In previous posts I discussed the problem of ADHD pseudoscience, and the neurological and genetic research on ADHD. In this post I will finish the series on ADHD by explaining what the research says about untreated ADHD.
If you know the research then you know that a subset of children seem to “outgrow” ADHD. And for some parents, this knowledge makes it tempting to forego treatment and wait it out. After all, if ADHD might go away on its own, why treat it? Especially when treatments like medication can have side effects.
Fortunately there is information to help you make a smart choice. ADHD has been a topic of intense interest for so long that research funding has enabled long-term studies of kids who have gone with and without treatment. The collective results show that treatment can work well and that untreated ADHD tends to negatively impact people in three overall areas: mental health, social development, and socioeconomic status (SES).
A consistent finding is that kids with ADHD suffer four overall mental health outcomes: low self esteem, increased risk of depression, anxiety, and an increased risk of substance abuse.
The finding that untreated ADHD leads to low self esteem makes sense when you consider that kids with ADHD are often blamed and punished for their symptoms, which are not under their direct control. Imagine what it would be like to be scolded, punished and teased for sneezing, when you are suffering with hay fever. If you imagine that the hay fever doesn’t go away and lingers for years, you can see how self-esteem can decline given enough time. The long-term failure to control the symptoms and the resulting decline in self-esteem may also help explain the increased risk for depression and anxiety in adolescence and adulthood, and sheds light on the increased risk for alcoholism and substance abuse as an adult. These three mental health problems are likely linked together, each increasing the risk of the other.
This point is worth exploring further because parents often ask me if treating ADHD with medication will put their child at risk for drug abuse. Many studies have been done to look at this issue, and two notable reviews were done, one in the American Journal of Pediatrics and one in the Journal of Clinical Psychiatry. These reviews both found the same thing, and it may be shocking to some parents: treating the symptoms of ADHD with medication appears to reduce the risk of developing a substance abuse disorder as an adult.
A recent meta-analysis (a study of studies) found that along with poor self esteem the other most common long term outcome for kids with untreated ADHD is poor “social functioning,” an umbrella term that encompasses the many skills it takes to make friends and be part of a group. The research consistently shows that children with ADHD often lag behind their peers in the development of social skills that would enable them to make and keep friends.
If you know a child with ADHD you’ll know that the difficulty making friends isn’t for a lack of trying. Kids with ADHD put great effort into developing friendships, but their attempts can go awry when they behave impulsively, disrupt group or class activities, or interrupt kids who are trying to respond to them. Other children begin to recognize that the behavior is inappropriate and shy away. If this goes on long enough the child with ADHD is pushed to the outside of social circles, and if this goes on long enough more severe problems can occur. The same meta-analysis shows that children with untreated ADHD experience more teasing and bullying than other children.
A new study looking at long term outcomes of kids with ADHD who have received evidence-based treatments found that they continue to struggle with social skill deficits even in young adulthood. Although it is just one study, it is an interesting finding that suggests that treatment for ADHD, even the best evidence-based treatment, may not be sufficient to help children overcome the social difficulties associated with ADHD. It suggests that many kids will also need some social skill practice as a complement to ADHD treatment.
A less coherent finding in the research, but still very important, is how untreated ADHD impacts one’s overall prospects for education, career, family, and success in society. The findings suggest that if ADHD goes untreated there is a greater likelihood of poor education, lower income, and increased risk of divorce. Studies have found that young adults with ADHD who have never received treatment are far more likely to have been arrested at least once. Long term education and career achievement is consistently lower for kids with untreated ADHD. The long-term research suggests that letting ADHD go untreated in childhood may set kids up for a cascade of negative outcomes that continue well into adulthood.
There is a temptation that comes with an ADHD diagnosis to simply wait and see if it gets better on its own. However the research shows that this is usually not a good idea. Kids with ADHD who do not receive adequate treatment can experience negative effects that impact their mental health, social functioning, and overall level of success in the long run. The good news is that the research also shows that treatment works. Children who receive adequate treatment have fewer mental health problems and better overall prospects than children who do not. My advice to parents is not to wait, to seek support and evidence-based treatment as soon as there is a diagnosis, not merely to treat the symptoms now, but to prevent bigger problems down the road.
Got questions? Contact Dr. Ron for a FREE 30 minute consult.