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
Altered brain activity in antisocial teenagers
May 28, 2019
Science Daily/University of Zurich
Teenage girls with problematic social behavior display reduced brain activity and weaker connectivity between the brain regions implicated in emotion regulation. The findings of an international study carried out by researchers from the University of Zurich and others now offer a neurobiological explanation for the difficulties some girls have in controlling their emotions, and provide indications for possible therapy approaches.
Becoming a teenager means going through a variety of physical and behavioral changes in the context of heightened emotionality. For everyday social functioning, as well as for personal physical and mental well-being, it is important that teenagers are able to recognize, process and control these emotions. For young people who are diagnosed with conduct disorder, this process is difficult, and may lead to antisocial or aggressive reactions that clearly lie outside the age-appropriate norms, e.g. swearing, hitting, stealing and lying. An international team of researchers from Switzerland, Germany and England have been able to demonstrate using functional magnetic resonance imaging that these behavioral difficulties are reflected in the brain activity.
Neural explanation for social deficits
The study involved almost 60 female teenagers aged between 15 and 18 who were asked to try to actively regulate their emotions while the researchers measured their brain activity. Half of the group had previously been diagnosed with conduct disorder, while the other half showed typical social development for their age. In the girls with problematic social behavior, less activity was seen in the prefrontal and temporal cortex, where the brain regions responsible for cognitive control processes are located. In addition, these regions were less connected to other brain regions relevant for emotion processing and cognitive control.
"Our results offer the first neural explanation for deficits in emotion regulation in teenage girls," says first author Professor Nora Raschle of the University of Zurich. "The difference in the neural activities between the two test groups could indicate fundamental differences in emotion regulation. However, it could also be due to delayed brain development in participants with conduct disorders."
Indications for therapy
Treatment for young people diagnosed with conduct disorders may target several levels: Helping them to recognize, process and express their emotions, as well as learning emotion regulation skills. "Our findings indicate that an increased focus on emotion regulation skills may be beneficial," says Raschle. Future studies will also look at the efficacy of specific therapy programs: "We will investigate cognitive-behavioral intervention programs that aim to enhance emotion regulation in girls with conduct disorder and see whether brain function and behavior may change accordingly," explains last author Christina Stadler of the Child and Adolescent Psychiatric Center in Basel.
It has not yet been investigated whether male teenagers with conduct disorder show similar brain activity during emotion regulation. According to the authors, there are several indicators that the neural characteristics of conduct disorders may be gender-specific. "However, most studies -- unlike ours -- focus on young men, for which reason the neuro-biological understanding established up to now is mainly related to males," says Raschle.
https://www.sciencedaily.com/releases/2019/05/190528095235.htm