Running head: ADHD AND YOUTH VIOLENCE: A CRITICAL APPRAISAL

ADHD and Youth Violence: A Critical Appraisal of the Literature
Capstone Project
Robert Hendry
Bachelor of Law Enforcement
Laws 4003 - Research Project
Justice Institute of British Columbia
David Smulders
Advisor - Marjory Jardine
April 10th, 2020

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Abstract
Attention Deficit Hyperactivity Disorder is one of the most common childhood disorders.
Diagnosed youth typically have a decreased ability to focus and an increased level of activity.
Typically, this leads to diminished social development in youth. Current literature has identified
violence to be a side effect of ADHD, but this body of literature has not been validated. Many
gaps have also been discovered, such as gender, ethnicity and family aspects of ADHD. These
areas have been neglected when assessing for violence in ADHD youth. To progress the field of
research regarding ADHD and youth violence, this paper is designed as a guide to critically
appraise the research that has been conducted. The purpose of this research is not to identify new
strategies of violence reduction, but rather to inform policy and programs to decrease future
violence associated with ADHD.
Keywords: ADHD, youth violence, aggression, youth mental health, effects of ADHD,
hyperactivity and youth aggression.

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Table of Contents
Abstract ......................................................................................................................................2
Table of Contents ........................................................................................................................3
Background.................................................................................................................................4
Research Question ......................................................................................................................5
Literature Review Methodology ..................................................................................................6
Literature Review........................................................................................................................7
Poor School Performance as an Indication of Increased Aggression ........................................8
Difficulty Creating and Sustaining Social Relationships ..........................................................9
Difficulty establishing relationships between peers. .............................................................9
Difficulty establishing relationships in a family setting. ..................................................... 10
Impulsivity and Socioeconomic Status as a Correlated Factor in Youth Violence .................. 12
Critical Appraisal ...................................................................................................................... 13
Gender in ADHD Youth Research......................................................................................... 13
Research on female youth. ................................................................................................. 13
Application of male results to females. .............................................................................. 14
Independent Diagnosis of ADHD .......................................................................................... 15
Collection of Violence Statistics ............................................................................................ 16
ADHD as a Factor in Family Relationships ........................................................................... 17
Discussion................................................................................................................................. 18
ADHD and Comorbidity in Youth ......................................................................................... 19
Female Approach to ADHD Youth Violence ......................................................................... 20
Distinguishing Between Varying Levels of Violence ............................................................. 20
Inclusion of Multiple Ethnicities ........................................................................................... 21
Strategies for Managing Violent ADHD Youth ..................................................................... 22
Conclusion ................................................................................................................................ 24
References ................................................................................................................................ 26
Appendix .................................................................................................................................. 30

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ADHD and Youth Violence: A Critical Appraisal of the Literature.
Background
Attention Deficit Hyperactivity Disorder (ADHD) is a condition commonly diagnosed in
childhood and defined as “a persistent pattern of inattention and/or hyperactivity-impulsivity that
interferes with functioning or development” (American Psychiatric Association [APA], 2015, p.
82). ADHD in Canadian children has been found to exist at a rate of 2.6% according to a study
conducted by Brault and Lacourse (2012, p. 4). This same study also found an increase in the
diagnosis of ADHD from 2000-2007. This condition complicates childhood, and many of the
same characteristics are found among violent offenders. It has also been established that ADHD
has consistent links to youth criminality, as indicated by Satterfield, Hope, and Schell (1982) and
Satterfield, Swanson, Schell, and Lee (1994). If the rate of ADHD youth offending continues to
increase, law enforcement may see a steady stream of crime committed by these youth.
Research conducted into the association between ADHD and youth violence has become
its own subcategory of literature. Presently, the research on ADHD and youth violence has many
gaps and requires a critical appraisal to assess these gaps and address the validity of the
literature. After an evaluation of the literature, it became apparent that a critical appraisal had not
been conducted on this topic. This paper is not intended to present solutions to the problem, but
rather to identify possible areas where future research should be conducted to further policy
development.
A pragmatic worldview will be applied to this research, as this is conducive to the present
study. Creswell (2014) suggests that pragmatism is best utilized when an emphasis is placed on
the research problem and a variety of approaches are used to develop solutions. For the present
study, the focus will revolve around the limitations and gaps in the research and how this can be

