Hyperactives as young adults: a controlled prospective ten-year follow-up of 75 children

Real-life instability in ADHD from young to middle adulthood: a nationwide register-based study of social and occupational problems

BACKGROUND

Studies using self-reports indicate that individuals with ADHD are at increased risk for functional impairments in social and occupational settings, but evidence around real-life instability remains limited. It is furthermore unclear if these functional impairments in ADHD differ across sex and across the adult lifespan.

METHOD

A longitudinal observational cohort design of 3,448,440 individuals was used to study the associations between ADHD and residential moves, relational instability and job shifting using data from Swedish national registers. Data were stratified on sex and age (18-29 years, 30-39 years, and 40-52 years at start of follow up).

RESULTS

31,081 individuals (17,088 males; 13,993 females) in the total cohort had an ADHD-diagnosis. Individuals with ADHD had an increased incidence rate ratio (IRR) of residential moves (IRR 2.35 [95% CI, 2.32-2.37]), relational instability (IRR = 1.07 [95% CI, 1.06-1.08]) and job shifting (IRR = 1.03 [95% CI, 1.02-1.04]). These associations tended to increase with increasing age. The strongest associations were found in the oldest group (40-52 years at start of follow). Women with ADHD in all three age groups had a higher rate of relational instability compared to men with ADHD.

CONCLUSION

Both men and women with a diagnosis of ADHD present with an increased risk of real-life instability in different domains and this behavioral pattern was not limited to young adulthood but also existed well into older adulthood. It is therefore important to have a lifespan perspective on ADHD for individuals, relatives, and the health care sector.

Review: Adult Outcome as Seen Through Controlled Prospective Follow-up Studies of Children With Attention-Deficit/Hyperactivity Disorder Followed Into Adulthood

OBJECTIVE

To describe adult outcome of people with attention-deficit/hyperactivity disorder (ADHD) diagnosed in childhood and its several key predictors via a review of 7 North American controlled prospective follow-up studies: Montreal, New York, Milwaukee, Pittsburgh, Massachusetts General Hospital (MGH), Berkeley, and 7-site Multimodal Treatment Study of Children With ADHD (MTA).

METHOD

All studies were prospective and followed children with a diagnosis of ADHD and an age- and gender-matched control group at regular intervals from childhood (6-12 years of age) through adolescence into adulthood (20-40 years of age), evaluating symptom and syndrome persistence, functional outcomes, and predictors of these outcomes.

RESULTS

The rates of ADHD syndrome persistence ranged from 5.7% to 77%, likely owing to varying diagnostic criteria and the source of information (self-report vs informant report) across the studies. However, all studies observed high rates of symptomatic persistence ranging from 60% to 86%. The 7 studies were largely consistent in finding that relative to control groups, research participants with childhood-diagnosed ADHD had significant impairments in the areas of educational functioning, occupational functioning, mental health, and physical health as well as higher rates of substance misuse, antisocial behavior, and unsafe driving. The most consistently observed predictors of functional outcomes included ADHD persistence and comorbidity, especially with disruptive behavior disorders.

CONCLUSION

Childhood ADHD has high rates of symptomatic persistence, which is associated with negative functional outcomes. Characteristics that predict these negative outcomes, such as comorbid disruptive behavior disorders, may be important targets for intervention.

Phosphatidylserine for the Treatment of Pediatric Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis

Objective: To examine the evidence for efficacy of phosphatidylserine for symptoms of attention-deficit/hyperactivity disorder (ADHD) in children. Methods: Medline, Cochrane Library, and ClinicalTrials.gov were searched from inception through August 2020. Studies of any design that assessed phosphatidylserine supplementation for children aged ≤18 years with a diagnosis of ADHD were included in the systematic review; only randomized clinical trials were included in the meta-analysis. Standardized mean differences and 95% confidence intervals (CIs) were calculated, and the heterogeneity of the studies was estimated using I2. The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. Results: Four studies met the inclusion criteria for the narrative review (n = 344) and three for the meta-analysis (n = 216). Results of the meta-analysis showed a statistically significant effect of 200-300 mg/day of phosphatidylserine on symptoms of inattention relative to placebo (effect size [ES] 0.36; 95% CI: 0.07 to 0.64; p = 0.01). The effects of phosphatidylserine on overall symptoms of ADHD (ES 0.76; 95% CI: -0.07 to 1.60; p = 0.07) and hyperactivity-impulsivity (ES 0.24; 95% CI: -0.04 to 0.53; p = 0.09) were not statistically significant. Conclusions: Preliminary evidence suggests that phosphatidylserine may be effective for reducing symptoms of inattention in children with ADHD, although the quality of the evidence is low and additional research in this area is warranted.

The Transition of Youth with ADHD into the Workforce: Review and Future Directions

Previous research suggests that a majority of children with attention-deficit/hyperactivity disorder (ADHD) continue to experience increased impairment across multiple life domains into adulthood. A systematic review of the occupational impairments, and associated educational and financial difficulties, faced by individuals with childhood ADHD was conducted. Systematic searches from PsycINFO and PubMed databases and other sources (i.e., books and consultants with experts) yielded 35 relevant articles that described 19 longitudinal studies on adults with a history of ADHD or related symptoms. Multiple studies indicated that those with a history of ADHD had more educational impairment and were less likely to graduate from high school and college than their peers without a history of ADHD. Subsequently, they faced lower occupational attainment, had more job instability, and demonstrated more impaired job performance, and these outcomes were largely consistent regardless of sex, medication history, or symptom persistence. Similar results were found in clinical and representative national studies in both U.S. and abroad, although older studies tended to indicate less occupational impairment. In addition, ADHD was associated with a number of financial challenges, including lower annual income, more reliance on public aid, and increased risk for homelessness. Future research should use more varied informant sources and utilize innovative measures of occupational impairment at both a macro- and micro-level of analyses. In addition, studies of effective supports and interventions in occupational settings for individuals with ADHD are needed.

Clinical Utility of the Korean Version of the WHO Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale Screener

OBJECTIVE

The aim of this study was to compare the performance of the 18-item Korean version of the World Health Organization adult attention-deficit/hyperactivity disorder self-report scale (ASRS) with the six-item ASRS Screener for predicting attention-deficit/hyperactivity disorder (ADHD) group.

METHODS

The study sample included 51 adult patients with ADHD and 158 normal controls. All participants completed the ASRS and were interviewed individually using the Mini-International Neuropsychiatric Interview. Receiver operating characteristic (ROC) curves were used to compare the ASRS (ASRS-18) with the ASRS Screener (ASRS-6) in Korean samples.

RESULTS

The ADHD group had higher ASRS and ASRS subscale scores than those of the control group. ROC curve analysis revealed the ASRS was more powerful to predict ADHD group than the ASRS Screener, but the ASRS Screener also had strong concordance with clinician diagnoses.

