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It Takes Two: Intimate Partner Violence According to Both Partners in Young Adult ADHD Couples

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Title: It Takes Two: Intimate Partner Violence According to Both Partners in Young Adult ADHD Couples
Language: English
Authors: Brian T. Wymbs (ORCID 0000-0002-8530-5211), Christie T. Pickel, Steven W. Evans (ORCID 0000-0002-7283-2274), Peggy M. Zoccola (ORCID 0000-0001-5709-0092), Ryan C. Shorey (ORCID 0000-0002-0927-3959), Levi M. Toback
Source: Journal of Attention Disorders. 2026 30(2):222-233.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 12
Publication Date: 2026
Sponsoring Agency: National Institute on Alcohol Abuse and Alcoholism (NIAAA) (DHHS/NIH)
Contract Number: R21AA025182
Document Type: Journal Articles
Reports - Research
Descriptors: Young Adults, Attention Deficit Hyperactivity Disorder, Victims, Incidence, Violence, Intimacy, Family Violence, Aggression, Psychological Patterns
Geographic Terms: Ohio
Assessment and Survey Identifiers: Conflict Tactics Scale
DOI: 10.1177/10870547251382679
ISSN: 1087-0547
1557-1246
Abstract: Objective: Attention-deficit/hyperactivity disorder (ADHD) has been shown to increase the risk of young adults perpetrating and being victims of intimate partner violence (IPV). However, research has yet to examine the IPV experiences of both dyad members where one or both partners has ADHD, and how those experiences differ from couples including partners without ADHD. Methods: 41 "ADHD couples" (m age = 22.7 years), where one (n = 33) or both (n = 8) dyad members had ADHD, and 28 "Non-ADHD couples" (m age = 23.4 years), where both dyad members did not have ADHD, participated. Both partners reported on the frequency they perpetrated and were victims of psychological and physical IPV. Results: Both partners in ADHD couples reported perpetrating more psychological and physical IPV than dyad members in Non-ADHD couples. Partners in ADHD couples also reported being victims of IPV more than partners in Non-ADHD couples. Conclusions: The risk of IPV perpetration in young adult couples with ADHD appears to be a two-way street. Research is needed to examine possible explanations for this pattern of reciprocal IPV, including mutual ADHD symptoms and related behavior (e.g., alcohol intoxication).
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1496132
Database: ERIC
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  Value: <anid>AN0190716728;gs001feb.26;2026Jan09.04:47;v2.2.500</anid> <title id="AN0190716728-1">It Takes Two: Intimate Partner Violence According to Both Partners in Young Adult ADHD Couples </title> <p>Objective: Attention-deficit/hyperactivity disorder (ADHD) has been shown to increase the risk of young adults perpetrating and being victims of intimate partner violence (IPV). However, research has yet to examine the IPV experiences of both dyad members where one or both partners has ADHD, and how those experiences differ from couples including partners without ADHD. Methods: 41 "ADHD couples" (m age = 22.7 years), where one (n = 33) or both (n = 8) dyad members had ADHD, and 28 "Non-ADHD couples" (m age = 23.4 years), where both dyad members did not have ADHD, participated. Both partners reported on the frequency they perpetrated and were victims of psychological and physical IPV. Results: Both partners in ADHD couples reported perpetrating more psychological and physical IPV than dyad members in Non-ADHD couples. Partners in ADHD couples also reported being victims of IPV more than partners in Non-ADHD couples. Conclusions: The risk of IPV perpetration in young adult couples with ADHD appears to be a two-way street. Research is needed to examine possible explanations for this pattern of reciprocal IPV, including mutual ADHD symptoms and related behavior (e.g., alcohol intoxication).</p> <p>Keywords: adult ADHD; intimate partner violence; romantic relationships</p> <hd id="AN0190716728-2">Introduction</hd> <p>Intimate partner violence (IPV), defined as the use of psychological aggression (i.e., verbal and non-verbal communication with the intent to harm or exert control) or physical aggression (i.e., intentional physical force with the potential for causing injury or harm) with a spouse or dating/sexual partner ([<reflink idref="bib9" id="ref1">9</reflink>]), is a significant public health concern. In a recent national investigation ([<reflink idref="bib33" id="ref2">33</reflink>]), nearly half of women and men reported experiencing psychological aggression from partners in their lifetimes and more than two in five women and men reported ever being victims of physical aggression perpetrated by partners. Initial IPV victimization tends to be in emerging adulthood (ages 18–25 years) for women and men ([<reflink idref="bib33" id="ref3">33</reflink>]). IPV victims are likely to experience a host of adverse psychological and medical concerns (e.g., PTSD symptoms, physical injuries, insomnia, chronic pain) that cause impairment in key domains (e.g., missing workdays; [<reflink idref="bib33" id="ref4">33</reflink>]). To reduce the incidence and impact of IPV, an essential step is to identify young adults prone to IPV perpetration and victimization.</p> <p>Recent empirical work indicates attention-deficit hyperactivity disorder (ADHD) increases risk for IPV perpetration and victimization ([<reflink idref="bib4" id="ref5">4</reflink>]; [<reflink idref="bib12" id="ref6">12</reflink>]). ADHD is a neurodevelopmental disorder characterized by developmentally inappropriate levels of inattention, hyperactivity, and impulsivity ([<reflink idref="bib3" id="ref7">3</reflink>]) and is one of the most common mental health disorders in children (11%) and adults (4%; [<reflink idref="bib30" id="ref8">30</reflink>]; [<reflink idref="bib44" id="ref9">44</reflink>]). Relationship dysfunction is one of the hallmark domains of impairment among youth with ADHD ([<reflink idref="bib28" id="ref10">28</reflink>]; [<reflink idref="bib36" id="ref11">36</reflink>]), and this dysfunction persists into adulthood for many adults with childhood histories of ADHD ([<reflink idref="bib5" id="ref12">5</reflink>]; [<reflink idref="bib7" id="ref13">7</reflink>]). Notably, adults with ADHD often report romantic relationship difficulties ([<reflink idref="bib56" id="ref14">56</reflink>]), including lower relationship satisfaction, higher levels of hostile/negative conflict behavior, and less positive conflict resolution behavior than reported by adults without ADHD ([<reflink idref="bib10" id="ref15">10</reflink>]; [<reflink idref="bib14" id="ref16">14</reflink>]). Partners of adults with ADHD report that their partners' symptoms interfere with their functioning in domains crucial for sustaining healthy romantic relationships, including emotion regulation ([<reflink idref="bib19" id="ref17">19</reflink>]; [<reflink idref="bib46" id="ref18">46</reflink>]). Unsurprisingly, difficulties with conflict resolution and self-regulation are robust predictors of IPV perpetration ([<reflink idref="bib22" id="ref19">22</reflink>]; [<reflink idref="bib40" id="ref20">40</reflink>]) and may explain why many adults with ADHD perpetrate IPV ([<reflink idref="bib60" id="ref21">60</reflink>], [<reflink idref="bib57" id="ref22">57</reflink>]).</p> <p>Though current evidence suggests ADHD increases risk of IPV, the literature base (reviewed below) has a key omission: no studies have asked the romantic partners of adults with ADHD to report on their own IPV perpetration or victimization. This limitation stands out for three reasons. First, IPV mutuality (e.g., partner A hits partner B, partner B hits partner A) is common and associated with severe IPV behavior and sequelae (e.g., injuries; [<reflink idref="bib49" id="ref23">49</reflink>], [<reflink idref="bib50" id="ref24">50</reflink>]). Only probing rates of IPV perpetration and victimization reported by the individual with ADHD, and not reported by both partners in the couple, misses the opportunity to determine if both partners are perpetrators and victims of IPV, and thus at risk for adverse consequences. Second, adults with ADHD persisting from childhood appear likely to select romantic partners with elevated ADHD symptoms ([<reflink idref="bib48" id="ref25">48</reflink>]; [<reflink idref="bib59" id="ref26">59</reflink>]), which is associated with high rates of IPV perpetration and victimization ([<reflink idref="bib48" id="ref27">48</reflink>]). Third, extant theoretical models of IPV (e.g., [<reflink idref="bib34" id="ref28">34</reflink>]) hypothesize that risk for IPV is largely a dyadic process that requires the interaction between dyad members, with research supporting the dyadic, bidirectional nature of IPV among couples ([<reflink idref="bib52" id="ref29">52</reflink>]). For these reasons, this study asked both partners in couples with and without ADHD persisting from childhood to report on their rates of IPV perpetration and victimization. Study findings may shed light on the degree of IPV mutuality in couples with ADHD histories, which could ultimately elucidate paths for interventions to lessen the risk and severity of IPV (e.g., including one or both partners in treatment to reduce perpetration/victimization).