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used to inform practical solutions to ADHD and youth violence. This creates the proper
conditions to conduct a pragmatic study.
Research Question
The field of ADHD and youth violent offending is a small but expanding area of
research. The material on this topic is growing, but still contains many large gaps that require
further investigation. This leads to the research question: what is the relationship between a
youth’s level of violence and their diagnosis of ADHD?
To better understand this topic the current paper is designed to act as a critical appraisal
of the current research. A critical appraisal would be best served for this type of research, as this
will identify future areas that need to be expanded upon. This will assist in identifying the
connections between different materials and where gaps exist in research. To gain a better
understanding of the topic and the literature, three additional questions will be asked: what is the
state of the literature? Where can the literature improve? And, what direction is the research
heading?
The literature suggests that a strong relationship exists between ADHD and youth
violence, but this relationship has not been well tested. If an increase in ADHD diagnoses does
occur, it will be important to establish how this affects rates of violence for policymakers to
respond appropriately. Analysis of the current research will indicate how policymakers can
develop better policies and programs to assist youth with ADHD and violent tendencies.
Wojciechowski (2017) demonstrated that youth with a diagnosis of ADHD were more
likely to be implicated in violent offending in youth and early adulthood. This research is
consistent with findings from Evans, Clinkinbeard, and Simi (2015) where youth with ADHD
were found to have a higher level of violence than youth without ADHD. To further the field

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these sources, and others must undergo an evaluation to ensure their validity and relevance to the
research question.
Literature Review Methodology
The research was gathered through a literature review of secondary source material. The
literature review was conducted with scholarly material only. Periodicals, newspaper articles,
and magazines were not included in the study. Further, when searching for the material it was
important to refrain from using broad terms such as “mental health” or “mental illness”. Rather,
it was more pertinent to use terms that directly related to ADHD, such as “attention deficit” or
“hyperactivity”. Articles from the year 2000 until the present day were included, any older
material was excluded. Creswell (2014) suggests using a broad collection of literature as an
effective way to gather material, so this was incorporated in the search strategy. Also included in
the search strategy was the utilization of Boolean operators such as “and” to narrow the search or
“or” to expand the search.
The Justice Institute of British Columbia (JIBC) Library’s online EBSCO Discovery
System (EDS) was the main system used to search for relevant material. In addition, the JIBC
Library’s ProQuest Criminal Justice database and National Criminal Justice References Services
(NCJRS) Database were searched. Google Scholar and the Northern Alberta Institute of
Technology (NAIT) Library online EDS database were other sources used to gather material. To
search for articles, keywords and phrases were identified to assist with the search, such as
impulsivity, violence, aggression, ADHD causing youth violence, and, hyperactivity leading to
violence.
Two different search strategies were utilized, the details of which are provided in
Appendix A. The first was a poor strategy with little detail and underutilization of the capacity of

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the search engine. This was limiting and ineffective in providing material pertinent to the
research question. The second search was much more robust and was guided by the assistance of
previous mistakes and advisors who understood how to manipulate the search engine to its best
ability. Within the search strategies, specific tools were utilized to maximize the potential results,
such as the inclusion of an asterisk to find all endings of a root word. Quotation marks were also
used to limit results to the exact phrase or term. In addition, limiting the field of search to the
TITLE FIELD only, allowed the results to be more specific to the search.
A secondary cursory search was also conducted on the literature about preventative
programming and policy development. This is an area that will require further examination in the
future, as from the search conducted very little research was found on this topic. One of the most
relevant results was the program by Eichelberger, Plück, Hautmann, Hanisch, and Döpfner
(2016), which will be discussed further in the discussion section.
Literature Review
Several themes emerged during the literature review. These themes were identified by
comparing multiple scholarly sources to see if any factors were consistent among the literature.
Low academic achievement in school was the first theme consistently linked to ADHD and
youth aggression. Youth with ADHD appeared to have a more difficult time in an educational
setting and would act out with violent impulses. The difficulty for youth to experience and
sustain social relationships was also identified as a factor that increased the likelihood of youth
violence. ADHD youth were disadvantaged in social settings, particularly in making friends and
meaningful relationships. Additionally, impulsivity, which is a common characteristic of ADHD,
was linked to lower socioeconomic status. The combination of these two factors consistently led
to an increase in violent behaviour for ADHD youth. After reviewing the literature, it became

