The adult outcome of hyperactive boys with attention deficit hyperactivity disorder was evaluated by prospective follow-up and direct psychiatric interviews of 85 probands and 73 comparison subjects at the Child and Adolescent Behavior Center, Long Island Jewish Medical Center, New Hyde Park, NY. The patients had been referred at an average age of 7 years, and they were interviewed at a mean age of 24 years. ADHD had resolved, occurring in only 4% of probands and none of the controls. Antisocial personality disorder (12% versus 3%) and nonalcohol substance abuse (12% versus 4%) were significantly more prevalent among patients than controls. Mood disorders in 4% and anxiety disorders in 2% were not significantly different from control prevalences. [1]

COMMENT. Children with uncomplicated ADHD referred to a psychiatric clinic may “outgrow” the symptoms of hyperactivity and inattentiveness but they are at risk of developing antisocial personality and nonalcoholic substance abuse disorders as grown ups. Substance abuse disorders in adults with a history of ADHD have been reported previously, but in association with persistence of ADHD.

Shaffer D, also from the NY State Psychiatric Institute, reported in 1994 that psychoactive substance abuse disorder is commonly associated with diagnoses of ADHD in adults. Biederman J et al, at the Massachusetts General Hospital, found in 1995 that childhood onset ADHD persisting in adults without comorbidity carried a 40% risk of substance abuse disorders, most commonly marijuana. Risk factors for persistence of ADHD into adolescence included 1) a genetic familiality of ADHD, 2) environmental psychosocial adversity and exposure to parental conflict, and 3) comorbidity with conduct, mood and anxiety disorders. (See PPN III, 1997; pp 231-233).

The probands in the NY study did not suffer from the comorbid conduct disorders, common to 30%-50% of children with ADHD seen at psychiatric centers. Follow-up studies of children with ADHD referred to pediatric neurologists would be of interest. Selection of cases based on clinic referral may be important in outcome epidemiological studies of ADHD.