findings support previous research showing links between ADHD and IPV. ^{Reference Arrondo, Osorio, Magallón, Lopez-del Burgo and Cortese16} They extend this previous research by showing that this association exists beyond adolescence and young adulthood, persisting through to middle age, and by demonstrating this using a large, nationally representative sample and a multidomain measure of IPV. These findings align with evidence on the increased prevalence of IPV in populations who experience social exclusion. ^{Reference Stewart, MacMillan and Kimber23} Findings are also in line with emerging evidence on increased rates of trauma and interpersonal harm in neurodivergent populations, including bullying ^{Reference Sciberras, Ohan and Anderson24} and childhood neglect. ^{Reference Semiz, Öner, Cengiz and Bilici25}

The prevalence rates of IPV observed in study appear to be broadly consistent with national estimates for women, but are higher for men in this study. According to the 2024 Crime Survey for England and Wales, 22.9% of women and 9.7% of men reported experiences of IPV at some point in their lives after the age of 16 years. ¹¹ Some research suggests that men may experience IPV at higher rates than commonly reported in these official statistics. For example, one study using data from the 2014 Adult Psychiatric Morbidity Survey reported that 15.3% of men experienced IPV. ^{Reference McManus, Walby, Barbosa, Appleby, Brugha and Bebbington26} This is consistent with rates reported in this study in men (14.28%). Taken together, this suggests that IPV experiences may be underestimated in official statistics, particularly for men. This may be related to the conceptualisation of IPV, the age of participants or underreporting in men.

Interpretation and potential explanations

Findings are based on observational data, and as such, causality cannot be inferred. The observed association may be attributable to a range of underlying mechanisms and broader pathways. Indeed, there are multiple potential explanations for the association between ADHD and experiences of IPV. First, people with ADHD are more likely to experience co-occurring mental health problems, ^{Reference French, Nalbant, Wright, Sayal, Daley and Groom7} often shaped by broader social determinants and systemic disadvantages across the life course. These include financial difficulties, ^{Reference Beauchaine, Ben-David and Bos8} housing instability, ^{Reference Murillo, Ramos-Olazagasti, Mannuzza, Castellanos and Klein9} adverse childhood experiences ^{Reference Semiz, Öner, Cengiz and Bilici25} and substance use, ^{Reference French, Nalbant, Wright, Sayal, Daley and Groom7} all of which are independently associated with increased IPV risk. Beyond these structural risks, people with ADHD may face heightened vulnerability because of social and psychological factors. Differences in impulsivity, emotional regulation and social communication can increase peer rejection and make people more susceptible to harm. ^{Reference Ros and Graziano27} Stigma and stereotypes that frame ADHD traits as laziness or irresponsibility can serve to legitimise mistreatment, and intersecting inequalities further compound risk. ^{Reference Mueller, Fuermaier, Koerts and Tucha28} Repeated experiences of rejection may erode self-esteem and self-advocacy, ^{Reference Cook, Knight, Hume and Qureshi29} and underdiagnosis and limited institutional support leave many adults without adequate safeguards. ^{Reference McKechnie, O’Nions, Dunsmuir and Petersen3,Reference Abdelnour, Jansen and Gold4,Reference Young, Asherson, Lloyd, Absoud, Arif and Colley30}

Observed associations may also reflect compounding disadvantages faced by people with ADHD across the life course. These include difficulties or delays in accessing diagnosis, ^{Reference McKechnie, O’Nions, Dunsmuir and Petersen3} limited access to appropriate and tailored services, ^{Reference Asherson, Leaver, Adamou, Arif, Askey and Butler31} challenges with medication access and adherence, ^{Reference Gajria, Lu, Sikirica, Greven, Zhong and Qin32} co-occurring health conditions ^{Reference French, Nalbant, Wright, Sayal, Daley and Groom7} and persistent stigma. ^{Reference Mueller, Fuermaier, Koerts and Tucha28} Together, these factors can reduce the resources available for people with ADHD to protect themselves, seek support or leave harmful relationships. Finally, evidence suggests that people who experience societal exclusion because of disability may be actively targeted by abusive partners, ^{Reference McCarthy, Bates, Triantafyllopoulou, Hunt and Milne Skillman33} a pattern that may also apply to ADHD. Taken together, these intersecting challenges may create conditions of increased vulnerability to IPV among people with ADHD.