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apparent that ADHD diagnosed youth are at a disadvantage in many areas of life and may
manifest their frustration in the form of aggression.
Poor School Performance as an Indication of Increased Aggression
One of the many consequences that youth with ADHD face as a result of the disorder is a
decreased ability to perform well academically. Bernat, Oakes, Pettingell, and Resnick (2012)
explored this, among other aspects of a youth’s environment that contributed to a decreased
quality of life. Their study is important in differentiating between youth who are at risk for
violence and those that are not. The study identified factors that were indicative of youth
violence, predictive factors, and characteristics that decrease the likelihood of youth violence,
protective factors. A variety of characteristics from a youth’s background were considered, such
as their age, ethnicity, and socioeconomic status. Bernat et al. (2012) indicated that ADHD youth
with a lower level of educational achievement were more inclined to use violence than those
without ADHD.
These results are consistent with other research, such as the longitudinal research study
conducted by Jolliffe, Farrington, Loeber, and Pardini (2016). Jolliffe et al. (2016) conducted a
similar analysis of data when they examined if certain characteristics, such as hyperactivity or
academic achievement, affected the youth’s overall violence level. Results of the Jolliffe et al.
(2016) research indicated that a higher level of academic achievement was correlated with a
lower level of violence among youth. The characteristic most strongly associated with low
violence levels was the ability for youth to achieve a high academic standard. The struggle of
ADHD youth in an educational setting puts them at a stark disadvantage from the rest of the
student population.

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Evans et al. (2015) provided another perspective on this theme when they examined
ADHD in the context of a learning disability. Youth diagnosed with ADHD are considered to
have a learning disability. Sitting in a classroom and focusing for extended periods can be very
difficult for these youth (Evans et al., 2015). This study compared rates of delinquency across a
group of youth with ADHD, and those without. The group with ADHD was found to have lower
achievement overall in academic success, as compared to those without ADHD (Evans et al.,
2015). The main goal of the study was to examine if youth with ADHD were more likely to
engage in delinquent behaviours to a greater extent than youth without ADHD. The results
demonstrated that youth with ADHD were more likely to engage in certain violent delinquent
behaviours than youth without ADHD. Youth with ADHD were found to engage in
approximately 25% more instances of violent behaviour than youth without (Evans et al., 2015,
p.11).
Violent behaviour was theorized to be the result of the youth acting out due to their
additional difficulties in school. The findings from Jolliffe et al. (2016) mirror these results, as in
both cases youth with lower academic achievement recorded more instances of aggressive
encounters. As a result of their learning disability, youth are more likely to have a poor
educational experience, which may then lead them to engage in more violent behaviours than
their peers. Hawkins et al. (2000) further reinforce this theme. Their report substantiates the
work of other scholarly material in the field when they identify both hyperactivity and poor
school performance as an indication of increased youth violence.
Difficulty Creating and Sustaining Social Relationships
Difficulty establishing relationships between peers. The theme of ADHD youth having
more difficulty experiencing and sustaining social relationships was consistently demonstrated

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throughout the literature. This was indicated in the Becker, Mehari, Langberg, and Evans (2017)
study conducted on Grade 6-8 students. In their study, ADHD diagnosed students were
administered a questionnaire regarding time spent with their peers in the student population.
They were questioned on several aspects including, how they were treated by their fellow
students, what relationship they had with their friends and how these factors affected their mental
health. The youth in the study indicated elevated levels of victimization as compared to their
peers. Becker et al. (2017) have acknowledged that the increase in victimization can cause
significant violence problems in the future. For example, one of the consequences of having few
peer relationships was a reduction in support for the youth when they are bullied by their
classmates. Higher instances of peer abuse can lead to lowered self-esteem causing some youth
to create friendships with delinquent peers (Becker et al., 2017).
Rabiner, Coie, Miller-Johnson, Boykin, and Lochman (2005) expanded on the findings of
the previous study. They explored how youth can form delinquent relationships that lead to
increased violent behaviour. Their longitudinal research study was conducted with participants
between 12 and 22 years of age. The participants who displayed a tendency for more violent
behaviour had difficulty forming and sustaining relations with their peers. And, as Becker et al.
(2017) have demonstrated, this can lead to a lowered level of self-value compared to others.
These same participants also indicated a higher level of ADHD symptoms than those who had a
lower level of violence. Not only are youth more likely to engage in aggressive behaviour after
peer rejection, but they are also more predisposed to become involved in peer groups where
aggressive behaviours and delinquency are commonplace (Rabiner et al., 2005).
Difficulty establishing relationships in a family setting. Relational problems are not
isolated to friends and peers. Difficulty establishing family relations is another aspect of