</p> <hd id="AN0190716728-3">ADHD and IPV</hd> <p>According to systematic reviews of the IPV literature, there are numerous risk factors for emerging adults perpetrating and being victims of IPV ([<reflink idref="bib15" id="ref30">15</reflink>]). [<reflink idref="bib23" id="ref31">23</reflink>] categorized IPV risk variables into background and personal attributes, including long-standing mental health problems, and current lifestyle behaviors, such as alcohol and drug use. One population with longstanding, chronic difficulties with self-regulation and impulsivity—attributes which are robust risk factors for IPV ([<reflink idref="bib15" id="ref32">15</reflink>]), as well as behavioral tendencies that increase risk of IPV (e.g., problematic alcohol use and use of illicit drugs; [<reflink idref="bib32" id="ref33">32</reflink>]), are adults with ADHD.</p> <p>As theorized, though not without exceptions (e.g., [<reflink idref="bib47" id="ref34">47</reflink>]), most prior research demonstrates that ADHD increases risk of IPV perpetration. In their meta-analytic review, [<reflink idref="bib4" id="ref35">4</reflink>] found that ADHD increased odds of any IPV perpetration (odds ratio = 2.50). ADHD has been shown to be a risk factor for perpetrating physical IPV among young men and women (<emph>m</emph> age = 22.0 years) reporting elevated ADHD symptoms in childhood ([<reflink idref="bib21" id="ref36">21</reflink>]) and in an emerging adult sample of men (<emph>m</emph> age = 19.8–20.0 years) diagnosed with ADHD as children ([<reflink idref="bib60" id="ref37">60</reflink>]). [<reflink idref="bib60" id="ref38">60</reflink>] also showed childhood ADHD histories predicted men who would perpetrate psychological IPV. More recent work by Wymbs and colleagues has continued to document the risk of physical and psychological IPV perpetration among young men and women (<emph>median</emph> age = 19.1 years) with elevated current ADHD symptoms ([<reflink idref="bib58" id="ref39">58</reflink>]) and among young men and women (<emph>m</emph> age = 27.3–28.6 years) diagnosed with ADHD as children, especially those with elevated current symptoms ([<reflink idref="bib57" id="ref40">57</reflink>]).</p> <p>Research also highlights that ADHD is associated with increased odds of reporting IPV victimization (odds ratio = 1.78; [<reflink idref="bib4" id="ref41">4</reflink>]). Studies have demonstrated a risk of physical IPV victimization among emerging adult females (<emph>m</emph> age = 19.6 years) diagnosed with ADHD in childhood ([<reflink idref="bib24" id="ref42">24</reflink>]) as well as a risk of psychological and physical IPV victimization among young adult men and women with elevated current ADHD symptoms, especially those who also had childhood ADHD histories ([<reflink idref="bib58" id="ref43">58</reflink>]; [<reflink idref="bib57" id="ref44">57</reflink>]). Altogether, there is evidence to suggest that adults with elevated ADHD symptoms, particularly those with symptoms persisting from childhood into adulthood, are at heightened risk to perpetrate <emph>and</emph> to be victims of psychological and physical IPV.</p> <p>Nonetheless, a key limitation of previous investigations of ADHD and IPV is the fact that no studies collected data from both partners in couples where one, or both, dyad members has ADHD. As IPV often occurs mutually in couples ([<reflink idref="bib49" id="ref45">49</reflink>], [<reflink idref="bib50" id="ref46">50</reflink>]) and has been theorized to often be a dyadic process that requires both partners ([<reflink idref="bib34" id="ref47">34</reflink>]; [<reflink idref="bib52" id="ref48">52</reflink>]), prior work examining IPV perpetration and victimization among adults with ADHD, but not their partners, may have overlooked patterns of IPV risk beyond the individual with ADHD. Clarity on the degree of IPV mutuality in couples including young adults with ADHD is needed as partners who engage in reciprocal IPV have more "severe and injurious assaults" ([<reflink idref="bib50" id="ref49">50</reflink>]). Furthermore, [<reflink idref="bib4" id="ref50">4</reflink>] concluded that existing evidence indicates a greater risk of IPV perpetration by males with ADHD and of IPV victimization reported by females with ADHD. However, they identified a notable lack of studies testing whether these patterns hold for individuals with a different sex (i.e., whether ADHD increases risk of females perpetrating, and males being victims, of IPV). By asking young adult men and women with ADHD, and their heterosexual partners, to report on IPV, there is an opportunity to examine whether ADHD increases risk of young men and women perpetrating and being a victim of IPV.</p> <p>One reason to consider the possibility that young adults with ADHD are at higher risk of having partners who also engage in IPV behavior is that partners of adults with ADHD are likely to have elevated ADHD symptoms themselves. In fact, preliminary data suggest that most (67% to 90%) young adults with ADHD histories report that their partners have elevated ADHD symptoms ([<reflink idref="bib48" id="ref51">48</reflink>]; [<reflink idref="bib59" id="ref52">59</reflink>]). The apparent tendency for young adults with ADHD to select partners with similar qualities is unsurprising given that patterns of "assortative mating" are common among adults with psychiatric disorders (e.g., alcohol use disorder, major depressive disorder; for reviews, see [<reflink idref="bib35" id="ref53">35</reflink>]; [<reflink idref="bib45" id="ref54">45</reflink>]). Notably, [<reflink idref="bib48" id="ref55">48</reflink>] showed that young adults with persistent ADHD (<emph>m</emph> age = 27.7 years) who had partners with elevated ADHD symptoms tended to report more psychological and physical IPV perpetration and victimization than young adults without ADHD histories (<emph>m</emph> age = 28.3). Results of this study are limited by fact that participants rated the ADHD symptoms of their partners, without partner input, and did not seek partner reports of IPV perpetration and victimization. Thus, it remains unclear whether ADHD increases risk of IPV mutuality from the perspective of both partners. Given the likelihood of young adults with ADHD selecting partners with elevated ADHD symptoms, and the risk of mutual (i.e., reciprocal) IPV that may indicate, it is important to better understand whether both partners of couples including young adults with ADHD endorse elevated IPV perpetration and victimization.</p> <hd id="AN0190716728-4">Current Study</hd> <p>The primary aim of this study was to compare rates of IPV perpetration and victimization reported by both partners in young adult couples where at least one dyad member had ADHD persisting from childhood (ADHD couples) and in young adult couples without ADHD histories or current symptoms/impairment (Non-ADHD couples). Based on preliminary evidence suggesting the possibility of reciprocal IPV in young adult ADHD couples ([<reflink idref="bib48" id="ref56">48</reflink>]), we hypothesized that each partner within ADHD couples in would report more IPV perpetration and victimization than each partner within Non-ADHD couples. We also expected that ADHD couples would have more frequent psychological IPV and more prevalent physical IPV than Non-ADHD couples.