Examination of mental health status and aggravation level among mothers of children with isolated oral clefts.

OBJECTIVE: To examine self-reported mental health status and aggravation level in mothers of children with isolated oral clefts. METHODS: Population-based sample of children (aged 4 to 9 years) with isolated oral clefts was enumerated from births from 1998 through 2003 in Arkansas, Iowa, and New York State. Mothers of 294 children completed the Mental Health Inventory 5-item questionnaire and Aggravation in Parenting Scale. The Mental Health Inventory and Aggravation in Parenting Scale scores, stratified by poor (Mental Health Inventory ≤ 67) and better (Mental Health Inventory > 67) mental health status or high (Aggravation in Parenting Scale ≤ 11), moderate (Aggravation in Parenting Scale = 12 to 15) and low (Aggravation in Parenting Scale = 16) aggravation, were compared by selected maternal and child characteristics. Mean scores for each instrument and proportion of mothers with poor mental health or high aggravation were compared with those reported in the National Survey of American Families. RESULTS: Mean scores for each instrument and proportion of mothers with poor mental health or high aggravation differed little from published data. Mothers with poor mental health tended to be less educated, to have lower household incomes, and to rate their health and their child's health lower than those in better mental health. Mothers with high aggravation tended to have lower household incomes, to have more children, and to rate their health and their child's health lower than those with moderate or low aggravation. CONCLUSIONS: Mothers of affected children were not more likely to experience poor mental health or high aggravation compared with published data; however, sociodemographic characteristics were associated with maternal psychosocial adaptation. Brief screeners for mental health and parenting administered during routine appointments may facilitate identifying at-risk caregivers.

Maternal periconceptional exposure to cigarette smoking and congenital limb deficiencies.

BACKGROUND: Congenital limb deficiencies (LD)s are characterised by the failure or disruption in formation of limbs or digits. Epidemiological research on maternal exposure to cigarette smoke and LDs is inconclusive. METHODS: Data from the National Birth Defects Prevention Study were used to examine LDs and maternal exposure to active or passive cigarette smoke. Mothers of LD case (n = 906) and unaffected control (n = 8352) pregnancies from October 1997 through December 2007 reported on exposure type and quantity. Logistic regression was used to estimate adjusted odds ratio (OR) and 95% confidence interval [95% CI]; interactions with folic acid (FA) intake were tested. RESULTS: For any LD, ORs were elevated for active (1.24 [95% CI 1.01, 1.53]), passive (home) (1.28 [95% CI 1.03, 1.59]), and 'active and passive' (1.34 [95% CI 1.05, 1.70]) exposures. The ORs for longitudinal LDs were elevated for passive (home) (1.62 [95% CI 1.14, 2.31]) and 'active and passive' (1.62 [95% CI 1.09, 2.41]) exposures. The OR for pre-axial LDs were elevated for any (1.39 [95% CI 1.01, 1.90]), active (1.53 [95% CI 1.03, 2.29]), passive (home) (1.82 [95% CI 1.23, 2.69]), and 'active and passive' (1.87 [95% CI 1.20, 2.92]) exposures. For lower limbs, ORs were elevated for passive (home) (1.44 [95% CI 1.01, 2.04]) and smoking 15 or more cigarettes/day (2.25 [95% CI 1.27, 3.97]). Interactions showed that ORs for any passive smoke exposure were 0.43 and 0.59 higher in the absence of FA intake for any and terminal transverse LDs. CONCLUSIONS: Maternal active smoking and exposure to passive cigarette smoke emerged as a potential teratogen that affects limb and digit formation. FA was not found to mitigate the impact.

How reliable are county and regional health rankings?

Surveillance system indicators of morbidity, mortality, or behaviors are used to provide regional information for ever-smaller areas, most recently for ranking counties. These rankings are thought to provide information about the relative standing of regions and provide information about problem areas and the success of programs. We investigate the ability of such rankings to reliably assess health. We assess the reliability of several ranked health indices used at the county level and the consistency of an index's quality across different states. Reliability is assessed using an index of reliability, simulations, and the ability of an index to consistently identify the top 10 % (worst) counties within a state. There is marked variability across measures to provide consistent ranks, across states, and, many times, across states for a particular measure. A few health measures do consistently well, e.g., Teen Birth, Chlamydia, and Years of Potential Life Lost rates. While a few health rankings appear worthy of use for policy and in the identification of local problems, in general, they are not consistent across regions.

Reproductive patterns among mothers of males diagnosed with Duchenne or Becker muscular dystrophy.