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meaningful bonds that ADHD diagnosed youth struggle with. Peasgood et al. (2016) examined
the relationship that ADHD youth form with their family, as these youth typically face more
challenges when forming interpersonal relationships. Youth were studied individually and
questioned about the relationship they held with their family. Peasgood et al. (2016) found that
ADHD youth overall had a lower quality of life as compared to their peers, due in part to their
inability to form meaningful relationships with their family. Siblings of these youth reported a
lower quality of life and self-reported more bullying towards their siblings with ADHD. Youth
with ADHD also reported significantly higher levels of bullying experienced in their family.
Bullying was more commonplace in these families due to the additional challenges ADHD youth
provide.
Connolly and Vance (2010) came to similar conclusions when they examined the
psychosocial aspects of a child’s life. Their longitudinal study was conducted over five years
where both teachers and parents were interviewed and surveyed. This data was then used to
identify certain factors consistent across a group of youth who were all identified to have ADHD.
Family dysfunction and interpersonal sensitivity were two of the characteristics examined that
encouraged aggression in youth (Connolly & Vance, 2010). Parents frequently noted an inability
for youth to form close relations with their family and the subsequent aggressive behaviour. The
findings of this study help corroborate the research conducted by Peasgood et al. (2016). Both
articles indicated that youth with high levels of aggression were also found to have an increased
dissociated relationship with their family members.
Where this literature becomes important is in understanding the difficulties these youth
experience daily. Youth with increased difficulty in developing social relations may be more
inclined to resort to violent practices, whether this is towards others or themselves. The difficulty

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for them to establish meaningful relationships, with family or otherwise, causes increased
difficulty when responding to challenges that are presented in their lives. The lack of
relationships can also cause bullying and abuse by their peers, causing further mental health
problems such as anxiety disorders and depression (Peasgood et al., 2016). The results from this
section of the literature reveal that youth with ADHD may need additional support to deal with
the challenges that come with peer relationship difficulties.
Impulsivity and Socioeconomic Status as a Correlated Factor in Youth Violence
One of the main characteristics of ADHD is the propensity to engage in impulsive
behaviour (Wojciechowski, 2017). This is often an adverse side effect of ADHD, as impulsivity
influences rash decision-making. Impulsivity, a frequently associated attribute of ADHD was
directly implicated in its association with violent youth offending. Wojciechowski (2017)
directly addressed the linkage between ADHD and its association with violent behaviour. This
study assesses the relationship in the context of the frequency of violent offending and
participation of the offending youth. Participants in this study were incarcerated youth taking
part in a program designed to rehabilitate them. Impulsivity was frequently cited as a reason for
committing a serious violent crime (Wojciechowski, 2017). Socioeconomic status was also
examined, as youth who existed in a lower socioeconomic state were often more inclined to
make impulsive, poor decisions. This study suggests that those with lower socioeconomic status
were at a greater risk of impulsively committing a violent crime.
Zalot, Jones, Kincaid, and Smith (2009) conducted a similar study, where African
American youth in single-mother homes were studied to examine the relationship between
violent behaviours and impulsivity. Impulsivity was found to exist frequently as a factor for
youth that indicated violence. Boys at the greatest risk for violence lived in neighbourhoods with

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lower than average median household income. The youth in this study were found to be more
impulsive and demonstrate other characteristics of ADHD as compared to their peers (Zalot et
al., 2009). These youth were more likely to associate with deviant peers leading to violent
encounters. Associating with deviant peers may be the result of the youth’s inability to properly
establish peer relationships. Additionally, the lower socioeconomic conditions of the youth
placed them at a disadvantage, as the proper social supports needed for ADHD youth were not
available.
Impulsivity in youth and their poor neighbourhood context was further discussed by
Lynam, et al. (2000). They examined how lower socioeconomic neighbourhood influences and
impulsive behaviours can affect the level of violent youth offending. Findings of the study
demonstrated that youth in poorer neighbourhoods are more inclined to act on impulsive urges
than those in more affluent neighbourhoods. These youth also demonstrated additional
characteristics of ADHD, such as inattentiveness and hyperactive behaviour. Perhaps ADHD is
more common among areas with lower socioeconomic status. Youth with ADHD that reside in
lower socioeconomic areas are at a greater risk for offending due to their lack of self-control
(Lynam et al., 2000). Areas with lower socioeconomic conditions are at the greatest risk for
ADHD youth offending, as there are few restraints to curb impulsive decision making (Lynam et
al., 2000; Zalot et al., 2009).
Critical Appraisal
Gender in ADHD Youth Research
Research on female youth. Within the literature, there was a considerable lack of
research on ADHD girls. Most of the literature focused on male youth. Females were included in
some research but generally were combined in samples of both boys and girls. The lack of

