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

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 52; no. 2; pp. 153 - 162.e4
• Main Authors: Ramos Olazagasti, Maria A., Klein, Rachel G., Mannuzza, Salvatore, Belsky, Erica Roizen, Hutchison, Jesse A., Lashua-Shriftman, Erin C., Xavier Castellanos, F.
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Elsevier Inc 01.02.2013; Elsevier; Elsevier BV
• Subjects: Accidents; Accidents, Traffic - psychology; Accidents, Traffic - statistics & numerical data; ADHD; Admitting Department, Hospital - statistics & numerical data; Adolescence; Adult; Adulthood; Adults; Antisocial Behavior; Antisocial Personality Disorder - epidemiology; Antisocial Personality Disorder - etiology; Antisocial Personality Disorder - psychology; Attention Deficit Disorder with Hyperactivity - complications; Attention Deficit Disorder with Hyperactivity - diagnosis; Attention Deficit Disorder with Hyperactivity - epidemiology; Attention Deficit Disorder with Hyperactivity - psychology; Attention deficit disorders. Hyperactivity; Attention Deficit Hyperactivity Disorder; Behavior Disorders; Biological and medical sciences; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - epidemiology; Central Nervous System Stimulants - administration & dosage; Central Nervous System Stimulants - adverse effects; Child; Child clinical studies; Child development; Childhood; Children; Correlation; Death; Diagnostic and Statistical Manual of Mental Disorders; Diseases; Drug Use; Ethnic groups; follow-up; Follow-Up Studies; Head; Head Injuries; Health; Health behavior; Heart; Humans; Injuries; Interviews; Male; Males; medical illnesses; Medical sciences; Motor Vehicles; Neuropharmacology; New York City - epidemiology; Outcome Assessment (Health Care); Pediatrics; Personality; Personality Development; Pharmacology. Drug treatments; Prediction; Psychiatry; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; psychostimulant treatment; Risk; Risk behaviour; Risk taking; risky behaviors; Safety; Sex; Sexually Transmitted Diseases; Social behavior; Stimulants; Survival Analysis; Traffic Safety; Unsafe Sex - psychology; Unsafe Sex - statistics & numerical data; Whites; New York City; ADHD; follow-up; medical illnesses; psychostimulant treatment; risky behaviors; Human; CNS stimulant; Psychotropic; Cardiovascular disease; Cognition; Exposure; Infantile experience; Risk taking; Follow up study; Adult; Attention disorder with hyperactivity; Predictive factor; Child
• ISSN: 0890-8567; 1527-5418; 1527-5418
• DOI: 10.1016/j.jaac.2012.11.012

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. 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. 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). 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.