OUTCOME

Life Outcomes: Productive or Destructive, John G. Kierman, Ph.D.

Prevalence - 60 to 70% of children with ADHD have continuing symptomatology in adulthood (Wender, 1995).

    1 to 6% of the adult population manifest appreciable ADHD symptoms (Wender, 1995,1996).

Conduct Disorder - A higher incidence of Conduct Disorder exists in children with ADHD in adolescence.  One eight year study (Barkley, Fischer, Edelbrock and Smallish, 1990) found 60% of an ADHD sample population had Conduct Disorder as well.

Antisocial Personality Disorder - Children who have ADHD are more likely to be diagnosed with Antisocial Personality Disorder as adults.  A study (Mannuzza, Klein, Bessler, Malloy and LaPadula, 1993) found 36% of the Adult ADHD with Antisocial Personality Disorder as compared to the controls.

Alcohol Abuse - Adults with ADHD have a higher rate of Alcohol Abuse - Twice the rate of a control group (Greenfield, Hechtman, Weiss, 1988).

Drug Abuse - Adults with ADHD demonstrate an increased risk for drug abuse syndromes.  Mannuzza, et al. (1993) found a five times greater likelihood.

Affective/Anxiety Disorders - There appears to be no evidence of increased risk of affective or anxiety disorders (Klein and Mannuzza, 1991).

Occupation - ADHD adults tend to have compromised occupational ranking in controlled studies, independent of psychiatric status (Mannuzza, Klein, Bessler, Malloy, LaPadula, 1993).  Less professionals and more small business owners are found in the samples.

Academics - Adolescents with ADHD demonstrated worse academic and cognitive status (Klein and Mannuzza, 1991).  Cognitive compromise is not as clearly demonstrated in adults.

Criminality - Studies have shown that groups of ADHD adults have higher rates of arrests, incarceration and institutionalization than controls (Klein and Mannuzza, 1991).  But, the predictor of criminality may be having Antisocial Personality Disorder, vs. merely having ADHD without this disorder.

OPPORTUNITY

"The Hunter vs. Farmer" - More small business owners than professionals are found in study samples (Mannuzza, Klein, Bessler, Malloy, LaPadula, 1993).

Industrial Age vs. the Computer Age - Organizing a large volume of routine work and performing it in a speedy manner vs. letting computers organize and perform routine work, allowing workers to create and innovate.

New Treatments - The identification of Adults as having ADHD has led to renewed alternative and innovative treatments, both medical and behavioral (many of which are still in need of empirical trial).

References

Barkley, R. A., Fischer, M., Edelbrock, C. S., and Smallish, L.  The adolescent outcome of hyperactive children diagnosed by research criteria: an 8 year prospective follow-up study. J. Am. Acad. Child Adolesc. Psychiatry, 29: 546-557, 1990.

Kelly, K. and Ramundo, P. You Mean I'm Not Lazy, Stupid or Crazy. Simon and Schuster, New York, 1993.

Klein, R. G. and Mannuzza, S. Long-term outcome of hyperactive children: a review. J. Am. Acad. Child Adolesc. Psychiatry. 30, 3: 383-387, 1991.

Greenfield B., Hechtman, L., and Weiss, G. Two subgroups of hyperactives as adults: correlation's of outcome. Can. J. Psychiatry. 33: 505-508, 1988.

Hallowell, E. M. and Ratey, J. J. Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood. Pantheon, New York, 1994.

Hallowell, E. M. and Ratey, J. J. Answers to Distraction. Pantheon, New York, 1994.

Mannuzza, S., Klein, R. G., Bessler, A., Malloy, Pl, LaPadula, M. Adult Outcome of Hyperactive Boys: Educational Achievement, Occupational Rank, and Psychiatric Status. Arch. Gen.Psychiatry. 50: 565-576, 1993.

Wender, P. H. Attention-Deficit/Hyperactivity Disorder in Adults. Oxford University Press, New York, 1995.

Wender, P. H. ADHD in adults. Psychiatric Times, July 1996.