Major Impacts of Untreated ADHD Across a Patient’s Lifespan

What happens when patients with attention-deficit/hyperactivity disorder (ADHD) don't get the treatment they need? And how can clinicians better screen for ADHD when patients come in needing help? Timothy Wilens, MD, co-director of the center for addiction medicine at Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School, examines what untreated ADHD may look like across a patient's life, starting with behavioral and academic problems as children, escalating to substance misuse in adolescence, and resulting in interpersonal problems and trouble keeping up at work in adulthood. Dr Wilens also recommends strategies and resources available for clinicians to ensure they are accurately diagnosing ADHD when they come across it. 

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Timothy Wilens, MD, is co-director of the center for addiction medicine at Massachusetts General Hospital. He is the MGH Trustee's Chair in addiction medicine and a professor of psychiatry at Harvard Medical School. Dr Wilens earned his MD at the University of Michigan Medical School in Ann Arbor and completed his residency at Mass General.

Dr Wilens’ research interests include the relationship among attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, and substance use disorders; embedded health care models, and the pharmacotherapy of ADHD across the lifespan. He has published more than 300 peer-reviewed articles, concerning these and related topics. Dr Wilens is a distinguished fellow of the American Psychiatric Association and is on the editorial boards or is a scientific reviewer for more than 35 journals.

Read the Transcript: 

Psych Congress Network: What are the major developmental impacts of untreated ADHD across a patient’s lifespan? How can clinicians better screen for the disorder?

Dr Wilens: I'm often asked what happens to ADHD over time, especially if you don't treat it. And this is very important because when you're thinking of treatment of ADHD, you also have to think about what happens if you don't treat the disorder. Well, I can tell you that, very early, it starts with more behavioral disruption, and, by the way, self-esteem issues that persist. And as kids age, you'll start to see more of the more classic school problems, academic issues, and even further, they start to have interpersonal problems. As they move through adolescence, you'll start to see more injuries. They start smoking cigarettes. You start to see issues with substance use, misuse, even prescription stimulant misuse in some.

And then it increases as they move into adults. They carry all of that plus occupational problems—if they're going to college, difficulties with college. If they're going into trades, they have problems even getting through the coursework for the trades. If they're in the military, difficulties with that. The interpersonal problems become, now, separations and sometimes divorces and it continues on and on.

How do you screen for ADHD? You can do it a number of ways. Most of the screening instruments we use are based on the Diagnostic and Statistic Manual, DSM, criteria for ADHD. There are, in kids, forms that you can download, and in adults, all you need to do is go to the World Health Organization and punch in ADHD and you'll see a screener that you can use for the diagnosis of ADHD in adults. Most of the forms that you can get online are non-proprietary—they're free. Others may charge. All of them, though, are helpful in helping you make a clinical diagnosis of ADHD.