Nearly one-third of children with ADHD may also have it as adults, a study suggests. The study focused on 5,718 children. All were born in the area of Rochester, Minn., between 1976 and 1982. Researchers had access to medical records of 367 who were diagnosed with attention-deficit hyperactivity disorder (ADHD) as children. Of that group, 232 agreed to be part of a follow-up study in their late 20s. About 29% still had symptoms of ADHD. More than half -- 57% -- also had another mental health issue. That compares with 35% of adults from the larger study who never had ADHD. Adults who had childhood ADHD also were twice as likely as others to have thought about or attempted suicide. The most common mental health issue in the ADHD group was alcohol abuse. The next two were antisocial personality disorder and other substance abuse. The study focused on ADHD patients from the general population in Minnesota. However, they were more likely to be white and middle class than the United States as a whole. Prior research was done in prisoners or psychiatric patients. The journal Pediatrics published the study March 4. HealthDay News, Reuters Health news service and MedPage Today wrote about it.

By Claire McCarthy, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Almost one-third of children with ADHD will still have it when they are adults, says a new study. And the bad news doesn't end there.

Researchers at Boston Children's Hospital and the Mayo Clinic did the study. They looked at almost 400 adults who were diagnosed with attention-deficit hyperactivity disorder (ADHD) as children. These adults were compared with others who did not have ADHD in childhood.

Here's what the study found:

• About 29% of those with ADHD in childhood still had it
• The majority (57%) of those with ADHD as children had at least one psychiatric disorder. Only one-third (35%) of the other group had such disorders.
• The most common psychiatric disorder was alcohol dependence or abuse. This was followed by:
  
  • Antisocial personality disorder
  • Other substance abuse problems
  • Hypomania
  • Anxiety
  • Depression
• Adults with childhood ADHD were twice as likely to have considered or attempted suicide by age 21.

As the authors wrote, "ADHD should no longer be viewed only as a disorder primarily affecting the behaviors and learning of children, but also as a major health condition that confers increased risk for early death due to suicide."

What Changes Can I Make Now?

The main point that the authors seem to be making is that we need to think of ADHD more like a chronic disease, such as diabetes. This means that it needs ongoing treatment and can cause ongoing problems. Those problems aren't just about school and learning -- they are about mental health.

Clearly, we need to change our thinking about ADHD and its treatment. Children with ADHD may need more resources and more aggressive treatment so that they enter adulthood in the best mental shape possible. If we limit our thinking only to how they do in school and their day-to-day behavior, we will miss important opportunities. Childhood is the time to give them the skills and support that they may need should their ADHD last into adulthood.

The results of this study certainly suggest that all children with ADHD should have regular contact with a mental health professional. The amount they need will depend on their behavior and situation. But it would be a mistake, given the results of this study, to think that ADHD is just about concentration and not have children regularly monitored.

This study also tells us that we need to continue to be watchful of teens and young adults who have the diagnosis of ADHD as children. Many parents and educators heave a sigh of relief when children with ADHD graduate from high school and move on with life. However, the results of this study show that moving on with life doesn't mean they are fine.

Internists and family practitioners will also need to learn more about and be more comfortable with diagnosing and managing ADHD. Currently, this is more within the purview of the pediatrician. But clearly ADHD is not just a condition in children.

While the medical profession gets fully up to speed on this, parents of children with ADHD need to be strong advocates. Be sure that your child is being monitored and treated for mental health problems -- and that this continues.

What Can I Expect Looking to the Future?

According to the American Psychiatric Association, 3% to 7% of U.S. schoolchildren have ADHD. That's millions of children who need help now. Many of them will need help as adults, too.

We need more studies to help us understand the causes and implications of ADHD, and how we can better prevent and treat it. With millions of lives at stake, this is a problem we really need to understand.