Childhood ADHD Linked to Poor Outcomes in Adulthood

Pam Harrison

October 18, 2012

Men diagnosed with attention-deficit/hyperactivity disorder (ADHD) in childhood have significantly worse functional outcomes as adults compared to their counterparts without the disorder, new research shows.

A 33-year follow-up study conducted by investigators at the Child Study Center at New York University Langone Medical Center in New York City showed that men who were diagnosed with ADHD as children had worse educational, occupational, economic, and social outcomes compared with non-ADHD comparison participants.

Led by Rachel G. Klein, PhD, the researchers also found higher rates of divorce, ongoing ADHD, antisocial personality disorder, and substance use disorders as well as more hospitalizations and incarcerations.

"Our findings confirm that men diagnosed with ADHD as children had multiple disadvantages throughout their lifetime," Dr. Klein said in a statement.

"It's essential that we monitor children with ADHD through adolescence and continue to treat them to help offset issues that can extend into adulthood," she added.

The study was published online October 15 in Archives of General Psychiatry.

Long-term Study

According to Dr. Klein, no previous prospective study of ADHD has gone beyond early adulthood.

To examine the long-term outcomes in this patient population, the investigators followed 135 men who were diagnosed with ADHD at a mean age of 8 years and a comparison group of 136 men not diagnosed with childhood ADHD. The average age at follow-up was 41 years.

At 33-year follow-up, results revealed that only 3.7% of affected men had academic degrees higher than high school diplomas, compared with 29.4% of comparator control participants.

Further, those with ADHD as children also had lower occupational status levels and relatively poorer socioeconomic status compared with control participants.

Despite the fact that 83.7% of men with ADHD held jobs, they were significantly less well off than their non-ADHD comparators, with an average annual income disparity of $40,000.

Men with childhood ADHD were also more likely to have ever been divorced — 31.1% vs 11.8% for the control group.

Men with childhood ADHD also had higher rates of ongoing ADHD, at 22.2% vs 5.1% for the comparison group. The authors note, however, that ADHD symptoms in the comparison group may have emerged during adulthood.

Both antisocial personality disorder and substance abuse disorder were also more frequent in men with childhood ADHD. However, the groups did not differ in the frequency of ongoing mood or anxiety disorders.

"Importantly, no new disadvantages emerged in adulthood in ADHD men," Dr. Klein added. "So problems started in adolescence, and this means that we need to help young patients with ADHD in adolescence."

Need for Continuous Treatment

Anthony Rostain, MD, from the Perelman School of Medicine at the University of Pennsylvania, in Philadelphia, told Medscape Medical News that this is the longest follow-up study of ADHD to date and for that reason alone, it is important.

The study findings are also important because they demonstrate that ADHD-related problems extend well into adulthood.

"Difficulties with substance use, academic underachievement, and relationship issues — all of those are already there in adolescence, so it speaks to the importance of addressing these problems in adolescence because they have lifelong consequences," said Dr. Rostain.

He noted that one of the issues not addressed in the study was how much treatment ADHD men received and what percentage of patients continued treatment at any point in time.

In fact, these men were diagnosed in the 1970s, when it was believed stimulants were addictive, so treatment with stimulants was discontinued by the time the children reached adolescence, he noted.

"This is likely an untreated group," Dr. Rostain speculated. "So this is the impact of not getting treatment continuously."

The findings also demonstrate the importance of identifying ADHD symptoms in patients of all ages. The study, he noted, measured both clinical and functional outcomes, which are "the cost of ADHD in terms of real-life adaptations and managing the demands of adulthood."

The authors and Dr. Rostain have disclosed no relevant financial relationships.

Arch Gen Psychiatry. Published online October 15, 2012. Abstract