</p> <hd id="AN0190716728-5">Method</hd> <p></p> <hd id="AN0190716728-6">Participants</hd> <p>Couples who participated in a research study examining acute alcohol intoxication as a risk factor for IPV ([<reflink idref="bib61" id="ref57">61</reflink>]) provided data for this study. Young adult couples were recruited between February 2017 and March 2020 from metropolitan central and rural southeast Ohio in a variety of ways, including physical flyers posted on local college campuses and nearby businesses, electronic flyers mass-emailed to the general student body of a mid-sized university and related regional campuses, as well as advertisements posted to local users of Facebook.com and CraigsList.com. Inclusion criteria included being in a romantic relationship with a different sex partner for at least 4 months, both dyad members being 21 to 35 years of age, and meeting criteria for being an ADHD or Non-ADHD couple (see <emph>ADHD Couple Status</emph> below). Couples were excluded if either dyad member reported arrest histories due to violence, or histories of being violent with partners in front of other people, or endorsed histories of serious head injury, autism, bipolar disorder, or psychosis. As part of the larger study, participants needed to meet additional eligibility criteria typical for alcohol administration studies, including endorsement of at least one binge drinking episode (i.e., 4 or more standard drinks for women, 5 or more standard drinks for men) in the past month, and denying current alcohol-related treatment or current alcohol abstinence. Finally, based on self-reported symptoms of ADHD on the Childhood Symptom Scale ([<reflink idref="bib6" id="ref58">6</reflink>]), couples including partners evincing ADHD desistance (i.e., reporting several or more ADHD symptoms prior to age 12 but reporting limited or no current ADHD symptoms or impairment) were excluded. Couples including partners with significant current ADHD symptoms and impairment but not having several ADHD symptoms prior to age 12 were also excluded.</p> <p>Altogether, 69 couples (41 "ADHD couples" including one or two adults with ADHD, 28 "Non-ADHD couples" including two adults without ADHD) provided data for this study. Of the 41 ADHD couples, 8 couples (19.5%) included two partners with ADHD and 33 (80.5%) included one partner with ADHD. In ADHD couples, "Partner A" was always the adult with ADHD in the relationship and "Partner B" were the adults without ADHD in the relationship. In ADHD couples including two adults with ADHD, Partner A was selected based on their gender such that the proportion of men and women was approximately the same as the couples including one adult with ADHD. In Non-ADHD couples, Partner A and B were selected based on their gender such that the proportion of men and women was approximately the same as the ADHD couples.</p> <p>As shown in Table 1, partners in ADHD and Non-ADHD couples did not vary in their endorsement of commitment or length of relationship, which indicated they were in long-term, committed relationships for 2 to 3 years on average. Partner A tended to be female and Partner B tended to be male, and this was invariant across ADHD couple status. Both partners tended to be emerging adults, white and with some post-secondary education, and these trends did not vary based on couple ADHD status. Notably, both partners in ADHD couples were significantly less likely to endorse an exclusively heterosexual identity than both partners in Non-ADHD couples. In fact, the odds of either partner in ADHD couples endorsing sexual orientations other than exclusively heterosexual was nearly 6 times greater than the odds of partners in the Non-ADHD couples. Given this between-group difference, sexual identity was covaried in our analyses. Current hyperactivity/impulsivity and inattention symptom counts as well as ratings of overall impairment were significantly higher in both partners of ADHD couples than Non-ADHD couples (see Table 1). Effect sizes for these comparisons indicated very large differences between inattention, hyperactivity/impulsivity, and overall impairment in Partner A (Cohen's d = 3.86, 2.53, and 1.33, respectively) and Partner B (Cohen's d = 1.66, 1.63, and 1.23, respectively). Similarly, childhood hyperactivity/impulsivity and inattention symptom counts were significantly higher as reported by both partners of ADHD couples than Non-ADHD couples (see Table 1). Effect sizes for these comparisons indicated very large differences between inattention and hyperactivity/impulsivity in Partner A (Cohen's d = 2.32 and 2.08, respectively) and Partner B (Cohen's d = 2.22 and 2.17, respectively).</p> <p>Table 1. Sample Demographics by Couple ADHD Status.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Couple Demographics</th><th align="center" colspan="2">Non-ADHD couples (<italic>n</italic> = 28)</th><th align="center" colspan="2">ADHD couples (<italic>n</italic> = 41)</th><th align="center" colspan="2">Significance</th></tr></thead><tbody><tr><td>% committed relationship</td><td colspan="2">32.14%</td><td colspan="2">29.27%</td><td colspan="2"><italic>X</italic>2 (1) = 0.07, <italic>p</italic> =.799</td></tr><tr><td>Years in current relationship (SD)</td><td colspan="2">2.09 (2.19)</td><td colspan="2">2.64 (2.24)</td><td colspan="2"><italic>t</italic> (67) = 1.01, <italic>p</italic> =.317</td></tr><tr><th align="left">Individual Demographics</th><th align="center">Partner A</th><th align="center">Partner B</th><th align="center">Partner A</th><th align="center">Partner B</th><th align="center">Sig. (Partner A)</th><th align="center">Sig. (Partner B)</th></tr><tr><td>% Female</td><td>64.29%</td><td>35.71%</td><td>63.41%</td><td>36.59%</td><td><italic>X</italic>2 (1) = 0.01, <italic>p</italic> =.941</td><td><italic>X</italic>2 (1) = 0.01, <italic>p</italic> =.941</td></tr><tr><td>Age in years (SD)</td><td>23.43 (3.21)</td><td>23.46 (3.44)</td><td>22.61 (2.91)</td><td>22.73 (2.18)</td><td><italic>t</italic> (67) = 1.10, <italic>p</italic> =.276</td><td><italic>t</italic> (67) = 1.08, <italic>p</italic> =.282</td></tr><tr><td>% White, Non-Hispanic</td><td>78.57%</td><td>92.86%</td><td>90.24%</td><td>92.68%</td><td><italic>X</italic>2 (1) = 1.83, <italic>p</italic> =.176</td><td><italic>X</italic>2 (1) = 0.00, <italic>p</italic> =.978</td></tr><tr><td>% Black, African American</td><td>3.57%</td><td>7.14%</td><td>2.44%</td><td>4.88%</td><td /><td /></tr><tr><td>% Hispanic, Latinx</td><td>3.57%</td><td>0.00%</td><td>0.00%</td><td>0.00%</td><td /><td /></tr><tr><td>% Asian American, Pacific Islander</td><td>7.14%</td><td>0.00%</td><td>4.88%</td><td>0.00%</td><td /><td /></tr><tr><td>% Other, mixed race</td><td>7.14%</td><td>0.00%</td><td>2.44%</td><td>2.44%</td><td /><td /></tr><tr><td>% Exclusively heterosexual</td><td>89.29%</td><td>89.29%</td><td>58.54%</td><td>57.50%</td><td><italic>X</italic>2 (1) = 7.64, <italic>p</italic> =.006</td><td><italic>X</italic>2 (1) = 8.02, <italic>p</italic> =.005</td></tr><tr><td>% Predominantly heterosexual</td><td>7.14%</td><td>7.14%</td><td>29.27%</td><td>32.50%</td><td /><td /></tr><tr><td>% Equally heterosexual/non-heterosexual</td><td>0.00%</td><td>3.57%</td><td>9.76%</td><td>10.00%</td><td /><td /></tr><tr><td>% Asexual, non-sexual</td><td>3.57%</td><td>0.00%</td><td>2.44%</td><td>0.00%</td><td /><td /></tr><tr><td>% Current student</td><td>82.14%</td><td>82.14%</td><td>85.37%</td><td>75.00%</td><td><italic>X</italic>2 (1) = 0.13, <italic>p</italic> =.720</td><td><italic>X</italic>2 (1) = 0.49, <italic>p</italic> =.484</td></tr><tr><td>% ≥Associates degree</td><td>46.43%</td><td>39.29%</td><td>39.02%</td><td>43.90%</td><td><italic>X</italic>2 (1) = 0.37, <italic>p</italic> =.541</td><td><italic>X</italic>2 (1) = 0.15, <italic>p</italic> =.703</td></tr><tr><td>Current HI symptoms (<italic>SD</italic>)</td><td>1.50 (0.88)</td><td>1.14 (0.93)</td><td>5.22 (1.88)</td><td>3.78 (2.09)</td><td><italic>t</italic> (67) = 9.76, <italic>p</italic> <.001</td><td><italic>t</italic> (67) = 6.25, <italic>p</italic> <.001</td></tr><tr><td>Current IA symptoms (<italic>SD</italic>)</td><td>0.50 (0.79)</td><td>0.75 (0.97)</td><td>6.54 (2.07)</td><td>4.05 (2.63)</td><td><italic>t</italic> (67) = 14.65, <italic>p</italic> <.001</td><td><italic>t</italic> (67) = 6.35, <italic>p</italic> <.001</td></tr><tr><td>Self overall impairment (<italic>SD</italic>)</td><td>0.39 (0.39)</td><td>0.18 (0.39)</td><td>2.12 (1.65)</td><td>1.61 (1.56)</td><td><italic>t</italic> (67) = 5.29, <italic>p</italic> <.001</td><td><italic>t</italic> (67) = 4.73, <italic>p</italic> <.001</td></tr><tr><td>Partner overall impairment (<italic>SD</italic>)</td><td>0.23 (0.51)</td><td>0.29 (0.55)</td><td>1.73 (1.60)</td><td>1.80 (1.71)</td><td><italic>t</italic> (65) = 4.63, <italic>p</italic> <.001</td><td><italic>t</italic> (63) = 4.21, <italic>p</italic> <.001</td></tr><tr><td>Self childhood HI symptoms (<italic>SD</italic>)</td><td>0.36 (0.56)</td><td>0.46 (0.74)</td><td>4.27 (2.65)</td><td>2.32 (2.74)</td><td><italic>t</italic> (67) = 7.69, <italic>p</italic> <.001</td><td><italic>t</italic> (67) = 3.48, <italic>p</italic> <.001</td></tr><tr><td>Self childhood IA symptoms (<italic>SD</italic>)</td><td>0.18 (0.55)</td><td>0.11 (0.31)</td><td>3.61 (2.97)</td><td>2.07 (2.87)</td><td><italic>t</italic> (67) = 6.02, <italic>p</italic> <.001</td><td><italic>t</italic> (67) = 3.61, <italic>p</italic> <.001</td></tr><tr><td>Parent childhood HI symptoms (<italic>SD</italic>)</td><td align="center">—</td><td align="center">—</td><td>3.68 (2.03)</td><td>3.40 (2.67)</td><td align="center">—</td><td align="center">—</td></tr><tr><td>Parent childhood IA symptoms (<italic>SD</italic>)</td><td align="center">—</td><td align="center">—</td><td>4.95 (2.17)</td><td>3.60 (3.34)</td><td align="center">—</td><td align="center">—</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note.