Impact of parent and teacher concordance on diagnosing attention deficit hyperactivity disorder and its sub-types

Objective  This study examines the extent to which parents and teachers agree on the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and its subtypes, as per the DSM IV criteria. It assesses whether the extent of agreement between informants improves by making the ADHD criteria more flexible. Methods  Parents and teachers of 119 clinic-referred sample of children (mean age=8.4 years, S.D= 2.48) with disruptive behavioral symptoms completed the Vanderbilt Attention Deficit Hyperactivity Disorder Diagnostic Parent and Teacher Rating Scales, respectively. Concordance of parent and teacher reports for the presence or absence of diagnosis of ADHD and type of ADHD was examined by percent agreement and the kappa statistics. Results  Of the 119 children referred for disruptive behavior disorders, 96 (80.6%) met criteria for any type of ADHD according to the parents’ report; and only 68 (57.1%) met criteria according to the teachers’ report. Parent and teacher agreement for the diagnosis of any type of ADHD was only 52% :(k= .11, n.s); and the agreement regarding diagnosis of sub-type was even poorer. Making the criteria more flexible vis-à-vis impairment or number of symptoms did not improve agreement between the informants. Conclusion  Clear guidelines are needed to reconcile the differences between informants in order to promote uniform diagnostic practices among clinicians working with children having ADHD.     

Parent and teacher mental health ratings of children using primary-care services: interrater agreement and implications for mental health screening.

OBJECTIVE: To examine interrater agreement when screening for child mental health problems during primary-care visits. METHODS: Children aged 5 to 10 (n = 227) and one of their parents were systematically recruited from the waiting rooms of 15 primary-care sites located in Baltimore, Md; Washington, DC; and rural New York from 2002 to 2005. The parent and teacher of the child completed the Strengths and Difficulties Questionnaire to measure the child's emotions, behaviors, and functional impairment. RESULTS: Parents and teachers identified a similar proportion of children as having high symptoms (25% vs 23%) and high impairment (27% vs 32%) but rarely agreed in their assessments of specific children. Parent ratings alone missed 52% of children rated by teachers as having both high symptoms and high impairment (kappa = 0.15). Only 6% of these discrepant visits were for mental health problems, making it unlikely that teacher reports would have been solicited. CONCLUSIONS: Parent reports failed to detect half of school-aged children considered to be seriously disturbed by their teachers. Efforts to improve detection of mental health problems by using screening tools in primary care may require algorithms that help providers judge when to solicit teacher reports and how to interpret conflicting information from parents and teachers.     

Interaction of dopamine transporter (DAT1) genotype and maltreatment for ADHD: a latent class analysis

Background: Although the association of the dopamine transporter (DAT1) gene and attention‐deficit/hyperactivity disorder (ADHD) has been widely studied, far less is known about its potential interaction with environmental risk factors. Given that maltreatment is a replicated risk factor for ADHD, we explored the interaction between DAT1 and maltreatment with ADHD symptoms defined dimensionally and using latent class analysis (LCA). Method: We tested the association of the 40 base‐pair variable number of tandem repeats polymorphism in DAT1, maltreatment, and their interaction in 2,488 boys and girls from the National Longitudinal Study of Adolescent Health. Results: In boys, ADHD symptoms were optimally defined by four classes (Combined, Hyperactive/Impulsive, Inattentive, and Normal), whereas in girls, ADHD symptoms were defined by three classes (Combined, Combined‐Mild, Normal). A significant DAT1 × maltreatment interaction revealed that maltreated girls homozygous for the 10‐repeat allele had more symptoms of ADHD, and were also 2.5 times more likely to be classified in the Combined ADHD group than in the Normal Group. Conclusions: The underlying structure of ADHD symptoms differed between boys and girls and DAT1 interacted with maltreatment to predict ADHD symptoms and ADHD status derived from LCA. Interactive exchanges between maltreatment and DAT1 for ADHD symptoms, and their implications for intervention, are discussed.     