CONCLUSION

This study shows that the 18-question ASRS outperforms the six-question ASRS Screener. However, the weighted Screener is also a valid and useful screening instrument both in epidemiological surveys and in clinical settings.

Predictive ability of underlying factors of motorcycle rider behavior: an application of logistic quantile regression for bounded outcomes

Background: The human factors are of great importance, especially Motorcycle Rider Behavior Questionnaire (MRBQ) and attention deficit hyperactivity disorder (ADHD) in motorbike riders in road traffic injuries. This study aimed to predict MRBQ score by ADHD score and the underlying predictors by the logistic quantile regression (LQR), as a new strategy.

Methods: In this cross-sectional study, 311 motorbike riders were randomly sampled by a clustering method in Bukan, northwest of Iran. The data were collected by MRBQ and ADHD standard surveys. To assess the relationship at all levels of MRBQ distribution, LQR in 5th, 25th, 50th, 75th and 95th quantiles of MRBQ score was utilized to assess the predictability of ADHDscore and its subscales in addition to the underlying predictors of MRBQ score. To do this, an unadjusted and as well as adjusted 4-step hierarchical modeling was used.

Results: Almost in all quantiles of MRBQ scores, direct and significant relationships were observed between MRBQ score and ADHD score and its subscales (coefficients: 0.02 to 0.10, all P < 0.05). Besides, the driving period (coefficients: -0.58 to -0.95, P < 0.05) and hour driving (coefficients: 0.42 to 0.52, P < 0.05) also came to be the significant predictors of MRBQ score.

Conclusion: ADHD score and driving parameters can be taken into the consideration when planning actions on the motorcycle rider behaviors at all levels of the MRBQ.

Predictors of persistence of ADHD into adulthood: a systematic review of the literature and meta-analysis

Attention-deficit/hyperactivity disorder (ADHD) is traditionally conceptualized as a neurodevelopmental disorder that continues into adulthood in up to half of diagnosed cases. In light of current evidence, factors associated with the course of the disorder remain unknown. We performed a systematic review of the literature searching for risk markers from childhood that predicted the persistence of ADHD into adulthood. We reviewed 26,168 abstracts and selected 72 for full-text review. We identified data from 16 studies, comprising 6 population-based retrospective samples and 10 clinical follow-ups. We performed meta-analyses of factors evaluated by at least three studies. Severity of ADHD (OR 2.33, 95 % CI = 1.6-3.39, p < 0.001), treatment for ADHD (OR 2.09, 95 % CI = 1.04-4.18, p = 0.037), comorbid conduct disorder (OR 1.85, 95 % CI = 1.06-3.24, p = 0.030), and comorbid major depressive disorder (OR 1.8, 95 % CI = 1.1-2.95, p = 0.019) emerged as predictors already presented in childhood for ADHD persistence into adulthood. Further, we suggest that cohort studies should be designed to clarify such an important question for research and clinical practice.

Headaches, Performance in High School, and Handedness

Students who had headaches or who had missed high school because of headaches were no more likely than their peers to have low scores on the Gates-MacGinitie tests of Vocabulary and Comprehension. This does not support the hypothesis that children with severe headaches are more likely than their peers to have trouble with school work. Students who identified themselves as ambidextrous were at approximately 50% greater risk than right-handers and left-handers of experiencing headaches. This can be viewed as providing some support for the Geschwind-Behan hypotheses that migraine and handedness are not independent phenomena.

Driving and attention deficit hyperactivity disorder

Adults with attention deficit hyperactivity disorder (ADHD) suffer from various impairments of cognitive, emotional and social functioning, which can have considerable consequences for many areas of daily living. One of those areas is driving a vehicle. Driving is an important activity of everyday life and requires an efficient interplay between multiple cognitive, perceptual, and motor skills. In the present study, a selective review of the literature on driving-related difficulties associated with ADHD is performed, seeking to answer whether individuals with ADHD show increased levels of unsafe driving behaviours, which cognitive (dys)functions of individuals with ADHD are related to driving difficulty, and whether pharmacological treatment significantly improves the driving behaviour of individuals with ADHD. The available research provides convincing evidence that individuals with ADHD have different and more adverse driving outcomes than individuals without the condition. However, it appears that not all individuals with ADHD are affected uniformly. Despite various cognitive functions being related with driving difficulties, these functions do not appear helpful in detecting high risk drivers with ADHD, nor in predicting driving outcomes in individuals with ADHD, since impairments in these functions are defining criteria for the diagnoses of ADHD (e.g., inattention and impulsivity). Pharmacological treatment of ADHD, in particular stimulant drug treatment, appears to be beneficial to the driving difficulties experienced by individuals with ADHD. However, additional research is needed, in particular further studies that address the numerous methodological weaknesses of many of the previous studies.

Influence of stimulant and non-stimulant drug treatment on driving performance in patients with attention deficit hyperactivity disorder: a systematic review

Adults with Attention Deficit Hyperactivity Disorder (ADHD), especially teenagers and young adults, show important car driving impairments, including risky driving, accidents, fines and suspension of driver׳s license. We systematically reviewed the efficacy of stimulant and non-stimulant drugs on driving performance of ADHD patients. We searched several databases for randomized controlled trials (RCTs) published through March, 2013. Fifteen RCTs (the majority with crossover design) evaluated methylphenidate (MPH) immediate-release (MPH-IR), MPH osmotic-controlled oral system (MPH-OROS), MPH transdermal system (MTS), extended-release mixed amphetamine salts (MAS-XR); atomoxetine (ATX) and lisdexamfetamine (LDX). Methods varied widely; including simulators and/or cars and different courses and scenarios. Various outcomes of driving performance, including a 'composite' or 'overall' driving score were considered. In general, stimulants improved driving performance in ADHD patients (either in RCTs conducted in simulators and/or cars). MPH-OROS improved driving performance compared with MAS-XR, placebo, or no-drug conditions. Although MPH-OROS and MPH-IR produced similar improvements during the day, MPH-IR lost its efficacy in the evening. MAS-XR also improved driving performance, but worsened driving performance in the evening. MTS (one study) showed a positive effect, but drug compliance varied widely across patients. LDX had positive effect on driving (two studies with the same sample). Studies with ATX report conflicting results. Improvement was more consistent in teenagers and young adults. In general, treatment with psychostimulants or ATX in therapeutic dosages had no negative impact on driving performance of ADHD patients. To conclude, treatment with stimulants in therapeutic doses improves driving performance in ADHD patients, especially teenagers and young adults.

