Split views on ADHD’s effect in adulthood

People with attention deficit hyperactivity disorder sometimes outgrow the condition. But more often than not, the symptoms linger into adulthood.

A 2006 study in Psychological Medicine found that about 65% of patients retain at least partial symptoms of the condition when they grow up. But only about 10% of adults with ADHD are treated and diagnosed, says Russell A. Barkley, a clinical professor of psychiatry at the Medical University of South Carolina in Charleston.

Only a handful of long-term studies have tracked kids with ADHD into adulthood. In one of them, Barkley and his colleagues followed 158 people who were diagnosed as children in southeastern Wisconsin, along with 81 controls from the same area. The researchers found that 14% to 35% of the patients had fully recovered from ADHD by the time they were 27 years old. The range reflects the difference between using strict or loose criteria to define “full recovery.”

Among the patients who continued to have ADHD symptoms, 38% had dropped out of high school — more than triple the dropout rate for Wisconsin students as a whole. Only 22% of the 158 subjects went to college, and only 5% graduated. In the control group, 77% of kids attended some type of college, including technical schools, and 35% completed a college degree, comparable to the national average.

The research team also found that 40% of the subjects who were diagnosed with ADHD had become parents by the age of 20, compared with 4% in the control group. And they found that 22% of the ADHD subjects developed at least one substance abuse problem; in comparison, 6% of the controls had an addiction.

Although 80% of the study subjects had taken ADHD drugs — and did so for an average of three years — only 27% kept taking medication into high school. The researchers found no difference in outcomes between those who stopped taking their drugs and those who never even started with medication.

One of the key messages from the study is the importance of staying on medication into adolescence, Barkley says. “This is the diabetes of psychiatry, and you’ve got to manage it like diabetes,” he says. “The treatments do work, but they just have to be continued. The biggest obstacle right now is getting people to continue in their treatments.”

Barkley published his findings in a 2008 book he co-wrote, “ADHD in Adults: What the Science Says.”

The Wisconsin study suggests that “ADHD is a lifelong disorder, and you probably ought to be on pharmaceuticals your whole life,” says Dr. Lawrence H. Diller, a behavioral and developmental pediatrician in Walnut Creek, Calif., who was not involved with Barkley’s work.

Diller says he hasn’t observed such “gloomy outcomes” in the patients he has treated since childhood in his own practice, and he wondered why. So he tracked down 10 former patients he had written about in his 1998 book, “Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill” and revisited them as adults.

Of the 10, half had graduated from college, eight were employed, one had a substance abuse problem and one had spent several years in prison, he says. Only two were still taking medicine for their condition.

“There are some problems there,” Diller says, “but as a group they’re doing much better.” He wrote about them in “Remembering Ritalin: A Doctor and Generation Rx Reflect on Life and Psychiatric Drugs,” which was released this year.

Diller believes that the difference between his findings and Barkley’s is the socioeconomic status of the patients they studied. Whereas Barkley’s subjects represent a cross-section of socioeconomic classes that’s representative of people with ADHD, Diller’s patients all came from middle- and upper-middle-class families in the Bay Area.

“These families seem to be able to better cocoon their children” until they became adults and were able to choose what they wanted to do with their lives, Diller says. “If you can choose what you want to do, the issues of inattention and impulsivity are much less.”

healthkey@tribune.com