Confirmation and extension of association of blood lead with attention-deficit/hyperactivity disorder (ADHD) and ADHD symptom domains at population-typical exposure levels

Background:  Recent studies have suggested that child attention-deficit/hyperactivity disorder (ADHD) and its symptom domains are related to blood lead level, even at background exposure levels typical in western countries. However, recent studies disagreed as to whether lead was related to inattention or hyperactivity-impulsivity within the ADHD domain. More definitive evaluation of these questions was sought.
Methods:  Two hundred and thirty-six (236) children aged 6–17 years participated (61 ADHD-Combined type, 47 ADHD Predominantly Inattentive type, 99 non-ADHD control, 29 unclassified borderline, situational, or not otherwise specified (NOS) cases). Formal diagnosis was reliably established by a best estimate procedure based on a semi-structured clinical interview and parent and teacher ratings. Lead was assayed from whole blood using inductively coupled plasma mass spectrometry with a method detection limit of .3 μg/dL.
Results:  Blood lead levels were slightly below United States and Western Europe population exposure averages, with a mean of .73 and a maximum of 2.2 μg/dL. This is the lowest level of blood lead ever studied in relation to ADHD. After statistical control for covariates including IQ and prenatal smoking exposure, blood lead was associated with ADHD-combined type but not inattentive type. Parent and teacher report indicated association of blood lead with Conners cognitive problems, but only teacher report showed effects on DSM-IV inattention symptoms. Blood lead was associated with hyperactivity-impulsivity in parent report regardless of measurement method, whereas teacher report effects depended on child treatment history.
Conclusions:  These findings confirm that in children with typical US population lead exposure, careful identification of children with ADHD also identifies children with slightly elevated blood lead.     

Mother–child dyadic synchrony is associated with better functioning in hyperactive/inattentive preschool children

Background: Hyperactive/inattentive (HI) behaviors are common in preschoolers, but they result in functional impairment and attention deficit/hyperactivity disorder (ADHD) diagnoses in only some children. We examined whether the quality of mother–child interaction accounts for variance in level of functioning among preschool children with elevated ADHD symptoms. Method: Parent and teacher ADHD‐RS ratings were used to assess 126 HI preschoolers, and clinician Children’s Global Assessment Scale (CGAS) ratings were used to quantify level of functioning. Mother–child interactions during a 5‐minute free‐play and a 5‐minute structured task were coded for child, parent and dyadic behaviors. Results: Partial correlations, controlling for symptom severity and IQ, revealed child and dyad factors that were related to children’s functioning. Regression analyses revealed that low dyadic synchrony accounted for additional unique variance in children’s functioning, above and beyond the influence of symptom severity and IQ. Conclusions: Dyadic synchrony between mother and child plays a role in the functioning of preschool children displaying elevated symptoms of hyperactivity/inattention, and may represent a potential area for intervention that is not generally addressed in most parent management training programs.     

Differences between preschool children with ODD, ADHD, and ODD+ADHD symptoms

BACKGROUND: This study examines differences between children (ages 3 to 6 years) who have the symptoms of oppositional defiant disorder (ODD) with or without attention-deficit/hyperactivity disorder (ADHD), ADHD alone, and a nonODD/ADHD comparison group. Parent (N=595) and teacher (N=538) ratings were obtained for children attending the same community early childhood programs and for youngsters evaluated in an outpatient clinic (N=224) using a DSM-IV-referenced rating scale. RESULTS: Differences between symptom groups varied depending on how they were configured (teacher versus parent ratings) and setting (clinic versus community). In general, the ODD+ADHD group received the highest (and the comparison group the lowest) ratings of severity for the symptoms of other disorders, difficulties with peers, and developmental deficits. Moreover, the clinical impact of comorbidity was largely additive. Differences between youngsters with ODD versus ADHD symptoms were most apparent for teacher-defined groups in the community sample and parent-defined groups in the clinic sample. CONCLUSIONS: Collectively, these findings provide preliminary evidence for the notion that ODD and ADHD may constitute distinct clinical entities in preschool-aged children and suggest that informant may be an important consideration in the formulation of diagnostic criteria.     

Prevalence of Attention-Deficit/Hyperactivity Disorder Symptoms in Preschool-aged Iranian Children

Objective

The aim of this study was to determine the prevalence of attention-deficit/hyperactivity disorder (ADHD) symptoms in Iranian preschool children based on evaluations by parents and teachers because a thorough understanding of epidemiologic features of ADHD symptoms in preschool children is important for prevention and management.

Methods

Children between the ages of three and six attending kindergarten participated in this study. For the survey, 37 kindergartens were selected by multistage (stratified cluster random) sampling, consisting of 2213 children with a design effect equal to 1.5. A 19-item observer-rating questionnaire was generated to assess ADHD symptoms in children within the last 6 months. This questionnaire was used by both teachers and parents to assess ADHD behavior in participating children.