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research may be due to the differentiating diagnoses between the two genders, as boys are more
likely to meet the criteria of ADHD than girls (Peasgood et al., 2016, p.1). Some of the literature
mentioned the inclusion of girls, but the individual characteristics were not examined separately.
For example, Peasgood et al. (2016) studied the quality of life and family relationships of ADHD
youth. Both youth with ADHD and their siblings were questioned, but no distinction was made
between how male and female youth experience sibling bullying differently.
In this section of the literature, it is important to make the separation between male and
female youth because they are experience relationships differently. Further, the interactions
between families are different for males and females. Blending the two genders creates broad
assumptions that can be incorrect for one gender. Both the ADHD youth and their siblings
respond differently to situations they encounter in life. Some of the research that did differentiate
between males and females typically did not have an even ratio of male to female participants,
such as Connolly and Vance (2010). Other studies focused exclusively on males (Rabiner et al.,
2005; Jolliffe et al., 2016). Literature is available to assess the tendencies of violent females,
such as Leschied, Cummings, Van Brunschot, Cunningham, and Saunders (2001). Although this
study simply suggested additional research should be conducted to assess girls for ADHD.
Application of male results to females. Another issue in the study of ADHD youth
violence was the tendency to apply the results from male-focused studies to females. The
material from Connolly and Vance (2010) is indicative of this, as the article has a substantially
smaller number of female participants than male yet draws conclusions that are applied to both
genders from the data. This occurred frequently throughout the literature. Often when females
were included in the study, they represented a very small number of the participants. One of the

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themes, peer relations and ADHD, was particularly poor in this regard and tended to apply malefocused results to females.
Very little research has been conducted on female aggression as a result of failed peer
relationships. Mikami and Lorenzi (2011) conducted one of the few studies that addressed this
issue. These findings indicate that females have more difficulty adapting to peer rejection.
Making the distinction between male and female needs is important for policy and program
development. Additionally, female aggression is demonstrated differently than males. Females
may first commit violent acts towards themselves rather than towards others as Leschied et al.
(2001) have demonstrated. Females typically self-harm before they use violence against others.
Independent Diagnosis of ADHD
Another consistent limitation in the literature was the lack of independent diagnosis of
ADHD. Many of the studies relied on a self-reported diagnosis or youth with a cluster of
characteristics that resembled those with ADHD (Evans et al., 2015; Zalot et al., 2009).
Researchers should not depend on a previous diagnosis of ADHD due to the variability of
diagnosis methods. ADHD, like many childhood disorders, is a subjective assessment of
common characteristics. This allows for the diagnosis process to be contingent on the assessor.
Diagnosis is typically conducted using the Diagnostic and Statistical Manual of Mental
Disorders (DSM). The DSM diagnosis provides a subjective diagnosis of the youth. When the
criteria in the DSM changes, entire populations of diagnosed individuals can be affected. For
example, from 1979-1996 three different iterations of the manual were published resulting in the
rate of diagnosis for ADHD increasing 5.4-fold in the United States (Brault & Lacourse, 2012, p.
2).

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Independently diagnosing the youth in a sample population should be sought rather than
relying on a previous diagnosis. Diagnosing the youth independently provides control over the
process to ensure it is done correctly. Further, ADHD is divided into three differing
subcategories: impulsive/hyperactive, inattentive/distractible and combined type (APA, 2015, p.
82). To correctly diagnose a youth the assessor must understand the differing types. Many of the
studies did not identify a specific type that the youth were diagnosed with. Rather it was more
common to refer to the youth as having general ADHD. An independent diagnosis of ADHD
would allow the researcher to assess for one of the specific subtypes. When researching the link
between ADHD and youth violence it is imperative to have a proper diagnosis to focus research
on the specific type of youth. Generalizing ADHD as a disorder characterized by identifiable
traits will diminish the three subtypes and become more difficult to measure characteristics that
are consistent with violence.
Collection of Violence Statistics
The collection of violence statistics was another general area of the research that may
need additional validity testing. Research often relied on self-reporting violence from the youth
or the parents/guardians. This method may be ineffective in gathering data on youth offending
for a variety of reasons. First, the youth are under no obligation to self-report their actual violent
history. The study by Bernat et al. (2012) relies on youth to self-report their violence, which may
incentivize youth to exaggerate their number of actual occurrences. Youth may inflate their
number of violent encounters to appear more socially accepted, as violence can sometimes be
used by youth to gain social notoriety (Rabiner et al., 2005).
The opposite is also at risk of occurring, as youth may neglect to be truthful when selfreporting instances of violence. A youth may do this for a variety of reasons, for example, they

