Can we predict the long-term outcome of boys with ADHD?

Attention Deficit/Hyperactivity disorder (ADHD) is not uncommon among boys, but how well children with ADHD fare later in life varies considerably

Attention Deficit/Hyperactivity disorder (ADHD) is not uncommon among boys, but how well children with ADHD fare later in life varies considerably



Washington, DC, August 1, 2018

A study published in the August 2018 issue of the Journal of the American Academy of Child and Adolescent Psychiatry(JAACAP) reports on a group of boys diagnosed with ADHD in childhood (when they were, on average, 8 years old) and followed into adulthood (when they were in their early 40s). The goal was to examine whether boys’ characteristics in childhood and adolescence predicted their subsequent school performance, their work, and social adjustment.

A major challenge has been to identify childhood features that are associated with a favorable vs. unfavorable long-term outcome.

“Research shows that children with ADHD achieve lower levels of education, have poorer social functioning, and less success at work than peers without ADHD. Being able to identify indicators of future success early in life is critical to help inform preventive and therapeutic practices,” said lead author María Ramos-Olazagasti, a senior research scientist at Child Trends and assistant professor at Columbia University.

The study conducted at the Hassenfeld Children’s Hospital at NYU Langone Medical Center focused on a cohort of 207 white, middle- and lower-class boys between the ages of 6 to 12 years, who were referred to a psychiatric clinic by their school due to behavior problems. The children in the study, who had to have IQ’s of at least 85, exhibited symptoms consistent with the DSM-5 definition of ADHD. The boys participated in three follow-up interviews, in adolescence at mean age 18, in early adulthood at age 25, and in mid adulthood at age 41. At each period, the study evaluated the participants’ social and occupational functioning, their overall adjustment, and their educational attainment.

Most of the early characteristics failed to distinguish the poor versus good outcomes. There were two potentially important exceptions. For one, higher IQ levels were related to better function in several domains. Also, the study found that conduct problems in childhood were negatively related to overall adult functioning, educational attainment, and occupational functioning. This finding is remarkable given that none of the children had a conduct disorder when they entered the study. Thus, the finding indicates that even mild conduct problems may predict relatively low educational, occupational, and overall achievement later in life. Interestingly, the authors found that boys who had concrete educational goals for their future in adolescence had better overall functioning in adulthood.

Clinicians still face many difficulties in identifying early predictors of functional outcomes among children with ADHD. However, the results provide some clinical guidance: “These results suggest that we should not overlook even relatively mild problems of conduct among children with ADHD, and that early interventions might be considered for children with a normal, but low, IQ”, said Dr. Ramos-Olazagasti. “These findings also show promise in highlighting the importance of goal setting and providing a rationale for examining young people’s attitudes toward their future.”

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Notes for editors

The article is "Predicting the Adult Functional Outcomes of Boys with ADHD 33 Years Later," by María A. Ramos-Olazagasti, PhD, Francisco Xavier Castellanos, MD, Salvatore Mannuzza, PhD, and Rachel G. Klein, PhD (https://doi.org/10.1016/j.jaac.2018.04.015). It appears in the Journal of the American Academy of Child and Adolescent Psychiatry, volume 57, issue 8 (August 2018), published by Elsevier.

Dr. Ramos-Olazagasti is an expert in children’s mental health and risk behaviors. Her research focuses on understanding the social mechanisms that lead to the existence and maintenance of socioeconomic and mental health disparities.

Copies of this paper are available to credentialed journalists upon request; please contact Mary Billingsley at mbillingsley@aacap.org or +1 202 587 9672. Journalists wishing to interview the authors may contact María A, Ramos-Olazagasti, PhD at maramos@childtrends.org.

About JAACAP

Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.

The Journal’s purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families. www.jaacap.org