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Adult Outcome of Hyperactive Boys:  Educational Achievement, Occupational Rank, and Psychiatric Status

Salvatore Mannuzza, PhD; Rachel G. Klein, PhD; Abrah Bessler; Patricia Malloy; Maria LaPadula, MA
Arch Gen Psychiatry. 1993;50(7):565-576. doi:10.1001/archpsyc.1993.01820190067007.
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Objective:  The paucity of data concerning the longterm natural history of attention-deficit hyperactivity disorder (ADHD), a common childhood psychiatric disorder, prompted a longitudinal study to investigate the adult sequelae of the childhood disorder.

Design:  Prospective study, follow-up intervals ranging from 13 to 19 years (mean, 16 years), with blind systematic clinical assessments.

Subjects:  Ninety-one white males (mean age, 26 years), representing 88% of a cohort systematically diagnosed as hyperactive in childhood, and 95 (95%) of comparison cases of similar race, gender, age, whose teachers had voiced no complaints about their school behavior in childhood.

Results:  Probands had significantly higher rates than comparisons of ADHD symptoms (11% vs 1%), antisocial personality disorders (18% vs 2%), and drug abuse disor- ders (16% vs 4%). Significant comorbidity occurred between antisocial and drug disorders. Educational and occupational achievements were significantly compromised in the probands. These disadvantages were independent of psychiatric status. We did not find increased rates of affective or anxiety disorders in the probands.

Conclusions:  Childhood ADHD predicts specific adult psychiatric disorders, namely antisocial and drug abuse disorders. In the adolescent outcome of this cohort, we found that these disturbances were dependent on the continuation of ADHD symptoms. In contrast, in adulthood, antisocial and drug disorders appeared, in part, independent of sustained ADHD. In addition, regardless of psychiatric status, ADHD placed children at relative risk for educational and vocational disadvantage. The results do not support a relationship between childhood ADHD and adult mood or anxiety disorders.

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