Medical: ADHD and Homeless

[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;

[abaris]

It may be one contributing factor. But I don't think, fighting that is the curethemall.

Usually there are many controbuting facors to homelesness. A costly divorce, losing one's job and not being able to land another one within a certain amount of time, trauma, other mental or physical ailments leading up to not being able to pay the bills anymore.

And once someone's homeless a vicious circle is entered. Homeless people tend to drink, since there's nothing left in their lives to lighten up their days. They're probably dirty because there are no facilites available to get cleaned up on a regular basis. Which makes it even harder to get back into something like a normal life.

[brewer]

Not taking a position, just relaying info from one of my medical feeds.

If you (collectively) are tired of these, I'll stop posting them.

[abaris]

If you (collectively) are tired of these, I'll stop posting them.

Did I given that impression? No, it's just that usually there's more to homelesness than one single factor. Just wanted to point that out, since there are a lot of sad life stories involved.

[brewer]

If you (collectively) are tired of these, I'll stop posting them.

Did I given that impression? No, it's just that usually there's more to homelesness than one single factor. Just wanted to point that out, since there are a lot of sad life stories involved.

The review pointed out other factors.

[rexbeccarox]

I'll be forty next month, was diagnosed at ~13 with, then, ADD, and have struggled even more with it, now ADHD, in later years than I did as a child. Concerta has been able to calm it in the past, but as creative type, I resented it because it sapped my creativity. A few months ago, I was dangerously close to becoming homeless, until my mom and stepdad saved me from that fate, and I'm now living with them until my depression, job, and financial prospects are managed a little better.

Unofficially, my mental health is the major factor in my troubles. Due to my major, chronic, depression, it's rare I have the confidence to pursue anything, rendering me paralyzed, and due to the ADHD, when I do have the confidence, my very-low attention span holds me back dramatically.

I can't imagine what it would be like if I didn't have the support of my family and access to my meds. I would be, without a doubt, homeless or dead... though, there are still too many days I wish I were one or the other: homelessness would at least allow for a hint of my independence; death would allow all of it to stop.

I totally relate to this study, even if I'm not male or actually homeless. I've never had conduct issues, and I come from a relatively normal background. My mom, who has fairly severe ADHD, doesn't suffer from depression and manages it well, being self-employed and able to wear as many figurative hats as she wants.

Interesting post, MH. Thanks.