What happens when children with ADHD become adults?

Attention Deficit Hyperactivity Disorder (ADHD) is probably the most controversial of all mental health problems. Due to the lack of hard scientific evidence, there are those who consider it an invention cultivated by commercial interests; in the opposite camp are those who attribute to it any misbehavior in class, poor school performance or disruptive antics. If ADHD sufferers and their families are to be helped, time should be taken to analyze what most closely resembles scientific evidence while avoiding ideologized discourse from those who claim to be “in possession of the truth.”

What we do know is that some children are constantly on the move, apparently driven by an internal generator that makes them run, jump, squirm in their chairs and talk endlessly and at inappropriate moments. They may also be impulsive, find it difficult to suppress what is going on in their heads, get bored quickly with tasks they are set and constantly interrupt conversations. They may be inattentive and become distracted by the slightest stimulus; are absent-minded and forgetful, leaving tasks half done, not listening when spoken to, with their minds invariably “elsewhere.”

Almost all the very young display these traits and, consequently, any diagnosis of ADHD should not be done before the age of six or seven. But when the child gets older and these traits persist in ways that seriously affect their performance and wellbeing both in and outside the home, the underlying cause should be investigated. Such an assessment is not designed to label the child in question – no one should be considered their diagnosis – nor to limit their childhood to a few simple consensual requirements; a diagnosis is simply the beginnings of a roadmap that might help them cope. Such a roadmap should be integral and multidisciplinary, involving the families, the teacher, the school counselor, the psychologist, the pediatrician and the psychiatrist.

According to the World Health Organization (WHO), ADHD affects approximately 5% of children, with genetic factors possibly playing a role: having a parent with ADHD multiplies the risk of suffering from it by the age of eight, though as always, this seems to be the result of a complex nature-nurture interaction: low birth weight and maternal alcohol and tobacco consumption during pregnancy multiplies the risk by three, and social adversity by four. Explanations of the underlying complex brain dysfunction are as yet insufficient. This should encourage us to push for quality biopsychosocial research, rather than dismiss the possibility that there is no cerebral link.

But the most urgent aspect of ADHD is its impact on the lives of those who appear to have it. If not adequately addressed, it can lead to failure at school (40% drop out in under 16s), strained relationships with other children, including fights and bullying, and a higher frequency of accidents and serious self-esteem problems. As well as being a disorder, ADHD acts as a developmental risk factor for other mental health problems and can lead in maturity to depression, anxiety, behavior problems disorders and substance addiction.

Fortunately, longitudinal studies have consistently shown that ADHD symptoms tend to decrease over time, though they do persist in 40% to 50% of adults. Hyperactivity usually improves, sometimes morphing into restlessness. What prevails is often a difficulty with concentration, organization and time management. Such adults may become easily frustrated, are impulsive and, in more than half the cases, have been seen to succumb to substance abuse. Diagnosing ADHD in adulthood is difficult, as it becomes confused with personality disorders and addiction. Untreated, ADHD is associated with higher rates of traffic accidents and fines, family conflicts and unemployment. Adult ADHD sufferers are more likely to face legal problems, and there are studies that put the prevalence of ADHD among the prison population at 30%.

There is a significant indication that the symptoms labelled in childhood as ADHD persist in a large percentage of sufferers; but these symptoms present differently in adult life, simulating a borderline or antisocial personality disorder, with frequent substance abuse issues alongside personal, social and legal problems. Perhaps it would be useful, when faced with adults with the aforementioned problems, to ask them what they were like as children – what difficulties they wrestled with on a day-to-day basis, if they were inattentive or found it hard to sit still, or if ADHD was ever mooted to explain their behavior. This rarely happens. Instead, society tends to interpret such behavior as a moral disorder. I remember an interview with the brilliant psychiatrist Luis Rojas Marcos in which he revealed having been diagnosed with ADHD: “I came to think I was a bad child.”

Knowledge of mental health problems can help us to understand abnormal behaviors. This, in turn, means that the appropriate help can be sought and adaptations made, with a view to a positive impact on the future of the ADHD sufferer. Of course, ADHD cannot explain the vast majority of puzzling and unpredictable human behaviors, but it can shed light on some.