Hyperactivity combined wit h conduct problems—but not hyperactivity
alone—predicted later criminal behavior in adulthood in a 30-year
prospective study of 179 boys in California who had been referred to a
psychiatric outpatient clinic because of hyperactivity.
One conduct problem in particular, lying, predicted both adolescent and
adult criminal behavior in this cohort, according to James Satterfield, M.D.,
now retired from the Department of Psychiatry at Oregon Health and Science
University in Portland.
"This suggests that this behavioral variable should always be
included in ADHD childhood evaluations," wrote Satterfield and
colleagues in the May Journal of the American Academy of Child and
Adolescent Psychiatry. Socioeconomic status and IQ should also be
included in such assessments, since they, too, had a strong influence on this
Up to three years of individualized treatment when the boys were
preadolescents produced better school outcomes, improved attention, less
antisocial behavior, and better adjustment at home. That effect extended into
adolescence for those who were treated for more than two years, but not for
those treated for shorter times. However, any beneficial effects of treatment
disappeared by adulthood.
The 179 white boys were first evaluated at ages 6 to 12 and compared with
75 matched controls between 1970 and 1973. Seventy-six of the boys received
multimodality treatment, and 103 got drug treatment alone. Satterfield and
colleagues have published previous studies about this cohort over the past
three decades. Their latest report comes as the subjects reached a mean age of
37 years. In the years since they entered the study, 79 (44.1 percent) of the
hyperactive boys and 11 (14.7 percent) of the controls had been arrested,
giving an odds ratio of 4.57 (p<0.001). Roughly similar odds ratios were
recorded for convictions and imprisonment. Sixty-nine hyperactive boys had 228
arrests for felonies (the others were arrested for misdemeanors). The common
reasons for arrest included battery/assault (39 arrests) and drug possession
(49). The mean age after which they no longer were arrested was 30.
The effects held only for boys with both hyperactivity and conduct
problems. Hyperactivity alone led to outcomes that were no different from
those of controls.
Analysis showed that higher IQ and higher socioeconomic status (SES) were
protective factors. Those with low SES were twice as likely to violate the
law, compared with those from high-SES families.
The choice of treatment had no effect on outcomes. Nearly equal percentages
of the multimodality and drug-only treatment groups had the same rates of
arrest and imprisonment.
Satterfield and his colleagues believe that multimodality failed to prevent
adult criminality because it was applied too late. "Serious behavioral
problems tend to be established by the age of school entry and to remain
stable thereafter," they wrote. "From our study, we conclude that
it is unlikely that a time-limited (three year) intensive [multimodality]
clinical intervention for boys aged 6 to 12 years will either permanently
eliminate existing antisocial behaviors or protect against their reemergence
long after the intervention has ended."
The authors noted that the study is limited by the ethnic homogeneity of
the subjects and a lack of random assignment to treatment groups. Satterfield
has received support from several pharmaceutical manufacturers.
A lot happens between youth and adulthood, said Edward Mulvey, Ph.D., a
professor of psychiatry at Western Psychiatric Institute and Clinic of the
University of Pittsburgh School of Medicine, in an interview. Hyperactivity
may set the stage for adjustment problems, making it difficult for children to
make friends, do well in school, or get along with parents, but it's not the
only factor. "In the long run, the presence of hyperactivity does not
doom a kid to criminality."
Nor is he surprised at the lack of long-term benefits from treating these
boys only when they were in elementary school.
"All treatments have a window of effectiveness that closes after a
while," said Mulvey. "It helps them but does not inoculate them
against future problems forever. Any treatment should be expected to exert a
positive influence for a limited time after implementation, to get the child
under sufficient control and give him enough skills to deal with the next set
"I'm surprised that there's not more in the literature on this
subject. This is an important mechanism to investigate."
The study was funded in part by a grant from the National Institute of
An abstract of "A 30-Year Prospective Follow-Up Study of
Hyperactive Boys With Conduct Problems: Adult Criminality" is posted at<www.jaacap.com/pt/re/jaacap/currenttoc.htm>.▪