What happens when children with attention deficit/hyperactivity disorder grow up?

Abstract

Attention deficit/hyperactivity disorder1 and the associated hyperkinetic disorder,2 hereafter both referred to as ADHD, are the most prevalent and best researched of all the childhood mental illnesses. Although not diagnostically identical, the combined type ADHD and ICD-10 hyperkinetic disorder have sufficient in common for research into the two to be considered in parallel. They are, as we shall see, common, disabling and probably neurobiologically based. The received wisdom over the years has been that ADHD is a disorder of childhood whose symptoms lessen over time;3,4 consequently little attention was paid to the possibility that it might continue into adulthood. But is this old consensus correct? What does happen to the children who have ADHD? The diagnosis and treatment of ADHD is a perplexing area for the child and adolescent psychiatrist, and in the opinion of some clinicians and researchers the check-lists of the DSM-IV and ICD-10 do little justice to the psychosocial and behavioural aspects of hyperkinetic activities.5 Moreover, review of the published work is hampered by the numerous changes in diagnostic criteria over the years.6 The notion that ADHD phenomena reflect other disorders, rather than being core components of a nosologically separate identity, persisted (particularly in the UK) long after the discovery by Bradley in 1937 that stimulant medication has a calming effect on hyperactive children.7 However, as the diagnostic tools have become more robust and the evidence to support pharmacological treatment has become stronger, the doubters are now in a minority. The attention dyscontrol–impulsivity–hyperactivity triad is widely accepted not only as a formal mental disorder but also as one whose diagnosis and management, both pharmacological and psychosocial, can offer profound benefit for the child and family. Because ADHD was diagnosed and managed principally by child and adolescent psychiatrists, the long-term fate of the patients suffered relative neglect. The likelihood of remission seemed to be supported by a steady reduction in symptoms over time.8 However, the dearth of information has been substantially remedied over the past two decades and the possibility of ADHD as an adult diagnosis is gaining ground—opening treatment options for those affected. This paper explores existing knowledge and potential areas for further research.