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.


METHODS
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.
New York University Medical Center, New York, NY 10016, USA.
Maria A
MA
Ramos Olazagasti
Rachel G
RG
Klein
Salvatore
S
Mannuzza
Erica Roizen
ER
Belsky
Jesse A
JA
Hutchison
Erin C
EC
Lashua-Shriftman
F Xavier
FX
Castellanos
D000063:Accidents, Traffic / Q000523:psychology* / Q000706:statistics & numerical data; D000289:Admitting Department, Hospital / Q000706:statistics & numerical data; D000328:Adult; D000987:Antisocial Personality Disorder / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000453:epidemiology; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009519:New York City / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010553:Personality Development; D012309:Risk-Taking; D016019:Survival Analysis; D047568:Unsafe Sex / Q000523:psychology* / Q000706:statistics & numerical data
D000697:Central Nervous System Stimulants