The study, published in the Archives of General Psychiatry, found that men who were diagnosed as children with Attention Deficit-Hyperactivity Disorder (ADHD) appeared to have significantly worse educational, occupational, economic and social outcomes in a 33-year, follow-up study that compared them with men without childhood ADHD.
ADHD has an estimated worldwide prevalence of 5 percent, so the long-term outcome of children with ADHD is a major concern, according to the study background.
I spoke with lead study author Rachel G. Klein, Ph.D., of the Child Study Center at NYU Langone Medical Center in New York, about why this study focuses exclusively on men, and what it means for both kids and adults with ADHD.
First let’s take a look at some of the study’s findings:
- On average, the adult men with ADHD had 2-1/2 fewer years of schooling than comparison participants.
- 31.1 percent did not complete high school (vs. 4.4 percent of comparison participants) and hardly any (3.7 percent) had higher degrees (whereas 29.4 percent of comparison participants did).
- The adult men with ADHD had significantly lower occupational attainment levels. Most were holding jobs (83.7 percent), but the men without ADHD made an average of $40,000 a year more than those with ADHD.
- The men who were diagnosed with ADHD in childhood also had more divorces (currently divorced, 9.6 percent vs. 2.9 percent, and ever been divorced 31.1 percent vs. 11.8 percent).
- The men with ADHD had higher rates of antisocial personality disorder (ASPD, 16.3 percent vs. 0 percent) and substance use disorders (14.1 percent vs. 5.1 percent), according to the results.
- During their lifetime, the men with ADHD did not have more mood or anxiety disorders, or more psychiatric hospitalizations, or more incarcerations than their typical counterparts.
The authors noted the design of their study precludes generalizing the results to women and all ethnic and social groups. The men studied were white men, of average intelligence, who were referred to a clinic because of their combined-type ADHD.
As a woman with ADHD, and as a mom with a daughter with ADHD, I was particularly interested in why this study didn’t address women and girls. I asked Dr. Klein if it was simply because girls were (and are) so massively under-diagnosed, that there weren’t enough women available to provide a statistically valid number.
“We had 207 boys and 19 girls,” in the data, Dr. Klein told me. “So they didn’t make a sufficient group. You can’t assume that the trajectory is identical, so we didn’t combine them.”
Another interesting, and important, aspect of this study is that it focuses on men who were diagnosed with ADHD with behavioral components, such as hyperactivity and impulsivity.
“The people in this study had combined hyperactivity, inattentive issues, and impulsivity as children,” said Dr. Klein. “This is very different from the inability to sustain attention only.”
To be clear, there are two major types of ADHD: the “primarily hyperactive type” (this is what you typically think of when you think of someone with ADHD), and the “primarily inattentive type” (this is more of an inability to regulate attention; the person can come off as a “space cadet” or a “dreamer,” and may also actually hyperfocus on tasks).
This study did not address boys and men with the primarily inattentive type of ADHD, and Dr. Klein noted that there’s not a lot of research yet on the primarily inattentive type of ADHD.
“It’s hard to account for why it isn’t better studied,” said Dr. Klein. ”Kids with primarily inattentive type, their outcomes are likely to be different. No one has really focused on those children.”
“It’s unfortunate that they two types are lumped together,” she added. “The data reported simply does not apply to people who have the inattentive type. They have different outcomes.”
Another thing to note about this study is that most of the adult men who participated were not in treatment for their ADHD. Presumably an adult whose ADHD is treated (e.g., with medication and/or therapy) would have more successful outcomes.
“The vast majority were not in treatment. There were about 9 individuals in treatment, but very few. There is sort of a conundrum, when you look at people who have the disorder, most of them are untreated.”
Dr. Klein noted that while the press has reported an increase in both adult men and women taking prescription ADHD medications, “when you start from about zero, of course the rate is going to go up.”
As the study authors point out, this study definitely highlights “the importance of extended monitoring and treatment of children with ADHD.” It could also be used to help pinpoint the executive function skills (such as time management, task completion, etc.) that specifically need to be taught to children with ADHD. When parents and schools create Individual Education Plans (IEPs), they need to focus not just on accommodating the child’s challenges, but teaching them the actual skills they will need in order to succeed in life.
Dr. Klein suggested that parents pay particular attention to helping kids manage impulsiveness. “Continued impulsivity is a source of difficulty,” she said. “It leads to conflict with authority. School becomes essentially intolerable, so you have trouble doing the work even if you want to.”
The good news is that ADHD symptoms do often get better as kids get older, said Dr. Klein. “It does get better in many cases. You may have some residual difficulties, but no worse than most other people, and you function well.”
Even if adults do struggle with ADHD, “it’s not a life sentence,” said Dr. Klein.
Adults who want to help manage ADHD symptoms should consider turning to a professional. “There are some coach-like therapies that are effective,” said Dr. Klein, “where you train people to have better organizational skills, and to become more aware of the impact of their symptoms on their lives.”
Unfortunately, those therapies are scarce, and can be difficult to find depending on where you live.
Dr. Klein suggested that adults with ADHD start by checking with local teaching hospitals, or psychiatry departments within medical schools. If those aren’t nearby, ask your primary physician for a recommendation.
“In terms of medication, you have to go to someone who is savvy,” said Dr. Klein, noting that some ADHD medications can present problems with high blood pressure, for example. “For therapy, you also want someone who is experienced in treating adults with ADHD.”
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