A third of children with ADHD still have it in adulthood

A third of children diagnosed with attention-deficit/hyperactivity disorder still have ADHD in adulthood, and more than half had another psychiatric disorder, found a study released online today in Pediatrics.

The study looked at 232 adults from Rochester, Minn., who were diagnosed with ADHD as children in the late 1970s and early 1980s, and compared them to adults who did not have a childhood ADHD diagnosis. Of the children with ADHD, almost 30 percent met the criteria for adult ADHD at age 27.

Nearly 57 percent of adults with childhood ADHD had another psychiatric disorder as adults, these included alcohol dependence or abuse, antisocial personality disorder, other substance abuse or dependence, generalized anxiety disorder, and current major depressive episode. Suicide was nearly 5 times higher among childhood ADHD cases compared to those children without ADHD.

We asked blog contributor W. Douglas Tynan, Ph.D., chief psychologist with Nemours Health and Prevention Services Nemours/Alfred I. duPont Hospital for Children, to take a closer look at the study, and he tells us that diagnosing for ADHD in the past was for much more serious cases of the disorder and better treatment exists today for children.

Researcher Bill Barbariesi and his colleagues in Minnesota continue to give us great insight and research on the life course of children who have ADHD, but it is important that the findings don’t overly frighten parents of children of ADHD into thinking that terrible outcomes await their children.  

First, we have to look at the who is being followed in the study. This is a study of all the children born in one school district in Minnesota between 1976 and 1982, a group of 5718 people. The children were categorized as having ADHD by reviewing school records. The records show if they were diagnosed as children in their elementary school years by using the classification manual of that time time. The manual provides a common language and standard criteria for defining mental disorders.

As a result, 367 children in this group, or about 6 percent, diagnosed at age 10 on average were determined to have ADHD. These were children who had significant, untreated ADHD. The study does not look at treatment, so we can assume most were not treated with therapy or medicine. These children don’t do very well. There are higher rates of accidents, of suicides, substance abuse and lower rates of school completion.  

Currently, we are diagnosing 8 to 10 percent of the population with ADHD, so many children diagnosed today would not be included in this group of children with more serious ADHD. We also are intervening earlier to teach parents behavior management to teach their children better self control, and for those who benefit, medications that help.

Parents need to think about ADHD not as a disorder that predicts their child’s destiny, but as a set of unlearned skills that need to be intensively taught. Planning, self control, improved emotional control can all be achieved with careful teaching and coaching, and medication has a role. Some day, 30 years from now, Dr. Barbariesi’s colleagues will have a look at kids treated for ADHD, and I am certain they will see a different set of outcomes.