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Childhood ADHD Often Persists Into Adulthood

By Megan Brooks
Medscape Medical News

March 4, 2013 -- Nearly 30% of children with ADHD continue to struggle with the condition as adults, and some may develop other mental health issues, commit suicide, or end up in jail, a new study shows.

"We suffer from the misconception that ADHD is just an annoying childhood disorder that’s overtreated," researcher William Barbaresi, MD, of Boston Children’s Hospital, says in a prepared statement. "This couldn’t be further from the truth. We need to have a chronic-disease approach to ADHD as we do for diabetes. The system of care has to be designed for the long haul."

The study is published in Pediatrics.

Fivefold Increase in Suicide

The study included more than 5,700 adults separated into two groups: One with childhood ADHD and the other without ADHD to serve as a comparison.  

Out of 367 participants who had childhood ADHD, 232 were followed into adulthood. At age 27, nearly 30% had adult ADHD.  

According to the researchers, nearly 57% of adults with childhood ADHD had at least one other mental health issue as adults, compared with 35% of adults without childhood ADHD. The most common mental health problems were substance abuse or dependence, antisocial personality disorder, mild forms of mania, generalized anxiety, and major depression.

Death from suicide was nearly five times higher among adults with childhood ADHD, the researchers write.

Among all 367 adults with childhood ADHD, seven (1.9%) had died, three of them from suicide. Of 4,946 people without ADHD, only 37 (0.7%) had died, five by suicide.

Ten people who’d had childhood ADHD (2.7%) were in jail at the time of recruitment for the study.

Need to Improve Long-Term Treatment

The researchers write that ADHD "should no longer be viewed as a disorder primarily affecting the behavior and learning of children, but as a major health condition that confers increased risk" for death, social adversity in the form of criminal behavior, persistence of ADHD into adulthood, and higher rates of other mental health problems.

This study "speaks to the need to greatly improve the long-term treatment of children with ADHD and provide a mechanism for treating them as adults," researcher Slavica Katusic, MD, of the Mayo Clinic, in Rochester, Minn., says in a prepared statement. 

"Stimulant medications used to treat ADHD in children are also effective in adults, although adults tend not to be treated and may not be aware they have ADHD," Barbaresi says.

The researchers think their results may underestimate the poor outcomes of childhood ADHD, given that it was conducted in a largely middle class educated population with good access to health care. 

"It is possible, if not likely, that the magnitude of the [bad] outcomes in this [group] would be even greater in populations with additional challenges such as higher rates of poverty," they write.

To see a version of this story for physicians, visit Medscape, the leading site for physicians and health care professionals.

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