Childhood ADHD associated with increased risk of suicide [Physician Comment]

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1. There is an association between having childhood ADHD and having additional psychiatric disorders later in life (P <0.01).  

2. There is an association between childhood ADHD and suicide (P = 0.032).  

This prospective study of long-term adult outcomes of childhood ADHD found that childhood ADHD might affect the risk of suicide and that it increases the risk of developing additional psychiatric disorders in later life, especially if ADHD persists. This is the first long term study of its kind.

This implies that the treatment of childhood ADHD could have an important impact on later outcomes. Previous research from this group has shown that treatment of childhood ADHD can improve a number of outcomes through the age of 19. Forthcoming research should shed light on the impact of treatment on adult outcomes.

It remains to be clarified whether there is some underlying mechanism that predisposes individuals both to ADHD and other psychiatric disorders, or whether ADHD itself promotes the development of other psychiatric disorders (or both). If the latter is true, proper treatment of childhood ADHD should reduce the likelihood of developing additional psychiatric disorders.

The study population was relatively homogenous in terms of race and socioeconomic status, which limits the generalizability of the study. However, one might predict worse outcomes in settings of poverty and lack of access to treatment.

Click to read the study in Pediatrics

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1. There is an association between having childhood ADHD and having additional psychiatric disorders later in life (P <0.01). 

2. There is an association between childhood ADHD and suicide (P = 0.032).  

Dr. William Barbaresi, M.D., talks to 2 Minute Medicine: Associate Chief, Division of Developmental Medicine, Boston Children’s Hospital; Associate Professor of Pediatrics, Harvard Medical School

“The findings presented in Pediatrics represent the first, high level report of adult outcomes for our cohort of childhood ADHD cases.  We have collected an extensive set of data, including information about childhood treatment.  In forthcoming manuscripts, we will be addressing the issue of treatment and its association with a variety of outcomes.

It is very important to recognize that the long-term impact of childhood ADHD is related not just to the persistence of ADHD into adulthood, but also includes the significant risk for other adult mental health problems, as we reported in this paper… The long-term impact of childhood ADHD includes essentially every aspect of adult life, including education, employment, income, relationships, risk-taking behavior, etc.”

This [prospective] study: Individuals born between 1976 and 1982 in a district of Rochester, MN who gave consent were eligible for the study. Cases of childhood ADHD were identified retrospectively using a multi-step process drawing on school and medical records. 367 individuals with childhood ADHD from this cohort were enrolled in the prospective arm of the study.

There were 3 suicides in the childhood ADHD cohort, and 5 suicides in the rest of the birth cohort (n = 4946) through 2009. There is a weakly significant association between childhood ADHD and suicide (P = 0.032).

57% of the individuals with childhood ADHD had one or more psychiatric disorders as adults, compared to 34.9% of the prospectively followed controls (n = 801, P <0.01). The association is even stronger for those whose ADHD persists into adulthood compared to those whose ADHD did not persist (80.9% vs. 47.0%; P < 0.001).

In sum: This prospective study of long-term adult outcomes of childhood ADHD found that childhood ADHD might affect the risk of suicide and that it increases the risk of developing additional psychiatric disorders in later life, especially if ADHD persists. This is the first long term study of its kind.

This implies that the treatment of childhood ADHD could have an important impact on later outcomes. Previous research from this group has shown that treatment of childhood ADHD can improve a number of outcomes through the age of 19. Forthcoming research should shed light on the impact of treatment on adult outcomes.

It remains to be clarified whether there is some underlying mechanism that predisposes individuals both to ADHD and other psychiatric disorders, or whether ADHD itself promotes the development of other psychiatric disorders (or both). If the latter is true, proper treatment of childhood ADHD should reduce the likelihood of developing additional psychiatric disorders.

The study population was relatively homogenous in terms of race and socioeconomic status, which limits the generalizability of the study. However, one might predict worse outcomes in settings of poverty and lack of access to treatment.

Click to read the study in Pediatrics

By Tomi Jun and Mitalee Patil

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