Diagnosis of a child with Duchenne or Becker muscular dystrophy (DBMD) may impact future maternal reproductive choice; however, little is known about the reproductive patterns of mothers with a male child diagnosed with DBMD. Using population-based surveillance data collected by the muscular dystrophy surveillance, tracking, and research network, the proportion of mothers who conceived and delivered a live birth following the diagnosis of DBMD in an affected male child and factors associated with such reproductive choice were identified. To accomplish this, maternal demographic data were linked to birth certificate data to construct the reproductive history for 239 mothers. Univariable and bivariable analyses were conducted to determine the proportion of mothers delivering a live birth and associated factors. By the time of the current study, 96 (40.2%) of the 239 mothers had at least one live birth following delivery of their oldest affected male child; 53 (22.2%) of these mothers had a live birth before and 43 (18.0%) had a live birth after DBMD diagnosis of a male child. Mothers with a live birth after diagnosis were significantly younger at diagnosis of the oldest affected male child (26.2 ± 4.2 years vs. 31.5 ± 5.5 years), and were less likely to be white non-Hispanic compared to those with no live birth after diagnosis. These results suggest that about one in five mothers deliver a live birth subsequent to DBMD diagnosis in a male child. Maternal age and race/ethnicity were associated with this reproductive choice.

Use of complementary and alternative medicine by males with Duchenne or Becker muscular dystrophy.

Use of complementary and alternative medicine by males with Duchenne or Becker muscular dystrophy was examined using interview reports from caregivers enrolled in the population-based Muscular Dystrophy Surveillance, Tracking, and Research Network. Of the 200 caregivers interviewed, 160 (80%) reported "ever" using complementary and alternative medicine for their affected children. Mind-body medicine (61.5%) was most frequently used, followed by biologically based practices (48.0%), manipulative and body-based practices (29.0%), and whole medical systems (8.5%). Caregivers reporting use of whole medical systems had higher education and income levels compared with nonusers; affected males had shorter disease duration. Caregivers reporting use of mind-body medicine, excluding aquatherapy, had higher education level compared with nonusers. Overall, complementary and alternative medicine use was high; disease duration, education, and income levels influenced use. These findings have implications for developing clinical care protocols and monitoring possible interactions between complementary and alternative medicine and conventional medical therapies.

Use of active surveillance methodologies to examine over-reporting of stillbirths on fetal death certificates.

BACKGROUND: Data from Iowa fetal death certificates (FDCs) suggest that reportable stillbirths (unintended fetal deaths ≥ 20 weeks gestation and/or weighing ≥ 350 grams) occur in about 1 in 200 deliveries. In 2005, the Iowa Department of Public Health and the Iowa Registry for Congenital and Inherited Disorders (IRCID) collaborated with other state stakeholders to establish the Iowa Stillbirth Surveillance Project. The goal of this project was to use population-based, active surveillance methodologies to identify reportable stillbirths delivered by Iowa residents since January 1, 2000. METHODS: To conduct stillbirth surveillance, the IRCID expanded its existing public health authority and electronic abstract application for birth defects surveillance. The expanded application was piloted using a random sample (n = 250 of 989) of FDCs reported from January 2000 through December 2004. RESULTS: IRCID procedures for active case finding and medical record abstraction verified 192 (76.8%) as reportable stillbirths. Stillbirths not verified as reportable were due to findings of elective terminations (n = 30), live births (n = 3), induced deliveries (n = 2), and FDC entries for gestational age and/or delivery weight that were either inaccurately recorded (n = 13) or accurately recorded but did not meet Iowa FDC reporting criteria (n = 9); medical records for one FDC were unavailable. Infant malformations were more common among unverified stillbirths, whereas the cause of death due to maternal-related conditions was higher among verified stillbirths. CONCLUSIONS: These results suggest that over-reporting limits the use of FDCs as a primary ascertainment source for stillbirth surveillance in Iowa. Continued expansion of the IRCID active surveillance methodologies to monitor stillbirths in Iowa is recommended.

DRD4 genotype moderates the impact of parental problems on unresolved loss or trauma.

