Source:Barkley RA, Fischer M, Smallish L, et al. Young adult outcome of hyperactive children: adaptive functioning in major life activities.
J Am Acad Child Adolesc Psychiatry.

Researchers from the Medical University of South Carolina, Charleston; the Medical College of Wisconsin, Milwaukee; and the University of Massachusetts, Worcester, sought to quantify functional outcomes in 149 young adults who had been diagnosed with childhood hyperactivity. These patients had a history of significant problems with inattention and impulse control as children and had scored at ≥98th percentile on several rating scales of attention deficit hyperactivity disorder (ADHD) symptoms. Study participants in the hyperactive group and a group of community controls (n=81) were followed for at least 13 years. At follow-up 94% participated; 91% were male, 94% white, and the age range was 19–25 years. Of the hyperactive group, 8.1% used psychiatric medication (vs 1.3% of controls). Educational, occupational, social, and financial outcomes were evaluated by means of structured interview, review of high school transcripts, and evaluation of behavior and job performance by current employment supervisors.

As young adults, those with childhood hyperactivity were significantly more likely to have been fired from a job, less likely to be enrolled in college, and less likely ever to have had a credit card or savings account. They reported fewer close friends and more difficulty keeping friends. More had been involved in a pregnancy and had children (P<.015 for all). The groups did not differ in annual salary. School records confirmed that those with childhood hyperactivity were significantly more likely to have repeated a grade and to have been suspended during high school. After controlling for childhood hyperactivity, IQ, enrollment in special education, treatment with stimulant medication, and lifetime conduct disorder symptoms, grade retention was found to be the greatest predictor of failure to graduate from high school (OR=3.13).

Dr. Schonwald reports having been a paid member of the Novartis speakers’ bureau in the past 12 months. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

ADHD is a lifelong, chronic disease for up to 66% of those diagnosed as children.1 Unfortunately, measures used to diagnose childhood hyperactivity in this study differ from present ADHD diagnostic criteria. Nonetheless, the authors argue that this cohort would meet ADHD combined type criteria and may reflect a particularly hyperactive subset of children with ADHD. In addition, the control group was recruited after the hyperactive patients were evaluated, and therefore, controls were younger at follow-up in young adulthood (20.5 vs 21.1 years), potentially affecting outcome findings.

Despite these limitations, the study documents the real-life impact that ADHD can have for adults and might help to guide our interventions. Children with ADHD may benefit from early job training, intensive contraception counseling, and assistance with financial planning. Grade retention, known to be an ineffective strategy for those struggling academically,2 seems particularly detrimental to this group...

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