Skip to main content Accessibility help
Hostname: page-component-77c89778f8-vpsfw Total loading time: 0 Render date: 2024-07-19T21:32:30.121Z Has data issue: false hasContentIssue false

Chapter 10 - Comorbid Mental Disorders and Neurodevelopmental Conditions

from Section 1 - An Overview: Definitions, Epidemiology and Policy Issues

Published online by Cambridge University Press:  18 May 2023

Jane M. McCarthy
Sussex Partnership NHS Foundation Trust and University of Auckland
Regi T. Alexander
Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire
Eddie Chaplin
Institute of Health and Social Care, London South Bank University
Get access


The link between neurodevelopmental disorders and offending behaviour is examined in other chapters of this book. This chapter’s focus is on the comorbidity between neurodevelopmental conditions and psychiatric disorders, when a person with one or more neurodevelopmental condition develops additional mental health problems. Specifically, the impact of such comorbidity in the development and maintenance of offending behaviour is addressed. In doing so, the authors examine each of the major neurodevelopmental disorders (intellectual disability, autism spectrum disorder and attention deficit hyperactivity disorder separately in the light of up-to-date evidence for each condition. The importance of identifying the presence of comorbid psychiatric disorders, including substance use disorder, is highlighted as essential in the diagnostic evaluation of those with neurodevelopmental conditions presenting with offending behaviour.

Forensic Aspects of Neurodevelopmental Disorders
A Clinician's Guide
, pp. 112 - 124
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Young, S, González, RA, Mullens, H, Mutch, L, Malet-Lambert, I, Gudjonsson, GH. Neurodevelopmental disorders in prison inmates: comorbidity and combined associations with psychiatric symptoms and behavioural disturbance. Psychiatry Research 2018; 1(261): 109–15.Google Scholar
McCarthy, J, Chaplin, E, Forrester, A, Underwood, L, Hayward, H, Sabet, J, et al. Prisoners with neurodevelopmental difficulties: vulnerabilities for mental illness and self‐harm. Criminal Behaviour and Mental Health 2019; 29(5–6): 308–20.Google Scholar
Cooper, SA, Smiley, E, Morrison, J, Williamson, A, Allan, L. Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. British Journal of Psychiatry 2007; 190(1): 2735.Google Scholar
King, C, Murphy, G. A systematic review of people with autism spectrum disorder and the criminal justice system. Journal of Autism and Developmental Disorders 2014; 44(11): 2717–33.Google Scholar
Reale, L, Bartoli, B, Cartabia, M, Zanetti, M, Costantino, MA, Canevini, MP, et al. Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. European Child & Adolescent Psychiatry 2017; 26(12): 1443–57.CrossRefGoogle ScholarPubMed
Thomas, SDM, Nixon, M, Ogloff, JRP, Daffern, M. Crime and victimization among people with intellectual disability with and without comorbid mental illness. Journal of Applied Research in Intellectual Disabilities 2019; 32(5): 1088–95.Google Scholar
Department of Health. The Bradley Report: Lord Bradley’s review of people with mental health problems or learning disabilities in the criminal justice system. Available at: Scholar
Hellenbach, M, Karatzias, T, Brown, M. Intellectual disabilities among prisoners: prevalence and mental and physical health comorbidities. Journal of Applied Research in Intellectual Disabilities 2016; 30(2): 230–41.Google Scholar
Fogden, B, Thomas, S, Daffern, M, Ogloff, J, Crime and victimisation in people with intellectual disability: a case linkage study. BMC Psychiatry 2016; 16: 170.Google Scholar
Cooper, SA, Melville, CA, Einfeld, SL. Psychiatric diagnosis, intellectual disabilities and diagnostic criteria for psychiatric disorders for use with adults with learning disabilities/mental retardation (DC-LD). Journal of Intellectual Disability Research 2003; 47(1): 315.Google Scholar