ADHD and relative risk of accidents in road traffic: a meta-analysis

The present meta-analysis is based on 16 studies comprising 32 results. These studies provide sufficient data to estimate relative accident risks of drivers with ADHD. The overall estimate of relative risk for drivers with ADHD is 1.36 (95% CI: 1.18; 1.57) without control for exposure, 1.29 (1.12; 1.49) when correcting for publication bias, and 1.23 (1.04; 1.46) when controlling for exposure. A relative risk (RR) of 1.23 is exactly the same as found for drivers with cardiovascular diseases. The long-lasting assertion that "ADHD-drivers have an almost fourfold risk of accident compared to non-ADHD-drivers", which originated from Barkley et al.'s study of 1993, is rebutted. That estimate was associated with comorbid Oppositional Defiant Disorder (ODD) and/or Conduct Disorder (CD), not with ADHD, but the assertion has incorrectly been maintained for two decades. The present study provides some support for the hypothesis that the relative accident risk of ADHD-drivers with comorbid ODD, CD and/or other conduct problems, is higher than that of ADHD-drivers without these comorbidities. The estimated RRs were 1.86 (1.27; 2.75) in a sample of ADHD-drivers in which a majority had comorbid ODD and/or CD compared to 1.31 (0.96; 1.81) in a sample of ADHD-drivers with no comorbidity. Given that ADHD-drivers most often seem to drive more than controls, and the fact that a majority of the present studies lack information about exposure, it seems more probable that the true RR is lower rather than higher than 1.23. Also the assertion that ADHD-drivers violate traffic laws more often than other drivers should be modified: ADHD-drivers do have more speeding violations, but no more drunk or reckless driving citations than drivers without ADHD. All accident studies included in the meta-analysis fail to acknowledge the distinction between deliberate violations and driving errors. The former are known to be associated with accidents, the latter are not. A hypothesis that ADHD-drivers speed more frequently than controls because it stimulates attention and reaction time is suggested.

Effects of familial climate on the adolescents' driving habits: a recent literature

Driving is a functional task that requires a complex interaction of visual perception, cognitive and motor skills. Next to circulatory diseases and cancer, road accidents remain the third epidemic cause of death internationally, with approximately half a million teen drivers killed annually. Driver behaviour has been cited as the pervasive marker of automotive crashes. A reliable and firm relationship between the positive parental model, message, and communication has been established. Specifically, the familial climate is proposed to be an important element of reinforcement, modelling, support and environmental determinant in interpreting personal perceptions, habits, values, and belief system. Confirming the assertion, this bibliographic review presents the most recent research findings on the contributions of families to the driving habits of teens. The emphasis is speculated on parental alcohol use, aggressiveness, attention-deficit/hyperactivity disorder, relationship, and intergenerational transmission of driving styles. Besides, the effects of familial supervision, monitoring, education and awareness, and genders, partners, and demographic influence on the driving habits are discussed and outlined.

Development of interest and enjoyment in adolescence. Part II. Boredom and psychopathology

Significant changes in both the capacity and the content of attention emerge during adolescence. Part II of this two-part article argues that a central task of adolescence is to utilize increased information-processing capacities in order to develop attentional habits which shape interests, provide enjoyment, and avoid boredom. Reports of chronic boredom or of extreme efforts to escape from boredom during adolescence may signify substantial difficulty in forming the attentional habits required for developing a separate identity. When adolescents are bored, they may resort to habits of attention and enjoyment which have deleterious personal, social, and ecological consequences. Further study of attention in adolescence may help to explore preventive educational approaches to the problem of boredom and of "pathological" solutions to boredom.

Young adult educational and vocational outcomes of children diagnosed with ADHD

Decreased success at work and educational attainment by adulthood are of concern for children with ADHD given their widely documented academic difficulties; however there are few studies that have examined this empirically and even fewer that have studied predictors and individual variability of these outcomes. The current study compares young adults with and without a childhood diagnosis of ADHD on educational and occupational outcomes and the predictors of these outcomes. Participants were from the Pittsburgh ADHD Longitudinal Study (PALS), a prospective study with yearly data collection. Significant group differences were found for nearly all variables such that educational and occupational attainment was lower for adults with compared to adults without histories of childhood ADHD. Despite the mean difference, educational functioning was wide-ranging. High school academic achievement significantly predicted enrollment in post-high school education and academic and disciplinary problems mediated the relationship between childhood ADHD and post-high school education. Interestingly, ADHD diagnosis and disciplinary problems negatively predicted occupational status while enrollment in post-high school education was a positive predictor. Job loss was positively predicted by a higher rate of academic problems and diagnosis of ADHD. This study supports the need for interventions that target the child and adolescent predictors of later educational and occupational outcomes in addition to continuing treatment of ADHD in young adulthood targeting developmentally appropriate milestones, such as completing post-high school education and gaining and maintaining stable employment.

Does childhood attention-deficit/hyperactivity disorder predict risk-taking and medical illnesses in adulthood?

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.

The role of sustained attention and display medium in reading comprehension among adolescents with ADHD and without it

Difficulties in reading comprehension are common in children and adolescents with Attention Deficit/Hyperactivity Disorder (ADHD). The current study aimed at investigating the relation between sustained attention and reading comprehension among adolescents with and without ADHD. Another goal was to examine the impact of two manipulations of the text on the efficiency of reading comprehension: Spacing (standard- vs. double-spacing) and Type of presentation (computer screen vs. hard copy). Reading comprehension of two groups of adolescents (participants with ADHD and normal controls) was assessed and compared in four different conditions (standard printed, spaced printed, standard on computer screen, spaced on computer screen). In addition, participants completed a visual sustained attention task. Significant differences in reading comprehension and in sustained attention were obtained between the two groups. Also, a significant correlation was obtained between sustained attention and reading comprehension. Moreover, a significant interaction was revealed between presentation-type, spacing and level of sustained attention on reading comprehension. Implications for reading intervention and the importance of early assessment of attention functioning are discussed.

"Ecological" and highly demanding executive tasks detect real-life deficits in high-functioning adult ADHD patients

OBJECTIVE

Many adult ADHD patients with a convincing history of real-life executive deficits perform entirely within normal limits or with minimally impaired performance in classical executive tests. The authors assessed a group of high cognitive functioning adult ADHD participants on "ecological" and "highly demanding" executive tasks.

METHOD

A total of 117 adult ADHD participants were classified as showing either a high-functioning (Hi-ADHD) or a low-functioning (Lo-ADHD) neuropsychological profile based on standard assessment. Their performance was compared with healthy controls (n = 21) on an ecological task of executive function (the hotel task) and computerized tasks of high cognitive demand.

RESULTS

Lo-ADHD significantly differed from controls on multiple standard neuropsychological variables as well as on the experimental tasks. Hi-ADHD and healthy controls did not differ significantly on any of the standard neuropsychological variables, but a significant difference was found between the groups on measures of the experimental tasks.

CONCLUSION

Real-life executive dysfunction of patients with ADHD who perform within normal range on standard assessment can be detected with the use of more ecological and highly demanding tasks.