</emph> Non-ADHD couples = couples including no partners with ADHD; ADHD Couples = couples including at least one partner with ADHD; Committed Relationship = Percentage of couples reporting they were "living together," "engaged," or "married"; % Current student = percentage endorsing current enrollment in college or university courses; %≥Associates degree = percentage endorsing highest level of education is two-year/Associates degrees or higher; Current HI Symptoms = number of clinically-significant hyperactivity/impulsivity symptoms across self and/or partner reports (range 0–9); Current IA symptoms = number of clinically-significant inattention symptoms across self and/or partner reports (range 0–9); Self overall impairment = self-reported level of overall impairment in functioning on adult IRS (score ≥ 1 is clinically significant); Partner overall impairment = partner-rated level of overall impairment in functioning on Adult IRS (score ≥ 1 is clinically significant); Self childhood HI Symptoms = number of clinically-significant hyperactivity/impulsivity symptoms self-reported to have occurred in childhood (range 0–9); Self childhood IA symptoms = number of clinically-significant inattention symptoms self-reported to have occurred in childhood (range 0–9); Parent childhood HI symptoms = number of clinically-significant hyperactivity/impulsivity symptoms reported by parents to have occurred in childhood (range 0–9); Parent childhood IA symptoms = number of clinically-significant inattention symptoms reported by their parents to have occurred in childhood (range 0–9).</p> <hd id="AN0190716728-7">Measures</hd> <p></p> <hd id="AN0190716728-8">ADHD Couple Status</hd> <p>To determine whether couples were eligible for the ADHD or Non-ADHD group, both members of the couple were asked to report on their current symptoms and their level of functional impairment on the Conners Adult Attention-Deficit/Hyperactivity Rating Scale-Long form (CAARS; [<reflink idref="bib17" id="ref59">17</reflink>]) and the Adult Impairment Rating Scale (IRS; [<reflink idref="bib18" id="ref60">18</reflink>]), respectively, as well as the same CAARS items and the Adult IRS regarding their partner. The CAARS includes the eighteen <emph>Diagnostic and Statistical Manual of Mental Disorders</emph>, Fourth Edition (<emph>DSM-IV</emph>; [<reflink idref="bib2" id="ref61">2</reflink>]) symptoms of inattention and hyperactivity/impulsivity. Responses are scored on a 4-point scale from 0 (<emph>not at all</emph>) to 3 (<emph>very much</emph>), with responses of 2 or 3 considered to be clinically significant. The CAARS has strong test–retest reliability (1 month <emph>r</emph> =.89; [<reflink idref="bib20" id="ref62">20</reflink>]) and internal consistency (α =.86 to.92; [<reflink idref="bib16" id="ref63">16</reflink>]). CAARS scores are positively correlated with other self-report ADHD measures and show good sensitivity and specificity to adult ADHD diagnoses made via semi-structured clinical interview ([<reflink idref="bib20" id="ref64">20</reflink>]). The Adult IRS ([<reflink idref="bib18" id="ref65">18</reflink>]) is a 12-item measure assessing impairment in core functional domains such as home (e.g., "your relationships with your parents"), school/work (e.g., "your academic progress at school"), and interpersonal relations (e.g., "your relationships with other people your age"). Participants are asked to indicate their level of impairment, if applicable, by marking on a continuum from "no problem" to "extreme problem," which is later re-coded numerically (0–6), with scores of 1 or higher indicating clinically significant impairment. The Adult IRS has demonstrated good convergent, divergent, and incremental validity as well as good interrater reliability between ratings provided by romantic partners ([<reflink idref="bib18" id="ref66">18</reflink>]).</p> <p>For this study, we adapted the CAARS Observer Short Version (CAARS-OSV; [<reflink idref="bib16" id="ref67">16</reflink>]) to allow for respondents to answer questions regarding the DSM-IV symptoms of ADHD exhibited by their partners. The adaptation was minor in that the beginning of items were altered from its original state (e.g., "<emph>The person being described</emph> interrupts others when talking") to more directly ask about how common it is for the respondent's partner to exhibit the behavior of interest ("<emph>My partner</emph> interrupts others when talking"). The response scale is the same as the CAARS, and responses of "<emph>pretty much"</emph> or "<emph>very much"</emph> on the partner version were considered clinically significant symptoms. The CAARS-OSV has been shown to have adequate internal consistency (α =.78) and test–retest reliability (mean <emph>r</emph> =.73, <emph>p</emph> <.001; [<reflink idref="bib1" id="ref68">1</reflink>]). We also adapted the Adult IRS to allow respondents to rate the extent to which they believed their partners exhibited functional impairment. Again, the adaptation was minor in that the items were altered from its original state (e.g., rate "<emph>Your relationship with your partner</emph>") to more directly ask about how common it is for the respondent's partner to demonstrate impairment in the same domain (e.g., rate "<emph>Your partner's relationship with you</emph>").</p> <p>In order to evaluate for childhood history of symptoms of ADHD, participants endorsing elevated current symptoms were asked to recall their symptoms of inattention and hyperactivity/impulsivity prior to age 12 on the Childhood Symptom Scale ([<reflink idref="bib6" id="ref69">6</reflink>]). Participants were also asked to provide email addresses for their parents so they could be asked to report on the symptoms of the participants prior to age 12 on the same scale.</p> <p>To determine whether couples were eligible for the ADHD or Non-ADHD groups, the "and/or" rule was used to determine individual ADHD status, such that current clinically-significant symptoms of inattention and hyperactivity/impulsivity were counted as unique (and summed) if they were endorsed by self- and/or partner-report. In order to be considered an "ADHD couple," at least one partner must have (a) 5 or more current clinically-significant symptoms of inattention, hyperactivity/impulsivity or both; (b) both self- and partner endorsement of current ADHD-related impairment in at least one domain; and (c) several self- or parent-reported clinically significant symptoms of ADHD prior to age 12. In order to be eligible for the Non-ADHD group, respondents and their partners had to report that they currently exhibit 3 or fewer symptoms of inattention and hyperactivity/impulsivity, currently exhibit no clinically-significant impairment, and did not have several symptoms of ADHD prior to age 12.</p> <hd id="AN0190716728-9">Intimate Partner Violence</hd> <p>The 78-item Revised Conflict Tactics Scales (CTS-2; [<reflink idref="bib51" id="ref70">51</reflink>]) is the most widely used and psychometrically sound measure of IPV perpetration and victimization. We used the CTS-2 subscales of psychological IPV perpetration (α = 0.65; e.g., "I insulted or swore at my partner") and victimization (α = 0.70; "My partner insulted or swore at me") as well as physical IPV perpetration (α = 0.65; "I threw something at my partner that could hurt") and victimization (α = 0.71; "My partner threw something at me that could hurt"). Respondents were asked to report on how many times they perpetrated each of these behaviors in the past year with their current partner, and how many times their current partner did the same behaviors to them in the past year. The response scale for each item in these subscales ranges from 0 ("<emph>this has never happened, or has not happened in last year"</emph>) to 6 (<emph>"this has happened more than 20 times in the past year"</emph>). For psychological IPV perpetration and victimization, we followed the guidelines recommended by [<reflink idref="bib51" id="ref71">51</reflink>] for scoring the CTS-2 by summing together the midpoints for item responses chosen by the participant within each subscale. The midpoints are the same as the item response numbers for 0, 1 (<emph>once in past year</emph>), and 2 (<emph>twice in past year</emph>). For "<emph>3–5 times in the past year</emph>," the midpoint is 4, for "<emph>6–10 times in the past year</emph>," the midpoint is 8, for "<emph>11–20 times in the past year</emph>," the midpoint is 15, and for "<emph>more than 20 times in the past year</emph>," [<reflink idref="bib51" id="ref72">51</reflink>] recommend 25 as the midpoint. Because most participants did not report physical IPV perpetration and victimization, and the preponderance of "0" responses (i.e., indicating no endorsement of IPV perpetration or victimization) created skewed distributions of both variables, summary scores were recoded such that any endorsement of physical IPV perpetration or victimization (i.e., summary score ≥1) was coded as "1."