Risk and resilience: adverse and positive childhood experiences and aggression in adults with and without ADHD

Identifying risk and protective factors for aggressive behavior is central to effective violence prevention and public safety. In forensic psychiatry, attention-deficit/hyperactivity disorder (ADHD) is common among offenders and is linked to adverse childhood experiences (ACEs) on the one hand and increased aggression on the other hand. Yet, the mechanisms connecting these factors remain insufficiently understood. Evidence on the protective potential of positive childhood experiences (PCEs), particularly when considered alongside ACEs, is also limited.

Guided by resilience theory and a compensatory resilience model, this study analyzed the dynamics among self-reported ACEs, PCEs, and current aggression in an ADHD subsample (n = 154) and a non-ADHD population (n = 205) using hierarchical linear regression analyses.

Compared with the non-ADHD group, adults with ADHD reported higher ACE loads, lower PCE scores, and greater aggressive tendencies. In both subsamples, ACEs significantly predicted higher aggression. Among individuals without ADHD, PCEs demonstrated an independent protective association with aggression after adjusting for ACEs and attenuated the ACE-aggression association. This compensatory effect of PCEs was not observed in the ADHD group. Overall, the harmful influence of ACEs on adult aggression appeared to outweigh any mitigating role of PCEs, particularly among individuals with ADHD.

ACEs emerged as a robust correlate of current aggression in adults with and without ADHD, underscoring the need to systematically integrate developmental adversity into forensic risk assessment. For individuals with ADHD, violence prevention and public safety strategies may particularly benefit from early prevention and reduction of childhood adversity, trauma-focused interventions where indicated, and evidence-based ADHD treatment to limit the impact of ADHD-related impairments on dynamic aggression-related risk factors. For individuals without ADHD, prevention and rehabilitation efforts may be strengthened by simultaneously reducing ACEs and actively promoting PCEs as resilience-enhancing conditions.