Findings

Of 1403 children aged 3–6 years, 362 were classified as having ADHD symptoms according to their parent evaluation [25.8% (23.6–28.1%)] and 239 according to their teachers evaluation [17% (14.1–20.4%)]. Child rank among siblings, mother''s education level, and interest in aggressive television programs were all independent explanatory variables according to parents’ evaluation. Gender, parent education, child rank, single parent and interest in aggressive television programs were all independent explanatory variables according to teachers’ evaluation.

Conclusion

Our findings reveal a large discrepancy in the prevalence of ADHD symptoms in preschool children based on evaluation by parents and teachers. Thus, it seems that the ADHD screening should be performed in multiple settings in order to identify children who need further investigations.     

Are maternal smoking and stress during pregnancy related to ADHD symptoms in children?

BACKGROUND: There are some indications that maternal lifestyle during pregnancy (smoking and stress) contributes to symptoms of ADHD in children. We prospectively studied whether prenatal exposure to maternal smoking and/or stress is associated with ADHD symptoms and diagnostic criteria (according to DSM-IV) in 7-year-olds. METHODS: Nulliparous Scandinavian women were consecutively recruited at their first prenatal health care visit and assessments of smoking and stress were collected at gestational weeks 10, 12, 20, 28, 32, and 36. Children were followed up at 7 years old. We obtained full data for 72% of the sample: ADHD symptoms were rated by 74% of mothers (n=290) and 96% of eligible teachers (n=208). Attrition analyses showed no differences on key variables between participants and non-participants at follow-up. RESULTS: Results of multiple regression analyses showed prenatal exposure to smoking (beta=.16, p<.01) and stress (beta=.18, p<.01) were independently associated with later symptoms of ADHD. Results of logistic regression analyses showed that fulfillment of the diagnostic criteria for ADHD was related to exposure to prenatal stress (beta=.68, p<.01) especially in boys. The results were not confounded by sociodemographic factors or birth outcomes. CONCLUSIONS: This study provides evidence that prenatal exposure to stress and smoking is independently associated with later symptoms of ADHD in human children, particularly for boys. Because stress and smoking are relatively common during pregnancy, and yet preventable, these results are of public health significance.     

Methodological challenges to treatment trials for recurrent abdominal pain in children

BACKGROUND: Studies evaluating the efficacy of treatments for recurrent abdominal pain (RAP) in children have used a wide range of methods, causing difficulty in the comparison of results. An expert panel on functional gastrointestinal disorders recently made recommendations regarding the standardization of study methods for childhood RAP, but many of their recommendations remain untested or lack supportive evidence. METHODS: During completion of a pilot study and randomized controlled trial for childhood RAP, baseline data were collected regarding the child and parent reports of abdominal pain frequency and intensity, type of abdominal pain, missed activities due to abdominal pain, psychological factors for the parent and child, parenting styles, and referral source (pediatric gastroenterologist vs general pediatrician). RESULTS: Children and parent pain reports showed good agreement in children younger than 13 years (weighted kappa, 0.77; 95% confidence interval [CI], 0.71-0.84), but only marginal agreement in children 13 years or older (weighted kappa, 0.37; 95% CI, 0.30-0.45). We found no significant differences in pain characteristics or psychological factors between children referred by pediatric gastroenterologists in a tertiary care center and those referred by community-based primary care pediatricians. However, children with symptoms consistent with nonspecific functional abdominal pain were reported by their parents to have less frequent pain (P=.003) and fewer missed activities (P=.003) than children with symptoms of irritable bowel syndrome or functional dyspepsia. CONCLUSIONS: Subjects referred by gastroenterologists and general pediatricians were similar, but the subtype of functional gastrointestinal disorder might be an important baseline characteristic of subjects in future RAP studies. We suggest that future interventional studies of childhood RAP measure 2 outcomes with pain reports obtained directly from children. Any child with fewer days of pain and missed activities due to pain after therapy would be considered improved, and those with no missed activities and 4 or fewer days of pain per month at follow-up would be considered healed.     

