I have been so wrong about ADHD. I confess I used to think attention disorders were not as serious as other disorders. Sure, these kids had big problems, but they didn’t seem to compare with the disabling, even dangerous, symptoms of disorders like bipolar or schizophrenia. ADHD kids just seemed more ‘functional’ to me, and the treatments seemed to work better. While other families talked about psychotic breaks, suicide, and uncontrollable rages, I heard parents of ADHD kids talk about intense frustration and daily calls from school. Heck, ADHD kids could attend school! When I attended children’s mental health conferences, the ‘youth-talk-back’ workshops were all led by young people with ADHD. They were articulate about their experiences and needs, answered questions, and interacted appropriately with audiences. So many strengths! Youth with other disorders are challenged by all of these tasks.
I confess, I also found ADHD funny…
…but my perception changed radically when I found recently published research on children with ADHD who were followed from childhood to adulthood. These studies revealed deeply unsettling news—the long-term effects of ADHD can be serious. Adults with ADHD have a higher risk of developing other psychiatric problems, being victimized and incarcerated, and facing lifetime struggles with education and employment. Summaries from 10 research studies on the long term prognoses of ADHD are found at the end of this post.
Children and teens with ADHD deserve the chance to reach adulthood with skills that keep them from sliding inexorably downhill, which studies show is common.
Treatment is imperative, not optional! ADHD hits hardest in adulthood, but starts in childhood when parents have an opportunity to change it’s course. Parents and caregivers should aggressively and persistently seek an appropriate treatment for their ADHD child that improves functioning: behavior at school and home, school attendance and educational attainment, self-esteem, and self-actualization. In addition to medical/medication treatment as recommended, the child must learn self-management and self-calming skills so they can control impulses when they reach adulthood.
Little things start adding up – Without skills (and/or medication), a person with ADHD slips up on life’s daily little challenges–losing, forgetting, neglecting, overreacting, disappointing others, and undermining themselves in a thousand different ways.
Needing others and resenting it – I’ve noticed that those with ADHD seem to find or attract others they can depend on. They seek and get support to be functional, but the effort can weigh heavily on their “caretakers” (spouse, friends, co-workers) and family. They lose opportunities to practice self-reliance when this happens, and they resent their dependence on others. Who wants to be stuck within other’s limits, and on the receiving end of their frustration and impatience?
Unfinished business – Those with ADHD drag unfinished projects with them indefinitely, keeping them in an actual or metaphorical garage full of costly but unfinished projects. Little repairs become big expensive repairs through lack of maintenance. Bills don’t get paid, licenses don’t get renewed, debtors get away with never paying them back.
Guide your child to his or her gifts – From personal experience with ADHD children and adults, I know they can love, be affectionate, funny, generous, and show empathy for others. They strive to be better. Think of careers your child or teen might pursue that require creativity, energy, and enthusiasm. Introduce them to experiences that challenge them, and ignore the myth that they can’t focus or that they mess things up, not true. ADHD kids readily focus on projects they enjoy, demonstrate mental nimbleness with complexities, multitask with accuracy, and shine in emergencies, whether debugging software, making music, or even doing surgery.
Writer’s commentary: To medicate or not to medicate? Two extremes, neither appropriate. I’ve read articles that question the existence of ADHD, or vilify the families that treat with medications. Prejudice against this disorder and parents is common. Even uninformed people think they understand ADHD, and comfortably spread personal opinions about the use of medications or consequences for ADHD behaviors. This is unhelpful. Public controversy over ADHD negatively influences parents’ decisions regarding diagnosis and their choice of a child’s treatment.
At one extreme: some think medications turn children into zombies, and that ADHD is a fake diagnosis or treatable with natural substances or meditation, etc. Non-drug options may help, but what if the results are marginal and short-lived? What if a parent stubbornly sticks with a treatment that fits a personal goal and refuses to notice that it’s not working? If a non-drug remedy is effective, there will be hard proof: the child will keep up with school, maintain grade level, exhibit behaviors appropriate for their age, and show signs of self-control. These are more important to a child’s future than a parent’s loyalty to a belief.
Ironically, the choice of drugs for those of us with children with severe disorders may be easier than for parents of ADHD kids. Drugs keep psychotic kids safe and alive, here and now. Worrying about side effects is a luxury.
At the other extreme: some parents want a “quick fix” with pills, but chemical control also makes it easier for these parents to avoid hard parenting work like teaching their child to check impulses and set boundaries. And if parents are happy with the drug, might they overlook their child’s discomfort with side effects and ignore this child’s need for an adjustment? Might they also overlook how their home environment promotes distraction and chaos? A pill will compensate for bad parenting and a crazy-making lifestyle until the child reaches adulthood, having never been taught to make choices that promote their gift of creativity and reduce their risk of addiction, or having never been taught self-discipline.
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High School Students With ADHD: The Group Most Likely to…Fizzle
Breslau J, Miller E, Joanie Chung WJ, Schweitzer JB.Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time. Journal of Psychiatric Research. Jul 15 2010
Adolescents with attention deficit/hyperactivity disorder (ADHD), conduct disorder, or who smoke cigarettes are least likely to finish high school (HS) on time or most likely to drop out altogether, researchers at the University of California, Davis, School of Medicine (UC Davis) have found.