</p> <p>We also created couple composite summary scores for psychological and physical IPV perpetration and victimization subscales. For psychological IPV, the composite score was computed by averaging Partner A and B subscale summary scores. For physical IPV, the composite score was computed by coding "0" for couples who did not report any physical IPV engagement and coding "1" for couples who included at least one partner reporting physical IPV engagement.</p> <hd id="AN0190716728-10">Analytic Plan</hd> <p>Primary analyses were conducted to assess between-group (ADHD couple status) differences in individual partner IPV experiences. For psychological IPV perpetration and victimization, analyses of covariance (ANCOVAs; covarying sexual identity) were conducted to test whether ADHD couple status predicted variation in psychological IPV frequency reported by Partner A and Partner B, separately. In the presence of significant ANCOVAs, partial eta-squared was used to assess the magnitude of differences in psychological IPV perpetration/victimization frequency by ADHD couple status (<.01 indicates no effect,.01–.06 indicates a small effect,.06–.14 indicates a medium effect, and ≧.14 indicates a large effect). For physical IPV perpetration and victimization, chi-square analyses were conducted to assess whether ADHD status predicted the occurrence of physical IPV reported by Partner A and Partner B, separately. In the presence of significant chi-square values, odds ratios were computed to assess the magnitude of differences in rates of physical IPV perpetration/victimization by ADHD couple status.</p> <p>Additionally, we assessed for between-group (ADHD couple status) differences in couple composite scores for psychological and physical IPV perpetration and victimization. ANCOVAs and partial eta-squares were conducted to examine differences in psychological IPV composite scores, while chi-square tests and odds ratios were conducted to investigate differences in physical IPV composite scores.</p> <hd id="AN0190716728-11">Results</hd> <p></p> <hd id="AN0190716728-12">Psychological IPV</hd> <p>ANCOVAs indicated that ADHD couple status predicted the frequency of psychological IPV perpetration reported by Partner A and Partner B (Table 2). Specifically, partners with and without ADHD in the ADHD couples both reported perpetrating psychological IPV significantly more frequently than partners in Non-ADHD couples. Partial eta-squared results indicated medium effects for Partner A and Partner B. Similarly, ADHD couple status predicted the frequency of psychological IPV victimization reported by Partner A and B (Table 2). Specifically, partners with and without ADHD in the ADHD couples both reported being a victim of psychological IPV significantly more frequently than partners in Non-ADHD couples. Partial eta-squared results indicated medium effects for Partner A and Partner B.</p> <p>Table 2. Results of Between-group Testing for Psychological and Physical IPV Perpetration and Victimization Reported by Both Partners in ADHD and Non-ADHD Couples.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Partner A ratings</th><th align="center">Non-ADHD couples (<italic>n</italic> = 28)</th><th align="center">ADHD couples (<italic>n</italic> = 41)</th><th align="center">Significance</th><th align="center">Effect size</th></tr></thead><tbody><tr><td>Frequency of psychological perpetration</td><td>6.04 (7.46)</td><td>11.46 (12.95)</td><td>F (1, 66) = 8.55, <italic>p</italic> =.005</td><td>Partial Eta2 =.12</td></tr><tr><td>Frequency of psychological victimization</td><td>7.50 (8.73)</td><td>13.85 (16.45)</td><td>F (1, 66) = 5.15, <italic>p</italic> =.027</td><td>Partial Eta2 =.07</td></tr><tr><td>Any physical perpetration?</td><td>7.14%</td><td>26.83%</td><td>X2 (1) = 4.22, <italic>p</italic> =.040</td><td>Odds ratio = 4.77</td></tr><tr><td>Any physical victimization?</td><td>10.71%</td><td>26.83%</td><td>X2 (1) = 2.67, <italic>p</italic> =.102</td><td>Odds ratio = 3.06</td></tr><tr><th align="left">Partner B ratings</th><th align="center">Non-ADHD couples (n = 28)</th><th align="center">ADHD couples (n = 41)</th><th align="center">Significance</th><th align="center">Effect size</th></tr><tr><td>Frequency of psychological perpetration</td><td>4.64 (5.87)</td><td>10.15 (10.39)</td><td>F (1, 65) = 4.12, <italic>p</italic> =.046</td><td>Partial Eta2 =.06</td></tr><tr><td>Frequency of psychological victimization</td><td>5.64 (7.54)</td><td>12.78 (13.48)</td><td>F (1, 65) = 6.99, <italic>p</italic> =.010</td><td>Partial Eta2 =.10</td></tr><tr><td>Any physical perpetration?</td><td>14.29%</td><td>36.59%</td><td>X2 (1) = 4.15, <italic>p</italic> =.042</td><td>Odds ratio = 3.46</td></tr><tr><td>Any PHYSICAL VICTIMIZATION?</td><td>10.71%</td><td>31.71%</td><td>X2 (1) = 4.12, <italic>p</italic> =.042</td><td>Odds ratio = 3.87</td></tr><tr><th align="left">Couple composite ratings</th><th align="center">Non-ADHD couples (<italic>n</italic> = 28)</th><th align="center">ADHD couples (<italic>n</italic> = 41)</th><th align="center">Significance</th><th align="center">Effect size</th></tr><tr><td>Frequency of psychological perpetration</td><td>5.33 (5.97)</td><td>11.17 (10.04)</td><td>F (1, 65) = 7.59, <italic>p</italic> =.008</td><td>Partial Eta2 =.10</td></tr><tr><td>Frequency of psychological victimization</td><td>6.57 (7.26)</td><td>13.61 (12.47)</td><td>F (1, 65) = 7.23, <italic>p</italic> =.009</td><td>Partial Eta2 =.10</td></tr><tr><td>Any physical perpetration?</td><td>17.86%</td><td>48.78%</td><td>X2 (1) = 6.89, <italic>p</italic> =.009</td><td>Odds ratio = 4.38</td></tr><tr><td>Any PHYSICAL VICTIMIZATION?</td><td>17.86%</td><td>46.34%</td><td>X2 (1) = 5.95, <italic>p</italic> =.015</td><td>Odds ratio = 3.97</td></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note.</emph> Frequency of psychological perpetration/victimization = sum of responses to seven items with the following response scale: 0 (happened no times in past year), 1 (once), and 2 (twice), 4 (3–5 times), 8 (6–10 times), 15 (11–20 times), and 25 (more than 20 times) ([<reflink idref="bib51" id="ref73">51</reflink>]); Any physical perpetration/victimization? = percentages of respondents who indicated perpetrating or being a victim of physical IPV on one or more occasions with their partner in the last year. Non-ADHD couples = couples including no partners with ADHD; ADHD Couples = Couples including at least one partner with ADHD.</p> <p>Additionally, ANCOVAs indicated that ADHD couple status predicted the couple composite score for psychological IPV perpetration. Psychological IPV perpetration occurred more frequently in ADHD couples than Non-ADHD couples (Table 2). Partial eta-squared results indicated a medium effect for the couple composite. ADHD couple status also predicted the couple composite for psychological IPV victimization. Similarly, psychological IPV victimization was also reported to occur more frequently in ADHD couples than Non-ADHD couples. Partial eta-squared results indicated a medium effect for the couple composite.</p> <hd id="AN0190716728-13">Physical IPV</hd> <p>Chi-square tests indicated that ADHD couple status predicted the occurrence of physical IPV perpetration reported by Partner A and B (Table 2). Specifically, the partners with and without ADHD in the ADHD couples were more likely to report perpetrating physical IPV than partners in Non-ADHD couples. The odds of either partner in ADHD couples perpetrating physical IPV was 3 to 5 times greater than the odds of partners in the Non-ADHD couples. Notably, couple ADHD status significantly predicted the occurrence of physical IPV victimization in Partner B but not Partner A (Table 2). That is, the partner typically without ADHD in the ADHD couples was more likely to report being a victim of physical IPV than comparisons in Non-ADHD couples. The odds of the partner typically without ADHD in ADHD couples being a victim of physical IPV was 3 to 4 times greater than the odds of comparisons in the Non-ADHD couples. Though the pattern was similar for the partner with ADHD in ADHD couples, the difference between groups was not significant.</p> <p>Moreover, ADHD couple status predicted the couple composite for physical IPV perpetration. Physical IPV perpetration occurred in nearly 50% of ADHD couples, with ADHD couples having more than 4 times greater odds of perpetrating physical IPV than the odds of Non-ADHD couples. ADHD couple status also predicted our couple composite for physical IPV victimization. Similarly, physical IPV victimization occurred in about 50% of ADHD couples, with ADHD couples having 4 times greater odds of being a victim of physical IPV than the odds of Non-ADHD couples.