Nearly a third of all children diagnosed with attention-deficit/hyperactivity disorder (ADHD) continue to have ADHD into adulthood, according to an alarming new 20-year study that followed children with the disorder.
The majority of those adults who still live with their childhood ADHD are subject to heightened risks of additional mental health issues and nearly five times the risk of suicide, according to the study.
The study, “Mortality, ADHD, and Psychosocial Adversity in Adults With Childhood ADHD: A Prospective Study,” found nearly 30 percent of children diagnosed with the disorder continued to have ADHD at age 27, with more than half of them diagnosed as having an additional psychiatric disorder.
"Given that we know ADHD persists for so many affected children, it's incredibly important for parents to keep their children in treatment through childhood and adolescence," Boston Children’s Hospital's William Barbaresi, MD, the study's lead author, tells Parenting. "That's often the age at which they drift way from treatment and the age at which they enter the highest risk for associated problems."
Of the nearly 6,000 study participants, 232 adults were found to still have childhood ADHD. Nearly 57 percent of those had another psychiatric disorder as adults – a rate much higher than the non-ADHD population (35 percent).
"I think we as a society continue to primarily think of ADHD as the obvious behaviors in young children," Dr. Barbaresi tells Parenting.com. "Our studies have shown that the majority of children and adults with ADHD have other problems that go with it. In childhood they include learning disabilities, which affect over 60 percent of children with ADHD. So these issues have to be identified and addressed along the way. Often that does not happen."
The key, Dr Barbaresi says, is consistent and attentive care and, when called for, responsible medication.
"Although it has to be done carefully, stimulant treatment for children can be incredibly helpful, safe and efficient. That message often gets drowned out by sensationalist stories," he says.
"A combination of medication and other treatments for, for example, the learning and other mental health problems that often go with ADHD, is the way to go. Careful, regular follow-up is associated with signficant improvement associated with the most concerning outcomes -- in education, risk of substance abuse and reduced rates of emergecy room visits."
The stakes couldn't be higher. The suicide rate is five times higher among childhood ADHD cases compared to controls from the same birth cohort. As a result, the authors conclude that ADHD should no longer be viewed as a disorder primarily affecting the behavior and learning of children, but as a major health condition with lifelong implications and need for effective treatment.
"This is mostly about biology," says Dr. Barbaresi. "The brain continues to develop in important ways much longer into a later age than we thought. In men the development of the frontal lobe, which controls attention and impulse control, continues into their 20s."
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The study – based on a sample of 5,718 people born between Jan. 1, 1976, and Dec. 31, 1982 – is the most extensive to date establishing links between childhood and adult ADHD, and between adult ADHD and other mental health diagnoses.
A recent study out of Johns Hopkins suggested, however, that long-term medical treatments for very young children with moderate to severe ADHD may not have a lasting impact.
According to that study, 160 out of 180 children followed by researchers continued to meet the criteria for moderate to severe ADHD – six years after diagnosis.
More than two-thirds of the children followed were on medication, but they met the clinical conditions for ADHD symptoms at rates slightly higher than the kids who hadn't been medicated (62 and 58 percent, respectively, for hyperactivity and impulsivity, and 65 and 62 percent, respectively, for inattention).
The Johns Hopkins reasearchers concluded that better intervention strategies for the youngest patients still need to be devised.
"Parents have to be in it for the long haul. Stay in treatment. Follow up because things will change over time. At this point we may not be able to predict what will happen in 10 or 15 years to a child with ADHD who is 5 or 10," says Dr. Barbaresi. "It's a very complicated issue."