Study: ADHD takes a toll well into adulthood

The first large, population-based study to follow children with attention-deficit hyperactivity disorder (ADHD) into adulthood shows that ADHD often doesn't disappear, and that children with ADHD are more likely to have other psychiatric disorders as adults.

"Only 37.5 percent 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."

The long-running study, begun when Barbaresi was at the Mayo Clinic and continued in collaboration with Mayo researchers, led by Slavica Katusic, MD, followed 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 percent of the children with ADHD still had ADHD as adults (ascertained through structured neuropsychiatric interviews).
• 57 percent 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 depression.
• Of the children who still had ADHD as adults, 81 percent had at least one other psychiatric disorder, as compared with 47 percent of those who no longer had ADHD and 35 percent of controls.

"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."

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 populations."