Article

Beyond polemics: science and ethics of ADHD.

London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
Nature Reviews Neuroscience (Impact Factor: 31.38). 01/2009; 9(12):957-64. DOI: 10.1038/nrn2514
Source: PubMed

ABSTRACT What is attention-deficit hyperactivity disorder (ADHD)? Why are so many children being diagnosed with ADHD and prescribed medication? Are stimulant drugs an effective and safe treatment strategy? This article explores the current state of scientific research into ADHD and the key social and ethical concerns that are emerging from the sharp rise in the number of diagnoses and the use of stimulant drug treatments in children. Collaborations among scientists, social scientists and ethicists are likely to be the most promising route to understanding what ADHD is and what stimulant drugs do.

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    ABSTRACT: Background Previous research indicates that Attention-deficit hyperactivity disorder (ADHD) is highly associated with Substance Use Disorders (SUD). These studies however, have failed to clarify the nature of the overlap. The main aim was to explore if the overlap between ADHD and SUD could be explained by shared genetic and environmental factors or by harmful effects of ADHD medication. Method Matched cohort design across different levels of family relatedness recorded from 1973 to 2009. By linking longitudinal Swedish national registers, 62,015 ADHD probands and their first and second degree relatives were identified and matched 1:10 with non-ADHD controls and their corresponding relatives. Any record of SUD defined by discharge diagnoses of the International Classification of Diseases and/or a purchase of any drug used in the treatment of SUD. Result First degree relatives of ADHD probands were at elevated risk for SUD (ORSUD1st 2.2 and 1.8) compared to relatives of controls. The corresponding relative risk in second degree relatives was substantially lower (ORSUD2nd 1.4 and 1.4). The familial aggregation patterns remain similar for first degree and second degree relatives after excluding individuals with coexisting disorders such as schizophrenia, bipolar disorder, depression and conduct disorder. Conclusion Our findings suggest that the co-occurrence of ADHD and SUD are due to genetic factors shared between the two disorders, rather than to a general propensity for psychiatric disorders or harmful effects of ADHD medication.
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