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may not want others to know of their violence, or they may feel others are judging them. The
study conducted by Zalot et al. (2009) used self-reporting surveys to gather data, and while the
entire study is not invalid, the validity must be taken into consideration when using this type of
data. One way for the research to increase its validity is through independent interviews with
youth and others in their lives. Comparing this data against the self-reported statistics boosts the
credibility of the research, as both sets of data can be verified against each other to ensure wellfounded research.
Another way the rates of violence were collected was through the anecdotes of
parents/guardians and educators. There is also a considerable risk when doing this, as parents
may be inclined to hide their child’s true behaviour. The parent may not want to disclose this
information on a survey, or to an interviewer. The guardian may also be unaware of the
behaviour of their child, as the child may hide it, or have limited contact with their parent.
Utilizing educators may be a more effective way to gather data depending on the child’s level of
involvement in school. An educator may spend more time around a child than a parent, therefore
it is important to gather this data to substantiate the information from a parent. Some of the
literature relied on parental anecdotal evidence, for instance, Peasgood et al. (2016). Others,
Connolly and Vance (2010), utilized the method of corroborating the parent data with educators.
ADHD as a Factor in Family Relationships
The family dynamic for youth with ADHD is important, as they typically require
additional support compared to those without the condition (Peasgood et al., 2016). Higher levels
of anxiety, underperformance in school, and a lacking ability to form adequate social
relationships with peers increase the need for the youth to have a social safety net in their family
(Peasgood et al., 2016). This area of research represents both a gap and limitation in the

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literature, as very little research has been conducted on the siblings of ADHD youth and how
they are associated with sibling violence. The study conducted by Peasgood et al. (2016) is one
of the few pieces of literature that address families with ADHD youth. However, this example
has its limits, as there was also very little data collected on the actual siblings themselves.
The additional attention and support required to raise a child with ADHD may create a
rift in the family dynamic more than some of the other side effects. Discovering how this
relationship is associated with ADHD may indicate how youth become aggressive or resort to
violence. Becker et al. (2017) have demonstrated that youth with ADHD have a difficult time
establishing peer relations more so than those without ADHD. But further research is required to
see if this applies to siblings. The effects on a family can be difficult, including a lack of sleep
and siblings bullying the ADHD youth (Peasgood et al., 2016). More research should be
conducted to discover how this relationship affects the youth with ADHD and their inclination to
resort to violence. Additionally, there is minimal research on the siblings of ADHD youth.
Siblings spend a substantial amount of time together and may have insight that other methods of
analysis do not have. Examining this relationship will be important in discovering if any
association exists between sibling relationships and elevated levels of violence.
Discussion
To further the process of the critical appraisal, predictions and suggestions for future
research must be conducted. For this to occur a process was implemented whereby literature
gaps were identified, the surrounding literature was examined and, based on suggestions and
conclusions of other research, predictions were made. When speculating on the future of this
research there was also special consideration to account for future policy implications. The
results of the literature review were also indicative of future research. Some of the themes that

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were consistently identified in that section commonly involved problems, such as the inability
for youth to form adequate relationships. These problems then informed predictions for research
to find solutions.
ADHD and Comorbidity in Youth
Comorbidity is defined as a combination of two mental health disorders occurring within
one individual (Evans et al., 2015). This is a topic of research that has been neglected in the
study of ADHD and its association with violence. ADHD has been studied in conjunction with
other issues in a youth’s life, but its coexistence with other mental health disorders has been
neglected. This is a particularly important topic for future research, as the implication of
additional mental health problems may push youth to engage in violence. Peasgood et al. (2016)
have shown that youth with ADHD may be more at risk for future mental health disorders such
as anxiety or depression. As previously demonstrated, ADHD youth who were victims of
frequent sibling bullying at the age of 12 were also more predisposed to depression, anxiety, or
self-harming behaviour (Peasgood et al., 2016, p. 12). This may suggest that the strain on
siblings caused by ADHD increases the likelihood of developing a comorbid mental health
disorder.
Further research into this topic must consider all associations with conduct and defiance
disorders in youth. Youth ADHD and violence research would be heavily impacted by
exploration in this area, as the results would indicate how youth become violent. Peasgood et al.
(2016) examined the implications of defiance and oppositional disorders on youth violence, and
their impact on the quality of a youth’s life. The study indicates that comorbid disorders, with a
focus on defiance disorders, is an area that requires future research. Further, the research would
be better served if there was an indication as to the type of ADHD associated with comorbidity.

