ADHD Persists in Adulthood, Ups Mental Illness, Suicide Risk

Megan Brooks

March 04, 2013

Nearly 30% of children with attention-deficit/hyperactivity disorder (ADHD) continue to struggle with the condition as adults, and some may develop other psychiatric disorders, commit suicide, or end up in jail, a new study shows.

"We suffer from the misconception that ADHD is just an annoying childhood disorder that's overtreated," lead investigator William Barbaresi, MD, of Boston Children's Hospital, said in a statement. "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."

The study was published online March 4 in Pediatrics.

Five-fold Increase in Suicide

A total of 5718 adults with childhood ADHD and non-ADHD control participants from the 1976 to 1982 Rochester, Minnesota, birth cohort participated in this prospective outcome study.

The investigators determined the vital status for 367 childhood ADHD patients, and 232 patients (63.2%; 167 males, 65 females) were prospectively followed into adulthood. At age 27 years, 68 (29.3%) met criteria for adult ADHD.

According to the investigators, nearly 57% of adults who had had ADHD as children had at least 1 other psychiatric disorder as adults, compared with 35% of adult control participants who had not had childhood ADHD (odds ratio, 2.6; 95% confidence interval [CI], 1.8 - 3.8; P < .01). The most common psychiatric disorders were substance abuse or dependence, antisocial personality disorder, hypomanic episodes, generalized anxiety, and major depression.

The incidence of death from suicide was nearly 5 times higher among adults who had had childhood ADHD compared with control participants (standardized mortality ratio [SMR], 4.83; 95% CI, 1.14 - 20.46; P =.032), the researchers say.

Among all 367 adults who had had childhood ADHD, 7 (1.9%) had died at the time of study recruitment, 3 (42.8%) from suicide. Of 4946 non-ADHD control individuals whose outcomes could be ascertained, only 37 (0.7%) children had died, 5 (13.5%) by suicide.

Ten individuals who had had childhood ADHD (2.7%) were incarcerated at the time of recruitment for the study.

Need to Improve Long-term Treatment

The investigators state that ADHD "should no longer be viewed only as a disorder primarily affecting the behavior and learning of children, but also as a major health condition that confers increased risk" for mortality, social adversity in the form of criminal behavior, persistence of ADHD into adulthood, and increased rates of other mental health problems.

This study "speaks to the need to greatly improve the long-term treatment of children with ADHD and provide a mechanism for treating them as adults," study investigator Slavica Katusic, MD, of the Mayo Clinic, Rochester, Minnesota, said in a statement.

"Data indicate that the stimulant medications used to treat ADHD in children are also effective in adults, although adults tend not to be treated and may not be aware they have ADHD," Dr. Barbaresi added.

The researchers think their results may underestimate the poor outcomes of childhood ADHD, given that it was conducted in a largely middle-class, educated population with good access to health care.

"It is possible, if not likely, that the magnitude of the adverse outcomes in this cohort would be even greater in populations with additional challenges such as higher rates of poverty," they write.

The study was supported by Public Health Service research grants. Pilot work for a portion of the project was funded by an investigator-initiated grant from McNeil Consumer and Specialty Pharmaceuticals. The authors have reported no relevant financial relationships.

Pediatrics. Published online March 4, 2013. Abstract