In the current study we tested whether the dopamine receptor D4 (DRD4) genotype moderates the association of experienced parental problems during childhood (e.g., parental depression, marital discord) with unresolved loss or trauma during the Adult Attachment Interview. To test the specificity of this moderation the role of the serotonin transporter gene promoter (5-HTTLPR) was also examined. Subjects were 124 adopted adults (mean age 39 years). Participants with the DRD4-7 repeat (7R) allele who experienced parental problems had the highest scores for unresolved loss or trauma whereas participants with DRD4-7R who did not experience parental problems showed the lowest ratings. Among participants without DRD4-7R, the parental problems during childhood did not make a difference. 5-HTTLPR did not moderate the relation between parental problems and unresolved loss or trauma. Our study shows heightened susceptibility to environmental influences for carriers of the DRD4-7R allele, and suggests that the interplay between specific dopamine-related genes and family contexts leads to more or less successful coping with adverse childhood experiences.

Assessing community variation and randomness in public health indicators.

BACKGROUND: Evidence-based health indicators are vital to needs-based programming and epidemiological planning. Agencies frequently make programming funds available to local jurisdictions based on need. The use of objective indicators to determine need is attractive but assumes that selection of communities with the highest indicators reflects something other than random variability from sampling error. METHODS: The authors compare the statistical performance of two heterogeneity measures applied to community differences that provide tests for randomness and measures of the percentage of true community variation, as well as estimates of the true variation. One measure comes from the meta-analysis literature and the other from the simple Pearson chi-square statistic. Simulations of populations and an example using real data are provided. RESULTS: The measure based on the simple chi-square statistic seems superior, offering better protection against Type I errors and providing more accurate estimates of the true community variance. CONCLUSIONS: The heterogeneity measure based on Pearson's χ2 should be used to assess indices. Methods for improving poor indices are discussed.

Cognition and nondysphoric depression among adoptees at high risk for psychopathology.

BACKGROUND: Association between poor cognition and symptom clusters including depressive ideation (eg, guilt) and vegetative symptoms in the absence of dysphoria (nondysphoric depression [NDD]) has been suggested in the elderly. The current study examined associations between NDD and premorbid and concurrent cognitive functioning in younger adults at high risk for psychopathology. Nondysphoric depression and depressed subjects were expected to show poorer premorbid and current cognition than nondepressed participants. METHOD: Subjects were adoptees enrolled in the Iowa Adoption Study [Yates W, Cadoret R, Troughton E. The Iowa adoption studies: methods and results. On the way to individuality: methodological issues in behavioral genetics. In: LaBuda M, Grigorenko E, (Eds), Editor. 1999, Commack (NY): Nova Science Publishers, Inc. p. 95-121]. Nondysphoric depression subjects were compared with nondepressed comparison subjects and with subjects with dysphoric depression (DD) on measures of premorbid cognition (estimated by standardized school achievement test scores) and concurrent cognition (intelligence, attention, memory, and executive abilities). RESULTS: Nondysphoric depression and DD showed lower premorbid cognition and executive functioning, whereas DD showed lower verbal and performance IQ compared to nondepressed subjects. The size of the comparison between NDD and nondepressed subjects for premorbid cognition was double that between DD and nondepressed subjects. No significant differences in cognition were found between NDD and DD. These effects were no longer significant after controlling for premorbid cognition. CONCLUSIONS: Poorer premorbid cognition and executive functions in NDD (and the absence of current cognitive differences compared with DD) suggest that NDD may be a condition of clinical interest. Because poor cognition is a known correlate of alexithymia, these results (including their magnitude) are consistent with the view that NDD may be a paradoxical presentation of depression in persons with limited ability to be aware and to verbally-report emotions.

Maternal periconceptional exposure to cigarette smoking and alcohol consumption and congenital diaphragmatic hernia.

BACKGROUND: Congenital diaphragmatic hernia (CDH) is a major birth defect that occurs when abdominal organs herniate through a diaphragmatic opening into the thoracic cavity and is associated with high mortality (>50%). The etiology of CDH is not well understood. METHODS: Using data from the National Birth Defects Prevention Study, we examined associations between CDH and maternal periconceptional exposure (1 month before through the third month of pregnancy) to cigarette smoking and alcohol. Interview reports of exposures were provided by mothers of CDH (n = 503) and unaffected control (n = 6703) infants delivered from October 1997 through December 2005. Any exposure (yes/no), as well as quantity (average number of cigarettes or drinks), type (active/passive smoking; beer, wine, distilled spirits), and duration (e.g., number of months exposed) were examined. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated for all CDH cases combined, selected subtypes (Bochdalek, Morgagni, not otherwise specified), and phenotypes (infants with/without additional major birth defects). RESULTS: The aOR for any smoking was nonsignificantly elevated for all CDH cases combined. Odds of any smoking was significant for isolated Bochdalek CDH (aOR, 1.9; 95% CI, 1.2-3.0). The aORs associated with all measures of alcohol consumption were near unity for each CDH category examined. Stratification of smoking exposure by alcohol consumption and stratification of alcohol consumption by smoking exposure did not appreciably change the aORs. CONCLUSIONS: These findings identified periconceptional smoking exposure as a potential risk factor for CDH. Future studies need to confirm our findings and explore possible pathways accounting for the teratogenic effect of smoking.