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The three different clusters of comorbidities create challenges when assessing for ADHD. This
information would assist in furthering the field of research to help address a potential cause of
violence in ADHD youth and how to provide solutions to the problem.
Female Approach to ADHD Youth Violence
ADHD is typically diagnosed and found more in male youth than in female youth
(Mikami & Lorenzi, 2011). Additionally, the problems faced by male youth and female youth
are considerably different. This is another opportunity for study, as females are under-researched
in the ADHD and youth violence field. While the number of diagnosed female youth is lower
than males, there is still a need to examine them as they represent a portion of the violent
offences committed. The social experiences of female and male youth are different also, as
females may face more of a challenge in both peer and family settings. Research conducted by
Mikami and Lorenzi (2011) refers specifically to female youth, but this is one of the few
research articles conducted in this field so far. While this study does provide valuable
information, it requires additional follow up to build upon this research.
The topic of gender and youth crime may provide considerable insight into the types of
violence that youth commit. Female youth may express their anger and violent behaviours in
other ways than males. For example, Leschied et al. (2001) found that aggressive female youth
are more likely to commit acts of self-harm before violence towards others. Research such as this
should be expanded upon to see if it is consistent with ADHD girls.
Distinguishing Between Varying Levels of Violence
The type of violent act that a youth commits is another important consideration when
researching in this area. Future research will need to examine what types of violent offences
youth commit, as this will assist in developing programs to target these specific indicators.

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21

Assault with a weapon is a dramatically different display of aggression than a child uttering
threats. As research has yet to explore this area, any future literature should consider the type and
severity of offences committed by youth. This research would assist in developing strategies for
combating the serious assaults that are committed. Additionally, discovering the precipitating
events that encourage youth to commit violence will be important for policymakers. Concurrent
research is supportive of this, as Evans et al. (2015) suggested that differentiation between the
types of violence provides considerable value to the field.
Wojciechowski (2017) is another scholar in support of this area of research and provides
direction for the future. This study suggested that the types of diagnosable ADHD need to be
further examined to assist in violence prevention. Future research should devote considerable
time to this method. If a youth’s level of violence can be predicted by their cluster of behaviour,
this will provide invaluable insight into preventing future violence. Specific programming could
be developed for youth who are significantly more prone to violence with a particular cluster of
ADHD.
Inclusion of Multiple Ethnicities
Another approach this area of research would benefit from greatly is in the discovery of
ethnically diverse approaches to ADHD and youth violence. A large portion of this literature is
based on the Western approaches to ADHD and youth violence. A better way to promote the
topic would be through an analysis of youth from various ethnic backgrounds. There appeared to
be two trends in the literature; the first being a focus on one racial group specifically, a majority
being black or white males. The other approach was more general, where a sample of blended
ethnicities was studied. Perhaps for future examination of this topic, an approach should be
undertaken to specifically analyze other ethnic groups, such as Asian or Hispanic. Policies could

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be created using the results from these studies, as certain ethnicities or geographical areas may be
more prone to violence than others. Neighbourhoods and pockets of certain ethnic groups could
be examined, and policy framed to deal with these youth specifically.
ADHD has been considered a North American condition, with rates of diagnosis higher
in Western countries (Faraone, Sergeant, Gillberg, & Biederman, 2003). It may appear as though
ADHD is found in North America more often; this may be due to several factors. Faraone et al.
found that ADHD is consistent among youth across the world (2003, p. 8). If this is true, then
why is ADHD diagnosed at a rate of 2.6% in Canada (Brault & Lacourse, 2012, p. 4)?
Contrasting the Canadian rates with the rates of the world, approximately 6-7%, may provide
insight into the diagnosis in other ethnicities and geographical areas (Willcutt, 2012, p. 9). The
research should be conducted in other nations and compared to the level of violence. With this
information the violence rates of youth in other countries could be compared to the rates in North
America. This may describe certain characteristics that are consistent with some ethnic groups,
and inconsistent with others. Further, there has been very little research conducted on whether
one ethnic group is specifically more inclined to violence due to ADHD. This research will
provide more insight into how to create policies and programs to help prevent future ADHD
youth violence.
Strategies for Managing Violent ADHD Youth
This is the most encompassing speculative area of research for violent ADHD youth. To
implement successful strategies and policy to reduce ADHD youth offending, the previous gaps
need to be examined. A generalized policy or program cannot consider the multiplicity of factors
that increase violence in youth. Additionally, the literature review suggests that educational
facilities may be an area to focus future research and strategies. The lack of research on factors,