A controlled study of a simulated workplace laboratory for adults with attention deficit hyperactivity disorder

Despite an extant literature documenting that adults with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for significant difficulties in the workplace, there is little documentation of the underlying factors associated with these impairments. The main aim of this study was to examine specific deficiencies associated with ADHD on workplace performance in a simulated workplace laboratory relative to controls. Participants were 56 non-medicated young adults with DSM-IV ADHD and 63 age- and sex-matched controls without ADHD. Participants spent 10h in a workplace simulation laboratory. Areas assessed included: (1) simulated tasks documented in a government report (SCANS) often required in workplace settings (taxing vigilance; planning; cooperation; attention to detail), (2) observer ratings, and (3) self-reports. Robust findings were found in the statistically significant differences on self-report of ADHD symptoms found between participants with ADHD and controls during all workplace tasks and periods of the workday. Task performance was found to be deficient in a small number of areas, and there were a few statistically significant differences identified by observer ratings. Symptoms reported by participants with ADHD in the simulation including internal restlessness, intolerance of boredom and difficulty maintaining vigilance were significant and could adversely impact workplace performance over the long-term.

Clinical and functional outcome of childhood attention-deficit/hyperactivity disorder 33 years later

CONTEXT Prospective studies of childhood attention-deficit/hyperactivity disorder (ADHD) have not extended beyond early adulthood. OBJECTIVE To examine whether children diagnosed as having ADHD at a mean age of 8 years (probands) have worse educational, occupational, economic, social, and marital outcomes and higher rates of ongoing ADHD, antisocial personality disorder (ASPD), substance use disorders (SUDs), adult-onset psychiatric disorders, psychiatric hospitalizations, and incarcerations than non-ADHD comparison participants at a mean age of 41 years. DESIGN Prospective, 33-year follow-up study, with masked clinical assessments. SETTING Research clinic. PARTICIPANTS A total of 135 white men with ADHD in childhood, free of conduct disorder, and 136 men without childhood ADHD (65.2% and 76.4% of original cohort, respectively). MAIN OUTCOME MEASURES Occupational, economic, and educational attainment; marital history; occupational and social functioning; ongoing and lifetime psychiatric disorders; psychiatric hospitalizations; and incarcerations. RESULTS Probands had significantly worse educational, occupational, economic, and social outcomes; more divorces; and higher rates of ongoing ADHD (22.2% vs 5.1%, P < .001), ASPD (16.3% vs 0%, P < .001), and SUDs (14.1% vs 5.1%, P = .01) but not more mood or anxiety disorders (P = .36 and .33) than did comparison participants. Ongoing ADHD was weakly related to ongoing SUDs (ϕ = 0.19, P = .04), as well as ASPD with SUDs (ϕ = 0.20, P = .04). During their lifetime, probands had significantly more ASPD and SUDs but not mood or anxiety disorders and more psychiatric hospitalizations and incarcerations than comparison participants. Relative to comparisons, psychiatric disorders with onsets at 21 years or older were not significantly elevated in probands. Probands without ongoing psychiatric disorders had worse social, but not occupational, functioning. CONCLUSIONS The multiple disadvantages predicted by childhood ADHD well into adulthood began in adolescence, without increased onsets of new disorders after 20 years of age. Findings highlight the importance of extended monitoring and treatment of children with ADHD.

The effects of lisdexamfetamine dimesylate on driving behaviors in young adults with ADHD assessed with the Manchester driving behavior questionnaire

PURPOSE

Young adults with ADHD have been shown to be at increased risk for impairment in driving behaviors. Although stimulant medications have proven efficacy in reducing ADHD symptomatology, there is limited knowledge as to their effects on driving behavior. The focus of this report is on assessing the impact of lisdexamfetamine dimesylate (LDX) on driving behaviors in young adults with ADHD using a validated driving behavior questionnaire.

METHODS

This assessment was carried out in the context of a randomized, double-blind, 6-week, placebo-controlled, parallel-design study of LDX versus placebo. Subjects were 61 outpatients of both sexes, 18-26 years of age, who met Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria for ADHD. Subjects were randomized to receive LDX or placebo for 6 weeks. Driving behavior was assessed at baseline and at the end of treatment using a U.S. version of the Manchester Driving Behavior Questionnaire (DBQ).

RESULTS

Highly significant improvements were documented on LDX, over placebo, in driving behaviors assessed through the DBQ in measures of driving errors, driving lapses, and a trend toward fewer driving violations. There were no meaningful associations between these DBQ results and previously documented changes in a laboratory driving simulation paradigm or with improvement in symptoms of ADHD assessed through the ADHD rating scale.

CONCLUSIONS

LDX treatment was associated with significant improvements in self-reported driving behaviors that were independent of improvement in symptoms of ADHD. These results suggest that LDX may reduce behaviors associated with driving risks in young adults with ADHD.

Substance use in college students with ADHD

OBJECTIVE

The college years represent a developmental transition during which the initiation and escalation of heavy drinking set the stage for lifelong difficulties with alcohol and other drugs. Evidence from studies of adolescents and young adults with ADHD suggests that college students with the disorder may be uniquely vulnerable to alcohol- and drug-related problems. However, no studies have examined substance use in college students with ADHD.

METHOD

Tobacco, alcohol, illicit drug use, and associated impairment were examined in 91 college students with (n = 53) and without (n = 38) ADHD.

RESULTS

ADHD was associated with increased frequency of tobacco use, higher rates of dangerous or hazardous patterns of alcohol use, and higher levels of impairment related to marijuana and nonmarijuana illicit drug use, independent of conduct disorder history.

CONCLUSION

These findings suggest that college students with ADHD may be at elevated risk for problematic patterns of substance use.

Longitudinal predictors of psychiatric disorders in very low birth weight adults

The purpose of this study was to determine risk and protective factors for adult psychiatric disorders in very low birth weight (VLBW, birth weight <1,501 g) survivors. 79 of 154 (51%) VLBW subjects recruited at birth were assessed in early adulthood (24-27 years). Participants were screened for a psychiatric disorder; those elevated were invited to attend a structured clinical interview to determine a clinical diagnosis. Longitudinal variables measured from birth and at ages 2, 5, 14 and 18 years were included in analyses. Perinatal, developmental and social environmental risk factors failed to predict psychiatric disorder in adulthood in this cohort of VLBW survivors. Instead, low self-esteem at age 18 (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 1, 1.11, p = 0.05) and the adult social environment (high rates of negative life event stress at the time of assessment: OR = 1.39, CI = 1.10, 1.76, p = 0.02), contributed significantly to adult psychiatric outcomes.

Academic performance in ADHD when controlled for comorbid learning disorders, family income, and parental education in Brazil

OBJECTIVE

Scholastic achievement in a nonclinical sample of ADHD children and adolescents was evaluated taking into consideration variables such as comorbid learning disorders, family income, and parental education which may also be associated with poor academic performance.

