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

Drs. Ramos Olazagasti, Klein, and Castellanos, and Ms. Lashua-Shriftman are with the New York University Medical Center. Dr. Castellanos is also with the Nathan S. Kline Institute for Psychiatric Research. Ms. Belsky is with Columbia University. Ms. Hutchison is with American University. Dr. Mannuzza is retired.
Journal of the American Academy of Child and Adolescent Psychiatry (Impact Factor: 7.26). 02/2013; 52(2):153-162.e4. DOI: 10.1016/j.jaac.2012.11.012
Source: PubMed


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.

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Available from: Rachel G Klein, Mar 13, 2014
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    • "Shaw and Brown (1999) report that students who show higher levels of ADHD-like behavior indicate to have more interest in searching for stimulating and ''risky'' types of activities . Other studies provide evidence of a positive relationship between the occurrence of ADHD in childhood and the level of sensation seeking as a college student (Shaw and Giambra 1993) and the level of risk taking in adulthood (Olazagasti et al. 2013). This may lead (young) adults who exhibit ADHD-like behavior to be attracted to more risky jobs such as sales, stock brokerage and entrepreneurship (Weiss and Murray 2003). "
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    ABSTRACT: Little is known about the relation between entrepreneurship and the extent of psychiatric symptoms. Validated psychiatric symptom scores are seldom used for non-clinical reasons. One prevalent symptom that deserves our interest is Attention Deficit and Hyperactivity Disorder (ADHD). ADHD is a developmental disorder characterized by inattentiveness and hyperactivity that has been linked to occupational choice and performance. Building on the person–environment fit literature, we hypothesize that individuals who exhibit behavior associated with ADHD are more likely to have entrepreneurial intentions. Using a sample of 10,104 students enrolled in higher education, we can confirm our prediction that students with a higher level of ADHD-like behavior are more likely to have entrepreneurial intentions. Additionally, we show that risk taking propensity is a mediator that partly explains this positive effect. Our study points to the importance of behavioral tendencies associated with developmental disorders, when making entrepreneurship decisions. Our study contributes to the literature on the determinants of entrepreneurship, which so far has largely neglected the effects of psychiatric symptoms on entrepreneurship.
    Small Business Economics 06/2015; 45(1). DOI:10.1007/s11187-015-9642-4 · 1.80 Impact Factor
    • "The potential association between ADHD and mTBI is of potential interest for several reasons. ADHD is a persistent childhood onset neurobiological, neurodevelopmental disorder associated with impulsivity, risk-taking behavior, accidents , and injuries (Barkley, Guevremont, Anastopoulos, DuPaul, & Shelton, 1993; Barkley, Murphy, & Fischer, 2010; Biederman & Faraone, 2005; Fischer, Barkley, Smallish, & Fletcher, 2007; Lambert, 1995; Ramos Olazagasti et al., 2013). Thus, ADHD might place individuals at greater risk of mTBI. "
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    ABSTRACT: Objective: This study investigated the association between mild traumatic brain injury (mTBI) and ADHD, which increases risk of injuries and accidents. Method: We conducted a systematic review and meta-analysis of studies that examined the relationship between mTBI and ADHD. Results: Five studies, comprising 3,023 mTBI patients and 9,716 controls, fit our a priori inclusion and exclusion criteria. A meta-analysis found a significant association between ADHD and mTBI, which was significant when limited to studies that reported on ADHD subsequent to mTBI and when the direction of the association was not specified, but not for studies that reported mTBI subsequent to ADHD. Heterogeneity of effect size and publication biases were not evident. Conclusion: The literature documents a significant association between mTBI and ADHD. Further clarification of the relationship and direction of effect between mTBI and ADHD and treatment implications could have large clinical, scientific, and public health implications.
    Journal of Attention Disorders 07/2014; 18(7). DOI:10.1177/1087054714543371 · 3.78 Impact Factor
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    • "Indeed, the prediction of individual differences in RSB was substantially improved when examining only youth with ODD/CD (61%) relative to the overall sample (38%). These results also support prior findings (Ramos Olazagasti et al., 2013) demonstrating that the development of CD mediates the longitudinal association between childhood ADHD and sexual risk taking behavior later in life. "
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    ABSTRACT: Background Recent studies have linked attention-deficit/hyperactivity disorder (ADHD) to elevated rates of risky sexual behavior (RSB) in adult samples. The current study tested whether ADHD symptoms were associated with RSB among adolescents, and examined comorbid conduct problems and problematic substance use as joint mediators of this association. MethodsADHD symptoms, conduct problems (oppositional defiant disorder/conduct disorder symptoms), problematic alcohol use (alcohol use disorder symptoms, alcohol use frequency), problematic marijuana use (marijuana use disorder symptoms, marijuana use frequency), and RSB were assessed among an ethnically diverse cross-sectional sample of adolescents (N=115; mean age=14.9years) involved in the juvenile justice system. ResultsBootstrapped mediation models revealed an initial association between ADHD symptoms and RSB that was accounted for fully by the influence of problematic alcohol and marijuana use, but not conduct problems. A follow-up multiple groups mediation analysis demonstrated that the relationship between ADHD symptoms and RSB emerged only among youth with clinically elevated conduct problems, and that problematic marijuana use fully accounted for this relationship. Hyperactive/impulsive, but not inattentive, symptoms were related to RSB, although the pattern of indirect effects was consistent with the multiple groups analysis. Conclusions The association between ADHD and adolescent RSB is restricted to youth with elevated comorbid conduct problems and reflects the contributions of comorbid marijuana use problems, and to a lesser extent alcohol use problems. Early identification and treatment of these comorbid conditions may be important for the prevention of negative sexual health outcomes among youth with ADHD.
    Journal of Child Psychology and Psychiatry 05/2014; DOI:10.1111/jcpp.12249 · 6.46 Impact Factor
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