Parent and teacher rating scales in the evaluation of attention-deficit hyperactivity disorder: contribution to diagnosis and differential diagnosis in clinically referred children

This study evaluated diagnostic utility of parent and teacher ratings in the attention-deficit hyperactivity disorder (ADHD) assessment and differential diagnosis of a clinical sample of children referred for suspected ADHD. Participants were 184 5- to 12-year-old children for whom the following were available: multimethod multi-informant assessment, firm decision regarding presence or absence of ADHD, and parent-completed Child Behavior Checklist and revised 48-item Conners Parent Rating Scale, and teacher-completed Teacher Report Form and 39-item Conners Teacher Rating Scale. Parent ratings of children diagnosed with and without ADHD were generally similar. In contrast, teachers rated students diagnosed with ADHD as displaying higher levels of behavioral difficulties. Discriminant function analyses indicated parent ratings of narrowband measures of ADHD and broadband measures of externalizing symptoms displayed high sensitivity. Teacher ratings outperformed parent ratings when considering sensitivity, specificity, and overall classification accuracy. For clinically recommended cut scores, teacher measures displayed good specificity and positive predictive power. Combining rating scales within informants. did not improve classification accuracy. Combining across parent and teacher measures produced results consistent with teacher ratings. Results support recommendations to include parent and teacher rating scales in ADHD assessment. Scales contributing most to classification accuracy were those designed to assess ADHD. Imperfect performance of rating scales supports recommendations to include other methodologies in diagnosis and differential diagnosis of ADHD.     

A longitudinal twin study on the association between ADHD symptoms and reading

Background: Attention deficit hyperactivity disorder (ADHD) and reading disability commonly co‐occur because of shared genetic risk factors. However, the stability and change of these genetic influences and the predictive relationships underlying this association longitudinally remain unclear. Methods: ADHD symptoms and reading were assessed as continuous dimensions in a UK general population sample of approximately 7,000 twin pairs. Parent ratings of ADHD symptoms and teacher ratings of reading were obtained at two ages: middle childhood (ages 7–8 years) and early adolescence (ages 11–12 years). Cross‐lagged quantitative genetic analyses were applied. Results: ADHD symptoms and reading significantly predicted each other over time. However, ADHD symptoms were a significantly stronger predictor of reading than vice versa. Inattentive and hyperactive‐impulsive symptoms of ADHD both contributed to the prediction of reading, but inattentiveness was a significantly stronger predictor. Furthermore, ADHD symptoms and reading were highly heritable, and their association was primarily attributable to shared genetic influences. Despite notable genetic innovation for each trait, genetic factors involved in the association of ADHD symptoms and reading over time were highly stable. Conclusions: ADHD symptoms may put children at increased risk for reading problems and vice versa. Moreover, enduring genetic mechanisms appear to be important in the association of ADHD symptoms and reading over time.     

Biological predictors and co-morbidity of attention deficit and hyperactivity disorder in extremely low birthweight infants at school

Objective: To examine biological predictors and co-morbidity of Attention Deficit Hyperactivity Disorder (ADHD) and associated academic and social impairment in a cohort of extremely low birthweight of (ELBW) children attending school.
Methodology: Eight seven (70%) of 125 ELBW children born between 1977 and 1986 were followed prospectively. Neonatal and biological data including cranial ultrasound for 62% of children, formal developmental assessment at 4 or 6 years of age, teacher and parent ADHD questionnaire, parental rating of health status and social impairment and school teacher rating of academic performance was recorded.
Results: Apart from grades 3 or 4 intraventricular haemorrhage in a minority of children, there was no evidence to suggest an association between ADHD and perinatal adversity in ELBW children. Social impairment, academic difficulty and atopic symptoms were significantly related to ADHD.
Conclusions: Extremely low birthweight children presenting with symptoms of ADHD are likely to suffer social and learning impairment and these, rather than perinatal risk factors, should be the focus of clinical attention.     

Attention deficit hyperactivity disorder in children: diagnosis, treatment, and follow-up.

Hyperactive, and fidgeting behavior in children, is not a new syndrome, but has been present in children for centuries. Only in recent years have health providers begun to observe these features and behaviors in children and recommend some therapies. Children labeled with Attention Deficit Hyperactivity Disorder (ADHD) display the symptoms of inattention, impulsivity, and hyperactivity; however, these behaviors are seen in a variety of conditions. This article describes some of the symptoms associated with ADHD, as well as the evaluation, therapeutic modalities (behavioral, psychodynamic and pharmacological), and the follow-up of children with ADHD.     

