Poor prognosis reported for ADHD children with coordination disorder

Hyperactivity and coordination disorders are "a particularly ominous combination," say Swedish researchers who recently evaluated a group of children diagnosed years earlier as having attention deficit hyperactivity disorder (ADHD), developmental coordination disorder (DCD), or both.

(Individuals with developmental coordination disorder exhibit marked impairments in the development of motor coordination, significantly interfering with daily living or academic skills. Symptoms include clumsiness and difficulty with fine or gross motor skills. DCD is often seen in children with ADHD or language disorders.)

Peder Rasmussen and Christopher Gillberg initially evaluated the children when they were seven years old. At follow-up, the subjects were 22 years old. The researchers compared 55 subjects with ADHD (with or without DCD), and 46 age-matched control subjects. Among their findings:

• Fifty-eight percent of the ADHD subjects, but only 13 percent of controls, had a "poor outcome," defined as being convicted of a crime, being permanently unable to work, being diagnosed with alcoholism or substance abuse, and/or being diagnosed with a psychiatric disorder. Among severely affected ADHD/DCD individuals, the number was even higher (69 percent), and the DCD-only group had the worst outcome of all with 80 percent of subjects scoring in the poor range.

• Twenty-four percent of the ADHD group were alcoholics or had substance abuse disorder, compared to only 4 percent of the controls.

• Thirty-three percent of the ADHD group, but only 7 percent of the controls, were diagnosed with personality disorders in adulthood. "Antisocial personality was the most common type diagnosed," Rasmussen and Gillberg say, with ADHD subjects eight times as likely as controls to exhibit antisocial personality disorder.

• Eight of the ADHD subjects, but none of the controls, had been convicted of criminal offenses.

• Eleven percent of the ADHD subjects, but none of the controls, had been given full sick pensions due to neuropsychiatric problems.

• Three of the ADHD/DCD group were completely illiterate-a problem not seen in any controls. In addition, 58 percent of the ADHD/DCD subjects, but only 15 percent of controls, exhibited reading and writing disorders.

"The early adult psychosocial outcome of so many of the individuals with ADHD and DCD in this study was worse than expected," the researchers say. They note, "The rate of antisocial personality disorder was very high in the [ADHD with or without DCD] groups.... [However] an even more striking finding was the high rate of alcohol abuse." They add that DCD may be an especially strong indicator of poor prognosis, since individuals with DCD only fared worse than those with ADHD only.

"Natural outcome of ADHD with developmental coordination disorder at age 22 years: a controlled, longitudinal, community-based study," Peder Rasmussen and Christopher Gillberg, Journal of the American Academy of Child and Adolescent Psychiatry, Vol.39, No. 11, Nov. 2000, pp. 1424-1431. Address: Peder Rasmussen, Dept. of Child and Adolescent Psychiatry, University of Göteborg, Kungsgatan 12, SE-41119, Göteborg, Sweden, peder.rasmussen@sahlgrenska.se.