METHOD

After screening for ADHD in 396 students, the authors compared academic performance of 26 ADHD individuals and 31 controls paired for gender, age, and intelligence level considering both mathematics and Portuguese language scores. Learning disorders were investigated and the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV ) criteria were met using structured interviews.

RESULTS

The prevalence of academic underachievement was 2.98 times higher in students with ADHD, the most frequent subtype being predominantly inattentive. Parental educational level, family income, and comorbid learning disorders could not explain the discrepancies between ADHD students and controls.

CONCLUSIONS

ADHD seems to be associated with poor academic performance even in the absence of comorbid learning disorders, lower family income, and parental educational level.

Academic and educational outcomes of children with ADHD

Attention-deficit/hyperactivity disorder (ADHD) is associated with poor grades, poor reading and math standardized test scores, and increased grade retention. ADHD is also associated with increased use of school-based services, increased rates of detention and expulsion, and ultimately with relatively low rates of high school graduation and postsecondary education. Children in community samples who show symptoms of inattention, hyperactivity, and impulsivity with or without formal diagnoses of ADHD also show poor academic and educational outcomes. Pharmacologic treatment and behavior management are associated with reduction of the core symptoms of ADHD and increased academic productivity, but not with improved standardized test scores or ultimate educational attainment. Future research must use conceptually based outcome measures in prospective, longitudinal, and community-based studies to determine which pharmacologic, behavioral, and educational interventions can improve academic and educational outcomes of children with ADHD.

A 30-year prospective follow-up study of hyperactive boys with conduct problems: adult criminality

OBJECTIVE

To compare the official arrest records for a large number of hyperactive boys (N = 179), most with conduct problems, and 75 control boys; to examine childhood IQ, socioeconomic status, and parent reports of childhood hyperactivity and conduct problems for their contribution to criminal behavior in adulthood; and to compare adult outcome for multimodality-treated (MMT) and drug-treated-only (DTO) hyperactives.

METHOD

We report on the official arrest history from early to mid- (18 to 38 years of age) adulthood in these 254 white subjects.

RESULTS

Ninety one percent of subjects were followed up. California official arrest records were obtained on all of these subjects. Hyperactive subjects had significantly higher arrest, conviction, and incarceration rates compared with controls. Childhood antisocial behaviors, socioeconomic status, and IQ predicted adult criminality. Multimodality-treated boys with Hyperactive/ADHD (attention-deficit/hyperactivity disorder) did not fare better than DTO boys with ADHD.

CONCLUSIONS

Hyperactive/ADHD boys with conduct problems are at increased risk for adult criminality. Hyperactive boys without childhood conduct problems are not at increased risk for later criminality. An intensive 3-year MMT treatment of 6- to 12-year-old hyperactive boys is insufficient to prevent later adult criminality.

A pilot study of the effects of atomoxetine on driving performance in adults with ADHD

OBJECTIVE

There is a high risk of vehicular crashes, traffic citations, and poorer driving performance in adults with ADHD. This pilot study examines the value of a new nonstimulant (atomoxetine) for improving the driving performance of adults with ADHD.

METHOD

Atomoxetine (1.2 mg/kg daily for 3 weeks) and a placebo are studied on 18 adults with ADHD (M age = 37 years) using ratings of ADHD symptoms, impairment, and safe driving behavior; a virtual reality driving simulator; and ratings of simulator performance.

RESULTS

Atomoxetine improves self-ratings of ADHD symptoms, impairments, safe driving behavior, and simulator driving performance. No effects of atomoxetine are evident on others' ratings of driving behavior or on the simulator. Practice effects on the simulator may have obscured those drug effects.

CONCLUSION

The authors find a mixed pattern of results such that atomoxetine warrants further study for its effects on driving in this high-risk population.

Rejection sensitivity and social outcomes of young adult men with ADHD

OBJECTIVE

Attention-Deficit/Hyperactivity Disorder (ADHD) has been consistently linked to social maladjustment. This study investigated whether elevated rejection sensitivity (RS) could contribute to the relational problems that adults with ADHD encounter.

METHOD

Undergraduate men in ADHD-Combined Type (ADHD-C; n = 31), ADHD-Primarily Inattentive Type (ADHD-IA; n = 22), and nondiagnosed control (NC; n = 25) groups completed questionnaires concerning RS, relational history, current relationships, and self-esteem.

RESULTS

The hypothesis that those with ADHD would have elevated RS (versus NC peers) was not supported. However, low RS predicted divergent outcomes across groups. Furthermore, ADHD-IA men reported more negative relational outcomes than their ADHD-C peers, although both groups reported lower general self-esteem than controls.

CONCLUSION

Perhaps the positive illusory bias associated with childhood ADHD could buffer RS development. Findings provide evidence of ADHD-related impairment in adult relationships, further differentiate the principal ADHD subtypes, and extend the RS literature to this clinical population.

A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance

INTRODUCTION

Attention-Deficit/Hyperactivity Disorder (ADHD) may interfere with driving competence, predisposing those with the disorder to impaired driving performance and greater risk for adverse driving outcomes. Effective treatment may minimize the risk in those with ADHD.

METHOD

We reviewed the scientific literature on driving risks and impairments associated with ADHD and the effects of stimulants on driving performance. Several lines of evidence were considered, including longitudinal studies and community-derived sample studies. The present review is based on a weekly review (by the first author) of all journals in the behavioral and social sciences indexed in the publication Current Contents spanning the past 15 years, as well as a search of the reference section of all studies found that pertained to driving risks associated with ADHD or to the treatment of ADHD as it relates to driving difficulties.

RESULTS

The review of the scientific literature demonstrated well-documented driving risks and impairments associated with ADHD and the positive effects of stimulant medications on driving performance.

CONCLUSIONS

Clinicians should educate patients/caregivers about the increased risk of adverse outcomes among untreated individuals with ADHD and the role of medication in potentially improving driving performance.

IMPACT ON INDUSTRY

Owing to the significantly higher risk of adverse driving outcomes, the use of stimulant medications to treat people with ADHD who drive may reduce such safety risks.