</p> <hd id="AN0190716728-14">Discussion</hd> <p>Our understanding of romantic relationship quality in adults with ADHD has grown substantially in recent years ([<reflink idref="bib56" id="ref74">56</reflink>]). However, the depth of our knowledge is relatively shallow given our limited investigation of partners of adults with ADHD. The current study sought to address this concern by investigating the perspectives of both partners on IPV perpetration and victimization, a particularly relevant outcome for clinicians and researchers working with adults with ADHD in relationships ([<reflink idref="bib4" id="ref75">4</reflink>]). Our findings indicate that both partners in young adult couples where at least one dyad member has ADHD are more likely to perpetrate and to be victims of psychological and physical IPV than both partners in young adult couples without ADHD.</p> <hd id="AN0190716728-15">Psychological IPV Reciprocity</hd> <p>We found that both partners in ADHD couples reported perpetrating more frequent psychological IPV than partners in Non-ADHD couples. Similarly, Partners A and B also reported being victims of more frequent psychological IPV in ADHD couples than Non-ADHD couples. Frequency of psychological IPV perpetration and victimization averaged across partners was greater for ADHD couples than for Non-ADHD couples. These results further highlight ADHD as a risk factor for adults perpetrating psychological IPV ([<reflink idref="bib60" id="ref76">60</reflink>], [<reflink idref="bib57" id="ref77">57</reflink>]; [<reflink idref="bib58" id="ref78">58</reflink>]) and extend this work by underscoring that partners of adults with ADHD are also at risk of perpetrating psychological IPV. IPV mutuality is commonplace ([<reflink idref="bib49" id="ref79">49</reflink>], [<reflink idref="bib50" id="ref80">50</reflink>]; [<reflink idref="bib52" id="ref81">52</reflink>]) and alarming, with reciprocal IPV predicting severe consequences ([<reflink idref="bib50" id="ref82">50</reflink>]; [<reflink idref="bib55" id="ref83">55</reflink>]).</p> <p>The increased risk of reciprocal IPV in ADHD couples might be triggered by both partners having elevated ADHD symptoms. In the present study, nearly 20% of our ADHD couples included two partners with clinically-elevated ADHD symptoms, and both partners in the ADHD couples reported significantly more symptoms of inattention and hyperactivity on average than Non-ADHD couples (Table 1). Even Partner B, who was less likely to have clinically-elevated ADHD symptoms than Partner A, had substantially greater inattention (Cohen's d = 1.66) and hyperactivity/impulsivity (Cohen's d = 1.63) than Partner B in the Non-ADHD couples. The magnitude of these effects was similar to the very large effects observed in partners of adults with ADHD in a previous study (i.e., Cohen's d = 1.80 inattention, Cohen's d = 2.29 hyperactivity/impulsivity; [<reflink idref="bib48" id="ref84">48</reflink>]). Altogether, the risk of IPV perpetration in couples including adults with ADHD appears to be a two-way street, possibly initiated by mutual ADHD symptoms. Elevated inattention (e.g., missing verbal and nonverbal cues) and hyperactivity/impulsivity (e.g., talking too much, interrupting others) during heated exchanges with partners may make adaptive conflict resolution skills difficult to implement. Still, future research is needed to replicate and extend these findings before firm conclusions can be made.</p> <hd id="AN0190716728-16">Physical IPV Reciprocity</hd> <p>Results indicated that both partners in ADHD couples were 3 to 5 times more likely to report perpetrating physical IPV than partners in Non-ADHD couples, and Partner B in the ADHD couples was about 4 times more likely to report being a victim of physical IPV than Partner B in Non-ADHD couples. Notably, physical IPV perpetration and victimization occurred in about <emph>half</emph> of ADHD couples, with ADHD couples having more than 4 times greater odds of perpetrating and being victims of physical IPV than the odds of Non-ADHD couples. These results further highlight ADHD as a risk factor for adults being perpetrators and victims of physical IPV ([<reflink idref="bib21" id="ref85">21</reflink>]; [<reflink idref="bib24" id="ref86">24</reflink>]; [<reflink idref="bib58" id="ref87">58</reflink>]; [<reflink idref="bib57" id="ref88">57</reflink>]).</p> <p>The fact that we found these group differences is especially notable, given that both partners in our Non-ADHD couples were about twice as likely to report experiencing physical IPV victimization in the last year (10.7%) than adults in the general population (4.5-5.5%; [<reflink idref="bib33" id="ref89">33</reflink>]). These elevated rates of physical IPV in our Non-ADHD couples may be due to the requirements for the larger study (CITATION MASKED), including a requirement that participants engaged in binge drinking at least monthly. By requiring participants to engage in episodic heavy drinking, we may have included a sample with patterns of excessive alcohol consumption, which is a robust predictor of IPV risk ([<reflink idref="bib15" id="ref90">15</reflink>]). Even still, both partners in the ADHD couples endorsed substantially more IPV behavior than Non-ADHD couples with partners reporting at least monthly binge drinking. Thus, our data suggest that couples including adults with ADHD are at risk for physical IPV over and above risks associated with episodic heavy drinking.</p> <hd id="AN0190716728-17">Limitations and Future Directions</hd> <p>Although this study has several key strengths, including collecting self- and partner-report of ADHD and IPV as well as studying adults with ADHD symptoms persisting from childhood, a group particularly at risk of IPV ([<reflink idref="bib57" id="ref91">57</reflink>]), this study also has limitations. First, as noted above, this sample excluded adults who did not report binge drinking at least once per month. Investigating IPV in a sample of adults with persistent ADHD who are not episodic heavy drinkers is needed to confirm whether their risks of IPV perpetration and victimization are uniquely associated with their longstanding ADHD and independent of binge drinking. At the same time, binge drinking is not uncommon in emerging adults ([<reflink idref="bib39" id="ref92">39</reflink>]), especially those with ADHD persisting from childhood ([<reflink idref="bib27" id="ref93">27</reflink>]; [<reflink idref="bib37" id="ref94">37</reflink>]). As such, the results of this study are likely to generalize to a substantial portion of emerging adults with ADHD. Relatedly, only couples with participants aged 21 to 35 years were eligible for this study. This is a peak period for IPV ([<reflink idref="bib33" id="ref95">33</reflink>]), and as such results described here may not represent the likelihood of reciprocal IPV behavior in couples with older partners and those in longer relationships. Second, adults with histories of being arrested for violence or of being violent with their partners in front of others were excluded from study participation. These exclusion criteria were required by the IRB to conduct the larger study from which these data were gathered. Thus, it is possible results may have varied without these restrictions of IPV perpetration severity in place. Third, Partner A, who were the partners in the ADHD couples with persistent ADHD, were mostly women. As ADHD is more commonly recognized in male children, adolescents, and adults than female ([<reflink idref="bib30" id="ref96">30</reflink>]; [<reflink idref="bib44" id="ref97">44</reflink>]), we were expecting more men than women to have ADHD in our ADHD couples. Women with ADHD may be more apt to participate in couples research than men. Future studies with ADHD couples may wish consider over-recruiting for men with persistent ADHD if the goal is to have a balanced sample. Fourth, our study focused on opposite-sex couples and as such, results may only generalize to couples including men and women in relationships with a partner of a different sex. On a related note, both partners in our ADHD couples were less likely to report being "exclusively heterosexual" in their sexual identity than partners in our Non-ADHD couples. Though samples of adults with and without ADHD tend to report a heterosexual identity ([<reflink idref="bib7" id="ref98">7</reflink>]; [<reflink idref="bib26" id="ref99">26</reflink>]), adults with ADHD have been found to more often endorse a bisexual identity ([<reflink idref="bib7" id="ref100">7</reflink>]) or have same-sex experiences ([<reflink idref="bib26" id="ref101">26</reflink>]) than adults without ADHD. Indeed, [<reflink idref="bib25" id="ref102">25</reflink>] found that sexual and gender minority young adults reported more ADHD symptoms than heterosexual cisgender men and women. In light of this, as well as evidence of elevated rates of IPV perpetration and victimization among sexual and gender minority adults ([<reflink idref="bib29" id="ref103">29</reflink>]; [<reflink idref="bib42" id="ref104">42</reflink>]), an important direction for research is to investigate the experiences of IPV in adults with ADHD who have diverse sexual and gender identities. Finally, our study was not powered to examine whether self and partner reported IPV perpetration and victimization varied between couples including one or two adults with ADHD. As it is plausible that the results of the present study are driven by the relatively small percentage of couples including two adults with ADHD, future studies with larger samples of couples including one and two partners with ADHD should investigate this.