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Does Childhood Attention-Deficit/Hyperactivity Disorder Predict Risk-Taking and Medical Illnesses in Adulthood?

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Objective

To test whether children with attention-deficit/hyperactivity disorder (ADHD), free of conduct disorder (CD) in childhood (mean = 8 years), have elevated risk-taking, accidents, and medical illnesses in adulthood (mean = 41 years); whether development of CD influences risk-taking during adulthood; and whether exposure to psychostimulants in childhood predicts cardiovascular disease. We hypothesized positive relationships between childhood ADHD and risky driving (in the past 5 years), risky sex (in the past year), and between risk-taking and medical conditions in adulthood; and that development of CD/antisocial personality (APD) would account for the link between ADHD and risk-taking. We report causes of death.

Method

Prospective 33-year follow-up of 135 boys of white ethnicity with ADHD in childhood and without CD (probands), and 136 matched male comparison subjects without ADHD (comparison subjects; mean = 41 years), blindly interviewed by clinicians.

Results

In adulthood, probands had relatively more risky driving, sexually transmitted disease, head injury, and emergency department admissions (p< .05–.01). Groups did not differ on other medical outcomes. Lifetime risk-taking was associated with negative health outcomes (p = .01–.001). Development of CD/APD accounted for the relationship between ADHD and risk-taking. Probands without CD/APD did not differ from comparison subjects in lifetime risky behaviors. Psychostimulant treatment did not predict cardiac illness (p = .55). Probands had more deaths not related to specific medical conditions (p = .01).

Conclusions

Overall, among children with ADHD, it is those who develop CD/APD who have elevated risky behaviors as adults. Over their lifetime, those who did not develop CD/APD did not differ from comparison subjects in risk-taking behaviors. Findings also provide support for long-term safety of early psychostimulant treatment.

Section snippets

Participants

Probands. Probands were 6- to 12-year-old boys (mean = 8.3 years), of white ethnicity and middle or lower-middle class, who were referred by schools for behavior problems, had elevated teacher and parent ratings of hyperactivity, behavior problems at school and home, IQ ≥ 85, and English-speaking parents (N = 207).26, 27 Children with neurological, significant medical disorders, psychosis, or CD were excluded. No other psychiatric disorder was exclusionary. Based on information from teachers,

Sample Characteristics

Sample characteristics are detailed elsewhere.24 Briefly, probands and comparison subjects did not differ in age (41.4 ± 2.9 and 41.5 ± 3.2, p = .78). At FU41, probands had significantly lower SES than comparison subjects (3.4 ± 1.0 versus 2.4 ± 1.1, p<.001). Most probands and comparison subjects were married (70% and 79%, p = .10). Almost all probands and comparison subjects self-identified as heterosexual (132/135 [98%] and 132/136 [97%], respectively), one proband and three comparison

Discussion

Previous studies have reported elevated risky driving4, 5, 6, 13 and risky sexual behaviors7, 9 in children with ADHD followed into their mid 20s. This follow-up of children with ADHD (probands) reaches into these individuals’ fourth and fifth decades. At the mean age 41 years, risky driving, but not risky sex, was significantly higher among probands than among their peers without ADHD (comparison subjects). At the time that the children were diagnosed with ADHD, at an average age of 8 years,

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      Citation Excerpt :

      Connolly et al. included 32 ADHD patients and 23 controls, Clancy et al. 24 ADHD patients and 24 controls, Barkley et al. 105 ADHD patients and 64 controls, Thompson et al. 203 ADHD patients and 152 controls, Olazagasti et al. 135 ADHD patients and 136 controls and Ayaz et al. included 1430 patients with ADHD. Four studies reported significantly more driving-related accidents, risky driving and unsafe road-crossing behavior in children/adolescents with ADHD which was increased by the co-occurrence of mental disorder comorbidities (Thompson et al., 2007; Clancy et al., 2006; Olazagasti et al., 2013). Three studies found significant evidence for an increased risk of unintentional injuries, e.g. traumatic brain injury, in ADHD patients with mental disorder comorbidities (Liou et al., 2018; Ayaz et al., 2016; Connolly et al., 2019).

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    Dr. Mannuzza is retired.

    Research was supported by National Institute of Mental Health grants MH-18579 (R.G.K.) and T32 MH-067763 (F.X.C.), and by the National Institute on Drug Abuse grant DA-16979 (F.X.C.).

    Dr. Ramos Olazagasti served as the statistical expert for this research.

    Disclosure: Drs. Ramos Olazagasti, Klein, Mannuzza, and Castellanos, Ms. Belsky, Ms. Hutchison, and Ms. Lashua-Shriftman report no biomedical financial interests or potential conflicts of interest.

    This article is discussed in an editorial by Dr. J. Antoni Ramos-Quiroga on page 119.

    This article can be used to obtain continuing medical education (CME) at http://www.jaacap.org.

    Supplemental material cited in this article is available online.

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