Negative Adult Outcomes Prompt Expert to Urge Taking Pediatric ADHD Seriously

ORLANDO — After reciting a litany of negative outcomes he and his colleagues uncovered in their recent study, William J. Barbaresi, MD, FAAP, urged attendees of the AAP's National Conference and Exhibition to take the diagnosis of attention deficit-hyperactivity disorder (ADHD) in children seriously. His comments came during his plenary session presentation,  "Why Pediatric Management of ADHD Matters: Adult Outcomes of Childhood ADHD," on Tuesday, Oct. 29.

Barbaresi discussed the study of the long-term adult outcomes, risks and preventive factors, and interventions for ADHD, of which he was lead author (Barbaresi WJ, Colligan RC, Weaver AL, Voigt RG, Killian JM, Katusic SK. Mortality, ADHD, and psychosocial adversity in adults with childhood ADHD: a prospective study. Pediatrics. 2013;131[4]:637-644).

The study's findings, he said, "should help us move beyond the idea that the diagnosis of ADHD in childhood is just an annoyance."

Even though ADHD has long been thought of as a neurodevelopmental disorder that adversely affects children's behavior and academic performance, and even though studies have suggested an increased risk for poor adult outcomes in children with it, until this study no prospective studies had examined long-term outcomes of childhood ADHD in an epidemiologic sample.

In their population-based birth cohort study, Barbaresi, who is associate chief of the Division of Developmental Medicine at Boston Children's Hospital, Harvard Medical School, and his coauthors evaluated 232 adults from Rochester, Minn., who had been diagnosed with ADHD as children and compared them with adults who did not have an ADHD diagnosis during childhood.

Among the results: ADHD persists into adulthood in nearly 30% of pediatric ADHD cases, and of those adults, nearly 57% have one or more psychiatric disorders aside from ADHD.

Additionally and most disturbingly, Barbaresi said, adults with a childhood diagnosis of ADHD have a 5 times higher risk for death from suicide.

Moreover, the study found that adults with ADHD have worse health and incur twice the medical costs of adults without it, and that they have poorer outcomes in employment, marriage and relationships, the number of years of education, and other psychosocial benchmarks.

"There are not many pediatric disorders with a one in three chance of a good outcome in adulthood," Barbaresi said. "ADHD is one of them."

In light of these findings, he concluded, ADHD should no longer be viewed as a disorder that primarily affects the behavior and academic performance of children, but instead ought to be viewed as a major health condition with lifelong implications and a strong need for effective clinical management.

—Michael Gerchufsky

For more information on pediatric attention deficit-hyperactivity disorder, click here for Focus on ADHD, a special supplement to Consultant for Pediatricians.