Predicting Long-Term Functional Outcomes in Boys with ADHD
In the longest follow-up study to date, researchers examined adult outcomes in educational, social, occupational, and overall adjustment in boys with ADHD.
August 8, 2018
In the longest, prospective follow-up study to date of children with attention deficit disorder (ADHD or ADD), researchers found that childhood IQ was a consistent predictor of successful adult function among boys with ADHD. Findings from the study published in Journal of the American Academy of Child & Adolescent Psychiatry showed that childhood IQ predicted better outcomes in educational attainment, occupational rank and functioning, and social functioning.1
“Research shows that children with ADHD achieve lower levels of education, have poorer social functioning, and less success at work than peers without ADHD. Being able to identify indicators of future success early in life is critical to help inform preventive and therapeutic practices,” said lead author María Ramos-Olazagasti, a senior research scientist at Child Trends and assistant professor at Columbia University. A challenge for practitioners has been to identify childhood characteristics that would predict subsequent performance in school, work, as well as social adjustment.
Thus, the goal of the study was to identify the factors that are predictive of adult functioning. Conducted at the Hassenfeld Children’s Hospital at NYU Langone Medical Center in New York, the study included 207 white, middle and lower-middle class boys between the ages of 6 to 12 years (mean age 8 years), who were referred to a child psychiatric clinic for behavior problems by their schools. Inclusion criteria were history of behavior problems, increased teacher and parent ratings of hyperactivity, behavior problems at home and school, verbal IQ of at least 85, and English-speaking parents. ADHD symptoms exhibited in the beginning of the study were consistent with the DSM-5 definition.
Researchers, blinded to all previous data, conducted three follow-up interviews: at mean age 18 (range 16-22; n=195), at mean age 25 (range 22-30; n=176), and at mean age 41 (range 30-47; n=135). At each follow-up, researchers evaluated the participants’ overall function, educational attainment, occupational ranking and functioning, and social functioning.
Contrary to researchers’ expectations, very few factors were predictive of adulthood functioningother than childhood IQ, parental socioeconomic status, reading ability, and conduct problems.
Childhood IQ was the most meaningful contributor and was positively associated with several outcomes: higher educational attainment, occupational ranking and functioning, and social functioning. The other two factors that had positive associations with adult adjustment were parental socioeconomic status and reading ability. Interestingly, high educational goals in adolescence were associated with better overall functioning in adulthood.
Conduct problems in childhood were associated with lower levels of overall adult functioning, lower educational attainment, and lower occupational functioning. The finding on conduct problems was “noteworthy” because none of the children with ADHD had comorbid conduct disorder at the beginning of the study.
Predicting the course of children with ADHD remains a challenge for clinicians but the findings from this study provide some clinical guidance and point to areas for future research. Early interventions might be considered for children with a relatively lower IQ. Also, conduct problems should not be overlooked, since even mild levels of conduct problems could indicate future risk. Moreover, while the findings show promise in the importance of goal setting, “replication is needed and future research should explore mechanisms linking educational goal setting and adult functioning in children with ADHD.”
1Ramos-Olazagasti MA, Castellanos FX, Mannuzza S, Klein RG. Predicting the adult functional outcomes of boys with ADHD 33 years later. J Am Acad Child Adolesc Psychiatry. 2018;57(8):571-582.e1. doi: 10.1016/j.jaac.2018.04.015