</p> <p>We hope researchers consider additional lines of inquiry to advance the science beyond this study. First, there is a need to identify ADHD couples particularly at risk for engaging in IPV. Early research has identified that problematic drinking increases the risk of adults with ADHD perpetrating IPV ([<reflink idref="bib62" id="ref105">62</reflink>]) and being a victim of IPV ([<reflink idref="bib57" id="ref106">57</reflink>]), which was part of the logic of including adults reporting periodic binge drinking in the larger study ([<reflink idref="bib61" id="ref107">61</reflink>]) from which data were drawn for this investigation. Studies evaluating robust predictors of IPV perpetration and victimization among individuals with ADHD (e.g., antisocial personality, illicit drug use) as well as risk factors at the couple level (e.g., frequency of mutual alcohol intoxication) could identify couples with ADHD to screen in for IPV prevention or intervention programs. Investigations could also examine the relative strength of ADHD symptoms vs. other predictors in order to determine if ADHD plays a unique role in facilitating IPV behavior or if ADHD is a marker for other risk factors that do. Second, investigations are also needed to identify mechanisms explaining reciprocal, escalating IPV in couples including adults with ADHD. IPV escalation could be studied in ADHD couples by assessing whether Partner A's ADHD symptoms or communication/problem-solving behavior may spark violent behavior from Partner A or B, or trigger mutual exchanges between Partner A and B. Studies of this sort could identify intervention targets. For example, if Partner A's verbal impulsivity is found to trigger their own or Partner B's IPV perpetration, as there is some reason to speculate ([<reflink idref="bib53" id="ref108">53</reflink>]), interventions for impulsivity (e.g., medication, cognitive behavior therapy [CBT]; Knouse et al., 2017; [<reflink idref="bib38" id="ref109">38</reflink>]; [<reflink idref="bib43" id="ref110">43</reflink>]) could be tested. Preliminary evidence indicates effective stimulant treatment of ADHD (i.e., yielding symptom reduction) decreases IPV perpetration in offenders ([<reflink idref="bib11" id="ref111">11</reflink>]), but studies have yet to investigate IPV behavior as an outcome of non-stimulant treatments or CBT for ADHD. Alternatively, if Partner A's impulsivity triggers negative communication from Partner B, which triggers negative communication from Partner A, which ultimately escalates to IPV behavior from one or both partners, as is possible ([<reflink idref="bib14" id="ref112">14</reflink>]), then perhaps communication and problem-solving skills taught in couples therapy could be adopted ([<reflink idref="bib54" id="ref113">54</reflink>]). Preliminary evidence underscores the potential utility of integrating couples therapy skills with CBT for adult ADHD ([<reflink idref="bib41" id="ref114">41</reflink>]; [<reflink idref="bib59" id="ref115">59</reflink>]) and couples therapy for reducing IPV ([<reflink idref="bib8" id="ref116">8</reflink>]). Effort spent by researchers to better understand IPV in couples including adults with ADHD, and by clinicians screening for IPV in their patients with ADHD or screening for ADHD in violent offender clients ([<reflink idref="bib13" id="ref117">13</reflink>]), is a worthwhile endeavor towards the goal of disrupting reciprocal, harmful IPV.</p> <ref id="AN0190716728-18"> <title> References </title> <blist> <bibl id="bib1" idref="ref68" type="bt">1</bibl> <bibtext> Amador-Campos J. A., Gómez-Benito J., Ramos-Quiroga J. A. (2014). The Conners' adult ADHD rating scales—short self-report and observer forms: Psychometric properties of the Catalan version. Journal of Attention Disorders, 18, 671–679.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref61" type="bt">2</bibl> <bibtext> American Psychiatric Association. (1994). 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Poster accepted for presentation at the annual conference of the Research Society on Alcoholism, New Orleans, LA. Conference canceled owing to COVID-19 pandemic.</bibtext> </blist> <blist> <bibtext> Wymbs B. T., Walther C. A. P., Cheong J., Belendiuk K. A., Pedersen S. L., Gnagy E. M., Pelham W. E., Molina B. S. G. (2017). Childhood ADHD potentiates the association between problematic drinking and intimate partner violence. Journal of Attention Disorders, 21, 997–1008.</bibtext> </blist> </ref> <ref id="AN0190716728-19"> <title> Footnotes </title> <blist> <bibtext> Brian T. Wymbs</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0002-8530-5211 Steven W. Evans</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0002-7283-2274 Peggy M. Zoccola</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0001-5709-0092 Ryan C. Shorey</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0002-0927-3959</bibtext> </blist> <blist> <bibtext> The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors received funding from the National Institute on Alcohol Abuse and Alcoholism (R21AA025182).</bibtext> </blist> <blist> <bibtext> The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> </ref> <aug> <p>By Brian T. Wymbs; Christie T. Pickel; Steven W. Evans; Peggy M. Zoccola; Ryan C. Shorey and Levi M. Toback</p> <p>Reported by Author; Author; Author; Author; Author; Author</p> <p></p> <p>Brian T. Wymbs, PhD, is an associate professor of Psychology at Ohio University. His primary research interests focus on examining links between ADHD and romantic relationship difficulties. He has examined rates of intimate partner violence and potential explanatory factors among young adults with ADHD.</p> <p>Christie T. Pickel, PhD, is a licensed psychologist at Psychology Specialists of Maine. Her work is dedicated to the implementation and dissemination of evidence-based treatments for adult ADHD, a goal she pursues through direct clinical practice, treatment development, and training and consultation for clinicians.</p> <p>Steven W. Evans, Ph.D. is a Principal Investigator and is the Joe & Linda Chlapaty Endowed Scholar in Mental and Behavioral Health Research in the Institute for Mental and Behavioral Health Research at Nationwide Children's Hospital. His research focuses on treatment development and evaluation research as well as developmental psychopathology as it pertains to adolescents with ADHD and related problems.</p> <p>Peggy M. Zoccola, PhD, is a professor of psychology at Ohio University. Her primary research examines how cognitive and emotional processes (e.g., ruminative thought, emotion regulation) contribute to the prolonged physiological and psychological effects of stress and their implications for health.</p> <p>Ryan C. Shorey, PhD, is a Professor in the Department of Psychological & Brain Sciences at the University of Wisconsin-Milwaukee. His research focuses on risk and protective factors for intimate partner and sexual violence, particularly alcohol use, among young adult and sexual and gender minority populations.</p> <p>Levi M. Toback, M.S., is a graduate student in clinical psychology at Ohio University. His primary research interests focus on examining links between child externalizing problems, the coparenting relationship, and parent outcomes.