Post by Amtram on Mar 22, 2014 10:01:41 GMT -5
JAMA Psychiatry published results of a long-term study on 271 men, 135 with ADHD and no conduct disorder, and 136 without ADHD to see how likely they would be to have various negative outcomes in adulthood. It's a long read, so I'm going to share the conclusion from the abstract:
Essentially, it provides more evidence to support the hypothesis that ADHD continues to be a problem into adulthood. . .
Conclusions The multiple disadvantages predicted by childhood ADHD well into adulthood began in adolescence, without increased onsets of new disorders after 20 years of age. Findings highlight the importance of extended monitoring and treatment of children with ADHD.
Virtually all areas of adjustment have been found to be deficient in children with attention-deficit/hyperactivity disorder (ADHD), which has an estimated worldwide prevalence of 5%.1 Consequently, the long-term outcome of childhood ADHD is a major concern. Previously, conventional wisdom held that ADHD symptoms dissipated by adolescence. However, controlled longitudinal studies have documented elevated rates of ADHD and conduct disorder, as well as multiple other dysfunctions, in adolescence.2- 6
Five prospective investigations followed up preadolescents with ADHD into early adulthood (ages 21-27 years).6- 12 All found higher rates of ADHD symptoms and antisocial personality disorders (ASPDs) in those with childhood ADHD compared with those without ADHD. In early adulthood (mean age, 25 years), we found a relative increase of non–alcohol-related substance disorders (SUDs) in probands but only in those who had developed conduct disorder during adolescence.9,12
The few prospective, controlled studies have not gone beyond the third decade of life. Knowledge beyond this developmental period has been inferred from clinically referred adults diagnosed as having ADHD, whose reports of early ADHD symptoms relied on recall, which problematically has limited accuracy.13,14 Nevertheless, cross-sectional studies of individuals whose conditions were first diagnosed in adulthood indicate that ADHD occurs in adults and suggest associated disabilities and comorbidities. However, such studies do not document the frequency and range of outcomes into adulthood because dysfunctions may attenuate over time or new disorders may emerge. Functional impairment caused by childhood ADHD may vary through life because adults, unlike adolescents, are not as confined by standardized demands, such as those in school. Adults may modify their environment through occupational choices and selection of significant others. Therefore, the negative consequences of ADHD may be minimized in later life. Alternatively, new or more complex adult demands may aggravate the effect of persistent ADHD.
This report presents the adult outcome (follow-up at the mean age of 41 years [referred to as FU41]) of boys (mean age, 8 years) who were diagnosed as having ADHD (probands). Two previous follow-ups have been reported on this cohort. The first, a 10-year follow-up, compared the probands with men without ADHD (comparison participants) at the mean age of 18 years (referred to as FU18),4,5 and the second follow-up was at the mean age of 25 years (referred to as FU25).9,12
We hypothesized that adults diagnosed as having ADHD in childhood have significantly worse outcome than those without ADHD with regard to the following: (1) educational attainment; (2) occupational level and functioning; (3) social functioning; (4) marital status (more divorced); (5) ongoing DSM-IV ADHD, ASPD, and SUDs (no directional hypotheses were proposed for other mental disorders, which we report); (6) psychiatric hospitalizations; (7) incarcerations; and (8) new onsets of psychiatric disorders from 21 years of age onward. We also posited positive significant associations among ongoing DSM-IV ADHD, ASPD, and SUDs in probands. Because childhood ADHD is believed to carry long-term disadvantages, even among individuals who no longer meet criteria for the disorder,15 we hypothesized that even probands without any ongoing mental disorder at follow-up would have relatively worse occupational and social functioning than those without childhood ADHD.
Virtually all areas of adjustment have been found to be deficient in children with attention-deficit/hyperactivity disorder (ADHD), which has an estimated worldwide prevalence of 5%.1 Consequently, the long-term outcome of childhood ADHD is a major concern. Previously, conventional wisdom held that ADHD symptoms dissipated by adolescence. However, controlled longitudinal studies have documented elevated rates of ADHD and conduct disorder, as well as multiple other dysfunctions, in adolescence.2- 6
Five prospective investigations followed up preadolescents with ADHD into early adulthood (ages 21-27 years).6- 12 All found higher rates of ADHD symptoms and antisocial personality disorders (ASPDs) in those with childhood ADHD compared with those without ADHD. In early adulthood (mean age, 25 years), we found a relative increase of non–alcohol-related substance disorders (SUDs) in probands but only in those who had developed conduct disorder during adolescence.9,12
The few prospective, controlled studies have not gone beyond the third decade of life. Knowledge beyond this developmental period has been inferred from clinically referred adults diagnosed as having ADHD, whose reports of early ADHD symptoms relied on recall, which problematically has limited accuracy.13,14 Nevertheless, cross-sectional studies of individuals whose conditions were first diagnosed in adulthood indicate that ADHD occurs in adults and suggest associated disabilities and comorbidities. However, such studies do not document the frequency and range of outcomes into adulthood because dysfunctions may attenuate over time or new disorders may emerge. Functional impairment caused by childhood ADHD may vary through life because adults, unlike adolescents, are not as confined by standardized demands, such as those in school. Adults may modify their environment through occupational choices and selection of significant others. Therefore, the negative consequences of ADHD may be minimized in later life. Alternatively, new or more complex adult demands may aggravate the effect of persistent ADHD.
This report presents the adult outcome (follow-up at the mean age of 41 years [referred to as FU41]) of boys (mean age, 8 years) who were diagnosed as having ADHD (probands). Two previous follow-ups have been reported on this cohort. The first, a 10-year follow-up, compared the probands with men without ADHD (comparison participants) at the mean age of 18 years (referred to as FU18),4,5 and the second follow-up was at the mean age of 25 years (referred to as FU25).9,12
We hypothesized that adults diagnosed as having ADHD in childhood have significantly worse outcome than those without ADHD with regard to the following: (1) educational attainment; (2) occupational level and functioning; (3) social functioning; (4) marital status (more divorced); (5) ongoing DSM-IV ADHD, ASPD, and SUDs (no directional hypotheses were proposed for other mental disorders, which we report); (6) psychiatric hospitalizations; (7) incarcerations; and (8) new onsets of psychiatric disorders from 21 years of age onward. We also posited positive significant associations among ongoing DSM-IV ADHD, ASPD, and SUDs in probands. Because childhood ADHD is believed to carry long-term disadvantages, even among individuals who no longer meet criteria for the disorder,15 we hypothesized that even probands without any ongoing mental disorder at follow-up would have relatively worse occupational and social functioning than those without childhood ADHD.
Essentially, it provides more evidence to support the hypothesis that ADHD continues to be a problem into adulthood. . .