Studying ADHD from childhood through adulthood and old age

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Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inappropriate levels of inattention, hyperactivity, and impulsivity. ADHD symptoms often persist into adulthood and psychiatric comorbidities, as well as adverse somatic outcomes, can emerge throughout life.

The health outcomes of ADHD in adulthood and old age and the long-term consequences of ADHD medications remain understudied and are now in focus in Le Zhang’s thesis. As a Ph.D. student in the Department of Medical Epidemiology and Biostatistics, she included four studies;

  1. What are the patterns of co-medication and polypharmacy with ADHD medications among adults?
  2. Is ADHD related to Alzheimer’s disease and other dementias within families?
  3. Are ADHD medications associated with risk of cardiovascular disease according to all existing evidence?
  4. Does long-term use of ADHD medications increase the risk of cardiovascular disease?

What are the most important results of your thesis?

ADHD is a common neurodevelopmental disorder that persists into adulthood and even old age. Substantial psychiatric comorbidities and somatic outcomes can emerge throughout life. The results of my thesis suggest that co-medication with somatic medications was common among adults receiving ADHD medications. Additionally, ADHD has been linked to Alzheimer’s disease and any dementia that runs in families. Additionally, long-term use of ADHD medications has been associated with a modest increased risk of cardiovascular disease in both children and adults.

Why did you choose to study ADHD?

For a long time, the perception was that problems with ADHD would go away when the child grew up. We now know that this is rarely the case – core symptoms persist to a greater or lesser extent in most people. We also know that most adults with ADHD have at least one psychiatric comorbidity. However, there is still a lack of evidence of neurological and somatic comorbidity among people with ADHD, such as Alzheimer’s disease and other dementias and cardiovascular diseases, which are the main burden of disease in Sweden, especially among adults and the elderly.

Thus, my thesis examined comorbid conditions among adults with ADHD. Additionally, with the increased use of ADHD medications to treat the disorder, safety concerns have arisen, as ADHD medications are known to increase heart rate and blood pressure. For that purpose, we examined whether ADHD medications lead to clinically relevant serious cardiovascular disease.

What do you think should be done to advance this research area?

We found elevated rates of co-medication and polypharmacy with somatic and psychotropic medications in adults receiving ADHD medications. It should be investigated whether attention needs to be paid to the safety concerns of using multiple medications along with ADHD medications. Furthermore, the mechanisms underlying the association between ADHD and Alzheimer’s disease in families should be explored in future research.

Revealing the mechanisms underlying the co-aggregation between ADHD and Alzheimer’s disease may answer whether psychiatric prevention early in life can help prevent the later development of neurodegenerative diseases. Last but not least, although we found that prolonged exposure to ADHD medications was associated with a modestly increased risk of cardiovascular disease, and we suggest that clinicians should be vigilant for signs and symptoms of cardiovascular disease in patients treated with ADHD medications, ADHD, alternative observational research designs are important for triangulating our findings.

More information:
Developmental trajectories of attention-deficit/hyperactivity disorder in adulthood and aging: multimorbidity and polypharmacy.

Provided by Karolinska Institutet

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Studying ADHD from childhood through adulthood and old age

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