Discontinued Treatment of ADHD Could Impact Emotional, Social Well-Being, Study Finds

Oct. 16, 2012 — -- Young boys who discontinue treatment for attention deficit hyperactivity disorder (ADHD) are featured in a new study that many experts say highlights the importance of proper and continued treatment.

An average of 9 percent of children ages 4 to 17 are diagnosed with ADHD each year, according to the U.S. Centers for Disease Control and Prevention. Considered one of the most common childhood disorders, the condition is defined by over-activity, and difficulty focusing and controlling impulsive behaviors.

The study, published Monday in the Archives of General Psychiatry, followed nearly 300 boys living in New York City for 33 years. Half of the participants were diagnosed with ADHD during childhood but stopped taking medications for their treatment by the time they were enrolled. The men with ADHD were recruited for the study during childhood by a teacher and either a parent or psychiatrist. The men without ADHD were selected because medical records showed no signs of behavioral problems.

The men with ADHD were seven times more likely to drop out of school, and made on average $40,000 less per year than their non-ADHD counterparts. They were more than twice as likely to be divorced. Some 16 percent of the men with ADHD also had a form of personality disorder compared with none in the non-ADHD group. And 36 percent of the men with ADHD had gone to prison at least once, compared with only 11 percent in the non-ADHD group.

"The difference was surprising," said Rachel Klein, Fascitelli Family Professor of Child and Adolescent Psychiatry, NYU Child Study Center at NYU Langone Medical Center, and author of the study.

"We want the best for all kids," said Klein, adding that a majority of the men with ADHD did go on to live productive lives, but a smaller proportion of the group fared worse than those without ADHD.

"Overall the picture is not great," she said.

The study suggests that stopping ADHD treatment too early may hurt the social and emotional wellbeing of some men decades into their diagnosis.

"We don't know the outcome if they were still kept on treatments," said Klein. "The hope that if we kept treating them, these outcomes would not happen, but we don't know that for certain."

The study did not look at whether staying on treatment would have prevented the negative outcomes, but previous studies suggest that many individuals treated for ADHD appropriately fare better in society than those without the condition.

"The information will be helpful when counseling parents about the importance of treating ADHD with an aim to avoid the outcomes listed in the [study]," Dr. Anne Francis, a pediatrician with the Elmwood Pediatric Group in Rochester, N.Y.

However, This latest study may have overestimated how severe the effects may be in the long run. The men diagnosed with ADHD were enrolled in the study before they were teenagers, while those without ADHD were enrolled around age 18 and were only included if they did not have problems at school.

The gap between the two groups in enrollment, "would likely eliminate most kids with learning disabilities, substance abuse issues, lower IQ, antisocial personality disorder," among the group without ADHD, said ABC News chief health and medical editor, Dr Richard Besser.

"It is an unfair comparison," said Besser.

The study would have provided a more accurate comparison if both groups were enrolled at around the same age and the boys without ADHD were chosen regardless of whether they had problems in school, according to Besser.

Still, Klein's study does add to the question of whether continued ADHD treatment would have helped some of the boys with ADHD into adulthood.

The study comes at the heels of another by researchers in London also released Monday finding that children with ADHD who took stimulants reported feeling better and in control of their behavior.

Stimulants such as Ritalin, Adderall, and Strattera, are considered among many physicians the most effective treatment for ADHD.

"Not everyone needs medication, but when a good assessment is done, these medications are among the safest, not just in psychiatry, but all of medication," said Dr. David Rosenberg, professor of psychiatry at Wayne State University in Detroit, Mich. Rosenberg was not involved in either study.

But prescribing stimulants to children has been a growing controversy among experts and parents. Many who oppose say children who take the medication turn sluggish and even seemingly robotic.

The findings from both studies may underscore the importance of managing ADHD through proper treatment for the individual child, some experts said.

Since each child responds differently to treatment, "the best predictor of a good response to treatment is making an accurate diagnosis," said Rosenberg.

"When it is misdiagnosed, not diagnosed or not treated, the consequences to the child and whole family can be catastrophic," he said.