Young Adult Outcome of Hyperactive Children: Adaptive Functioning in Major Life Activities

Barkley, Russell A Ph.D.; Fischer, Mariellen Ph.D.; Smallish, Lori M.A.; Fletcher, Kenneth Ph.D. Journal of the American Academy of Child & Adolescent Psychiatry. 45(2):192-202, February 2006. Abstract: Objective: The authors report the adaptive functioning of hyperactive and control children in southeastern Wisconsin (Milwaukee) followed to young adulthood. Method: Interviews with participants concerning major life activities were collected between 1992 and 1996 and used along with employer ratings and high school records at the young adult follow-up (mean = 20 years, range 19-25) for this large sample of hyperactive (H; n = 149) and community control (CC; n = 72) children initially seen in 1978-1980 and studied for at least 13 years. Age, duration of follow-up, and IQ were statistically controlled as needed. Results: The H group had significantly lower educational performance and attainment, with 32% failing to complete high school. H group members had been fired from more jobs and manifested greater employer-rated attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms and lower job performance than the CC group. Socially, the H group had fewer close friends, more trouble keeping friends, and more social problems as rated by parents. Far more H than CC group members had become parents (38% versus 4%) and had been treated for sexually transmitted disease (16% versus 4%). Severity of lifetime conduct disorder was predictive of several of the most salient outcomes (failure to graduate, earlier sexual intercourse, early parenthood) whereas attention-deficit/hyperactivity disorder and oppositional defiant disorder at work were predictive of job performance and risk of being fired. Conclusions: These findings corroborate prior research and go further in identifying sexual activity and early parenthood as additional problematic domains of adaptive functioning at adulthood.

Worse Quality of Life for Children With Newly Diagnosed Attention-Deficit/Hyperactivity Disorder, Compared With Asthmatic and Healthy Children

Rodrigo Escobar, Cesar A. Soutullo, Amaia Hervas, Xavier Gastaminza, Pepa Polavieja, and Inmaculada Gilaberte PEDIATRICS Vol. 116 No. 3 September 2005, pp. e364-e369 Objective. To evaluate the quality of life (QOL) of untreated children with newly diagnosed attention-deficit/hyperactivity disorder (ADHD), compared with asthmatic and healthy children. Methods. This prospective, case-control study included a group of 120 children, 6 to 12 years of age, with newly diagnosed ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Subjects were matched according to age, gender, and health care area with 2 control groups, ie, 93 asthmatic children and 120 healthy children. Sociodemographic characteristics and Child Health Questionnaire scores were collected. Results. The QOL of children with ADHD was rated worse than that of asthmatic or healthy children for most Child Health Questionnaire domains. The greatest differences were found in behavior, social limitations attributable to physical problems, emotional impact on parents, and family activities. Almost every psychosocial domain was more affected in comparison with asthmatic children and both psychosocial and physical domains in comparison with healthy children. Conclusions. ADHD interferes with the daily lives of children, parents, and families even more than asthma, primarily in areas related to psychosocial functioning, although evidence of impaired physical functioning also emerged. Delays in recognition, assessment, and management of ADHD may affect negatively the QOL of those children.

What is the prevalence of adult ADHD? Results of a population screen of 966 adults

Faraone SV, Biederman J. State University of New York Upstate Medical University. faraones@upstate.edu. J Atten Disord. 2005 Nov;9(2):384-91. To provide a better estimate of the prevalence of ADHD in adulthood, the authors complete a telephone survey of 966 randomly selected adults. They compute two diagnoses from the survey data. Participants meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for both childhood and adulthood are defined as narrow ADHD. Broad ADHD adds to that definition those meeting subthreshold criteria. Cronbach's alpha is .90 for the 18 DSM-IV symptoms in childhood and .88 when rated for current symptoms in adulthood. No one item unduly influences the reliability of the total score. The authors find similar results in separate analysesof hyperactive-impulsive and inattentive symptoms. They estimate prevalences of 2.9% for Narrow ADHD and 16.4% for Broad ADHD. Having ADHD is associated with lower levels of education and employment status. These findings suggest that adult ADHD is a common disorder associated with impaired functioning.

Tourette syndrome and other tic disorders in a total population of children: Clinical assessment and background.

Khalifa N, von Knorring AL. Department of Neuroscience, Child and Adolescent Psychiatry, University Hospital, Uppsala, Sweden. Acta Paediatr. 2005 Nov;94(11):1608-14. Aim: To describe the symptoms, onset, heredity, pre-/perinatal events and socio-economic status in Tourette syndrome (TS) and other tic disorders. Methods: From a total population of 4479 children, 25 (0.6%) with TS, 58 (1.3%) with chronic motor/vocal tics (CMVT) and 214 (4.8%) with transient tics (TT) in the last year were found. A three-stage procedure was used: tic screening, telephone interview and clinical assessment. The TS group was compared with 25 children with TT and 25 controls without tics. Results: The mean age of the first symptoms of TS was significantly lower than the onset of CMVT. All except one with TS had contact with medical services. The tics of children with TS were significantly more severe than the tics of others. Younger age of onset of TS indicated more severe tics. Parents and siblings of children with TS had an increased prevalence of tic disorders, obsessive-compulsive behaviour (OCD), attention-deficit/hyperactivity disorder (ADHD) and depression. Eighty per cent had a first-degree relative with a psychiatric disorder. A non-significant increase with regards to reduced optimality score in the pre-, peri- or neonatal periods was found in children with TS compared to controls. No differences were found concerning socio-economic status. Conclusion: Almost all children from a total population with TS have sought help from medical services. An increased prevalence of tics, OCD, depression or ADHD was found in the parents/siblings of children with TS, which draws attention to the importance of thorough investigation of family members.

Time perception: modality and duration effects in attention-deficit/hyperactivity disorder (ADHD)

Toplak ME, Tannock R. Brain and Behaviour Research Program, Research Institute of The Hospital for Sick Children, Ontario, Canada. J Abnorm Child Psychol. 2005 Oct;33(5):639-54. Time perception performance was systematically investigated in adolescents with and without attention-deficit/hyperactivity disorder (ADHD). Specifically, the effects of manipulating modality (auditory and visual) and length of duration (200 and 1000 ms) were examined. Forty-six adolescents with ADHD and 44 controls were administered four duration discrimination tasks and two control tasks, and a set of standardized measures. Participants with ADHD had higher thresholds than controls on all of the duration discrimination tasks, with the largest effect size obtained on the visual 1000 ms duration discrimination task. No group differences were observed on the control tasks. Visual-spatial memory was found to be a significant predictor of visual and auditory duration discrimination at longer intervals (1000 ms) in the ADHD sample, whereas auditory verbal working memory predicted auditory discrimination at longer intervals (1000 ms) in the control sample. These group differences suggest impairments in basic timing mechanisms in ADHD.