Thursday, 13 October 2016

ADHD and conduct disorder long-term

Today I'm once again blogging about peer-reviewed research suggesting that when it comes to the long-term effects of attention-deficit/hyperactivity disorder (ADHD) on a person, there is some pretty solid evidence that addressing symptoms early could "potentially avert a wide range of future adverse outcomes."

The paper making such a conclusion is the one from Holly Erskine and colleagues [1] who conducted a systematic review and meta-analysis pertinent to this topic; also taking into account the potential effects of a diagnosis of conduct disorder (CD) in the long-term. Including nearly 100 studies "linking ADHD and CD with a range of health and psychosocial outcomes" authors were able to say with some degree of confidence that issues with academic achievement, risk of comorbid "mental and substance use disorders", employment prospect likelihood and risk of criminality (i.e. being arrested) were all seemingly linked to a diagnosis of ADHD. Similar findings were also reported for CD. I know this is kind of research is not exactly great PR for ADHD (or CD) but it is nonetheless important.

Accepting that (i) sweeping generalisations about ADHD/CD do no-one any good and (ii) there may be multiple variables attached to the 'adverse' outcomes detailed outside of just diagnosis, there are some important points to be acted upon following the Erskine review. I might for example, advocate the position that academic achievement is a particularly important area when it comes to the symptoms of ADHD (see here) and moves to address the impact of ADHD on education should perhaps be a priority.

Minus any medical and/or clinical advice being dished out on this blog (I don't do that), there are several intervention options that have been discussed in the collected science literature to think about. Medication is one possibility as per what is known about the effectiveness of something like methylphenidate on ADHD signs and symptoms (see here). Sleep training is something else that appears to be quite useful when it comes to [some] ADHD (see here) too and could probably tie into research looking at physical activity levels and ADHD (see here). And then we have the collected literature pointing to dietary elements as possibly showing some connection to some facets of ADHD as per the whole fatty acid story (see here) and even something potentially linked to milk allergy for at least some (see here). This nutrition research building on the almost forgotten studies on a few foods diet and ADHD (see here) for example, which seems to have ground to a shuddering halt in research strategy terms. The list is long and getting longer (immune system, nutritional supplements, etc) of where to look when it comes to potentially important intervention routes for something like ADHD. Discussions with physicians need to be had and further investment in research is needed.

And perhaps one might also be inclined to take more note of the research suggesting that various 'somatic disease' might also be more likely when a diagnosis of ADHD is received [2] and how, for a start, preferential screening might be undertaken?

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[1] Erskine HE. et al. Long-Term Outcomes of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder: A Systematic Review and Meta-Analysis. J Am Acad Child Adolesc Psychiatry. 2016 Oct;55(10):841-50.

[2] Instanes JT. et al. Adult ADHD and Comorbid Somatic Disease: A Systematic Literature Review. J Atten Disord. 2016 Sep 22. pii: 1087054716669589.

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ResearchBlogging.org Erskine HE, Norman RE, Ferrari AJ, Chan GC, Copeland WE, Whiteford HA, & Scott JG (2016). Long-Term Outcomes of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder: A Systematic Review and Meta-Analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 55 (10), 841-50 PMID: 27663939