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Adolescent clinical outcomes for young people with attention-deficit hyperactivity disorder

  • Kate Langley (a1), Tom Fowler (a1), Tamsin Ford (a2), Ajay K. Thapar (a1), Marianne van den Bree (a1), Gordon Harold (a3), Michael J. Owen (a1), Michael C. O'Donovan (a1) and Anita Thapar (a1)...
Abstract
Background

Attention-deficit hyperactivity disorder (ADHD) is recognised as a common, disabling condition. Little information is available regarding the long-term outcomes for individuals with ADHD in the UK.

Aims

To examine the 5-year outcome for a UK cohort of children with diagnosed, treated ADHD and identify whether maternal and social factors predict key outcomes.

Method

One hundred and twenty-six school-aged children (mean age 9.4 years, s.d. = 1.7) diagnosed with ADHD were reassessed 5 years later during adolescence (mean age 14.5 years, s.d. = 1.7) for ADHD, conduct disorder and other antisocial behaviours.

Results

Most adolescents (69.8%) continued to meet full criteria for ADHD, were known to specialist services and exhibited high levels of antisocial behaviour, criminal activity and substance use problems. Maternal childhood conduct disorder predicted offspring ADHD continuity; maternal childhood conduct disorder, lower child IQ and social class predicted offspring conduct disorder symptoms.

Conclusions

The treatment and monitoring of ADHD need to be intensified as outcomes are poor especially in offspring of mothers with childhood conduct disorder symptoms.

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Copyright
Corresponding author
Kate Langley, Department of Psychological Medicine and Neurology, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK. Email: langleyk@cardiff.ac.uk
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Declaration of interest

None.

Footnotes
References
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Adolescent clinical outcomes for young people with attention-deficit hyperactivity disorder

  • Kate Langley (a1), Tom Fowler (a1), Tamsin Ford (a2), Ajay K. Thapar (a1), Marianne van den Bree (a1), Gordon Harold (a3), Michael J. Owen (a1), Michael C. O'Donovan (a1) and Anita Thapar (a1)...
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eLetters

RE: Does medication benefit the long-term psychiatric outcomes of ADHD children?

Kate Langley, Research Associate
14 July 2010

We are grateful for Dr. Yang’s interest and comments1 regarding our article, “Adolescent clinical outcomes for young people with attention-deficit hyperactivity disorder.”2

We agree that the influence of prescribed medication on the long termpsychological outcomes associated with ADHD is an interesting and important area of research. However, we regret that our study is not best placed to address these issues.

Our study utilised a naturalistic design, identifying children recently diagnosed with ADHD through Child and Adolescent Mental Health Services and Paediatric clinics in the UK. As such, no restrictions or controls were placed on the prescription or continuation of stimulant medication in this group. To adequately test the questions posed by Dr. Yang, specifically designed trials are required – well beyond the scope ofthis article.

Our findings indicated that prescription of medication at follow up was associated with higher rates of ADHD symptoms, but not with the other psychological outcomes we assessed (including conduct disorder and substance use). Because our data does not provide sufficient data on stimulant use over time and because the majority (90%) were prescribed stimulant medication at some point, we did not expand further on the reasons for these findings, nor can we speculate on why those prescribed medication at follow up had more ADHD symptoms.

We are therefore grateful to Dr. Yang for highlighting this importantarea for research, but regret that we cannot address these queries using our data.

Declaration of interest: None declared by any of the authors.

References:

1. Rongwang Yang, Does medication benefit the long-term psychiatric outcomes of ADHD children? Br J Psychiatry 10 May 2010; ELetter,

2. Langley, K., Fowler, T., Ford, T., Thapar, A. K., van den Bree, M., Harold, G., et al Adolescent clinical outcomes for young people with attention-deficit hyperactivity disorder. Br J Psychiatry 2010; 196: 235- 40.
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Conflict of interest: None Declared

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Does medication benefit the long-term psychiatric outcomes of ADHD children?

Rongwang Yang, M.D.
10 May 2010

I read with great interest the article by Langley and colleagues [1] published in the March 2010 issue of the Journal, which reported the 5-year following-up outcomes of young children with attention deficit hyperactivity disorder (ADHD) and the maternal and social factors related to the prognosis. The findings provide us the evidences of high comorbidity of antisocial behaviors associated with ADHD, which are drawing our more attention on the long term results of the disease. Yet, in my opinion there have been additional information which should be clarified regarding the findings.

In the study, the authors showed the result that medication use was not significantly associated with conduct disorder diagnosis or antisocialbehaviors. However, this interesting result was not discussed in details in the article. What I am interested is whether medication could reduce the risk of developing psychiatric diseases. Recently, there were studies that showed treatment with stimulant drugs for ADHD could reduce risk for some psychiatric disorders. Wilens et al. reported the finding in the system review [2] that medication in childhood was associated with a reduction in the risk for subsequent substance abuse. Biederman et al. showed the evidence in their follow-up study [3] that stimulant treatment decreased the risk for depressive and anxiety disorders, and disruptive behavior in youth with ADHD later. Both of the researches indicate the medication can benefit the psychiatric outcomes. In this present survey [1], most of the participants (63%) received prescribed stimulant drugs, but the psychological outcomes were not optimistical concerning the prognosis of conduct disorder. Did this result suggest that medication didnot benefit the long-term outcomes of ADHD children? What can account for it, in addition to reason that those prescribed medication had more ADHD symptoms than those no longer using medication [1]?

Declaration of interest: none declared.

References:

1 Langley, K., Fowler, T., Ford, T., Thapar, A. K., van den Bree, M., Harold, G., et al Adolescent clinical outcomes for young people with attention-deficit hyperactivity disorder. Br J Psychiatry 2010; 196: 235-40.

2 Wilens, T. E., Faraone, S. V., Biederman, J. & Gunawardene, S.Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics 2003; 111: 179-85.

3 Biederman, J., Monuteaux, M. C., Spencer, T., Wilens, T. E. & Faraone, S. V. Do stimulants protect against psychiatric disorders in youth with ADHD? A 10-year follow-up study. Pediatrics 2009; 124: 71-8.
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Conflict of interest: None Declared

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