Confirmation that Child Behavior Checklist clinical scales discriminate juvenile mania from attention deficit hyperactivity disorder

OBJECTIVE: To determine whether boys meeting diagnostic criteria for juvenile mania and attention deficit hyperactivity disorder (mania-ADHD) may be distinguished from boys with ADHD alone on a range of clinical and family variables. METHODOLOGY: Boys aged 9-13 years with mania-ADHD (n = 25), ADHD alone (n = 99), or no psychiatric diagnosis (n = 27) were compared on parent and teacher report Child Behavior Checklists (CBCL) and Conners Questionnaires, self-report CBCLs, patterns of comorbidity, intellectual functioning, and family variables. RESULTS: Mania-ADHD subjects had significantly higher mean ratings than ADHD only subjects on the parent CBCL for the Withdrawn, Thought Problems, Delinquent Behavior and Aggressive Behavior scales and significantly higher rates of comorbid depression, anxiety and psychotic symptoms. Other variables did not distinguish the mania-ADHD and ADHD only groups. CONCLUSIONS: These data confirm previous research indicating that the CBCL may be used to assist in the clinical identification of manic children.     

Atomoxetine in the management of children with ADHD: effects on quality of life and school functioning

The purpose of this study was to examine in a controlled trial the effects of atomoxetine on the management of attention deficit-hyperactivity disorder (ADHD) symptoms and functional impairments at school and at home. Participants were 153 children (age 8 to 12 years) diagnosed with attention-deficit hyperactivity disorder who were randomized to double-blind treatment with either atomoxetine (n = 101) or placebo (n = 52). Findings revealed significant improvements both for parent and teacher ratings of behavior for children receiving atomoxetine therapy. Children also were reported to evidence a trend toward better response to active medication than to placebo for health-related quality of life as rated by parents. No significant effects were revealed for the teacher ratings of academic productivity. Data were interpreted to provide support for the efficacy of atomoxetine on the symptoms associated with ADHD. The effects of atomoxetine on other functional outcomes including academic performance and health-related outcomes are of interest, albeit less compelling for this particular investigation, than for the effects on overt symptom display.     

Hyperactivity in school-age boys and subsequent risk of injury.

Hyperactive boys between 6 and 8 years of age, identified through systematic population-based screening of a community in London, were compared prospectively with a nonhyperactive control group to determine whether they were at greater risk of sustaining injuries. The study sample was drawn from 1296 completed parent and teacher questionnaires. Hyperactive groups were designated in three ways (parental report, teacher report, and combined parent and teacher report). Injuries were assessed by reviewing the medical records of the five emergency departments serving the community. Although boys with conduct problems did sustain more injuries than control subjects, no relationship between hyperactivity and injury was found. Similarly, when milder injuries were excluded from the analysis, the association remained negative. The absence of an association could not be accounted for by differential parental protectiveness of boys designated hyperactive. This study, which has a power of .80 to determine an increase in the relative risk of injury of 1.5, found no effect for hyperactive behavior in boys. Hyperactive behavior is probably not a risk factor for injury; if it is, it exerts a modest effect, less than 1.5, therefore accounting for less than 4% of injuries to school-aged boys.     

Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): clinical correlates and familial prevalence

Background: The goal of this study was to investigate the occurrence, severity and clinical correlates of emotional lability (EL) in children with attention deficit/hyperactivity disorder (ADHD), and to examine factors contributing to EL and familiality of EL in youth with ADHD. Methods: One thousand, one hundred and eighty‐six children with ADHD combined type and 1827 siblings (aged 6–18 years) were assessed for symptoms of EL, ADHD, associated psychopathology and comorbid psychiatric disorders with a structured diagnostic interview (PACS) as well as parent and teacher ratings of psychopathology (SDQ; CPRS‐R:L; CTRS‐R:L). Analyses of variance, regression analyses, χ²‐tests or loglinear models were applied. Results: Mean age and gender‐standardized ratings of EL in children with ADHD were >1.5 SD above the mean in normative samples. Severe EL (>75th percentile) was associated with more severe ADHD core symptoms, primarily hyperactive‐impulsive symptoms, and more comorbid oppositional defiant, affective and substance use disorders. Age, hyperactive‐impulsive, oppositional, and emotional symptoms accounted for 30% of EL variance; hyperactive‐impulsive symptoms did not account for EL variance when coexisting oppositional and emotional problems were taken into account, but oppositional symptoms explained 12% of EL variance specifically. Severity of EL in probands increased the severity of EL in siblings, but not the prevalence rates of ADHD or ODD. EL and ADHD does not co‐segregate within families. Conclusion: EL is a frequent clinical problem in children with ADHD. It is associated with increased severity of ADHD core symptoms, particularly hyperactivity‐impulsivity, and more symptoms of comorbid psychopathology, primarily symptoms of oppositional defiant disorder (ODD), but also affective symptoms, and substance abuse. EL in ADHD seems to be more closely related to ODD than to ADHD core symptoms, and is only partly explainable by the severity of ADHD core symptoms and associated psychopathology. Although EL symptoms are transmitted within families, EL in children with ADHD does not increase the risk of ADHD and ODD in their siblings.     