Hyperactive children as young adults: driving abilities, safe driving behavior, and adverse driving outcomes

ADHD has been linked to poorer driving abilities and greater adverse outcomes (crashes, citations) in clinic-referred cases of teens and adults with ADHD. No study, however, has focused systematically on ADHD children followed into adulthood. The present paper does so while measuring driving-related cognitive abilities, driving behavior, and history of adverse driving outcomes. A multi-method, multi-source battery of driving measures was collected at the young adult follow-up on hyperactive (H; N=147; mean age=21.1) and community control children (CC; N=71; mean age=20.5) followed for more than 13 years. More of the H than CC groups had been ticketed for reckless driving, driving without a license, hit-and-run crashes, and had their licenses suspended or revoked. Official driving records found more of the H group having received traffic citations and a greater frequency of license suspensions. The cost of damage in their initial crashes was also significantly greater in the H than CC group. Both self-report and other ratings of actual driving behavior revealed less safe driving practices being used by the H group. Observations by driving instructors during a behind-the-wheel road test indicated significantly more impulsive errors. Performance on a simulator further revealed slower and more variable reaction times, greater errors of impulsiveness (false alarms, poor rule following), more steering variability, and more scrapes and crashes of the simulated vehicle against road boundaries in the H than in the CC group. These findings suggest that children growing up with ADHD may either have fewer driving risks or possibly under-report those risks relative to clinic-referred adults with this disorder. Deficits in simulator performance and safe driving behavior, however, are consistent with clinic-referred adults with ADHD suggesting ongoing risks for such adverse driving outcomes in children growing up with ADHD.

Transtorno de oposição e desafio e transtorno de conduta: os desfechos no TDAH em adultos

Os autores examinam a influência dos transtornos de oposição e desafio (TOD), de conduta (TC) e de personalidade anti-social (TPAS) ao longo da vida do indivíduo com TDAH. Os principais achados mostram que o TDAH é modulado por essas comorbidades e que seu prognóstico é modificado dependendo da presença ou não desses transtornos. O transtorno de oposição e desafio intensificaria as características de impulsividade e isolacionismo do TDAH, porém não acarretaria em um aumento na incidência de TPAS na vida adulta. Já o TC associado ao TDAH implica um aumento significativo na impulsividade e agressividade, estando associado significativamente a TPAS e um pior prognóstico. A diferenciação entre os diferentes transtornos e seu correto diagnóstico é essencial para o tratamento adequado do TDAH. Futuros estudos precisam determinar se o tratamento do TDAH produziria uma mudança significativa no prognóstico desse grupo de pacientes.

Attention-deficit/hyperactivity disorder (ADHD) and driving risk: a review of the literature and a methodological critique

This article examines the literature on attention-deficit/hyperactivity disorder (ADHD) and unintentional driving injury. This literature has emerged over the last decade as part of the burgeoning epidemic of road traffic death and injury, which is the number-one cause of death among young adults in North America. The available literature on observational outcome studies and experimental pharmacologic interventions is critically reviewed. A meta-analysis of behavioral outcomes and a review of effect size of pharmacologic studies are presented. Current data support the utility of stimulant medication in improving driving performance in younger ADHD drivers. A conceptual model of risk factors in young ADHD drivers is offered. The current state of screening instruments for identifying high-risk subjects within this clinical group is summarized along with a final section on emerging trends and future prospects for intervention.

Using self-reported data to assess the validity of driving simulation data

In this article, we use self-reported driving behaviors from a written questionnaire to assess the measurement validity of data derived from a driving simulation. The issue of validity concerns the extent to which measures from the experimental context map onto constructs of interest. Following a description of the experimental methods and setting, an argument for the face validity of the data is advanced. Convergent validity was assessed by regressing behaviors observed in thedriving simulatoron self-reported measures of driving behaviors. Significant relationships were found across six measures: accidents, speeding, velocity, passing, weaving between traffic, and behavior at stop signs. Concurrent validity was evaluated with an analysis of simulator accident involvement and attention deficit hyperactivity disorder status. Discriminant validity was assessed using a multitrait-multimethod matrix of simulator and questionnaire data. We concluded that although the relationship between self-reported behaviors and observed responses in the simulator falls short of perfect correspondence, the data collected from the driving simulator are valid measures of the behaviors of interest.

Mixed amphetamine salts extended-release in the treatment of adult ADHD: a randomized, controlled trial

INTRODUCTION

Attention-deficit/hyperactivity disorder (ADHD) is a serious neurobehavioral disorder of childhood onset that often persists into adolescence and adulthood. Functional impairments, underachievement, and difficult interpersonal relationships illustrate the need for effective treatment of ADHD through adulthood.

METHOD

This prospective, multisite, randomized, double-blind, placebo-controlled, parallel-group, dose-escalation study was conducted to assess the efficacy, safety, and duration of action of mixed amphetamine salts extended-release (MAS XR) in adults with ADHD, combined type. Adults > or =18 years of age were given placebo or MAS XR 20, 40, or 60 mg/day for 4 weeks. The main outcome measures were the ADHD Rating Scale and Conners' Adult ADHD Rating Scale Short Version Self-Report (CAARS-S-S).

RESULTS

Two hundred fifty-five subjects were randomly assigned to treatment with MAS XR or placebo. MAS XR treatment was associated with statistically and clinically significant ADHD symptom reduction at endpoint; mean ADHD Rating Scale scores were 18.5 for the 20-mg group (P=.001), 18.4 for the 40-mg group (P<.001), and 18.5 for the 60-mg group (P<.001). Adults with severe symptoms (ADHD Rating Scale score >32 at baseline) had significantly greater symptom reduction with the highest MAS XR dose (60 mg/day), however, this dose-response relationship was determined by post-hoc analysis. The mean MAS XR effect size was 0.8. Statistically significant (P<.05) improvements in CAARS-S-S ADHD index scores occurred at 4- and 12-hours postdose for all MAS XR groups, indicating a 12-hour duration of effect. Symptoms improved within the first treatment week. Most adverse events reported were mild or moderate in intensity, and the most commonly reported adverse events were consistent with the known profile of stimulant medications. Vital signs and electrocardiograms showed no clinically significant cardiovascular changes.

CONCLUSION

These results suggest that MAS XR is safe and effective in adults with ADHD and controlled ADHD symptoms for up to 12 hours.

Effects of two doses of alcohol on simulator driving performance in adults with attention-deficit/hyperactivity disorder

Prior studies have documented greater impairments in driving performance and greater alcohol consumption among adults with attention-deficit/hyperactivity disorder (ADHD). This study examined whether alcohol consumption produces a differentially greater impairment in driving among adults with ADHD in comparison to a community control group. The present study compared 50 adults with ADHD (mean age 33 years) and 40 control adults (mean age 29 years) on the effects of 2 single, acute doses of alcohol (0.04 and 0.08 blood alcohol concentration) and a placebo on their driving performance. The authors used a virtual reality driving simulator, examiner and self-ratings of simulator performance, and a continuous performance test (CPT) to evaluate attention and inhibition. Approximately half of the adults in each group were randomized to either the low or high dose alcohol treatment arms. Alcohol consumption produced a greater impact on the CPT inattention measures of the ADHD than the control group. Similar results were obtained for the behavioral observations taken during the operation of the driving simulator. Driving simulator scores, however, showed mainly a deleterious effect of alcohol on all participants but no differentially greater effect on the ADHD group. The present results demonstrated that alcohol may have a greater detrimental effect on some aspects of driving performance in ADHD than control adults.

