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Some Boys With ADHD May Struggle as Adults

MONDAY Oct. 15, 2012 -- Some boys who struggle with attention-deficit/hyperactivity disorder are more likely to experience a host of social, educational and financial difficulties as adults, a new study contends.

The observation reflects solely upon white males with attention-deficit/hyperactivity disorder (ADHD), as the researchers did not include sufficient numbers of either girls or non-white boys to draw conclusions about others with the disorder.

The finding stems from more than three decades of in-depth analysis of the well-being of boys initially diagnosed with ADHD as adolescents, tracking them into their 40s.

"The most salient issue is that if a boy develops serious difficulties in adolescence, having had ADHD in childhood he's at a greater risk to continue to have significant problems throughout life," said study author Rachel Klein, professor of child and adolescent psychiatry at the NYU Child Study Center in New York City. "That means being more likely to have lower-level jobs, being hospitalized more often, having more accidents, being in trouble with the law, going to jail and dying."

Klein, however, stressed that it's not all bad news, as the vast majority of adolescent boys with ADHD outgrow their condition and go on to have a mostly trouble-free adulthood.

"While 20 percent of the boys do go on to have a very rough time as adults, for about 80 percent there seems to be a point in late adolescence where they experience symptom relief," she noted. "And while some of these boys may experience some subtle social difficulties, many go on to lead very successful lives."

Klein and her team reported their findings in the Oct. 15 online issue of the journal Archives of General Psychiatry.

To explore the long-range impact of childhood ADHD, the team focused on 135 white boys between the ages of 6 and 12 who were diagnosed with ADHD and entered the study at some point between 1970 and 1978. As boys, all were deemed to be of average intelligence (an IQ of 85 and up) and none displayed any of the telltale signs of anti-social behavior that can sometimes accompany ADHD.

Outcomes among the ADHD group were compared to those in a group of 136 children who were not diagnosed with ADHD as kids.

The results: ADHD patients were not found to face a higher risk for either mood or anxiety disorders as adults.

Those in the ADHD group, however, were somewhat more likely to struggle with a myriad of psychiatric issues. Although 16 percent had antisocial personality disorder, that issue was present among virtually none of the non-ADHD patients. Similarly, substance abuse was an issue for about 14 percent of the ADHD group, but just 5 percent of the non-ADHD boys.

This means that those with ADHD did face a higher risk for poorer experiences in the realms of schooling, socializing and/or work, the researchers said.

Although the study showed an association between ADHD diagnosis and a successful adulthood, it did not prove a cause-and-effect link.

Specifically, boys with ADHD went on to acquire an average of two and a half fewer years of education, with nearly a third not completing high school while just over 4 percent of the non-ADHD patients failed to complete grade 12. Although nearly 30 percent of the non-ADHD boys went on to get a post-secondary degree, the same was true of less than 4 percent of those diagnosed with ADHD.

What's more, although most of those in the ADHD group (about 84 percent) were employed as adults, they were less likely to have jobs than non-ADHD boys. And perhaps as a consequence of lower educational levels, boys with ADHD earned a median salary that amounted to $40,000 a year less than those who had never struggled with the disorder.

Social interactions also were more problematic among the ADHD patients, with notably higher divorce rates. They also were more likely to be hospitalized for psychiatric issues and to have been jailed at some point.

Might today's children newly diagnosed with ADHD face better treatment options and perhaps better outcomes?

"I'm sorry to say that we can't really say that there's anything more today that works compared with 30 years ago," she said. "We've tried many things that didn't pan out. Right now, the only effective treatment is stimulant treatment, and the children in this study had access to that treatment back then."

Klein noted that although such treatment was automatically stopped at the age of 13 because of the fear among clinicians that stimulants could prove addictive, the thinking on that has since changed.

"It is possible that if we keep treating children to an older age they might do much better," she added.

Steven Safren, director of behavioral medicine in the department of psychiatry at Massachusetts General Hospital in Boston, said the findings "are in line with prior research."

"I think that what happens is that kids are diagnosed and treated while in childhood, while their parents have responsibility for it," he said. Unfortunately, there's not a lot of focus on treatments for adults with ADHD, Safren added.

More information

For more on ADHD, visit the U.S. National Institute of Mental Health.

Posted: October 2012


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