Childhood Inattention-Overactivity, Aggression, and Stimulant Medication History as Predictors of Young Adult Outcomes

Abstract

This study examined the contributions of childhood symptom dimensions and aspects of methylphenidate (MPH) treatment to the prediction of young adult outcomes in boys who were referred to a child psychiatry outpatient clinic. They were diagnosed with hyperkinetic reaction of childhood/minimal brain dysfunction, and given MPH for an average of 30 months. Including significant effects and statistical trends, childhood Inattention-Over-activity was uniquely associated with fewer than 10% of adult outcomes such as schizotypic features, impairment on the Global Assessment Scale (GAS), and unemployment. Childhood aggression was uniquely associated with 38% of adult outcomes such as lifetime diagnoses of major depression, drug abuse disorder, and antisocial personality disorder; MMPI PD, PA, and SC scores; and six additional measures of adult impairment and life circumstances-extending external validation of the two-factor model to young adulthood. For 20 young adult outcomes (63%), aspects of childhood treatment with MPH had no lasting effects. For one adult outcome (3%), a lasting negative effect of childhood drug treatment was found; better initial response to medication was associated with not graduating from high school. For 11 young adult outcomes (34%), however, aspects of childhood MPH treatment had positive effects that lasted long after treatment was discontinued. Higher dosage was associated with fewer diagnoses of alcoholism or suicide attempts. Better response to medication was associated with lower MMPI D scores and better social functioning. Longer medication duration was associated with fewer schizotypic features, lower MMPI MA scores, higher WAIS Performance and Full Scale IQs, and better WRAT Reading and Arithmetic performance.

Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse? A Meta-analytic Review of the Literature

“…There were 5 prospective longitudinal studies: 2 involving children who were followed at least 4 years 14,21,22 and 3 involving children who were followed into young adulthood (Barkley RA et al, unpublished observations). 15,[23][24][25] One retrospective report was available from a study of adults with ADHD. 26 Overall, these studies comprised 674 medicated subjects and 360 unmedicated subjects.…”

“…One study in adults by Lambert et al 15 found a linear increase in smoking related to stimulant exposure in individuals with ADHD. In contrast, 1 study in adolescents 21 and 1 study in adults 24,25 reported that the risk for stable tobacco use was higher in individuals with ADHD who were not receiving stimulant treatment. No effect of stimulant treatment of ADHD on later risk for cigarette smoking was reported in 1 study of adolescents 14,22 and 1 in adults (Barkley RA et al, unpublished observations).…”

“…Loney et al 24,25 found significant reductions in the risk for alcohol use disorders in treated youths with ADHD as young adults but failed to identify a similar effect for drug use disorders. The severity of ADHD and rates of comorbidity of this sample were similar between medicated and unmedicated sub- The OR measures the increase in the odds of not having an SUD outcome between medicated and unmedicated youths with ADHD.…”

Validation of the Immediate and Delayed Memory Tasks in Hospitalized Adolescents with Disruptive Behavior Disorders

“…For instance, the most important predictor of future development of a psychiatric disorder and of the degree of global impairment later in life is physical fighting in early childhood (Halperin et aI., 1995;Loeber et aI., 1992Loeber et aI., , 1993Loeber et aI., , 2000Paternite, Loney, Salisbury, & Whaley, 1999). Additionally, childhood physical aggression has frequently been demonstrated to be a useful grouping criterion in previous impulsivity studies (Dougherty, Bjork, et aI., 2000;Seguin, Boulerice, Harden, Tremblay, & Pihl, 1999).…”

Long-term treatment of children and adolescents with attention-deficit/ hyperactivity disorder (ADHD)

“…Satterfield et al [33] showed that children who received longer multimodal treatment had better outcomes than children who discontinued treatment earlier; however, poorer family functioning may have been a factor in the group that dropped out of treatment. Paternite et al [34] also found that longer medication treatment was associated with fewer schizotypic features, better Minnesota Multiple Psychological Inventory scores [35], higher IQ scores, and better wide-range achievement scores in reading and arithmetic. The findings of Satterfield et al [33] and Paternite et al [34] differ from those of Fischer et al [36] and Lambert et al [37], who found that ADHD children who had longer treatment had more negative outcome.…”