Lead investigator Joshua Breslau, PhD, ScD, medical anthropologist and psychiatric epidemiologist reported that of a total of 29,662 respondents, about one third (32.3%) of students with combined-type ADHD were more likely to drop out of high school than students with other psychiatric disorders. This figure was twice that of teens with no reported mental health problems (15%) who did not graduate. Students with conduct disorder were the second at-risk group (31%) to drop out or not finish on time. Cigarette smokers were third in line, with a staggering 29% who did not finish high school in a timely manner.
Educational achievement squelched in children with ADHD
Newsletter – NYU Child Study Center, New York, NY, February 2009
Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common disorders in childhood and adolescence, with prevalence estimates ranging from five to ten percent. Children with untreated ADHD drop out of high school 10 times more often than other children.
Adult psychiatric outcomes of girls with attention deficit hyperactivity disorder
American Journal of Psychiatry, January 2010
Researchers studied age 6 to 18-year-old girls with diagnosed ADHD and followed up after 11 years. Conclusions: By young adulthood, girls with ADHD were at high risk for antisocial, addictive, mood, anxiety, and eating disorders. However, ADHD medications appear to reduce the prevalence of multiple disorders at least in the short term. These findings, also documented in boys with ADHD, provide further evidence for negative long-term impacts ADHD across the life cycle.
Brain abnormality found in boys with attention deficit hyperactivity disorder
Journal of Abnormal Psychology, March 2009
Researchers trying to uncover the mechanisms that cause ADHD and conduct disorder found an abnormality in the brains of adolescent boys suffering from the conditions. The research focused on two brain areas, the “mid brain” striatal, and cerebral cortex. The mid brain motivates people to engage in pleasurable or rewarding behavior. The cortex notices if an expected reward stops and considers options. However, this doesn’t occur as quickly in boys with ADHD or conduct disorders. Instead, the mid brain region keeps trying for rewards, which is a quality of addictive behavior.
Kids with ADHD more likely to bully, and those pushed around tend to exhibit attention problems
Developmental Medicine & Child Neurology, February 2008
Children with attention deficit hyperactivity disorder are almost four times as likely as others to be bullies. And, in an intriguing corollary, the children with ADHD symptoms were almost 10 times as likely as others to have been regular targets of bullies prior to the onset of those symptoms. Bullies were the kids in class who couldn’t sit still and listen, didn’t do their homework and were almost constantly in motion. Children with ADHD symptoms make life miserable for their fellow students, and they too can develop attention problems related to the stress of being bullied.
Girls’ hyperactivity and physical aggression during childhood and adjustment problems in early adulthood: A 15-year longitudinal study.
Archives of General Psychiatry, March 2008
Girls with hyperactive behavior such as restlessness, jumping up and down, and difficulty keeping still or fidgety, and girls exhibiting physical aggression such as fighting, bullying, kicking, biting or hitting, all signs of ADHD, were found to have a high risk of developing adjustment problems in adulthood.
Teen’s inattentive symptoms may determine how long they stay in school
Forum for Health Economic & Policy, November 2009
Poor mental health of children and teenagers has a large impact on the length of time they will stay in school, based on the fact that at conception there are differences in genetic inheritance among siblings. This study provides strong evidence that inattentive symptoms of ADHD in childhood and depression in adolescents are linked to the number of years of completed schooling.
Children with ADHD more likely to participate in crimes
Yale School of Public Health and University of Wisconsin at Madison, October 2009
Children with ADHD are more likely to participate in crimes such as burglary, theft and drug dealing as adults. Those who had attention deficit hyperactivity disorder as children were at increased risk of developing criminal behaviors. Researchers said one reason is that children with ADHD tend to have lower amounts of schooling.
ADHD may affect adults’ occupational and educational attainments
Journal of Clinical Psychiatry September 2008
Adults who have ADHD generally have lower occupational and educational attainments as adults than they might have reached if they didn’t have the disorder, at least compared to what attainments would have been expected given their intellect. “Educational and occupational deficits… are a consequence of ADHD and not IQ,” lead researchers Dr. Joseph Biederman said. The finding strongly underscores the need for “diagnosing and treating ADHD to avert these serious consequences,” he said.
Attention-deficit/hyperactivity disorder (ADHD) in the course of life.
European Archives of Psychiatry and Clinical Neuroscience, September 2006.
ADHD is a pervasive disorder that extensively impairs quality of life and that can lead to serious secondary problems. Long-term studies have demonstrated that the disorder is not limited to childhood and adolescence. The clinical experience indicates substantial difficulties for adults whose ADHD is not diagnosed and treated, and they often create extensive costs for the welfare system. The evidence-based psychiatric treatment available is highly effective and inexpensive.
70% of crystal meth (methamphetamine) inpatients had ADHD
Journal of Addiction Disorders. 2005, and the blog: Adult ADHD Strengths.
Methamphetamine-dependent inpatients were screened for childhood attention deficit hyperactivity disorder (ADHD), and of the participants, 70.6% screened positive for ADHD and reported significantly more frequent methamphetamine use prior to baseline. ADHD participants exhibited significantly worse psychiatric symptomatology. At a three-week follow- up, all who didn’t complete treatment screened positive for ADHD.