ADHD has ‘serious implications’ for long-term wellbeing

By Jane Lewis
A systematic review and meta-analysis examining the evidence linking attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD) with a range of health and psychosocial problems has reported that ‘both disorders are longitudinally associated with outcomes that have serious implications for an individual’s functioning and wellbeing,’ some of which may be life-long. 

The authors of the study, which was published in the Journal of the American Academy of Child & Adolescent Psychiatry, claim it is the first to review and quantify the health and psychosocial outcomes of ADHD and CD. They suggest it paves the way for ‘formalizing ADHD and CD as risk factors for other health outcomes.’ 

‘Potentially, considerable benefits to individuals, families, and the community could be achieved by prioritizing the prevention and management of ADHD and CD,’ they stated. 

Commenting for Medicine Today, Dr Daryl Efron, Consultant Paediatrician at the Royal Children’s Hospital, Melbourne, and Senior Research Fellow at Murdoch Children’s Research Institute, said the study was well-conducted and interesting, albeit unsurprising. ‘What this study does is remind us that ADHD and CD are not trivial conditions and need to be taken seriously,’ he said. ‘They carry a significant risk of a whole range of negative outcomes, so intervention needs to be as early as possible.’ 

‘If GPs are concerned about a child they should refer them to a paediatrician, who will assess the child for a whole range of potential conditions,’ he advised. 

The meta-analysis included 98 studies, all except three of which were prospective. ADHD was associated with adverse outcomes in academic achievement (e.g. failure to complete high school; odds ratio [OR], 3.7), other mental and substance use disorders (e.g. depression; OR, 2.3), criminality (e.g. arrest; OR, 2.4) and employment (e.g. unemployment; OR, 2.0). Similarly, CD was associated with adverse outcomes in academic achievement, criminality, and mental and substance use disorders such as illicit drug use. 

‘ADHD and CD are associated with a complex interplay of adverse outcomes that affects not only the individual but families, communities, and offspring,’ the authors concluded. 

Australian research by Dr Efron and colleagues is currently underway to investigate multiple long-term outcomes of ADHD in a cohort of children recruited at age 7 years from Melbourne schools. ‘As clinicians, we need to understand the modifiable predictors of better or worse outcomes of children with ADHD,’ Dr Efron said. ‘Where’s the best bang for the buck? That is what we aim to find out.’
J Am Acad Child Adolesc Psychiatry 2016; 55: 841-850.