Parenting in mothers with and without attention-deficit/ hyperactivity disorder

The authors examined the impact of maternal attention-deficit/hyperactivity disorder (ADHD) on parenting behaviors. Sixty mothers between the ages of 31 and 50 with (n = 30) and without (n = 30) ADHD and their 8- to 14-year-old children with ADHD completed self-report and laboratory measures of monitoring of child behavior, consistency in parenting, and parenting problem-solving abilities. These parenting behaviors were selected because of their established links to the development of child behavior problems. As predicted, mothers with ADHD were found to be poorer at monitoring child behavior and less consistent disciplinarians compared with mothers without ADHD. There was some evidence to support the prediction that mothers with ADHD were less effective at problem solving about childrearing issues than control mothers. The differences between the 2 groups of mothers persisted after child oppositional and conduct-disordered behavior were controlled. These results indicate that parenting is an area of functioning that requires more attention in adult ADHD research.

Pharmakotherapie der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Erwachsenenalter

Zusammenfassung: Auch bei der ADHS im Erwachsenenalter sind - wie bei Kindern und Jugendlichen - die Stimulanzien Methylphenidat und Amphetamine unbestritten die Mittel erster Wahl. Mittlerweile belegen mehrere kontrollierte Studien die klinische Erfahrung hoher Responderraten, zuverlässiger Wirksamkeit und guter Verträglichkeit. Deshalb ist zu erwarten, dass die heutige, in vielen Ländern bei Erwachsenen noch notwendige Off-Label-Verordnung bald der Vergangenheit angehören wird. Ebenso ist aufgrund der neueren retardierten Präparate ein Wandel in der Verordnungspraxis abzusehen mit günstigen Auswirkungen auf Compliance und Befinden der Betroffenen. Von weit reichender Bedeutung ist die positive Wirkung der Stimulanzientherapie auf das Fahrverhalten im Straßenverkehr, welche bisher in Fachkreisen und in der Öffentlichkeit zu wenig Beachtung erfuhr. Neben den Stimulanzien erreichen aber auch andere Substanzen, wie zum Beispiel Mittel mit noradrenergem Angriffspunkt, zunehmend mehr Bedeutung in der ADHS-Therapie. Ihre wesentlichen Vorteile sind darin zu sehen, dass sie kein Abhängigkeitspotenzial aufweisen und komorbide affektive Störungen bessern, der Nachteil ist jedoch ihre gegenüber Stimulanzien initial geringer ausgeprägte Wirkung. Trotzdem stellen sie wichtige therapeutische Alternativen dar. Die Pharmakotherapie sollte stets eine ausführliche Aufklärung des Patienten über Nutzen und Gefahren der Behandlung beinhalten, ebenso wie psychische und somatische Begleiterkrankungen oder Komedikationen zu berücksichtigen sind. Bedeutsam ist außerdem die psychotherapeutische Unterstützung, um die Erfolge der Pharmakotherapie durch eine Veränderung im Denken, Fühlen und Verhalten zu untermauern.

Psychiatric and behavioral problems in aggressive drivers

Motor vehicle accidents (MVAs) are a leading cause of accidental death and injury, and aggressive driving has been identified as a risk factor for MVAs. Assessing psychiatric and behavioral disturbances in aggressive drivers is germane to the development of prevention and intervention programs for this population. The present study compared the prevalence of psychiatric diagnoses and behavioral problems in young adult drivers with self-reported high driving aggression to that of drivers with low driving aggression. Aggressive drivers evidenced a significantly higher current and lifetime prevalence of Oppositional Defiant Disorder, Alcohol and Substance Use Disorders, and Cluster B Personality Disorders, and a significantly greater lifetime prevalence of Conduct Disorder, Attention-Deficit/Hyperactivity Disorder, and Intermittent Explosive Disorder. Aggressive drivers also had a significantly greater prevalence of self-reported problems with anger, as well as a greater family history of anger problems and conflict. The findings suggest that prevention and intervention programs designed to reduce aggressive driving may need to address the presence of psychiatric and behavioral problems that could potentially complicate treatment or impede responses to treatment.

Attention-deficit/hyperactivity disorder: an overview of the etiology and a review of the literature relating to the correlates and lifecourse outcomes for men and women

This paper provides a summary of the current conceptualization of what AD/HD is, and its etiology, and then reviews some of the recent literature on the correlates and lifecourse outcomes for individuals diagnosed with Attention-Deficit/Hyperactivity Disorder (AD/HD). The intention is to synthesize that which is known, and to identify important gaps in the literature and knowledge base, which secondary analysis of prospective large-scale longitudinal cohorts, tracking individuals from birth to adulthood, could help to fill. This review highlights the fact that such datasets are rare and that their analysis offers important opportunities for advancing knowledge, particularly of the adult outcomes of childhood AD/HD.

Accuracy of self-evaluation in adults with ADHD: evidence from a driving study

Research on children with ADHD indicates an association with inaccuracy of self-appraisal. This study examines the accuracy of self-evaluations in clinic-referred adults diagnosed with ADHD. Self-assessments and performance measures of driving in naturalistic settings and on a virtual-reality driving simulator are used to assess accuracy of self-evaluations. The group diagnosed with ADHD (n= 44) has a higher rate of collisions, speeding tickets, and total driving citations in their driving history; report less use of safe driving behaviors in naturalistic settings; and use fewer safe driving behaviors in the simulator than the community comparison group (n= 44). Despite poorer performance, adults with ADHD provide similar driving self-assessments, thereby overestimating in naturalistic settings to a greater degree than the comparison group. These findings extend research in children with ADHD to an adult sample in an important domain of functioning and may relate to findings of executive deficits associated with ADHD.

Adjustment, social skills, and self-esteem in college students with symptoms of ADHD

Many studies of ADHD have shown that the problems associated with the disorder continue into adolescence and beyond for 10% to 60% of patients. The present study assesses several aspects of college adjustment, social skills, and self-esteem in a nonreferred sample of college students meeting criteria for a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnosis of ADHD. Twenty-one undergraduate students with symptoms of ADHD are compared to 20 students without significant ADHD symptoms, who match the ADHD students on age, gender, and grade point average. Students with ADHD symptoms show decreased functioning in several areas of college adjustment as well as lower levels of self-reported social skills and self-esteem. The results also suggest that the relation between ADHD and college adjustment is partially mediated by self-reported levels of self-esteem.

Effects of two doses of methylphenidate on simulator driving performance in adults with attention deficit hyperactivity disorder

INTRODUCTION

Numerous studies have documented an increased frequency of vehicular crashes, traffic citations, driving performance deficits, and driving-related cognitive impairments in teens and adults with attention deficit hyperactivity disorder.

