Long-term Outcomes for Childhood-Onset Disorders: ADHD
A symposium at the 2012 meeting of the American Academy of Child and Adolescent Psychiatry (AACAP) examined long-term outcomes of childhood onset disorders, including bipolar disorder, unipolar depression, ADHD, and anxiety disorder.
Course of Childhood Onset ADHD
Lily Hechtman reported on the long-term difficulties of adolescents who had childhood onset of attention deficit hyperactivity disorder (ADHD). They often experienced: continued typical symptoms including restlessness and over-activity, decreased academic performance, deficits in social interactions, and decreased self-esteem.
Twenty-five percent developed an antisocial personality disorder with 19-50% of these having difficulties with the legal system. There were again three distinct groups that showed different patterns of outcome. Thirty percent of the sample showed essential normality into adolescence and young adulthood. Sixty percent had continuous ADHD symptomatology, and 10% had serious psychiatric illness resulting in jail or hospitalization.
Other follow-up studies that extend as far as 40 years suggest that ADHD persists in older adults at a rate of 36%, while antisocial personality persists in 10%, and substance abuse in 17%. Adolescent controls went on to experience these disorders in adulthood at respective rates of 13%, 0%, and 7%. Hechtman provided systematic data that treatment of ADHD was not a risk factor for the subsequent adoption of substance abuse.
In another study, a latent class analysis showed that about 52% of those with ADHD became well and stayed well. The predictors of this good outcome were: lack of maternal drug exposure in the prenatal period, a stable family, not being on welfare, not having a comorbid psychiatric diagnosis, not having a severe form of ADHD, and not having lower social functioning at baseline.
There is some evidence that treatment of ADHD in young adults can lead to psychosocial benefits. In one study performed in 1984, a group of college-age participants treated with stimulants for 3 to 5 years showed improvement in social skills and self-esteem, but surprisingly, no increase in academic performance.
Course of Childhood Onset Anxiety Disorders
Danny Pine presented a study of 191 adolescents with an anxiety disorder, among whom 36% showed no anxiety disorder in adulthood, while 62% continued to have an anxiety disorder. Among a control population, 390 adolescents without an anxiety disorder remained so in adulthood, while 36 developed new onset of an anxiety disorder in adulthood. Sixty-two of the 98 participants who had anxiety disorders in adulthood had had the disorder continuously from its onset in adolescence. Thus, it appears that approximately two-thirds of adults with an anxiety disorder show a persistence of their childhood onset anxiety disorder, while approximately 1/3 had a new anxiety disorder diagnosis.
