Do They Grow out of It: Long-Term Outcomes of Childhood Disorders
O'Brien, John D., American Journal of Psychotherapy
LILY HECHTMAN, ED.: Do They Grow Out Of It?: Long-Term Outcomes of Childhood Disorders. American Psychiatric Press, Inc., Washington, DQ 1996, 287 pp., ISBN 0-88048-703-8.
The book consists of a preface and eleven chapters each mostly devoted to a particular clinical entity focusing on the research and clinical issues in longitudinal studies. The chapters deal with ADHD, Conduct Disorder, Childhood Depression, Anxiety Disorders, Obsession Compulsive Disorder, Pervasive Developmental Psychotic and Allied Disorders, and Childhood Speech and Language Disorders. Suicidal behavior and comorbidity with ADHD round out the book. As with any book having multiple authors writing different chapters, the chapters vary in style. However, overall there is a paucity of well-controlled long-term outcome studies in most of the entities (for anxiety disorders there are basically none while for ADHD there are a few very good ones), and virtually none that provide a picture of the impact of treatment.
Weiss, in the first chapter, puts forth the powerful reasons for doing longitudinal studies. First and foremost is to learn the outcome of a childhood disorder and to do this, one needs a control or comparison group, which is difficult to do. One study on outcome showed that ADHD is not outgrown but can persist into adulthood. This study examined the relationship between childhood and adult pathology, another reason to study outcome. The continuities and discontinuities in the nature and intensity of the symptomatology of a given syndrome are learned through longitudinal work. The effect of life events on the syndrome, the determination of risk and protective factors, and treatment effects are gleaned from this work.
One area in which there are a fair number of good longitudinal studies is ADHD and the book begins with this syndrome. While adult outcomes can vary significantly, three outcome groups are found. One is not especially different from a matched normal control group; a second is composed of adults with significant problems in concentration, impulsiveness, and social and emotional functioning and a third has significant psychiatric and/or antisocial pathology. The vast majority of young adults who are hyperactive fall into group two with a small percentage into three. Although one particular factor is not associated with a particular adult outcome, mental health of family members, IQ, and SES seem to be important. Also, continuation of the ADHD syndrome and the coexistence of aggression and conduct disorder are seemingly important in influencing adult outcome.
While further research is needed, there seems to be some trends in the effect of comorbidity on outcome. ADHD and CD have a more serious course and poorer outcome in adulthood. These children may constitute a subgroup of ADHD and they need to be studied with an eye to intervention strategies. Clearly, in the diagnostic process one must always consider comorbidity
With conduct disorder, studies show that there is a significant continuity from childhood to adulthood in aggression and that conduct problems in childhood and adolescence predict alcoholic abuse and dependence and, more weakly, drug abuse and dependence. Conduct problems in childhood predict greater rates of psychiatric disorders in all people, but the patterns are different for the genders. Also, conduct problems predict great social dysfunction. …