Fact, Fiction & Beyond

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ADHD:
FACT, FICTION AND BEYOND
A Comprehensive Study of Attention Deficit Hyperactivity Disorder

[ What Is ADHD ] [ Impairment ] [ History ] [ Etiology ] [ Treatment ]

Impairment

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A. ACADEMICS:

The single most common cause for referral for evaluation for children and adolescents is academic failure.

Weiss and Hechtman[i] in follow-up studies at 5, 10 and 15-year intervals demonstrated ADHD children performed poorly on achievement tests and failed grades/courses significantly more often than children of similar ability who did not have ADHD. Children with ADHD completed on average 3 fewer years of education than matched controls and were more likely not to graduate high school in spite of having more than adequate ability.2 When ADHD is combined with significant learning disabilities as occurs in more than 30% of cases, the academic impairment is often profound.

SOCIAL FUNCTIONING AND SELF ESTEEM:

ADHD people just don’t “get it.” They fail to respond appropriately to social cues, are chronically unobservant of body language and are often intrusive with others. They interrupt, talk too loudly and tactlessly blurt things out without thinking. They ramble on and on rarely completing one thought before jumping to the next. They don’t listen and are often considered to be “insensitive.”

Research on adolescents with ADHD indicates that the social problems of children with ADHD persist into adolescence and usually get worse. Even when the data was controlled for the features of conduct disorder, which can be significantly alienating, by themselves, children and adolescents with ADHD were found to have fewer friends, poorer social skills, and have lower scores on assessments of self-esteem.3 ADHD kids are the “last picked and the first picked on.”

This intuitive sense of how to navigate within a culture develops between 12 and 17 years of age and is one of the major developmental tasks to be mastered. During this time period individuals become aware that words alone no longer carry the meaning in interactions. The real meaning is often conveyed through non-verbal cues such as a look in the eye or a tone of voice. People who are inattentive or speeding from one stimulus to the next often miss these important non-verbal messages. If the development of this intuitive understanding is missed at this crucial stage it is commonly missed forever.

HEALTH AND INJURY:

Accidents are the leading cause of death until 44 years of age. Without treatment adolescents with ADHD have 400% more injury producing accidents and 300% more motor vehicle violations than do adolescents without ADHD or adolescents with ADHD who consistently take medication.4 A 9-year study of medical utilization (beyond just the direct costs of treating the ADHD) demonstrated that persons with ADHD have more than double the cost of care as compared to controls.5

SUBSTANCE USE:

Left untreated, persons with ADHD have more than three times the incidence of a substance use disorder diagnosis than does the population at large. Biederman and his colleagues6 demonstrated in a prospective, longitudinal study that the risk of substance abuse by ADHD individuals remains equal to that of controls until 15 years of age. Between the ages of 15 and 27, however, the rate of substance abuse severe enough to be diagnosed as a substance use disorder triples (47% vs. 15%). Far from predisposing to later drug abuse, treatment of ADHD with stimulant class medications actually protects against the development of substance use disorders (SUD’s). If the person with ADHD is consistently treated with stimulant class medication, the risk of developing SUD is the same as the general population.

PSYCHOSEXUAL FUNCTIONING:

In one of the longest longitudinal outcome studies done thus far, Barkley7 has followed a cohort of ADHD children into their mid-twenties. Their sexual lives give a grim look at the impact of untreated ADHD. At the most recent follow-up more than half of the ADHD group had been tested for HIV disease. No one in the matched control group had been tested. Of the 43 children born to participants in the study 42 had been born to the ADHD group. Perhaps the most disturbing finding was that 54 percent of these parents had already lost custody of their children.

CRIMINALITY:

ADHD has a high comorbidity with Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD).8 this comorbidity coupled with an impulsive, high-risk lifestyle puts ADHD individuals at risk for legal problems of all sorts. A long-term study in New York found that people with ADHD were more likely to be arrested (39% vs. 20%), and when they are arrested they are more likely to be convicted (28% vs. 11%) and much more likely to be jailed (9% vs. 1%) than were their non- ADHD peers.9

BELIEF VS EVIDENCE

There are a number of beliefs (or myths) held by many clinicians and laypersons and perpetuated by the lay media.

See if you can figure out which of the following statements are true:

ADHD doesn’t really exist but is just an excuse for bad behavior
Only males are affected
This is just “normal boy” behavior
These kids are just spoiled and need discipline
ADHD is outgrown by adolescence in most individuals10
ADHD is over-diagnosed and over treated
Teachers and parents want the child medicated so he won’t be a problem
The medications are powerful, dangerous and addictive drugs which can stunt growth

Not one of these assumptions or beliefs is true and there is an abundance of evidence to the contrary.

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References:

[i] Weiss G, Hechtman L. Hyperactive Children Grown Up 2^nd ed. Guilford Press, New York, 1993.

2 Mannuzza S, Klein RG, Diagnosis and Logitudinal Course of Attention Deficit Hyperactivity Disorder. The Economics of Neuroscience 47-53, April, 2001.

3 Hechtman L, Weiss G, Perlman T. Hyperactives as Young Adults; Self Esteem and Social Skills. Can J Psychiatry25: 478-483, 1980.

4 Barkley RA, et al. Driving related risks and outcomes of Attention Deficit Hyperactivity Disorder in adolescents and young adults: a 3-5 year follow-up survey. Pediatrics. 92:212-218, 1993.

5 Liebson CL, et al. Use and costs of medical care for children and adolescents with and without Attention Deficit Hyperactivity Disorder. JAMA 285(1)60-66, 2001.

6 Biederman J, Wilens T, Mick E, Spencer T, Faraone SV, Pharmacotherapy of Attention Deficit Hyperactivity Disorder reduces risk of substance use disorder. Pediatrics 104(2):1999

7 Barkley RA, ADD Research: a look at today and tomorrow. ATTENTION! 1996;8-11.

8 Biederman J, Faraone SV, Milberger S, et al. A Prospective 4-Year Followup Story Of Attention Deficit Hyperactivity Disorder And Related Disorders. Arch Gen Psychiatry 53:437-446, 1996.

9 Mannuzza S, Klein R, Konig PH, Giampino TLK. Hyperactive boys almost grown up: IV. Criminality and its relationship to psychiatric status. Arch Gen Psychiatry. 46:1073-1079, 1989.

10 Goldman LS, Genel M, Bezman RJ, Slanetz PJ, Diagnosis and treatment of Attention Deficit Hyperactivity Disorder in Children and Adolescents. JAMA 1998; 279(14) 1100-1107.