Sheehan, R, Hassiotis, A, Walters, K, Osborn, D, Strydom, A, Horsfall, L. Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study. BMJ 2015; 351: h4326.CrossRefGoogle ScholarPubMed
Hassiotis, A, Gazizova, D, Akinlonu, L, Bebbington, P, Meltzer, H, Strydom, A. Psychiatric morbidity in prisoners with intellectual disabilities: analysis of prison survey data for England and Wales. British Journal of Psychiatry 2011; 199(2): 156–7.Google Scholar
Chaplin, E, McCarthy, J, Underwood, L, Forrester, A, Hayward, H, Sabet, J, et al. Characteristics of prisoners with intellectual disabilities. Journal of Intellectual Disability Research 2017; 61(12): 1185–95.Google Scholar
Salekin, KL, Olley, JG, Hedge, KA. Offenders with intellectual disability: characteristics, prevalence, and issues in forensic assessment. Journal of Mental Health Research in Intellectual Disabilities 2010; 3(2): 97116.CrossRefGoogle Scholar
Marshall-Tate, K, Chaplin, E, Ali, S, Hardy, S. Learning disabilities: supporting people in the criminal justice system. 2019. Available at: Scholar
Scott, H, Havercamp, S. Comparison of self- and proxy report of mental health symptoms in people with intellectual disabilities. Journal of Mental Health Research in Intellectual Disabilities 2018; 11(2): 143–56.Google Scholar
McKinnon, I, Thorp, J, Grubin, D. Improving the detection of detainees with suspected intellectual disability in police custody. Advances in Mental Health and Intellectual Disabilities 2015; 9(4): 174–85.CrossRefGoogle Scholar
HMI Probation and HMI Prisons A joint inspection of the treatment of offenders with learning disabilities in the criminal justice system – phase 2 in custody and the community. 2015. Available at:>/cjji/wp-content/uploads/sites/2/2015/03/Learning-Disabilities-phase-two-report.pdf./cjji/wp-content/uploads/sites/2/2015/03/Learning-Disabilities-phase-two-report.pdf.>Google Scholar
Talbot, J. Experiences of the criminal justice system by prisoners with learning disabilities. 2008. Available at: Scholar
O’Brien, G, Taylor, J, Lindsay, W, Holland, A, Carson, D, Steptoe, L, et al. A multi‐centre study of adults with learning disabilities referred to services for antisocial or offending behaviour: demographic, individual, offending and service characteristics. Journal of Learning Disabilities and Offending Behaviour 2010; 1(2): 515.CrossRefGoogle Scholar
Alexander, R, Hiremath, A, Chester, V, Green, F, Gunaratna, I, Hoare, S. Evaluation of treatment outcomes from a medium secure unit for people with intellectual disability. Advances in Mental Health and Intellectual Disabilities 2011; 5(1): 2232.CrossRefGoogle Scholar
Wooster, L, McCarthy, J, Chaplin, E. Outcomes of an inner city forensic intellectual disability service. Journal of Intellectual Disabilities and Offending Behaviour 2018; 9(1): 18.CrossRefGoogle Scholar
Klimecki, MR, Jenkinson, J, Wilson, L. A study of recidivism among offenders with an intellectual disability. Australia and New Zealand Journal of Developmental Disabilities 2009; 19: 209–19.Google Scholar
Royal College of Psychiatrists. Forensic care pathways for adults with intellectual disability involved with the criminal justice. Available at: Scholar
Levy, SE, Mandell, DS, Schultz, RT. Autism. Lancet 2009; 374(9701): 1627–38.Google Scholar
Bradley, E, Bolton, P. Episodic psychiatric disorders in teenagers with learning disabilities with and without autism. British Journal of Psychiatry 2006; 189: 361–6.CrossRefGoogle ScholarPubMed
Royal College of Psychiatrists. The psychiatric management of autism in adults College Report 228. 2020. Available at: Scholar
Selten, JP, Lundberg, M, Rai, D, Magnusson, C. Risks for nonaffective psychotic disorder and bipolar disorder in young people with autism spectrum disorder: a population-based study. JAMA Psychiatry 2015; 72(5): 483–9.Google Scholar
