BOSTON — One of the most recent large-scale studies on attention-deficit hyperactivity disorder (ADHD) has some disturbing conclusions.
Dr. William Barbaresi, of Boston Children’s Hospital and one of the study’s lead investigators, joined WBUR on Monday evening to discuss the findings.
WBUR’s Deborah Becker: You surveyed about 5,700 children over a very lengthy period of time, and what did you find primarily that stuck out to you?
Dr. William Barbaresi: One of the most concerning aspects of the study is that having followed the largest representative group of children with ADHD ever examined in terms of their outcome in adulthood, that many of the conditions that we thought were associated with ADHD in fact are and in large numbers.
So for example, 30 percent of children with ADHD continue to have the same condition in adulthood and among them, 80 percent have at least one associated additional mental health problem. Among the children who no longer have ADHD, nearly 50 percent also have at least one other significant mental health problem. So in sum, what it suggests is that it’s really time to re-conceptualize ADHD for what it is: a chronic medical condition that begins in childhood and for most individuals continues to have some impact into adulthood.
What were some of the other mental health issues that were observed in those who were diagnosed with ADHD as children?
The most common ones are alcohol and other drug abuse and addiction, depression, anxiety and anti-social personality disorder. Those were the top four.
If you were to look at ADHD as a chronic medical condition, what would make it different from the way we are treating it right now?
First of all, our tendency has still been to trivialize this condition and really to think of it as primarily an annoying childhood behavior problem, and in fact what we need to be doing is to start organizing systems of care that are based on an understanding of the premise of ADHD. That includes insurance coverage, which unfortunately really severely limits our ability to do comprehensive initial assessments to identify the very conditions that we know are associated with the highest risk for an adverse outcome.
But typically, it’s my understanding that, even now if a child gets ADHD — and many folks say now children are over-diagnosed with ADHD — they’re given medication. Is that enough?
First of all I would have to disagree with the issue of over-diagnosis. There are certainly children who may be inappropriately diagnosed either by making a diagnosis or, probably more often, by not making a diagnosis when it exists. It’s a question of limited access to quality assessments to make accurate diagnoses.
But once they get the diagnosis, would there be a difference in treatment then or would it still be medication and maybe some therapy?
There are very effective treatments that include medications, such as stimulant medications, but the treatment for many children does not continue long enough. It’s quite typical, for example, for children to be treated when they’re younger and then as they get older and move into adolescence, to drift away from careful follow-up and treatment and that’s the very point in their life when they begin to be at greatest risk for some of the most concerning outcomes.