Medical: ADHD and Homeless
September 27, 2016 at 9:03 am
(This post was last modified: September 27, 2016 at 9:04 am by brewer.)
Just another shorty. ADHD in childhood is a predictor of homelessness.
Follow-up studies of people with childhood attention-deficit/hyperactivity disorder (ADHD) found psychiatric and psychosocial impairments, but homelessness was not studied. Studies of homeless adults found elevated rates of ADHD, but whether they had had childhood onset was not known.
Now, researchers have conducted a 33-year, prospective follow-up study of 207 white boys diagnosed with ADHD at mean age 8 years and 178 controls matched for age and socioeconomic status. Diagnoses were based on DSM-II criteria, but symptoms would fit DSM-5 criteria for ADHD, combined type. The boys did not have conduct disorder at baseline. Evaluations at mean age 41 were performed in 65% and 76% of the ADHD and comparison groups, respectively, with no differences in characteristics between study dropouts and those with reevaluations.
At mean age 41, ADHD cases were significantly more likely than comparison participants to be homeless for ≥1 week (24% vs. 4%), even in analyses controlling for conduct disorder developed by age 18, history of arrest, having a nonalcohol substance use disorder (SUD), or having dropped out of school. Having a nonalcoholic SUD or dropping out of school (but not persistence of ADHD at age 18) independently predicted homelessness.
Comment
The homelessness criterion used here is more conservative than the 1-day criterion in population studies. The findings are notable because, at baseline, the boys did not have conduct disorder and were not socially disadvantaged or from minority groups, and thus were not at higher risk for homelessness. Curiously, persistent ADHD did not predict homelessness. However, in other reports in this and similar populations (e.g., J Am Acad Child Adolesc Psychiatry 2016 Sep 2; [e-pub]), persistence predicted worse diagnostic and functional outcomes. Clinicians need to consider that ADHD in childhood might be a harbinger of other psychopathologies, such as schizophrenia and bipolar disorders, which increase the likelihood of homelessness.
Barbara Geller, MD Reviewing Murillo LG et al., J Am Acad Child Adolesc Psychiatry 2016 Sep 1;
Follow-up studies of people with childhood attention-deficit/hyperactivity disorder (ADHD) found psychiatric and psychosocial impairments, but homelessness was not studied. Studies of homeless adults found elevated rates of ADHD, but whether they had had childhood onset was not known.
Now, researchers have conducted a 33-year, prospective follow-up study of 207 white boys diagnosed with ADHD at mean age 8 years and 178 controls matched for age and socioeconomic status. Diagnoses were based on DSM-II criteria, but symptoms would fit DSM-5 criteria for ADHD, combined type. The boys did not have conduct disorder at baseline. Evaluations at mean age 41 were performed in 65% and 76% of the ADHD and comparison groups, respectively, with no differences in characteristics between study dropouts and those with reevaluations.
At mean age 41, ADHD cases were significantly more likely than comparison participants to be homeless for ≥1 week (24% vs. 4%), even in analyses controlling for conduct disorder developed by age 18, history of arrest, having a nonalcohol substance use disorder (SUD), or having dropped out of school. Having a nonalcoholic SUD or dropping out of school (but not persistence of ADHD at age 18) independently predicted homelessness.
Comment
The homelessness criterion used here is more conservative than the 1-day criterion in population studies. The findings are notable because, at baseline, the boys did not have conduct disorder and were not socially disadvantaged or from minority groups, and thus were not at higher risk for homelessness. Curiously, persistent ADHD did not predict homelessness. However, in other reports in this and similar populations (e.g., J Am Acad Child Adolesc Psychiatry 2016 Sep 2; [e-pub]), persistence predicted worse diagnostic and functional outcomes. Clinicians need to consider that ADHD in childhood might be a harbinger of other psychopathologies, such as schizophrenia and bipolar disorders, which increase the likelihood of homelessness.
Barbara Geller, MD Reviewing Murillo LG et al., J Am Acad Child Adolesc Psychiatry 2016 Sep 1;
I don't have an anger problem, I have an idiot problem.
