Aims To ascertain whether social risk factors have a significant association with complex ADHD and assess the relative role played by biological risk factors and coexisting neurodevelopmental disorders. This will enable a better understanding of factors that complicate management of ADHD and thus facilitate optimal management.
Methods 102 patients with a diagnosis of ADHD were identified using a computerised coding system. Each case was assessed individually using computer system entries and case notes. A specially designed proforma was used to identify the following risk factors:
social risk factors (e.g. parenting issues, child protection concerns)
biological risk factors (e.g low birthweight, antenatal use of drugs/alcohol)
coexisting neurodevelopmental conditions (e.g. autistic spectrum disorder, Tourette’s syndrome)
Patient outcomes were separated into two groups:
Easy to manage (ETM) – no additional measures needed (only school support, parental support, medication)
Difficult to manage (dtm) – additional emotional/behavioural problems necessitating input from external agencies.
Results Social risk factors were present in the majority of cases (70%), and were more prevalent in the DTM group (82%), than in the ETM group (53%).
There was a significant difference between the outcomes seen in the SR group (66%) and the NSR group (32%). The χ2 value for this difference was 8.752 (p < 0.05).
The difference between the percentages of patients with DTM versus ETM outcome was not significant in the BR group (55% & 45% respectively) or the NDD group (57% & 43% respectively), but was significant in the SR group (66% & 34%).
Conclusion The SR group was significantly more difficult to manage compared to the BR group and NDD group. There was a marked difference in outcome seen in the SR group, compared with the NSR group. The majority of DTM cases involve social risk factors, some of which are potentially modifiable. Although the presence of biological risk factors and coexisting disorders cannot be altered, early identification and amelioration of adverse social risk factors can potentially modify their effect and hence improve outcome.