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such as gender, ethnicity, and the side effects of ADHD results in a critical lack of information.
However, as many studies have discussed, the body of research is heading in the direction of
informing policy for the future (Wojciechowski, 2017; Evans et al., 2015; Lynam et al., 2000).
Research has discussed these implications for a considerable amount of time, as Lynam et
al. (2000) explained “They serve to remind us that accounts of antisocial behaviour that rely on
either trait or situational explanations alone are incomplete” (p. 10). This indicates that there are
many factors to be considered when developing strategies for reducing ADHD youth violence.
Perhaps, when developing policies for diagnosing youth, a better tool should be considered
rather than the current DSM. The variability and changing criteria contained within the DSM
create problems with consistency for diagnosing youth.
Current strategies of ADHD management are typically conducted through medication.
Medication is not the only type of strategy, as preventative programming has also been
developed, such as utilizing education for parents and educators. Eichelberger et al. (2016)
researched this topic and provided insight for programming that should be conducted in the
future. Their research is an example of the type of programming and policy the present study
attempts to inform. Eichelberger et al. (2016) assesses the side effects of ADHD and attempts to
reduce the harm they cause to the youth and others. By implementing parental and educator
training for ADHD youth, they found a subsequent reduction in violent behaviour in which
ADHD youth engaged (Eichelberger et al., 2016).
The results of this critical appraisal validate the research conducted by Eichelberger et al.
(2016) as many of the same characteristics, such as family dynamic and educational
achievement, were assessed when drawing conclusions. This is an area of research that should be

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expanded upon in the future. Research that isolates the most detrimental characteristics of
ADHD and supports the youth to overcome the disorder is greatest for policy development.
This research would suggest that an educational setting would be the preferable area to
implement strategies to assist ADHD youth. Due to the difficulty experienced in the educational
atmosphere, these youth would greatly benefit from additional programming. The needs of the
child would have to be considered, as those with an impulsive cluster may require more
stimulation than youth with a hyperactive cluster. By tailoring programming to the specific needs
of the youth future violence may be negated.
Conclusion
There is consistent thought among scholars that ADHD is associated with elevated levels
of youth violence. The characteristics of ADHD make some youth more predisposed to engage
in violent behaviour than youth without the disorder. There are still many gaps in this body of
literature, therefore it is important to critically appraise the information. The appraisal process
will assist in policy development for youth who are currently facing the challenges that ADHD
presents. To advance the field, this literature must continually undergo an analysis of its conduct
and credibility. This will push the research into new territory and allow for better policy and
programming to be created.
Additionally, certain themes emerged that were examined through critical analysis.
Gender and the state of the family dynamic represented large gaps in the literature. Further
analysis led to the discovery of limitations found consistently such as how the studies collected
information and the diagnosis of ADHD. The gaps and limitations found will assist to further the
topic, as the present study can inform future work. This is where the strength of a critical

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25

analysis lies, as this will inform future strategies and policy development for decreasing ADHD
youth violence.
The purpose of this analysis was not to present new policy or programs, but rather to
assess the current research and address future programming. As previously discussed, ADHD
causes many side effects throughout a youth’s life, and will, in some instances, lead to violent
behaviour. This research is best utilized in informing preventative programming and policy to
reduce the effects on families and youth. By conducting this appraisal of the literature future
strategies will be developed to reduce the violence and ADHD youth.

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Appendix
Search Strategy Chart
Search strategy 1

impuls* and youth violence

Number of hits

836

Inclusion criteria

Scholarly (peer reviewed) journals, academic journals, material in English,
articles published within 2000-2020
Terms: mental health, mental illness. Other criteria: news articles, magazines,
periodicals, articles published prior to 2000
48

Exclusion criteria
Revised number of hits

Search strategy 2

ADHD or "attention deficit hyperactivity disorder" (field of search: title) AND
Aggress* or violen* (field of search: title) AND youth or adolescents (field of
search not specified)

Number of hits

404

Inclusion criteria

Scholarly (peer reviewed) journals, academic journals, material in English,
articles published within 2000-2020,

Exclusion criteria

Terms: mental health, mental illness. Other criteria: news articles, magazines,
periodicals, articles published prior to 2000

Revised number of hits

140