Attention-deficit hyperactivity disorder (ADHD) is often thought to be a condition that children eventually "outgrow." But a new study shows that the disorder can have serious consequences well into adulthood, providing evidence that ADHD should be treated as a long-term condition.
Researchers found that the majority of individuals diagnosed with ADHD as children had other psychiatric disorders as adults, including substance abuse, anxiety and depression.
"As a society, I think we still tend to trivialize ADHD and think of it as an annoying childhood problem, but in fact, our findings confirm that it should be viewed as a significant, chronic health problem," says lead investigator Dr. William Barbaresi of Boston Children's Hospital.
The study, published online Monday by the journal Pediatrics, initially looked at 5,718 individuals born in Rochester, Minn., between 1976 and 1982, of whom 367 were diagnosed with ADHD as children. When contacted for a follow-up, 232 of the ADHD group agreed to participate. Nearly 30 per cent of the children with ADHD still had the disorder as adults and 57 per cent had at least one other psychiatric disorder, such as antisocial personality disorder, substance abuse, generalized anxiety or major depression, compared with 35 per cent of the participants who did not have ADHD as children.
The researchers also found that three of the 367 individuals who had childhood ADHD died by suicide, compared with five suicide deaths out of 4,946 participants in the control group. Moreover, 10 participants, or 2.7 per cent of those who had ADHD as children, were incarcerated.
Barbaresi notes that these findings may, in fact, underestimate the negative outcomes of childhood ADHD, since the population the researchers studied was predominately white, middle class and had access to good heath care and a good school system. "Unfortunately, if this kind of a study could be done in another population, for example one that was challenged by poverty and poor schools, we would expect the outcomes would, in fact, be worse," he says.
Barbaresi says the study underscores the need to change the way health care is provided for children with ADHD, so that they continue to receive monitoring and treatment into their adolescence and early adulthood, which he describes as "the period of greatest risk for some of the most concerning outcomes."
In childhood, those with ADHD should be assessed for psychological issues like learning disabilities and associated mental-health problems, he says. While medication is effective in treating the disorder, Barbaresi says, treatment should be comprehensive and should include educational and mental-health interventions, as well as long-term follow-up.
"We need to make an effort to keep children in appropriate follow-up and treatment because, in general, they will need it," he says.