Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with subsequent psychotic disorder, neurodevelopmental disorders, borderline personality disorders, and mood disorders. However, studies examining the link between ADHD and psychotic disorders have been mixed.

In a study recently published in JAMA Psychiatry, researchers explored the association between childhood ADHD and psychotic disorders via a literature review. They found a significantly higher risk in people who had a childhood ADHD diagnosis, though the mechanisms behind the link remain unclear.

The researchers searched the MEDLINE, Scopus, PsycInfo, and Web of Science databases from inception through July 7, 2020. They included studies that involved people under age 18 with an ADHD diagnosis; control groups from the general population, and groups with or without psychiatric disorders and with and without ADHD. A total of 12 unique studies and a total of 1.85 million participants were included in the review.

Psychotic disorders were present in .4% to 6.4% of the general populations, 0 to 4.2% in the control populations, and .7% to 12.5% in the ADHD populations. Those results suggest a relative effect of 4.74 (95% CI, 4.11-5.46; I2 = 43% [95% CI, 0%-70%]). There was no significant difference between psychotic disorders.


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The researchers theorized that the association stems from a developmental path with shared genetic susceptibility or social environmental factors. A comorbid substance use disorder and/or psychostimulant treatment during childhood may also play a role.

A limitation was that studies differed in the versions of international classifications used to diagnose ADHD. Establishing the time period for ADHD and psychotic disorder diagnoses was “difficult.”

“Given that [psychotic disorders] have a major functional effect, early detection and appropriate management are essential to improve the prognosis of children diagnosed with ADHD,” the researchers concluded. “To improve our knowledge, further cohort studies should be conducted.”

Conflicts of Interest: The authors report several conflicts of interest. Please see the original document.

Reference

Nourredine M, Gering A, Fourneret P, et al. Association of Attention-Deficit/Hyperactivity Disorder in childhood and adolescence with the risk of subsequent psychotic disorder: A systematic review and meta-analysis. JAMA Psychiatry. Published February 24, 2021. doi:10.1001/jamapsychiatry.2020.4799