Can we predict the long-term outcome of boys with ADHD?

A major challenge has been to identify childhood features that are associated with a favorable vs. unfavorable long-term outcome.

"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.

The study conducted at the Hassenfeld Children's Hospital at NYU Langone Medical Center focused on a cohort of 207 white, middle- and lower-class boys between the ages of 6 to 12 years, who were referred to a psychiatric clinic by their school due to behavior problems. The children in the study, who had to have IQ's of at least 85, exhibited symptoms consistent with the DSM-5 definition of ADHD. The boys participated in three follow-up interviews, in adolescence at mean age 18, in early adulthood at age 25, and in mid adulthood at age 41. At each period, the study evaluated the participants' social and occupational functioning, their overall adjustment, and their educational attainment.

Most of the early characteristics failed to distinguish the poor versus good outcomes. There were two potentially important exceptions. For one, higher IQ levels were related to better function in several domains. Also, the study found that conduct problems in childhood were negatively related to overall adult functioning, educational attainment, and occupational functioning. This finding is remarkable given that none of the children had a conduct disorder when they entered the study. Thus, the finding indicates that even mild conduct problems may predict relatively low educational, occupational, and overall achievement later in life. Interestingly, the authors found that boys who had concrete educational goals for their future in adolescence had better overall functioning in adulthood.

Clinicians still face many difficulties in identifying early predictors of functional outcomes among children with ADHD. However, the results provide some clinical guidance: "These results suggest that we should not overlook even relatively mild problems of conduct among children with ADHD, and that early interventions might be considered for children with a normal, but low, IQ," said Dr. Ramos-Olazagasti. "These findings also show promise in highlighting the importance of goal setting and providing a rationale for examining young people's attitudes toward their future."