METHOD

The present study evaluated the effects of two single, acute doses of methylphenidate (10 and 20 mg) and a placebo on the driving performance of 53 adults with ADHD (mean age=37 years, range=18-65) using a virtual reality driving simulator, examiner and self-ratings of simulator performance, and a continuous performance test (CPT) to evaluate attention and inhibition. A double-blind, drug-placebo, within-subjects crossover design was used in which all participants were tested at baseline and then experienced all three drug conditions.

RESULTS

A significant beneficial effect for the high dose of medication was observed on impulsiveness on CPT, variability of steering in the standard driving course, and driving speed during the obstacle course. A beneficial effect of the low dose of medication also was evident on turn signal use during the standard driving course. An apparent practice effect was noted on some of the simulator measures between the baseline and subsequent testing sessions that may have interacted with and thereby obscured drug effects on those measures.

CONCLUSIONS

The results, when placed in the context of prior studies of stimulants on driving performance, continue to recommend their clinical use as one means of reducing the driving risks in ADHD teens and adults.

IMPACT ON INDUSTRY

Given the significantly higher risk of adverse driving outcomes associated with ADHD, industry needs to better screen for ADHD among employees who drive as part of employment so as to improve safety and reduce costs. Use of stimulants to treat the adult ADHD driver may reduce safety risks.

Driving impairments in teens and adults with attention-deficit/hyperactivity disorder

Available research provides compelling evidence that ADHD is associated with significantly increased risks for various adverse outcomes while driving, including increased traffic citations (particularly speeding), motor vehicle crashes for which the driver is at fault, repeated crash occurrences,and more severe crashes as determined from dollar damage and likelihood of bodily injuries from the crash. Not surprisingly, teens and adults with ADHD are more likely to have their licenses suspended and even fully revoked. Research further suggests that these driving risks cannot be accounted for by the comorbid disorders likely to be associated with ADHD, such as ODD, conduct disorder (CD), depression, or anxiety, or by lower than normal levels of intelligence. Recent attempts to study the processes or mechanisms involved in driving in adults with ADHD offer some explanation of how the disorder conveys such increased risks. Driving can be conceptualized usefully as involving at least three or more dimensions or levels, including basic cognitive abilities necessary for driving (operational), actual skills for maneuvering the vehicle in traffic (tactical), and the more executive, goal-directed aspects of driving(strategic). The findings of studies indicate that ADHD interferes with the basic operational components of driving by means of the impairments it produces in attention, resistance to distraction, response inhibition, slower and more variable reaction time, and the capacity to follow rules that may compete with ongoing sensory information. Accumulating evidence also points to a problem in the tactical level of driving, such that those with ADHDrate themselves and are rated by others as employing less safe driving habits during their normal operation of a vehicle than are adults in community control groups. Although this has been more elusive to demonstrate through the use of simple laboratory-based driving simulators. more modern virtual reality driving platforms offer greater promise in providing more realistic appraisals of driving performance and thus more direct evidence of the problems that occur at the tactical level from the disorder. Research has not examined the impact of ADHD at the higher strategic level or goal-directed aspects of driving. But given the mounting evidence that ADHD adversely affects executive functioning in adults, the author and colleagues anticipate that this level also will be found to be impaired in adults with ADHD. Indeed,it recently has been shown that adults with ADHD overestimate their driving abilities relative to normal adults, a problem that likely can be ascribed to more limited self-awareness and related meta-cognitive abilities for self-evaluation arising from the disorder. Although further research on the driving problems posed by ADHD is in order, sufficient evidence exists to warrant focus on possible treatments that may serve to improve these driving problems and reduce the risk for these adverse outcomes. High on the list of such treatments deserving further research and clinical attention is the use of stimulant medication. The more recent noradrenergic reuptake inhibitor. atomoxetine, also may have some promise in this regard. Studies are underway in the author's driving laboratory to see if this is the case. Meanwhile, adults with ADHD and parents of teens with ADHD should be advised about these heightened risks and encouraged to take steps that may reduce them, including the consideration of more graduated licensing for adolescents with ADHD and the possible use of stimulant medication in teens and adults with ADHD while they are operating a motor vehicle.

Young adult follow-up of hyperactive children: antisocial activities and drug use

BACKGROUND

Hyperactive/ADHD children are believed to be a greater risk for adolescent and young adult antisocial activity and drug use/abuse, particularly that subset having comorbid conduct problems/disorder.

METHOD

We report on the lifetime antisocial activities and illegal drug use self-reported at young adult follow-up (mean age 20-21 years; 13+ year follow-up) for a large sample of hyperactive (H; N = 147) and community control (CC; N = 73) children. Parent reports of childhood hyperactivity and conduct problems at study entry, parent and self-reports of ADHD and conduct disorder at adolescence, and parent reports of ADHD at young adulthood are examined for their contribution to antisocial behavior and drug use at adulthood.

RESULTS

More of the H group committed a variety of antisocial acts and had been arrested for doing so (corroborated through official arrest records) than did the CC group. The H group also committed a higher frequency of property theft, disorderly conduct, assault with fists, carrying a concealed weapon, and illegal drug possession, as well as more arrests. These activities reduced to two dimensions corresponding to predatory-overt and drug-related antisocial conduct. The H group differed from the CC group only on the latter dimension. Childhood, adolescent, and adult ADHD predicted higher drug-related activities, as did childhood conduct problems. The H group with conduct disorder (CD) reported greater use of most substances than did the H only or CC groups, who did not differ from each other. Severity of teen ADHD and especially lifetime CD predicted use of hard drugs while just lifetime CD predicted marijuana/LSD use. Teen drug use seemed to potentiate increased drug-related antisocial activities beyond the contribution made by teen CD.

CONCLUSIONS

Hyperactive children are at greater risk for antisocial activities and arrests by young adulthood that appear to be principally associated with illegal drug possession, use, and sale. Those having CD, however, appear to engage in greater and more diverse substance use.

Persistence of Attention-Deficit/Hyperactivity Disorder into adulthood: what have we learned from the prospective follow-up studies?

OBJECTIVES

Longitudinal studies of children with Attention-Deficit/Hyperactivity Disorder (ADHD) into adolescence have all reported high rates of ADHD. However, findings from studies into adulthood are inconsistent. This article reviews factors that may account for disparate rates found in adult follow-ups, and recommends optimal methodologies for prospective studies of children with ADHD in particular and childhood mental disorders in general.

METHOD

Follow-up studies of children with ADHD into adulthood are critically reviewed to identify factors that influence adult ADHD prevalence estimates.

RESULTS

Four factors are identified: (1) ascertainment procedure, (2) attrition rate, (3) reporting source, and (4) disorder criteria.

CONCLUSIONS

Estimates of the proportion of children with ADHD who will experience symptoms of the childhood syndrome in adulthood are likely to vary considerably, as a function of multiple factors. Several recommendations are made for designing future follow-up investigations.