Lugo-Marin, J, Rodríguez-Franco, MA, Mahtani Chugani, V, Magán Maganto, M, Díez Villoria, E, Canal Bedia, R. Prevalence of psychiatric disorder in adults with ASD spectrum disorder: a systematic review and meta-analysis. Research in ASD Spectrum Disorders 2019; 59: 2233.CrossRefGoogle Scholar
McCarthy, J, Hemmings, C, Kravariti, E, Dworzynski, K, Holt, G, Bouras, N, Tsakanikos, E. Challenging behaviour and co-morbid psychopathology in adults with intellectual disability and autism spectrum disorders. Research in Developmental Disabilities 2010; 31: 362–6.CrossRefGoogle ScholarPubMed
Carey, C, Clear, D, Robertson, D. Mental health morbidity across the lifespan. In Chaplin, E, Spain, D, McCarthy, J, eds., A Clinician’s Guide to Mental Health Conditions in Adults with Autism Spectrum Disorders, Jessica Kingsley Publishers, 2020: 2439.Google Scholar
Chaplin, E, McCarthy, J. Substance use disorders. In Chaplin, E, Spain, D, McCarthy, J, eds., A Clinician’s Guide to Mental Health Conditions in Adults with Autism Spectrum Disorders, Jessica Kingsley Publishers, 2020: 373–86.Google Scholar
Arseneault, L, Moffitt, TE, Caspi, A, Taylor, PJ, Silva, PA. Mental disorders and violence in a total birth cohort: results from the Dunedin Study. Archives of General Psychiatry 2000; 57(10): 979–86.Google Scholar
Langstrom, N, Grann, M, Ruchkin, V, Sjostedt, G Fazel, S. Risk factors for violent offending in autism spectrum disorder: a national study of hospitalised individuals. Journal of Interpersonal Violence 2009; 24(8): 1358–70.CrossRefGoogle Scholar
Allen, D, Evans, C, Hider, A, Hawkins, S, Pecket, H, Morgan, H. Offending behaviour in adults with Asperger syndrome. Journal of ASD and Developmental Disorders 2008; 38(4): 748–58.Google Scholar
Newman, SS, Ghaziuddin, M. Violent crime in Asperger syndrome: the role of psychiatric comorbidity. Journal of ASD and Developmental Disorders 2008; 38(10): 1848.Google Scholar
Wachtel, LE, Shorter, E. ASD plus psychosis: a ‘one–two punch’ risk for tragic violence? Medical Hypotheses 2013; 81: 404–9.Google Scholar
Haw, C, Radley, J, Cooke, L. Characteristics of male autistic spectrum patients in low security: are they different from non-autistic low secure patients? Journal of Intellectual Disability & Offending Behaviour 2013; 4(1/2): 2432.Google Scholar
Søndenaa, E, Helverschou, SB, Steindal, K, Rasmussen, K, Nilsson, B, Nøttestad, JA. Violence and sexual offending behaviour in people with autism spectrum disorder who have undergone a forensic examination. Psychological Reports: Disability & Trauma 2014; 115(1): 3243.CrossRefGoogle ScholarPubMed
Wilens, T, Biederman, J, Faraone, S, Martelon, M, Westerberg, D, Spencer, T. Presenting ADHD symptoms, subtypes, and comorbid disorders in clinically referred adults with ADHD. Journal of Clinical Psychiatry 2009; 70(11): 1557–62.Google Scholar
Milberger, S, Biederman, J, Faraone, SV, Murphy, J, Tsuang, ST. ADHD and comorbid disorders: issues of overlapping symptoms. American Journal of Psychiatry 1995; 152(12): 1793–9.Google Scholar
Boland, H, DiSalvo, M, Fried, R, Woodworth, KY, Wilens, T, Faraone, SV, et al. A literature review and meta-analysis on the effects of ADHD medications on functional outcomes. Journal of Psychiatric Research 2020; 123: 2130.Google Scholar
Lichtenstein, P, Halldner, L, Zetterqvist, J, Sjölander, A, Serlachius, E, Fazel, S, et al. Medication for attention deficit–hyperactivity disorder and criminality. New England Journal of Medicine 2012; 367(21): 2006–14.CrossRefGoogle ScholarPubMed
Brus, MJ, Solanto, MV, Goldberg, JF. Adult ADHD vs. bipolar disorder in the DSM-5 era: a challenging differentiation for clinicians. Journal of Psychiatric Practice 2014; 20(6): 428–37.Google Scholar
