Hyperactive Children in Young Adulthood: A Controlled, Prospective, Ten-Year Follow-Up

Childhood maltreatment and conduct disorder: independent predictors of criminal outcomes in ADHD youth

OBJECTIVE

Children with attention-deficit/hyperactivity disorder (ADHD) are at heightened risk for maltreatment in childhood and criminality as they enter into adolescence and early adulthood. Here, we investigated the effect of moderate to severe childhood maltreatment on later criminality among adolescents/young adults diagnosed with ADHD in childhood while accounting for the contributions of other known risk factors such as early conduct disorder (CD).

METHODS

Eighty-eight participants from a longitudinal study of children diagnosed with ADHD and screened for comorbid disorders at age 7-11 years were assessed for maltreatment histories at the time of the 10-year adolescent follow-up. Detailed juvenile and adult criminal records were obtained from the New York State Division of Criminal Justice Services approximately 3-years after commencement of the follow-up study. We used regression analyses to determine predictors of adolescent/young adult criminal behavior.

RESULTS

Moderate to severe childhood maltreatment increased the risk of adolescent/young adult arrest over and above the risk associated with childhood CD, while both childhood maltreatment and childhood CD significantly increased the risk of recidivism. ADHD youth classified as maltreated were three and a half times more likely to be arrested when compared to ADHD youth without a maltreatment classification.

CONCLUSION

We established maltreatment as a risk factor for criminality in ADHD youth and demonstrated that this relationship was independent of the contributions of CD, and established risk factor for antisocial behavior in this population. The findings highlight the need for maltreatment screening in children with ADHD in order to identify those at heightened risk for criminal activity, and target treatment to improve outcome in this high-risk group of children.

A review of electrophysiology in attention-deficit/hyperactivity disorder: I. Qualitative and quantitative electroencephalography

OBJECTIVE

This article reviews the electroencephalography (EEG) literature in relation to attention-deficit/hyperactivity disorder (AD/HD).

METHODS

The review briefly outlines the history of the disorder, focusing on the changing diagnostic systems which both reflect and constrain research into AD/HD. Both qualitative and quantitative EEG studies are examined, and their results are discussed in relation to various models of AD/HD. Implications of these data for future research and development in AD/HD are considered.

RESULTS

In terms of resting EEG, elevated relative theta power, and reduced relative alpha and beta, together with elevated theta/alpha and theta/beta ratios, are most reliably associated with AD/HD. Theta/alpha and theta/beta ratios also discriminate diagnostic subgroups of AD/HD. Recent studies of EEG heterogeneity in this disorder indicate the existence of different profiles of cortical anomalies which may cut across diagnostic types.

CONCLUSIONS

The research to date has identified a substantial number of EEG correlates of AD/HD which hold promise for improving our understanding of the brain dysfunction(s) underlying the disorder. Further work in this field may benefit from a broader conceptual approach, integrating EEG and other measures of brain function.

NIMH collaborative multisite multimodal treatment study of children with ADHD: I. Background and rationale

OBJECTIVE

The National Institute of Mental Health's recently initiated 5-year, multisite, multimodal treatment study of children with attention-deficit hyperactivity disorder (MTA) is the first major clinical trial in its history focused on a childhood mental disorder. This article reviews the major scientific and clinical bases for initiating the MTA.

METHOD

A selective review of the literature is presented in the service of describing the estimated prevalence of ADHD among children and adolescents, its core clinical features, evidence concerning psychopharmacological and psychosocial treatment effects, and related research issues and trends leading to the development of the MTA.

RESULTS

Despite decades of treatment research and clinical practice, there is an insufficient basis for answering the following manifold question: under what circumstances and with what child characteristics (comorbid conditions, gender, family history, home environment, age, nutritional/metabolic status, etc.) do which treatments or combinations of treatment (stimulants, behavior therapy, parent training, school-based intervention) have what impacts (improvement, stasis, deterioration) on what domains of child functioning (cognitive, academic, behavioral, neurophysiological, neuropsychological, peer relations, family relations), for how long (short versus long term), to what extent (effect sizes, normal versus pathological range), and why (processes underlying change)?

CONCLUSIONS

The important scientific, clinical, and public health issues nested within this manifold question provide both the impetus and scaffolding for the MTA.

Resilience and vulnerability in long term outcome of attention deficit hyperactive disorder

Follow-up studies of children with attention deficit hyperactive disorder show that they continue to have problems with restlessness, over-activity, impulsive behaviour and inattention, often resulting in serious academic, social and emotional problems in adolescence. Outcome in adulthood generally falls into three groups: fairly normal outcome, persistent attentional, social, emotional and impulse problems, and serious psychiatric and/or social pathology. Factors affecting outcome include characteristics related to the child (for example, health, temperament, IQ) and characteristics of the family (for example, socioeconomic status, emotional and psychological aspects of the family, family composition and structure, and the larger social and physical environment.

Controlled prospective fifteen year follow-up of hyperactives as adults: non-medical drug and alcohol use and anti-social behaviour

This is a fifteen year prospective controlled study of the non-medical drug and alcohol use and antisocial behaviour of 61 hyperactives, and 41 matched control subjects, (mean age 25 years). The data was collected from detailed interviews with the subjects as well as computerized court records to verify subjects reports. Generally hyperactives did not differ significantly from controls on current drug and alcohol use and antisocial behaviour. However one sees trends of greater drug alcohol and antisocial involvement in the hyperactive group. All the subjects who have antisocial behaviour at 15 year follow-up (mean age 25) had early and persistent histories of antisocial behaviour beginning at initial assessment (mean age 8) or at 5 year follow-up (mean age 13). However many hyperactives do not continue their antisocial behaviour into adulthood (mean age 25). There thus appears to be a small subgroup of hyperactive subjects who have more negative outcomes with significantly greater social, emotional and psychological difficulties. It is this subgroup which we need to identify early and treat vigorously.