ADH/D: “How long is my child going to have ADHD?”

Vera Joffe, Ph.D.
(vjphdcr)
Copyright © 2001-present. All rights reserved.

ADH/D: “How long is my child going to have ADHD?”

The above question is a common one in my clinical practice. Once a child is correctly diagnosed with ADHD, parents often ask questions such as the one above: “Is my child going to need accommodations at school all his/her life? Is my child going to have to take medication all his life? How about behavior therapy: Are we going to be in therapy the rest of our lives? How is my child going to do in the work force as an adult? How is my child going to develop relationships?”

The questions cited have to do with prognosis of ADHD. A lot of research has been conducted to investigate the life span of ADHD.

1. Genetics and Pregnancy: There is enough research to suggest that ADHD is a neurodevelopmental disorder, and about 80% is genetic (just like height). In addition to that, there are environmental factors during pregnancy that contribute for the development of ADHD, such as smoking during pregnancy, drinking alcohol, and using other drugs. In addition, low birth weight, psychosomatic adversity, low socioeconomic level, the parents I.Q.’s and their difficulty with conduct and problems with the law.

2. Pre-school: Current research indicated that children who demonstrated difficulty in inhibiting their behavior (developmentally inappropriate), who were aggressive, were likely to develop mental health difficulties later in life, including ADHD, depression, conduct problems among other conditions. Thus, it is very important to screen pre-school children who present an unusual aggressive, noncompliant behavior to help them and their families develop interventions early in life.

3. ADHD and its course: “How long is it going to last? Is my child going to be “cured” from ADHD?” Biederman and colleagues (Biederman et.al, 2000) reviewed studies that dealt with the life span of ADHD, and they came to the conclusion that the definition of “remission of ADHD” varied from one study to another. If a researcher would define “remission” as having to fulfill the whole diagnostic criterium of ADHD, according to the DSM-IV, then there is remission in early adolescence. However, if remission is viewed as “symptomatic remission”, some symptoms decrease across time, and some become more clear, and evident. For instance, the symptoms of hyperactivity are the first ones to diminish across time, then the ones of impulsivity, then the symptoms of inattention persist more across time, and during adulthood.

Thus, ADHD continues across time, but there is a change in its course, as Biederman (2003) presented in the diagram below:

4. Other family factors: In addition to genetics (the most important item), and pregnancy factors, there are other elements that play a role in the prognosis of ADHD early in a child’s life. They are, for instance, the number of people in the immediate family, whether the parents are divorced, parental abuse of drugs and alcohol, history of psychopathology in the family.

5. Comorbidity: The more comorbidity there is with ADHD, the more impairment is noted across life time. Also, if children show anxiety early in life (in addition to ADHD), they are likely to show anxiety later in life. The same happens with other comorbid psychiatric conditions, such as depression, bipolar, as well as Conduct Disorder (CD), and Oppositional Defiance Disorder (ODD).

When there is comorbidity of ADHD with CD and ODD, the prognosis is more negative. There is current research that indicates that the combination of ADHD with CD and with ODD increases that probability of more involvement with the law, drug abuse and dependency. As a matter of fact, studies that investigated the correlation between drug abuse and ADHD indicated that it was the presence of CD that made the connection of those two variables strong, and not the mere presence of ADHD.

6. Learning disabilities: Children who had ADHD with comorbidity of learning disabilities were more likely to drop out of school, get school suspensions, and to have less prestigious jobs.

7. Other conditions: Barkley and his colleagues studied adolescents with ADHD, and driving behaviors (1993). They concluded that individuals with ADHD are more likely to have car accidents, more tickets, and to drive without a license than people without ADHD. Barkley (2003) has completed research recently, and he concluded that individuals with ADHD have a life expectancy that is lower than other people given their risky, impulsive behaviors. He also studied adolescent girls, and concluded that they are more likely to get pregnant, and to show promiscuous sexual behaviors than other young women.

Thus, with all the research mentioned above, how can we talk about prevention, and positive outcomes?

There is data that suggests some interventions that can be provided to increase that probability of success in life, if a child is diagnosed and treated early enough in life.

Early diagnosis and treatment: If children who are already showing significant impulsive, aggressive, destructive behaviors at preschool are screened for ADHD, Juvenile Bipolar Disorder, or other conditions, then they may be able to receive behavioral treatment right away. It is also suggested that if parents receive parenting training in behavior management techniques, they are more likely to be successful in parenting difficult children. Parenting classes, behavior management treatment, and family therapy for an extended period of time was proven to be effective in treating ADHD, and it should start as soon as significant symptoms are noted.

There is no doubt that medication has been proven to be the number one treatment for symptoms of ADHD. This avenue should be explored, and analyzed by the parents, and they should discuss this treatment mode with their physician.

Parent and child education about ADHD: Parent support groups, such as CHADD are possible avenues for parents to learn more about ADHD, to become more active advocates for their children’s needs, including at school.

An active team approach between parents, teachers, Special educators in developing an individualized educational program for the child with ADHD seems to be helpful in increasing the child’s feeling of success at school.

Brooks and Goldstein (2001) talked about the “Islands of Competence”. They focus on the child’s own strengths rather than on their failures and lack of competency. Helping parents adopt a more positive attitude, instead of a punishing one, in raising their children may help increase the children’s self-esteem, and improve the relationship in the family.

Brooks and Goldstein (2001) talked about “resilience”, and this is the internal strength that people have to deal with the daily challenges of life, such as stress, adversity, trauma. Helping children develop their resilience, and focusing on those aspects of their life, according to the authors, may increase their self-esteem, and the opportunities for success.

In sum, ADHD is a neurodevelopmental condition which can persist through a life-time. The impact of ADHD in an individual’s life depends on many different variables, which were described above. One of the most important elements in increasing the success of individuals with ADHD is to learn about the condition, to become involved with support groups, like the CHADD organization. Also, it is important to be an informed consumer regarding doctors, medications, treatments, education, and the law so that one receives the best treatment available in all areas of life.

References:

Barkley, R.A. et al. (1993). 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.

Barkley, R.A. (1998). Attention Deficit Hyperactivity Disorder: A Handbook for diagnosis and treatment. Second Edition. New York: Guilford.

Biederman, J.; Mick, E.; Faraone, S.V. (2000). Age dependent decline of symptoms of attention deficit-hyperactivity disorder: Impact of remission definition and symptom type. American Journal of Psychiatry, 157 (5): 816-818.

Biederman, J. (2003). Course and Outcome of ADHD. In: ATTENTIN DEFICIT HYPERACTIVITY DISORDER: ACROSS THE LIFESPAN. Boston: Massachusetts General Hospital, Department of Psychiatry. March 7-9.

Brooks, R. & Goldstein, S. (2001). Raising Resilient Children. Chicago: Contemporary Books.

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