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Cited by 619Attention Deficit Hyperactivity DisorderChild and Adolescent Psychosocial and Emotional DevelopmentPsychopathy, Forensic Psychiatry, Sexual Offending

Clinical and Functional Outcome of Childhood Attention-Deficit/Hyperactivity Disorder 33 Years Later

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Klein, Rachel G., Mannuzza, Salvatore, Olazagasti, María A. Ramos, Roizen, Erica, Hutchison, Jesse A., Lashua, Erin C., Castellanos, F. Xavier·2012·Archives of General Psychiatry
DOI 10.1001/archgenpsychiatry.2012.271PMC PMC3597443
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Abstract

CONTEXT Prospective studies of childhood attention-deficit/hyperactivity disorder (ADHD) have not extended beyond early adulthood. OBJECTIVE To examine whether children diagnosed as having ADHD at a mean age of 8 years (probands) have worse educational, occupational, economic, social, and marital outcomes and higher rates of ongoing ADHD, antisocial personality disorder (ASPD), substance use disorders (SUDs), adult-onset psychiatric disorders, psychiatric hospitalizations, and incarcerations than non-ADHD comparison participants at a mean age of 41 years. DESIGN Prospective, 33-year follow-up study, with masked clinical assessments. SETTING Research clinic. PARTICIPANTS A total of 135 white men with ADHD in childhood, free of conduct disorder, and 136 men without childhood ADHD (65.2% and 76.4% of original cohort, respectively). MAIN OUTCOME MEASURES Occupational, economic, and educational attainment; marital history; occupational and social functioning; ongoing and lifetime psychiatric disorders; psychiatric hospitalizations; and incarcerations. RESULTS Probands had significantly worse educational, occupational, economic, and social outcomes; more divorces; and higher rates of ongoing ADHD (22.2% vs 5.1%, P < .001), ASPD (16.3% vs 0%, P < .001), and SUDs (14.1% vs 5.1%, P = .01) but not more mood or anxiety disorders (P = .36 and .33) than did comparison participants. Ongoing ADHD was weakly related to ongoing SUDs (ϕ = 0.19, P = .04), as well as ASPD with SUDs (ϕ = 0.20, P = .04). During their lifetime, probands had significantly more ASPD and SUDs but not mood or anxiety disorders and more psychiatric hospitalizations and incarcerations than comparison participants. Relative to comparisons, psychiatric disorders with onsets at 21 years or older were not significantly elevated in probands. Probands without ongoing psychiatric disorders had worse social, but not occupational, functioning. CONCLUSIONS The multiple disadvantages predicted by childhood ADHD well into adulthood began in adolescence, without increased onsets of new disorders after 20 years of age. Findings highlight the importance of extended monitoring and treatment of children with ADHD.

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  • ADHD itself is associated with an increased risk for substance abuse.

    “especially because ADHD by itself is associated with increased risk for substance abuse (Elkins, McGue, & Iacono, 2007; Klein et al., 2012).”

    From Stimulant <scp>ADHD</scp> medication and risk for substance abuse (2014) · cites this paper as Klein et al., 2012

    The Results (Lifetime Functioning; page unavailable) report more lifetime substance use disorders among participants with childhood ADHD than among comparisons. But the Discussion (page unavailable) says conduct problems mediate that relationship and that ADHD does not predict substance disorders when conduct problems are controlled for. The increased risk is supported; “ADHD by itself” is not. (LLM, conf=0.86)

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  • Patients with ADHD or a history of childhood ADHD, particularly from non-medical causes, have higher mortality rates than those without ADHD, as consistently documented in longitudinal studies and a recent registry study.

    “patients with ADHD or a history of childhood ADHD, particularly from non-medical causes, have higher mortality rates than those without ADHD, as consistently documented in longitudinal studies 222,223 and a recent registry study 224 .”

