16 October 2012

ADHD kids struggle in school

Children with attention deficit hyperactivity disorder (ADHD) tend to fare worse as adults than kids without problems in school, according to a new study.


Children with attention deficit hyperactivity disorder (ADHD) tend to fare worse as adults than kids without problems in school, according to the longest follow-up study of the disorder to date.

They have less education and lower income, on average, and higher rates of divorce and substance abuse, according to findings released today in the Archives of General Psychiatry.

"A lot of them do fine, but there is a small proportion that is in a great deal of difficulty," said Dr. Rachel Klein, a professor of child and adolescent psychiatry at NYU Langone Medical Center in New York. "They go to jail, they get hospitalized."

How the study was done

Dr. Klein and her colleagues followed 135 white men who had been rated hyperactive by their school teachers back in the 1970s and referred to the hospital. According to Dr. Klein, the children did not have aggressive or antisocial behaviours and would have been diagnosed with ADHD today.

They all came from ordinary middle-class homes, Dr. Klein said, and had "well-meaning" parents. When the boys were 18, the researchers established a comparison group of age-matched white boys who had visited their medical centre for unrelated reasons and had not had any problems at school.

Based on interviews done when the men were 41 years old, on average, Dr. Klein's team found that those who'd had ADHD symptoms as kids left school 2.5 years before the comparison group. Only four percent had higher degrees versus 29% of their peers.

In both groups, salaries went as high as $1.5 million a year. But in the comparison group, the average salary was about $175,000, compared to $93,000 in the troubled children.

One in five has antisocial behaviour disorder

More than one in five of the hyperactive boys were diagnosed with ADHD three decades later, versus one in 20 in the comparison group. And about a third had been in jail at some point - about three times the comparison rate.

They were also more likely to be divorced, abuse drugs and be labelled with antisocial behaviour disorder. However, they weren't more likely to have mood or anxiety disorders.

It's not clear from the study that ADHD, per se, puts people at risk. But Dr. Klein said it's likely to be a slippery slope, with ADHD-linked impulsiveness making youngsters more likely to use drugs and spiral downward into crime and other antisocial behaviours.

"When you see signs of antisocial behaviour you really have to step in," she told Reuters Health. "You have to keep treating these kids as long as they face problems."

It's estimated that between 3% and 7% of school-aged children in the U.S. have ADHD, according to the Centers for Disease Control and Prevention.

Fewer than half will have lasting problems; for the rest, the outlook is better.

"The ones who had made it through adolescence were no different from ordinary kids," Dr. Klein said. "Most of them are married, most of them are employed. I think that is a silver lining."

Outcomes differ for individuals

Dr. J. Russell Ramsay, who studies ADHD at the University of Pennsylvania's Perelman School of Medicine, pointed out that although the kids fared worse than the comparison group, they still were within the normal range in many cases.

"We are not talking about awful outcomes necessarily," Dr. Ramsay, who was not involved in the research, told Reuters Health.

"There are different outcomes for different individuals with ADHD based on severity and complexity," he added. "This is sort of a reminder to pay attention to the unique needs of the child, the educational environment and the home environment."

Treatment options include both stimulant medications and behavioural coping strategies that can help address a child's specific difficulties.

"The going phrase is that pills don't teach skills," said Dr. Ramsay. "It is really an individualised treatment planning decision."

(Frederik Joelving, Reuters Health, October 2012)

Read more:

Most ADHD kids appreciate kids

ADHD meds and smoking link unclear

Early ADHD help wards off treatment


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ADHD Expert

Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation ( She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

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