If children with attention-deficit/hyperactivity disorder, or ADHD, continue to have the condition in adulthood, a new study suggests that they may face an array of physical and mental health issues.
The study, which spanned more than 30 years, found that people who had ADHD as teens and adults face a greater risk of stress, work problems, financial troubles, physical health issues and additional mental health issues, such as depression or antisocial personality disorder.
"When children who had ADHD in adolescence became adults with ADHD, they had a higher probability of depressive mood and anxiety, and they were much more likely to have antisocial personality disorder. They also had difficulty in terms of work and experienced a great deal of financial stress," said study author Judith Brook, a professor of psychiatry at New York University School of Medicine in New York City.
"The other thing we found was that marijuana had pervasive adverse effects and was associated with a number of other factors, such as impaired work performance," noted Brook.
The findings were released online Dec. 10 in advance of publication in the January print issue of the journal Pediatrics.
How the study was done
The study included 551 children. Seventy-two of those children were diagnosed with ADHD in 1975 when they were between the ages of 14 and 16. The researchers followed up with the children as they grew, and the final of five outcome surveys was given at an average age of 37.
Study volunteers were asked about their overall health with questions like: "How true or false is it that you seem to get sick a little easier than other people?" They were also asked about their mental health and possible stressors, with questions such as: "How much of the time have you been very nervous?" and "Have you been in physical fights repeatedly?" or "Because of your current financial situation, is it true that you sometimes worry about losing your job?"
Compared to people without ADHD in their teens and adulthood, those with the disorder had 82% higher odds of having impaired physical health. They were also more than twice as likely to have another mental health problem and more than three times as likely to have antisocial personality disorder, a condition in which a person often manipulates or even violates the rights of others. This behaviour is often criminal in nature, according to the US National Institutes of Health.
Adults with ADHD were also 2.5 times more likely to have problems at work, and more than three times as likely to have high financial stress, the investigators found.
"Work difficulties are probably the result of impulsivity and a lack of persistence. People with ADHD get distracted," Brook explained.
Reason for link unclear
As to how ADHD might affect overall physical health, she said it wasn't clear why people with ADHD might have poorer health. But, she theorised that this finding might also have to do with impulsive, distractable behaviour. People may not eat the foods they should or follow-up with their doctors, she suggested.
Brook said the researchers were surprised by the magnitude of the antisocial personality disorder finding, and they suspect it may have something to do with a less than ideal parent-child attachment, as well as being rejected by their peers.
So, are children with ADHD doomed to have difficult lives full of stress and struggle?
Not necessarily, said Brook. Many children and teens with ADHD will outgrow the disorder before they reach adulthood. And, today, more treatments are available to help those who continue to have ADHD than were available to the people in this study.
"With treatment, a certain number of these youngsters will develop techniques to cope, which helps a great deal. And, many will choose fields where they can excel," said Brook, who added that those affected by the disorder today may not be as stigmatised by society, either. "ADHD is more accepted today. Overall, it's just more acceptable now to have a psychological disorder than it was in 1975," said Brook.
Dr. Andrew Adesman, chief of developmental and behavioural paediatrics at the Steven and Alexandra Cohen Children's Medical Center of New York in New Hyde Park, said it's extremely important to realise that the findings are based on treatments that were available in the 1970s and 1980s, and that children diagnosed today have many more treatment options available to them.
"I don't want to suggest that there aren't increased risks for these kids, because there are. But, what was an outcome for kids who were diagnosed in 1975 may have relatively little relevance for children diagnosed with ADHD today," Adesman said.
"We have improvements in medications, educational accommodations and even higher education that could change outcomes. We can't ignore this study, but we need to look at it in context," he added.
Adesman said it's also important to remember that this is likely a very small percentage of the general population.
Both experts said it's important for parents to be attuned to their children and to get them evaluated right away if they suspect a problem.
"Problem behaviours can be minimised early on for the best possible outcomes," Adesman said.
Brook said the parent-child relationship is also key, but acknowledged that having a child with ADHD can be very hard on parents. She suggested encouraging children to develop the strengths they have.
"Try to pick areas where they can succeed, so they get positive reinforcement," she advised. "When they have some success, it can help offset other areas, and they'll be more likely to be accepted by their peers and less likely to feel depressed or anxious."
While the study found an association between ADHD in adulthood and a raised risk of problems with mental and physical health, it did not prove a cause-and-effect relationship.
Learn more about ADHD from the U.S. Centers for Disease Control and Prevention.
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