Symptoms, Impaired Function of ADHD Often Persist Beyond Childhood
Abstract
Even when their symptoms abate, people who were diagnosed with ADHD in childhood may face challenges in school or at work well into adulthood.
The symptoms of childhood attention-deficit/hyperactivity disorder (ADHD) often persist into adolescence and adulthood and may result in negative outcomes in educational, occupational, and other key areas of functioning, a review in the Journal of the American Academy of Child & Adolescent Psychiatry has found.
ADHD should be regarded as a chronic illness that requires ongoing care and support, says Lily Hechtman, M.D.
“We need to see ADHD as a chronic illness, not an acute one. Whatever support children need, they will continue to need for a long time in order to change the direction and trajectory of their development and have better outcomes,” principal investigator Lily Hechtman, M.D., told Psychiatric News. Hechtman is a professor of psychiatry and pediatrics and the director of research in the Division of Child Psychiatry at McGill University and Montreal Children’s Hospital.
Hechtman and colleagues reviewed the results of seven prospective studies that followed children with a diagnosis of ADHD and matched control groups at regular intervals from childhood through adolescence and into adulthood. Among all studies combined, there were 1,817 people with ADHD and 1,163 without ADHD. The studies began following participants when they were anywhere between 6 and 12 years old and concluded when participants were anywhere between 22 and 40 years old.
Overall, symptoms of ADHD persisted into adolescence or adulthood in 60% to 86% of those who were diagnosed as children. All of the studies that evaluated educational functioning revealed significant and ongoing impairments among participants with ADHD compared with those without ADHD. Those with ADHD tended to have lower grades, were more likely to require tutoring or placement in special classes, and were less likely to attend or complete college.
Compared with their peers without childhood ADHD, participants with childhood ADHD had lower occupational functioning in their early 20s, were more likely to be laid off, and were more likely to have lower performance ratings from their supervisors. This remained true even when their ADHD symptoms abated as they grew into adulthood.
“Enduring impairments in participants with remitted ADHD symptoms raise the possibility that educational deficiencies caused by childhood ADHD symptoms have downstream effects on later educational and consequently occupational outcomes,” Hechtman and colleagues wrote. “For example, childhood ADHD may interfere with the acquisition of foundational knowledge and skills that are necessary for further learning or even competent job performance.”
Most of the studies found increased rates of substance use among participants with ADHD compared with those without ADHD, and some suggested that this may be especially true during adolescence. In all of the studies, conduct problems and antisocial behaviors were more common among participants who had childhood ADHD.
Hechtman said that this may be because the experiences of children with ADHD may erode their self-esteem.
“Elementary school children with ADHD often have a hard time. They’re not doing well in classes because they are always getting in trouble for being disruptive. They’re also challenged socially because some do not read social cues well or are impulsive and other kids don’t want to play with them,” Hechtman said. “When they get to high school their self-esteem is already affected and they may be drawn to a negative peer group that is into antisocial behaviors, abusing substances, and problematic sexual behavior.”
She added that many adolescents stop taking their ADHD medications to try to fit in with their peers or because they want to try alcohol or other substances that they know they should not mix with their medications, which further compounds the problem.
Yet not all children who have ADHD have negative outcomes as adolescents and adults, Hechtman said.
“They may learn to adapt to some of their symptoms or they may get assistance so their symptoms are no longer impairing,” she said. For example, some may hire administrative assistants who keep their schedules and workflow organized for them so they can be productive.
Hechtman, who worked on two of the studies in the review, the Montreal Study and the Multimodal Treatment Study of Children With ADHD, noted that her prior research in the Montreal Study revealed the importance of social support in attaining positive outcomes.
“For those who do well, it’s often that they found someone who believed in them and encouraged them—a teacher, a coach, a parent, a romantic partner—someone who gave them the feeling that they had value and helped them do what was necessary to succeed,” Hechtman said.
The review and the studies therein were funded by the Canadian Medical Research Council, the National Institute of Mental Health, and the National Institute on Drug Abuse. ■
“Adult Outcome as Seen Through Controlled Prospective Follow-up Studies of Children With Attention-Deficit/Hyperactivity Disorder Followed Into Adulthood” is posted here.