</p> </aug> <nolink nlid="nl1" bibid="bib33" firstref="ref2"></nolink> <nolink nlid="nl2" bibid="bib12" firstref="ref6"></nolink> <nolink nlid="nl3" bibid="bib30" firstref="ref8"></nolink> <nolink nlid="nl4" bibid="bib44" firstref="ref9"></nolink> <nolink nlid="nl5" bibid="bib28" firstref="ref10"></nolink> <nolink nlid="nl6" bibid="bib36" firstref="ref11"></nolink> <nolink nlid="nl7" bibid="bib56" firstref="ref14"></nolink> <nolink nlid="nl8" bibid="bib10" firstref="ref15"></nolink> <nolink nlid="nl9" bibid="bib14" firstref="ref16"></nolink> <nolink nlid="nl10" bibid="bib19" firstref="ref17"></nolink> <nolink nlid="nl11" bibid="bib46" firstref="ref18"></nolink> <nolink nlid="nl12" bibid="bib22" firstref="ref19"></nolink> <nolink nlid="nl13" bibid="bib40" firstref="ref20"></nolink> <nolink nlid="nl14" bibid="bib60" firstref="ref21"></nolink> <nolink nlid="nl15" bibid="bib57" firstref="ref22"></nolink> <nolink nlid="nl16" bibid="bib49" firstref="ref23"></nolink> <nolink nlid="nl17" bibid="bib50" firstref="ref24"></nolink> <nolink nlid="nl18" bibid="bib48" firstref="ref25"></nolink> <nolink nlid="nl19" bibid="bib59" firstref="ref26"></nolink> <nolink nlid="nl20" bibid="bib34" firstref="ref28"></nolink> <nolink nlid="nl21" bibid="bib52" firstref="ref29"></nolink> <nolink nlid="nl22" bibid="bib15" firstref="ref30"></nolink> <nolink nlid="nl23" bibid="bib23" firstref="ref31"></nolink> <nolink nlid="nl24" bibid="bib32" firstref="ref33"></nolink> <nolink nlid="nl25" bibid="bib47" firstref="ref34"></nolink> <nolink nlid="nl26" bibid="bib21" firstref="ref36"></nolink> <nolink nlid="nl27" bibid="bib58" firstref="ref39"></nolink> <nolink nlid="nl28" bibid="bib24" firstref="ref42"></nolink> <nolink nlid="nl29" bibid="bib35" firstref="ref53"></nolink> <nolink nlid="nl30" bibid="bib45" firstref="ref54"></nolink> <nolink nlid="nl31" bibid="bib61" firstref="ref57"></nolink> <nolink nlid="nl32" bibid="bib17" firstref="ref59"></nolink> <nolink nlid="nl33" bibid="bib18" firstref="ref60"></nolink> <nolink nlid="nl34" bibid="bib20" firstref="ref62"></nolink> <nolink nlid="nl35" bibid="bib16" firstref="ref63"></nolink> <nolink nlid="nl36" bibid="bib51" firstref="ref70"></nolink> <nolink nlid="nl37" bibid="bib55" firstref="ref83"></nolink> <nolink nlid="nl38" bibid="bib39" firstref="ref92"></nolink> <nolink nlid="nl39" bibid="bib27" firstref="ref93"></nolink> <nolink nlid="nl40" bibid="bib37" firstref="ref94"></nolink> <nolink nlid="nl41" bibid="bib26" firstref="ref99"></nolink> <nolink nlid="nl42" bibid="bib25" firstref="ref102"></nolink> <nolink nlid="nl43" bibid="bib29" firstref="ref103"></nolink> <nolink nlid="nl44" bibid="bib42" firstref="ref104"></nolink> <nolink nlid="nl45" bibid="bib62" firstref="ref105"></nolink> <nolink nlid="nl46" bibid="bib53" firstref="ref108"></nolink> <nolink nlid="nl47" bibid="bib38" firstref="ref109"></nolink> <nolink nlid="nl48" bibid="bib43" firstref="ref110"></nolink> <nolink nlid="nl49" bibid="bib11" firstref="ref111"></nolink> <nolink nlid="nl50" bibid="bib54" firstref="ref113"></nolink> <nolink nlid="nl51" bibid="bib41" firstref="ref114"></nolink> <nolink nlid="nl52" bibid="bib13" firstref="ref117"></nolink>
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PubType: Academic Journal
PubTypeId: academicJournal
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: It Takes Two: Intimate Partner Violence According to Both Partners in Young Adult ADHD Couples
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Brian+T%2E+Wymbs%22">Brian T. Wymbs</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-8530-5211">0000-0002-8530-5211</externalLink>)<br /><searchLink fieldCode="AR" term="%22Christie+T%2E+Pickel%22">Christie T. Pickel</searchLink><br /><searchLink fieldCode="AR" term="%22Steven+W%2E+Evans%22">Steven W. Evans</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-7283-2274">0000-0002-7283-2274</externalLink>)<br /><searchLink fieldCode="AR" term="%22Peggy+M%2E+Zoccola%22">Peggy M. Zoccola</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-5709-0092">0000-0001-5709-0092</externalLink>)<br /><searchLink fieldCode="AR" term="%22Ryan+C%2E+Shorey%22">Ryan C. Shorey</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-0927-3959">0000-0002-0927-3959</externalLink>)<br /><searchLink fieldCode="AR" term="%22Levi+M%2E+Toback%22">Levi M. Toback</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Attention+Disorders%22"><i>Journal of Attention Disorders</i></searchLink>. 2026 30(2):222-233.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 12
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2026
– Name: SourceSuprt
  Label: Sponsoring Agency
  Group: SrcSuprt
  Data: National Institute on Alcohol Abuse and Alcoholism (NIAAA) (DHHS/NIH)
– Name: NumberContract
  Label: Contract Number
  Group: NumCntrct
  Data: R21AA025182
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Young+Adults%22">Young Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Attention+Deficit+Hyperactivity+Disorder%22">Attention Deficit Hyperactivity Disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Victims%22">Victims</searchLink><br /><searchLink fieldCode="DE" term="%22Incidence%22">Incidence</searchLink><br /><searchLink fieldCode="DE" term="%22Violence%22">Violence</searchLink><br /><searchLink fieldCode="DE" term="%22Intimacy%22">Intimacy</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Violence%22">Family Violence</searchLink><br /><searchLink fieldCode="DE" term="%22Aggression%22">Aggression</searchLink><br /><searchLink fieldCode="DE" term="%22Psychological+Patterns%22">Psychological Patterns</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Ohio%22">Ohio</searchLink>
– Name: SubjectThesaurus
  Label: Assessment and Survey Identifiers
  Group: Su
  Data: <searchLink fieldCode="SU" term="%22Conflict+Tactics+Scale%22">Conflict Tactics Scale</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/10870547251382679
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1087-0547<br />1557-1246
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: Attention-deficit/hyperactivity disorder (ADHD) has been shown to increase the risk of young adults perpetrating and being victims of intimate partner violence (IPV). However, research has yet to examine the IPV experiences of both dyad members where one or both partners has ADHD, and how those experiences differ from couples including partners without ADHD. Methods: 41 "ADHD couples" (m age = 22.7 years), where one (n = 33) or both (n = 8) dyad members had ADHD, and 28 "Non-ADHD couples" (m age = 23.4 years), where both dyad members did not have ADHD, participated. Both partners reported on the frequency they perpetrated and were victims of psychological and physical IPV. Results: Both partners in ADHD couples reported perpetrating more psychological and physical IPV than dyad members in Non-ADHD couples. Partners in ADHD couples also reported being victims of IPV more than partners in Non-ADHD couples. Conclusions: The risk of IPV perpetration in young adult couples with ADHD appears to be a two-way street. Research is needed to examine possible explanations for this pattern of reciprocal IPV, including mutual ADHD symptoms and related behavior (e.g., alcohol intoxication).
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2026
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1496132
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1496132
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/10870547251382679
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 12
        StartPage: 222
    Subjects:
      – SubjectFull: Young Adults
        Type: general
      – SubjectFull: Attention Deficit Hyperactivity Disorder
        Type: general
      – SubjectFull: Victims
        Type: general
      – SubjectFull: Incidence
        Type: general
      – SubjectFull: Violence
        Type: general
      – SubjectFull: Intimacy
        Type: general
      – SubjectFull: Family Violence
        Type: general
      – SubjectFull: Aggression
        Type: general
      – SubjectFull: Psychological Patterns
        Type: general
      – SubjectFull: Ohio
        Type: general
      – SubjectFull: Conflict Tactics Scale
        Type: general
    Titles:
      – TitleFull: It Takes Two: Intimate Partner Violence According to Both Partners in Young Adult ADHD Couples
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Brian T. Wymbs
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          Name:
            NameFull: Christie T. Pickel
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            NameFull: Steven W. Evans
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            NameFull: Peggy M. Zoccola
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            NameFull: Ryan C. Shorey
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            NameFull: Levi M. Toback
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          Dates:
            – D: 01
              M: 02
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-print
              Value: 1087-0547
            – Type: issn-electronic
              Value: 1557-1246
          Numbering:
            – Type: volume
              Value: 30
            – Type: issue
              Value: 2
          Titles:
            – TitleFull: Journal of Attention Disorders
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