Methylation matters: interaction between methylation density and serotonin transporter genotype predicts unresolved loss or trauma.

BACKGROUND: Do genetic or epigenetic factors play a role in making some individuals more vulnerable than others to loss of attachment figures or other traumatic experiences? METHODS: DNA was obtained from growth phase entrained Epstein-Barr Virus (EBV) transformed lymphoblast cell lines from 143 adopted participants. Genotype of the serotonin transporter linked polymorphic region (5HTTLPR) was determined, and methylation ratios for each of the C-phosphate-G (CpG) residues were assessed using quantitative mass spectroscopy. Unresolved loss or trauma was established using the Berkeley Adult Attachment Interview. RESULTS: Higher levels of methylation of the 5HTT promoter associated CpG island were associated with increased risk of unresolved responses to loss or other trauma in carriers of the usually protective 5HTTLPR//variant. The ss variant of 5HTTLPR predicted more unresolved loss or trauma, but only in case of lower levels of methylation. Higher levels of methylation of the ss variant were associated with less unresolved loss or other trauma. CONCLUSIONS: Associations between 5HTTLPR polymorphisms and psychological problems are significantly altered by environmentally induced methylation patterns. Methylation may serve as the interface between adverse environment and the developing organism.

Epidemiology of congenital idiopathic talipes equinovarus in Iowa, 1997-2005.

Congenital idiopathic talipes equinovarus (ITEV), also known as clubfoot, is a well-recognized foot deformity. To date, prevalence estimates and descriptive data reported for ITEV have varied due to differences in study methodology. Using population-based surveillance data collected by the Iowa Registry for Congenital and Inherited Disorders, we examined isolated ITEV births delivered from 1997 through 2005 and compared to live births in Iowa during the same time period. An overall prevalence was calculated for live, singleton full-term births only. Prevalence odds ratios (POR)s and 95% confidence intervals (CI)s were examined for selected infant and parental characteristics. The prevalence of isolated ITEV was 11.4 per 10,000 live, singleton full-term births (95% CI = 10.3, 12.6), with no significant variation in prevalence during the study period. Increased PORs were found for males (POR 1.8; 95% CI = 1.5, 2.3) and maternal smoking during pregnancy (POR = 1.5, 95% CI = 1.2, 1.9); low birth weight (<2,500 g) showed an increase among females (POR = 3.2, 95% CI = 1.5, 6.9) but not males (POR = 0.9, 95% CI = 0.3, 2.8). Elevated, but non-significant, PORs were found for season of birth, maternal education, and trimester prenatal care was initiated; decreased PORs were found for fetal presentation, maternal race/ethnicity, parity, area of residence, and parental age at delivery. Our study of a well-defined, homogenous sample suggested that prevalence of isolated ITEV in Iowa was similar to that reported in other population-based studies and provided support for some, but not all, previously reported associations with infant and parental characteristics. More detailed, longitudinal studies of isolated ITEV are recommended.

Effects of alcohol- and cigarette-use disorders on global and specific measures of cognition in middle-age adults.

OBJECTIVE: This study examined the effects of alcohol- and tobacco-use disorders on global and specific cognitive abilities in middle age. METHOD: The sample consisted of 118 men and 169 women ranging in age from 31 to 60 years (M [SD] = 43.59 [6.58]). Lifetime diagnoses were determined from a semistructured interview. Information about current levels of alcohol and cigarette use was also collected. A comprehensive neurocognitive assessment measuring global cognition, memory, and executive-functioning abilities was administered. Baseline cognition was estimated from average composite scores of the Iowa Test of Basic Skills school-achievement tests administered from third through eighth grade. Repeated-measures analysis of variance was used. Covariates comprised baseline cognition, current depression symptoms, and medication use. RESULTS: Lifetime alcohol- and tobacco-use disorders were not associated with cognition among men. Women having a diagnosis of tobacco dependence (according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]) performed less well on measures of global cognition and executive functioning. A lifetime diagnosis of DSM-IV alcohol abuse or dependence was associated with higher working memory among women only. CONCLUSIONS: These results demonstrate few negative effects of alcohol-use disorders on midlife cognition, especially if current consumption is light. Differential susceptibility to the effects of cigarette use on cognition was found with women showing greater deficits in visuospatial abilities, processing speed, and executive-functioning abilities.

