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New study shows ADHD persists well into adulthood

Teresa Tanoos's picture
ADHD children often still have it as adults

Nearly one-third of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) continue to suffer the condition well into adulthood, according to a new long-term study published in the April edition of Pediatrics.

The study also found that children with ADHD were more likely to develop other mental disorders in adulthood, such as anxiety or depression. Some even committed suicide.

Almost 60 percent of those participating in the study had been diagnosed with at least one other psychiatric disorder – a finding that authors of the study say confirms that ADHD is a chronic, lifetime disorder for many adults.

"We suffer from the misconception that ADHD is just an annoying childhood disorder that's overtreated," said study author Dr. William Barbaresi, associate chief of developmental medicine at Boston Children's Hospital in a written statement. "This couldn't be further from the truth."

Barbaresi led the study, which found that approximately 29 percent of participants diagnosed with ADHD as children ended up carrying that diagnosis over into their late twenties.

"They still clearly had symptoms that continued to be consistent with that diagnosis," said Barbaresi. "But that in itself has been an area of difficulty and controversy."

ADHD is the most common neurobehavioral disorder in children, affecting more than 5.4 million children between the ages of 4 and 17, according to the Centers for Disease Control and Prevention (CDC), which says such children tend to have a hard time paying attention, to be forgetful, fidget and be easily distracted to the point that it creates problems at school, home and with their friends.

For the study, researchers from the Boston Children’s Hospital and the Mayo Clinic tracked 5,718 children born between 1976 and 1982 for several decades. Among the children were 367 who’d been diagnosed with ADHD, of which 232 agreed to participate in the study and give researchers access to their medical records.

As the researchers found, life for those with ADHD was a lot more difficult than it was for their non-ADHD peers. ADHD sufferers were not only at higher risk for death and suicide, but nearly 60 percent of them suffered from an additional mental health condition – such as alcoholism, substance abuse, anxiety, and depression – compared to 35 percent of those in a comparison group who did not have ADHD while growing up.

The participants diagnosed with ADHD as children were also more likely to commit suicide as adults, with researchers finding that 3 of the 387 participants with ADHD had committed suicide – compared to only seven of the 4,946 participants who did not have ADHD.

Dr. J. Russell Ramsay, co-director of the University of Pennsylvania's adult ADHD treatment and research program, told USA Today that the study "is particularly telling because it used a community sample of children with ADHD followed to adulthood and not a clinical sample of individuals seeking treatment for their problems."

Ramsey, who was not involved in the study, found the findings chilling.

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“It is chilling to see evidence, at least in this study, of the increased risk for death by suicide among children diagnosed with ADHD, with most of these tragic cases also having a history of substance abuse and at least one co-existing psychiatric diagnosis," he said.

As the authors of the study point out, their findings may not apply to all children in the U.S. because the participants in the study were mostly from white, middle-class families and were born in one part of Minnesota.

Meanwhile, in a similar longitudinal study, researchers from New York University began tracking 207 boys diagnosed with ADHD between the ages of 6 and 12, as well as 178 boys who did not have ADHD.

According to the report published last December in the Archives of General Psychiatry, there were big differences between the two groups by the time the boys reached their 40s and 50s.

“Compared to the kids without ADHD, these children had more often died,” said clinical psychologist Rachel Klein, a pioneer in the field of ADHD who led the New York University study.

“Many more had been in jail. Many more had been hospitalized for psychiatric reasons, mostly drug abuse,” she added.

Worse yet, nearly a third of the ADHD boys had dropped out of high school – and they made less money and experienced a higher divorce rate than their non-ADHD peers. Indeed, there are many adults with ADHD who often go undiagnosed because they don’t realize it is not just a childhood disorder.

“I think … that there are still many people walking around who have ADHD who are being impaired by it, and they don’t even know it,” said Dr. Xavier Castellanos, director of the Center for Neurodevelopmental Disorders at the New York University Child Study Center and co-author of the study.

By the same token, Castellanos recognizes that some doctors may be over diagnosing ADHD, as there’s been a 53 percent jump in the number of children diagnosed with it, according to a New York story published last week.

One of the controversies surrounding ADHD is the use of stimulants to treat the symptoms. Naysayers claim stimulants can be dangerous when given to children who don’t really need them, but others insist that stimulants can be life-changing for those who do have the disorder.

Castellanos has done many brain scans in some of the study volunteers that demonstrate the validity of ADHD. In other words, it’s not just “in your head”. ADHD is a real and legitimate disorder as evidenced by the brain scans of those who have it.

In those diagnosed with ADHD as children, the scans show their brains are thinner in areas that are known to control attention and govern emotion.
“These are differences of less than a tenth of a millimeter,” Castellanos explained. “And yet, a tenth of a millimeter is a lot of brain cells.”

To learn more about the symptoms and diagnostic criteria for ADHD from the Centers for Disease Control and Prevention (CDC), click here.

- PEDIATRICS - Vol. 131, No. 4. April 1, 2013. pp. 637-644 (doi: 10.1542/peds.2012-2354)
- ARCHIVES OF GENERAL PSYCHIATRY - Arch Gen Psychiatry. 2012;69(12):1295-1303 (doi:10.1001/archgenpsychiatry.2012.271)