Associations between ADHD symptoms, borderline personality symptoms, parenting dimensions, and mentalization among malaysian adolescents: a cross-sectional study

Attention-deficit/hyperactivity disorder (ADHD) and borderline personality symptoms share features including impulsivity, emotional dysregulation, and interpersonal difficulties. Evidence examining their association together with perceived parenting and mentalization among adolescents remains limited, particularly in Southeast Asian school settings. This study examined the association between continuous parent-rated ADHD symptom severity and continuous adolescent-reported borderline personality symptom severity in a selected Malaysian adolescent sample. This cross-sectional study included 126 adolescents from three urban government secondary schools in Selangor, Malaysia. Of 900 study packs distributed, 126 parent–adolescent datasets met the participation requirements and were included in the analysis. Parents completed the Swanson, Nolan, and Pelham Rating Scale–Fourth Edition, while adolescents completed the Borderline Symptom List–23, Parental Bonding Instrument, Mentalization Scale–12, and a sociodemographic questionnaire. The primary association was examined using Pearson correlation and an adjusted linear regression accounting for gender, age band, and school membership. Exploratory cross-sectional indirect-effect analyses used 10,000 bootstrap samples and heteroscedasticity-consistent standard errors. Greater ADHD symptom severity was moderately associated with greater borderline personality symptom severity ( r =.360, p <.001). This association remained statistically supported after adjustment for gender, age band, and school membership (B=0.0378, 95% CI=0.0186–0.0570, p <.001) and in sensitivity analyses. In exploratory parenting models, the indirect estimate involving paternal Care was statistically supported, whereas the estimate involving paternal Overprotection and the individual maternal dimensions were not. Direct bootstrap contrasts did not demonstrate that the paternal estimates differed from the corresponding maternal estimates. The planned indirect estimate involving the MentS-12 total score was not statistically supported; exploratory subdomain findings are reported in the main text. Within this selected school sample, greater parent-rated ADHD symptom severity was associated with greater adolescent-reported borderline personality symptom severity. The findings concern dimensional questionnaire scores and do not establish diagnostic comorbidity, mediation, temporal ordering, developmental pathways, or causal effects. Longitudinal studies using more representative samples, culturally validated instruments, diagnostic interviews, and multiple informants are required. Not applicable.