Strengths and limitations

A key strength of this study is the use of the BCS70, a large birth cohort, with follow-up data available across more than 50 years. The BCS70 is a nationally representative cohort in England, Scotland and Wales, meaning that results from this study extend the existing literature, which is predominantly based in the USA. In addition to this, IPV was measured with a multidomain approach, which enabled a more comprehensive understanding of how ADHD traits are associated with various IPV experience, compared with studies that only considered one form of IPV (e.g. physical or sexual violence only). Additionally, ADHD was assessed by a trait-based approach, rather than relying on clinical diagnoses. This is a strength, given the underdiagnosis of ADHD in people aged ≥50 years. The full analytic sample was used, rather than a nested case–control design, to maximise statistical power and preserve the population-based structure of the cohort, as well as enabling inclusion of ADHD traits across their full distribution in the population.

The study is also subject to some limitations. For example, there was substantial attrition over the 51-year follow-up period, which may have introduced a selective and biased sample. Specifically, participants retained in analyses were more likely to be women, of White ethnicity and from more advantaged socioeconomic backgrounds, meaning observed associations may not be fully representative of the UK population. Additionally, only a relatively small set of potential covariates were controlled for in these analyses, to avoid inclusion of factors that may lie on the causal pathway. However, it is possible that unmeasured confounding may contribute to observed associations. Next, odds ratios are reported for some analyses, which can overstate strength of associations in cases where the outcomes are common. To help with interpretation, predicted probabilities estimated from model margins are additionally reported.

Another limitation is that although childhood ADHD traits were assessed prospectively according to DSM-5 criteria, they were based on behavioural questionnaires rather than clinical diagnostic interviews, and therefore may not capture all cohort members who would meet criteria for an ADHD diagnosis and also may include people whose symptoms may not have been at clinical levels or may have been better explained by other conditions. Additionally, follow-up data on ADHD traits into adulthood were not available, meaning stability of traits over time in this sample is not known. IPV experiences were reported retrospectively at a single time point only (age 51 years) and included only a binary response option (yes or no). More comprehensive information about IPV (such as the frequency, severity or timing) were not available in these data. This may introduce recall bias and limits understanding of the nuances of IPV experiences, particularly in relation to other life course factors. This should be considered when interpreting findings, particularly in terms of temporal sequencing across the life course. Finally, data were only available about binary gender, rather than gender identity.

Future research

Future research should focus on understanding the mechanisms that underlie observed associations between ADHD and IPV. This may include mental health problems over the life course and trauma histories. Qualitative research would also be valuable to provide richer insights into the experiences of IPV in people with ADHD. Research should aim to use a participatory approach, ensuring people with ADHD are at the heart of the translational research process. ^{Reference Sonuga-Barke, Chandler, Lukito, Kakoulidou, Moore and Cooper34}

In addition, understanding protective factors and sources of resilience, such as social support or ADHD-related strengths, is also an important direction for future research. Research could also test how different ADHD diagnostic categories and presentations may be linked to distinct patterns of vulnerability and risk. Finally, future research should also focus on how intersecting identities (e.g. related to gender, ethnicity, sexual orientation or disability) influence the associations between ADHD and IPV. This could help to identify particular subgroups of people with ADHD who may be at a higher risk.

Implications

These findings highlight the importance of recognising long-term outcomes of high ADHD traits beyond childhood and adolescence, particularly related to interpersonal harm. It is important that policy and support (including IPV prevention strategies, public health interventions and support services) take into account the barriers faced by people with ADHD, given the higher rates of IPV experiences in this population. Care should be taken to ensure such services are accessible for people with ADHD. In addition, professionals working across various settings (health, social care and criminal justice) should be appropriately trained to be able to provide accessible and appropriate support for people with ADHD experiencing IPV. Given increasing clinical and legal focus on coercive control, as well as its profound impacts on mental health and well-being, it is important that clinicians are sufficiently equipped to recognise and respond appropriately to less visible forms of IPV, such as coercive control – particularly in people with ADHD, who may be at increased risk.

This study provides longitudinal evidence from a large, prospective cohort to show that ADHD traits in childhood are associated with increased risk of experiencing multiple forms of IPV by midlife. These findings add to a growing body of evidence on the long-term outcomes of ADHD, including vulnerability to interpersonal harm. Addressing the needs of people with ADHD within IPV prevention and response systems is important for reducing harm in this population.