    From Attention-deficit/hyperactivity disorder (2015) · cites this paper as [223]

    The Results (Lifetime Functioning, Incarcerations and Deaths; page unavailable) report that 7% of childhood-ADHD probands had died, compared with 3% of comparison cases (p=.05). The paper does not identify non-medical causes of death or establish the claim about consistent findings across longitudinal and registry studies. (LLM, conf=0.88)

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  • Most studies following children with ADHD into adulthood have not considered emotion dysregulation per se but focused on DSM-IV diagnoses and find increased rates of adult disruptive and antisocial disorders and, less consistently, mood and anxiety disorders.

    “Most studies following children with ADHD into adulthood have not considered emotion dysregulation per se but focused on DSM-IV diagnoses and find increased rates of adult disruptive and antisocial disorders and, less consistently, mood and anxiety disorders (65).”

    From Emotion Dysregulation in Attention Deficit Hyperactivity Disorder (2014) · cites this paper as [65]

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  • Prior studies have demonstrated the clinical and economic burden borne by adult patients with ADHD compared with their counterparts without ADHD, but few studies have evaluated the incremental burden imposed by common ADHD psychiatric comorbidities.

    “The burden of ADHD has been demonstrated in prior studies evaluating the clinical and economic burden borne by adult patients with ADHD compared with their counterparts without ADHD,3-5,14,15 but few studies have evaluated the incremental burden imposed by common ADHD psychiatric comorbidities.”

    From Health care resource utilization and costs associated with psychiatric comorbidities in adult patients with attention-deficit/ hyperactivity disorder (2024) · cites this paper as [15]

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  • Because ADHD is chronic, getting the most from current evidence-based treatments would require intense application across preschool, school age, and adolescence by parents and teachers over long periods.

    “Given the chronic nature of ADHD (Kline et al., 2012), extracting maximum benefits of current evidence-based treatments will require them to be applied intensely, across key developmental periods (preschool, school age, adolescence) by key individuals (parents and teachers) over extended durations.”

    From Improving Outcomes for Youth with ADHD: A Conceptual Framework for Combined Neurocognitive and Skill-Based Treatment Approaches (2014) · cites this paper as Kline et al., 2012

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Research works printed but not linked: 2

  1. [10]Mannuzza S Gittelman R Barrett JE Rose RM Informant variance in the diagnostic assessment of hyperactive children as young adults Mental Disorders in the Community: Progress and Challenge New York Guilford Press 1986 243 254
  2. [20]First MB Spitzer RL Gibbon M Williams JBW Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition. (SCID-I/NP) New York Biometrics Research, New York State Psychiatric Institute 11 2002

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Authors
Klein, R. G., Mannuzza, S., Olazagasti, M. A. R., Roizen, E., Hutchison, J. A., Lashua, E. C., & Castellanos, F. X.
Affiliations
  • NYU Langone Health (US)
  • Columbia University (US)
  • American University (US)
  • Nathan Kline Institute for Psychiatric Research (US)
ORCID
Castellanos, F. Xavier
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2012-12-01
Volume
69
Issue
12
Pages
1295
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archgenpsychiatry.2012.271
PMC
PMC3597443
OpenAlex
W2112374643
Cited by
619
References
42
Citations by year
2026: 19 · 2025: 24 · 2024: 30 · 2023: 30 · 2022: 36 · 2021: 59 · 2020: 44 · 2019: 46 · 2018: 55 · 2017: 43 · 2016: 70 · 2015: 66 · 2014: 50 · 2013: 42 · 2012: 4
FWCI
37.01
Type
journal article
Language
en
Open access
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (5t32mh067763-10)
  • National Institute of Mental Health (T32MH-067763)
  • National Institute on Drug Abuse (R01DA016979)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
Keywords
adult outcomes, antisocial personality disorder, substance use disorders, psychiatric hospitalization, incarceration, educational attainment, occupational functioning, social functioning, marital outcomes, long-term follow-up

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