Masi, G, Perugi, G, Toni, C, Millepiedi, S, Mucci, M, Bertini, N, Pfanner, C. ADHD–bipolar comorbidity in children and adolescents. Bipolar Disorders 2006; 8(4): 378–81.Google Scholar
Wilens, TE. ADHD and the substance use disorders. In Buitelaar, JK, Kan, CC, Asherson, P, eds., ADHD in Adults: Characterisation, Diagnosis and Treatment. Cambridge University Press, 2011: 174–90.Google Scholar
Kessler, RC, Adler, L, Barkley, R, Biederman, J, Conners, CK, Demler, O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry 2006; 163(4): 716–23.CrossRefGoogle ScholarPubMed
Schatz, DB, Rostain, AL. ADHD and comorbid anxiety: a review of the current literature. Journal of Attention Disorders 2006; 10(2): 141–9.Google Scholar
Van Dijk, FE, Anckasaeter, H. ADHD, personality and its disorders. In Buitelaar, JK, Kan, CC, Asherson, P, eds., ADHD in Adults: Characterisation, Diagnosis and Treatment. Cambridge University Press, 2011: 174–90.Google Scholar
Hofvander, B, Ossowski, B, Lundstrom, S, Anckarsaeter, H. Continuity of aggressive antisocial behaviour from childhood to adulthood: the question of phenotype definition. International Journal of Law and Psychiatry 2009; 32(4): 224–34.Google Scholar
Fossati, A, Novella, I, Donati, D, Donini, M, Maffei, C. History of childhood ADHD symptoms and borderline personality disorder: a controlled study. Comprehensive Psychiatry 2002; 43: 369–77.Google Scholar
Young, S, Moss, D, Sedgwick, O, Fridman, M, Hodgkins, P. A meta-analysis of the prevalence of attention deficit hyperactivity disorder in incarcerated populations. Psychological Medicine 2015; 45(2): 247–58.Google Scholar
Young, S, González, RA, Wolff, K, Xenitidis, K, Mutch, L, Malet-Lambert, I, et al. Substance and alcohol misuse, drug pathways, and offending behaviors in association with ADHD in prison inmates. Journal of Attention Disorders 2020; 24(13): 1905–13.Google Scholar
Young, S, Wells, J, Gudjonsson, GH. Predictors of offending among prisoners: the role of attention-deficit hyperactivity disorder and substance use. Journal of Psychopharmacology 2011; 25(11): 1524–32.Google Scholar
Mannuzza, S, Klein, RG, Moulton, JL. Lifetime criminality among boys with attention deficit hyperactivity disorder: a prospective follow-up study into adulthood using official arrest records. Psychiatry Research 2008; 160(3): 237–46.CrossRefGoogle ScholarPubMed
Vélez-Pastrana, MC, González, RA, Ramos-Fernández, A, Padilla, RR, Levin, FR, García, CA. Attention deficit hyperactivity disorder in prisoners: increased substance use disorder severity and psychiatric comorbidity. European Addiction Research 2020; 26(4–5): 179–90.Google Scholar
Gudjonsson, GH, Sigurdsson, JF, Sigfusdottir, ID, Young, S. A national epidemiological study of offending and its relationship with ADHD symptoms and associated risk factors. Journal of Attention Disorders 2014; 18(1): 313.Google Scholar
Mohr-Jensen, C, Bisgaard, CM, Boldsen, SK, Steinhausen, HC. Attention-deficit/hyperactivity disorder in childhood and adolescence and the risk of crime in young adulthood in a Danish nationwide study. Journal of the American Academy of Child and Adolescent Psychiatry 2019; 58(4): 443–52.Google Scholar
Eisenbarth, H, Alpers, GW, Conzelmann, A, Jacob, CP, Weyers, P, Pauli, P. Psychopathic traits in adult ADHD patients. Personality and Individual Differences 2008; 45(6): 468–72.Google Scholar
Karlén, MH, Nilsson, T, Wallinius, M, Billstedt, E, Hofvander, B. A Bad Start: The combined effects of early onset substance use and ADHD and CD on criminality patterns, substance abuse and psychiatric comorbidity among young violent offenders. Journal for Person-Oriented Research 2020; 6(1): 3955.Google Scholar
Stickley, A, Koposov, R, Koyanagi, A, Inoue, Y, Ruchkin, V. ADHD and depressive symptoms in adolescents: the role of community violence exposure. Social Psychiatry and Psychiatric Epidemiology 2019; 54(6): 683–91.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats