Left untreated, persons with ADHD have more than three times the incidence of a substance use disorder diagnosis than does the population at large. Biederman and his colleagues6 demonstrated in a prospective, longitudinal study that the risk of substance abuse by ADHD individuals remains equal to that of controls until 15 years of age. Between the ages of 15 and 27, however, the rate of substance abuse severe enough to be diagnosed as a substance use disorder triples (47% vs. 15%). Far from predisposing to later drug abuse, treatment of ADHD with stimulant class medications actually protects against the development of substance use disorders (SUD’s). If the person with ADHD is consistently treated with stimulant class medication, the risk of developing SUD is the same as the general population.
In one of the longest longitudinal outcome studies done thus far, Barkley7 has followed a cohort of ADHD children into their mid-twenties. Their sexual lives give a grim look at the impact of untreated ADHD. At the most recent follow-up more than half of the ADHD group had been tested for HIV disease. No one in the matched control group had been tested. Of the 43 children born to participants in the study 42 had been born to the ADHD group. Perhaps the most disturbing finding was that 54 percent of these parents had already lost custody of their children.
ADHD has a high comorbidity with Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD).8 this comorbidity coupled with an impulsive, high-risk lifestyle puts ADHD individuals at risk for legal problems of all sorts. A long-term study in New York found that people with ADHD were more likely to be arrested (39% vs. 20%), and when they are arrested they are more likely to be convicted (28% vs. 11%) and much more likely to be jailed (9% vs. 1%) than were their non- ADHD peers.9
BELIEF VS EVIDENCE
There are a number of beliefs (or myths) held by many clinicians and laypersons and perpetuated by the lay media.
See if you can figure out which of the following statements are true:
- ADHD doesn’t really exist but is just an excuse for bad behavior
- Only males are affected
- This is just “normal boy” behavior
- These kids are just spoiled and need discipline
- ADHD is outgrown by adolescence in most individuals10
- ADHD is over-diagnosed and over treated
- Teachers and parents want the child medicated so he won’t be a problem
- The medications are powerful, dangerous and addictive drugs which can stunt growth
Not one of these assumptions or beliefs is true and there is an abundance of evidence to the contrary.