Are bedside features of shock reproducible between different observers?

Shock is often under-reported in children attending hospitals in developing countries. Readily obtainable features of shock (capillary refill time, temperature gradient, pulse volume, and signs of dehydration) are widely used to help prioritise management in the emergency assessment of critically ill or injured children. However, data are lacking on their validity, including, importantly, reproducibility between observers. Agreement of these signs was examined in 100 consecutive children admitted to a paediatric ward on the coast of Kenya. After an initial training of clinical sign recognition, there was moderate agreement for most features of cardiovascular compromise (delayed capillary refill > or =4 s, kappa = 0.49; and weak pulse volume, kappa = 0.4) and only substantial agreement for temperature gradient (kappa = 0.62). For hydration status, only in the assessment of skin turgor was there a moderate level of agreement (kappa = 0.55). Capillary refill times and assessment of pulse volume recommended by the recent American consensus guidelines achieved only a "low" moderate to poor interrater agreement, questioning the reliability of such parameters.     

Quebec child mental health survey: prevalence of DSM-III-R mental health disorders

The Quebec Child Mental Health Survey (QCMHS) was conducted in 1992 on a representative sample of 2400 children and adolescents aged 6 to 14 years from throughout Quebec. Prevalences of nine Axis-I DSM-III-R (American Psychiatric Association, 1987) mental health disorders were calculated based on each informant (for 6-11-year-olds: child, parent, and teacher; for 12-14-year-olds: child and parent). Informant parallelism allows the classification of results of the demographic variables associated with disorders in the logistic regression models. This strategy applies to group variables (correlates of disorders) whereas informant agreement applies to individual diagnoses. Informant parallelism implies that results for two informants or more are in the same direction and significant. In the QCMHS, informant parallelism exists for disruptive disorders, i.e. in two ADHD regression models (child and parent) higher rates among boys and young children, and in three oppositional/conduct disorders regression models (child, parent, and teacher) higher rates among boys. No informant parallelism is observed in the logistic regression models for internalizing disorders, i.e. the patterns of association of demographic variables with anxiety and depressive disorders vary across informants. Urban-rural residence does not emerge as a significant variable in any of the logistic regression models. The overall 6-month prevalences reach 19.9% according to the parent and 15.8% according to the child. The implications of the results for policy makers and clinicians are discussed.     

Young adult follow-up of hyperactive children: antisocial activities and drug use

BACKGROUND: Hyperactive/ADHD children are believed to be a greater risk for adolescent and young adult antisocial activity and drug use/abuse, particularly that subset having comorbid conduct problems/disorder. METHOD: We report on the lifetime antisocial activities and illegal drug use self-reported at young adult follow-up (mean age 20-21 years; 13+ year follow-up) for a large sample of hyperactive (H; N = 147) and community control (CC; N = 73) children. Parent reports of childhood hyperactivity and conduct problems at study entry, parent and self-reports of ADHD and conduct disorder at adolescence, and parent reports of ADHD at young adulthood are examined for their contribution to antisocial behavior and drug use at adulthood. RESULTS: More of the H group committed a variety of antisocial acts and had been arrested for doing so (corroborated through official arrest records) than did the CC group. The H group also committed a higher frequency of property theft, disorderly conduct, assault with fists, carrying a concealed weapon, and illegal drug possession, as well as more arrests. These activities reduced to two dimensions corresponding to predatory-overt and drug-related antisocial conduct. The H group differed from the CC group only on the latter dimension. Childhood, adolescent, and adult ADHD predicted higher drug-related activities, as did childhood conduct problems. The H group with conduct disorder (CD) reported greater use of most substances than did the H only or CC groups, who did not differ from each other. Severity of teen ADHD and especially lifetime CD predicted use of hard drugs while just lifetime CD predicted marijuana/LSD use. Teen drug use seemed to potentiate increased drug-related antisocial activities beyond the contribution made by teen CD. CONCLUSIONS: Hyperactive children are at greater risk for antisocial activities and arrests by young adulthood that appear to be principally associated with illegal drug possession, use, and sale. Those having CD, however, appear to engage in greater and more diverse substance use.