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Long Term Outcomes for Children with ADHD
Contrary to recently held views, it is now clear that many children with ADHD will not simply "outgrow" their symptoms when they reach adolescence. Although the absolute severity of ADHD symptoms often declines with age, between 70-80% of children with ADHD continue to show problems with attention and impulsivity relative to their agemates.
In addition to these continued ADHD symptoms, difficulties in a number of other areas are not uncommon. As many as half exhibit significant behavior problems, defiance, and antisocial acts such as fighting, stealing, and vandalism. Compared to their non-ADHD classmates, teenagers with this disorder are more likely to have been held back in school, to have been suspended from school, and to drop out. A recently completed study indicates that as young adults, children with ADHD will have completed approximately 2 years less formal schooling than their peers.
Several studies have followed children with ADHD into adulthood. Although these results vary from study to study, it appears that about 50% continue to show evidence of the disorder in adulthod, especially attention problems and impulsivity. Almost a third will have dropped out of high school, and only 5% complete a university degree compared to 40% of their peers. Approximately 25% have developed chronic patterns of anti-social behavior. Clearly, for many children with ADHD, this disorder is a chronic condition that can adversely affect their development over many, many years.
On the positive side, approximatley one third of children with ADHD appear to be relatively well adjusted and symptom free as young adults. Although reliable predictors of such good adult outcome have not been fully identified there are several factors that are important to note. First, not surprisingly, higher levels of intellectual functioning and better school performance are associated with better outcomes. Second, the absence of severe behavior and conduct problems during childhood, particularly before age 10, is associated with better adult outcome. And finally, children with ADHD who manage to get along well with their peers are likely to have better adjustments as adults.
These factors have clear implications for parents. It is very important to stress that it does not appear to be the primary symptoms of ADHD - inattention, hyperactivity, and impulsivity - that are most directly responsible for the negative adult outcomes that many children with ADHD attain. Instead, it is the behavioral, social, and academic difficulties that children with ADHD are at increased risk for that may be most clearly linked to negative adult outcome.
What this means is that if parents can succeed in preventing the development of these secondary problems - i.e. academic struggles, social problems, severe behavioral problems - their child is likely to have a much more successful adjustment in adolescence and young adulthood. Carefully monitoring a child's overall development, and not just focusing on ADHD symptoms, is thus critically important. When academic, behavioral, and social difficulties arise, working hard to address these problems is of paramount importance.
Note: This article originally appeared in Attention Research Update, an online newsletter written by Dr. David Rabiner, a Duke University psychologist and former member of CHADD's Professional Advisory Board. You can learn more about Attention Research Update and sign up for a free subscription at www.helpforadd.com.