Birth Outcomes, Lifetime Alcohol Dependence and Cognition in Middle Adulthood.

Prenatal exposure to alcohol is associated with cognitive abnormalities that persist throughout the lifespan and are also often a focus of studies examining cognitive outcomes associated with excessive alcohol use by an individual. This study examined the effect of birth outcomes consistent with fetal alcohol exposure on associations between lifetime alcohol dependence and cognition in middle adulthood. The sample was comprised of 315 adult adoptees ranging in age from 31 to 64 years (SD = 7.20). Facial morphology, pre-morbid cognition, and current cognition were assessed. Birth parent behaviors and birth outcomes (e.g., birthweight, gestational age) were obtained from adoption agency records. Lifetime alcohol dependence was determined from the Semi-Structured Assessment of the Genetics of Alcoholism - II. Univariate associations showed significantly poorer pre-morbid and current cognition when birth parent problems, short palpebral fissures, and thin upper lips were present. Lifetime alcohol dependence was associated with lower perceptional organization, processing speed and working memory. Multivariate analyses demonstrated continued significance suggesting unique contributions of each to cognition. Evaluating the possible role of fetal alcohol exposure within studies on alcoholism can only further improve the treatment and prevention of alcohol-related problems by isolating those cognitive outcomes uniquely attributable to an individual's consumption of alcohol.

IQ estimate smackdown: comparing IQ proxy measures to the WAIS-III.

Brief assessments of general cognitive ability are frequently needed by neuropsychologists, and many methods of estimating intelligence quotient (IQ) have been published. While these measures typically present overall correlations with the Wechsler Adult Intelligence Scale (WAIS) Full Scale IQ, it is tacitly acknowledged that these estimates are most accurate within 1 standard deviation of the mean and that accuracy diminishes moving toward the tails of the IQ distribution. However, little work has been done to systematically characterize proxy measures at the tails of the IQ distribution. Additionally, while these measures are all correlated with the WAIS, multiple proxy measures are rarely presented in one manuscript. The current article has two goals: (1) Examine various IQ proxies against Wechsler Adult Intelligence Scale (Third Version) scores, showing the overall accuracy of each measure against the gold standard IQ measure. This comparison will assist in selecting the best proxy measure for particular clinical constraints. (2) The sample is then divided into three groups (below, average, and above-average ability), and each group is analyzed separately to characterize proxy performance at the tails of the IQ distribution. Repeated measures multivariate analysis of variance compares the different proxy measures across ability levels. All IQ estimates are represented in tables so that they can be examined side by side.

Association between the serotonin transporter promoter polymorphism (5-HTTLPR) and adult unresolved attachment.

Research on antecedents of organized attachment has focused on the quality of caregiving received during childhood. In recent years, research has begun to examine the influence of genetic factors on quality of infant attachment. However, no published studies report on the association between specific genetic factors and adult attachment. This study examined the link between the 5-HTTLPR promoter polymorphism of the serotonin transporter gene and adult unresolved attachment assessed with the Adult Attachment Interview. Genetic material and information on attachment-related loss or trauma were available for 86 participants. Multivariate regression analyses showed an association between the short 5-HTTLPR allele and increased risk for unresolved attachment. Temperament traits and psychological symptoms did not affect the association between 5-HTTLPR and unresolved attachment. The authors hypothesize that the increased susceptibility to unresolved attachment among carriers of the short allele of 5-HTTLPR is consistent with the role of serotonin in modulation of frontal-amygdala circuitry. The findings challenge current thinking by demonstrating significant genetic influences on a phenomenon previously thought to be largely environmentally driven.

Lifetime substance misuse and 5-year incidence rates of emergent health problems among middle-aged adults.

Understanding the impact of prior substance misuse on emergent health problems is important to the implementation of effective preventive care. This study examined the 5-year incidence rates using a sample of middle-aged adult adoptees (N = 309, mean(age) = 44.32, standard deviation(age) = 7.28). Subjects reported on health problems at two waves of study. DSM-IV diagnoses of substance misuse were obtained using a semi-structured diagnostic interview. Finally, health services utilization and perceived health status were collected. Lifetime diagnoses of marijuana and other non-marijuana substance misuse significantly predicted new occurrences of cardiovascular and metabolic disease. Alcohol misuse predicted earlier onset of cardiovascular disease among men. Marijuana and other non-marijuana drugs predicted earlier onset of cardiovascular disease for men and women. Finally, marijuana and other non-marijuana drugs predicted earlier onset of metabolic disease among men. Substance misuse did not predict health services utilization despite higher rates of disease. These findings emphasize the need to assess lifetime substance misuse when evaluating health risks associated with use.

