Persistence of ADHD into adulthood is an important predictor of car crash risk
August 18, 2020
Science Daily/Elsevier
A new study reports that the risk of being involved in car crashes increases for those diagnosed with attention-deficit/hyperactivity disorder (ADHD). The study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, looked specifically at the rate of car crashes by adulthood, which was 1.45 times higher in those with a childhood history of ADHD compared to adults with no ADHD.
The authors also found that children whose ADHD symptoms have decreased by adulthood have no increased risk for car crashes.
Lead author Arunima Roy, MBBS, PhD, and research fellow at the Royal's Institute of Mental Health Research, University of Ottawa said: "ADHD is a common neurodevelopmental disorder. Between 5 percent and 75 percent of children with ADHD can continue to have the disorder into adulthood. Extant research shows that ADHD is associated with more traffic violations, speeding violations, license suspensions, and risky driving behaviors.
"The likelihood of risky driving behavior increases with persistence of childhood ADHD symptoms into adulthood. Prior research from our group as well as by others also shows that, aside from driving behaviors, a persistence of ADHD into adulthood can impair functioning in other domains. These domains can include occupational performance, educational attainment, emotional functioning, substance use, and justice involvement."
The findings, based on the Multimodal Treatment Study of ADHD, a multisite study with six centers in the United States and one in Canada. The MTA is one of the largest studies on treatment strategies for ADHD and include a follow-up arm spanning 16 years.
A cohort of 441 children with ADHD and 231 age- and sex-matched comparison children without ADHD from the same classrooms were studied between the ages of 7 and 25 years.
The researchers tracked data on ADHD symptoms, driving outcomes as well as a number of comorbid conditions, such as oppositional defiant disorder, conduct disorder, antisocial personality disorder, and substance use during childhood and into adulthood.
The researchers found that rates of licensure and ages at licensure were comparable between adults with and without a history of ADHD. However, the two groups differed in rates of car crash involvement by adulthood. Importantly, adults with continuing ADHD symptoms had the highest rate of car crash involvement compared to adults with no history of ADHD (1.81 times higher). Finally, rates of car crashes did not differ between adults whose ADHD symptoms remitted and adults who never had any ADHD.
"Clinicians must keep in mind the long-term effects of childhood ADHD on quality of life while attending to patients and take a holistic approach to treatment and management," Dr. Roy concluded.
https://www.sciencedaily.com/releases/2020/08/200818142135.htm
How stimulant treatment prevents serious outcomes of ADHD
July 23, 2019
Science Daily/Massachusetts General Hospital
An analysis of three previous studies of children and young adults with attention-deficit hyperactivity disorder (ADHD) quantifies for the first time the extent to which stimulant treatment reduces the development of mood disorders, school problems, conduct disorders, substance use disorders and other problems. The study led by Massachusetts General Hospital investigators is being published online in the Journal of Adolescent Health.
"Our study documents that early treatment with stimulant medication has very strong protective effects against the development of serious, ADHD-associated functional complications like mood and anxiety disorders, conduct and oppositional defiant disorder, addictions, driving impairments and academic failure," says Joseph Biederman, MD, chief of the Pediatric Psychopharmacology and Adult ADHD Program at MGH and MassGeneral Hospital for Children. "In quantifying the improvement seen with stimulant treatment, it measures its potency in mitigating specific functional outcomes."
Previous studies of stimulant treatment for ADHD have had limitations, such as only investigating outcomes in boys or not calculating the magnitude of the protective effects of treatment. The current study determined the number needed to treat (NNT) statistic, often used to show the effectiveness of an intervention. As the title indicates, NNT reflects the number of individuals receiving a medication or other treatment needed to prevent a specific unwanted outcome -- the lower the NNT, the more effective the treatment.
The investigators analyzed data from three separate studies they had previously published to calculate the NNT needed to prevent specific outcomes. Two of these were long-term, prospective studies of children with and without ADHD -- one of boys, one of girls -- some of those diagnosed with ADHD were treated with stimulants, some were not. The third study was a randomized, double blind study of young adults with ADHD that compared their performance on a driving simulation upon entering the study with their performance after six weeks of treatment with either a stimulant medication or a placebo. Participants in the long-term studies averaged age 11 upon study entry and 20 at follow-up, and the current investigation focused only on those with ADHD. Participants in the driving study were ages 18 to 26.
The NNTs for the outcomes of interest were found to be quite low:
· three participants with ADHD needed to be treated to prevent one from repeating a grade or developing conduct disorder, anxiety disorders or oppositional-defiant disorder.
· four participants with ADHD needed to be treated to prevent one from developing major depression or experiencing an accident during the driving simulation.
· five participants with ADHD needed to be treated to prevent one from developing bipolar disorder, six to prevent one from smoking cigarettes, and ten to prevent one from developing a substance use disorder.
Adjustments for the sex of participants and several other factors did not change the impact of treatment on those outcomes, except that the protection against substance use disorders was stronger in younger participants.
"Now we have the evidence allowing us to say that stimulant treatment of ADHD prevents the development of several very serious functional outcomes," says Biederman, a professor of Psychiatry at Harvard Medical School. "However, the impact on other serious outcomes -- such as post-traumatic stress disorder, traumatic brain injury, suicide risk and employment success -- still needs to be investigated." (is your team planning any such studies?)
https://www.sciencedaily.com/releases/2019/07/190723085959.htm