The first large, population-based study to follow children
with attention-deficit hyperactivity disorder (ADHD) into adulthood shows that
ADHD often doesn't "go away," and that children with ADHD are more
likely to have other psychiatric disorders as adults. Although numbers were
small, they also appear more likely to commit suicide and are often incarcerated
"Only 37.5% of the children we contacted as adults were
free of these really worrisome outcomes," says William Barbaresi, MD, of
Boston Children's Hospital, lead investigator on the study, published in the
April 2013 issue of Pediatrics and online
March 4. "That's a sobering statistic that speaks to the need to greatly
improve the long-term treatment of children with ADHD and provide a mechanism
for treating them as adults."
"This was a unique population based study of a large
group of individuals with ADHD followed from childhood to adulthood,"
added Slavica Katusic, MD, lead Mayo Clinic investigator of the study.
How the study was
ADHD is the most common neuro-developmental disorder of
childhood, affecting about 7% of all children and three times as many boys as
girls. Most prior follow-up studies of ADHD have been small and focused on the
severe end of the spectrum—like boys referred to paediatric psychiatric
treatment facilities—rather than a cross-section of the ADHD population.
The long-running study, begun when Barbaresi was at the Mayo
Clinic and continued in collaboration with Mayo researchers, led by Katusic,
followed all children in Rochester, Minn. who were born from 1976 through 1982,
were still in Rochester at age five and whose families allowed access to their
medical records. That amounted to 5 718 children, including 367 who were
diagnosed with ADHD; of this group; 232 participated in the follow-up study.
About three-quarters had received ADHD treatment as children.
At follow-up, the researchers found:
- 29% of the children with ADHD
still had ADHD as adults (ascertained through structured neuropsychiatric
- 57 % of children with ADHD had at
least one other psychiatric disorder as adults, as compared with 35 percent of
controls. The most common were substance abuse/dependence, antisocial
personality disorder, hypomanic episodes, generalized anxiety and major
- Of the children who still had
ADHD as adults, 81% had at least one other psychiatric disorder, as compared
with 47% of those who no longer had ADHD
and 35 % of controls.
- Seven of the 367 children with
ADHD (1.9%) had died at the time of study recruitment, three of them from
suicide. Of the 4 946 children without ADHD whose outcomes could be
ascertained, only 37 children had died, five by suicide.
- 10 children with ADHD (2.7%) were
incarcerated at the time of recruitment for the study.
"We suffer from the misconception that ADHD is just an
annoying childhood disorder that's overtreated," says Barbaresi.
"This couldn't be further from the truth. We need to have a chronic
disease approach to ADHD as we do for diabetes. The system of care has to be
designed for the long haul."
Some bad outcomes
Barbaresi thinks the study findings may actually
underestimate the bad outcomes of childhood ADHD. The study population in
Rochester, Minn., was relatively heterogeneous and largely middle class, and
the children tended to have good education and good access to health care.
"One can argue that this is potentially a best-case scenario,"
Barbaresi says. "Outcomes could be worse in socioeconomically challenged
He advises parents of children with ADHD to ensure that
their children are in high-quality treatment—and remain in treatment as they
enter adolescence. Children should also be assessed for learning disabilities
and monitored for conditions associated with ADHD, including substance use,
depression and anxiety.
"Data indicate that the stimulant medications used to
treat ADHD in children are also effective in adults, although adults tend not
to be treated and may not be aware they have ADHD," Barbaresi says.