A sibling adoption study of adult attachment: the influence of shared environment on attachment states of mind.

This study extends existing research investigating sibling concordance on attachment by examining concordance for adult attachment in a sample of 126 genetically unrelated sibling pairs. The Adult Attachment Interview (George, Kaplan, & Main, 1985; Main, Goldwyn, & Hesse, 2003) was used to assess states of mind with regard to attachment. The average age of the participants was 39 years old. The distribution of attachment classifications was independent of adoptive status. Attachment concordance rates were unassociated with gender concordance and sibling age difference. Concordance for autonomous/non-autonomous classifications was significant at 61% as was concordance for primary classifications at 53%. The concordance rate for not-unresolved/unresolved was non-significant at 67%. Our findings demonstrate similarity of working models of attachment between siblings independent of genetic relatedness between siblings and generations (i.e., parent and child). These findings extend previous research by further implicating shared environment as a major influence on sibling similarities on organized patterns of attachment in adulthood. The non-significant concordance for the unresolved classification suggests that unresolved loss or trauma may be less influenced by shared environment and more likely to be influenced by post-childhood experiences or genetic factors.

Co-morbid health conditions at mid-life in the Iowa adoptees.

Adverse health effects due to alcohol and illicit drug abuse and dependence have been well documented. This study examines the effect of substance misuse on five major groups of health conditions using a sample of well characterized adoptees. The sample consisted of 742 adoptees interviewed in the last wave of the Iowa Adoption Studies. Death rate analyses included an additional 34 participants who had died prior to the last follow-up. Substance use patterns and medical history were assessed using the SSAGA-II (Bucholz, K. K., Cadoret, R. J., Cloninger, C. R., Dinwiddie, S. H., Hesselbrock, V. M., Nurnberger, J. L., Jr., et al. (1994). A new, semi-structured psychiatric interview for use in genetic linkage studies: a report on the reliability of the SSAGA. Journal of Studies on Alcohol, 55 (2), 149-158). Subjects were divided into three groups according to DSM-IV diagnostic criteria, controls, alcohol abuse or dependence only (alcohol only), and the Alcohol-Drug group (abuse or dependence diagnosis on at least one illicit substance with or without alcohol diagnosis). Incidence rates of various diseases were measured using logistic regression. Survival analyses were used to examine whether substance abusers developed cardiovascular or metabolic disease at an earlier age than control subjects. Diagnostic grouping made no difference in the incidence rates or age of onset of health conditions. The amount of alcohol consumed by males significantly predicted higher number of overall health complaints as well as higher incidence rates of cardiovascular disease. The amount of illicit drug exposure did not predict an earlier age of diagnosis for cardiovascular or metabolic disease. Individuals in the Alcohol-Drug group had an increased incidence of deaths than either the alconly or the control groups.

Adult outcomes of attention deficit hyperactivity disorder and conduct disorder: are the risks independent or additive?

METHODS: Data were obtained from a longitudinal study sample of 754 adoptees and categorized based on review of the available adoption agency, medical, and psychiatric records of the biological parents. Categorical data were analyzed using chi2 or Fisher's exact tests, as appropriate. Logistic regression analyses were used to assess the relative contribution of variables. RESULTS: There was not a statistically significant difference in the frequency or type of self-reported adult disruptive behavior, arrests, jail stays, felony arrests, or frequency of conduct disorder (CD) when inattentiveness, impulsivity, and hyperactivity were analyzed individually. The contributions of attention deficit hyperactivity disorder (ADHD) were independent and no additional increased risk for future illegal behavior was conferred by the combination of the disorders. While the effect of CD on illegal behavior was correlated with substance abuse and dependence, ADHD continued to be a significant contributor after controlling for substance abuse and dependence. CONCLUSIONS: Data indicated that ADHD and CD are related but different disorders conferring risk for adult illegal behavior or arrest. In this sample, inattention was the most common domain impaired among those with ADHD, followed closely by hyperactivity, with impulsivity reported least often among those endorsing symptoms of ADHD.