Attention deficit disorder in young people

Study suggests untreated attention deficit disorder can stick with people

Brown University researchers say attention deficit disorder isn't something that is outgrown; it can persist into adulthood. The outcome for children with ADD is best when parents advocate an individualized combination of treatments.

PROVIDENCE, R.I. -- Listen carefully if your child has an attention deficit disorder.

A new study by researchers at Brown University compared teen-agers who had been diagnosed as children with one of two problems: attention deficit disorder (ADD), and learning disability. Their study shows that youngsters diagnosed with ADD in the 1980s - before schools offered services for them - grew into teens who fared worse in school and more poorly in social situations than teens who had been diagnosed as learning disabled.

Youngsters diagnosed as learning disabled may have received more educational help than ADD children in the 1980s. This may account for the differences in school performance between the two groups in the study.

ADD is considered a childhood disease marked by inattentive, impulsive and hyperactive behavior. But this study's comparison of the fates of attention-deficit children to those with learning disabilities suggests that ADD is not a malady that yountsters will outgrow without treatment. Instead, ADD may be a condition that sticks with people as they age, hampering academic and social skills and slowing adjustments into both adolescence and adulthood.

In the study, Brown University researchers found that the grade point averages of 48 ADD teens were significantly lower than those of 37 adolescents diagnosed in childhood as learning disabled. The lowest averages belonged to ADD teens considered conduct problems as children.

Problems with schoolwork often begin to show up for ADD students in middle school or high school. "Those problems may worsen in junior or senior high school because the amount of writing and homework dramatically increases," said Ann Marcotte, one of the study's authors. Marcotte is clinical assistant professor in the Department of Psychiatry and Human Behavior at Brown and a member of the pediatrics department at the Memorial Hospital of Rhode Island.

The study also showed that ADD teens had more trouble than the learning disabled group with social skills such as dating and getting along with peers. ADD teens also had lower levels of communication abilities such as writing a letter or addressing an envelope. Those who fared worst in social skill levels were the 18 ADD teens with conduct disorders. They had the lowest abilities to get along with others and the greatest behavioral and emotional difficulties.

On a positive note, the researchers found lower levels of psychiatric problems among the ADD teens compared to ADD young people profiled in previous studies. This may be because other researchers, based in psychiatric clinics, deal with young people who have more severe behavioral and psychiatric symptoms, biasing the outcomes of those earlier studies, said Julie Wilson, the study leader, instructor in the Department of Family Medicine and member of the pediatrics department at the Memorial Hospital of Rhode Island.

The study appears in the current issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Boys and girls in the study were evaluated between ages 6 and 12 and again at ages 14 to 18. At least five years elapsed between evaluations.

"Our intent is not to alarm parents," Wilson said. "Although ADD children today may get some educational assistance in school, programs vary greatly among schools. ADD children still need more help for their socialization skills both during the school day and in the afternoon."

Only in the last few years have some schools begun to recognize that an ADD diagnosis may require a remedial education strategy, and not all schools offer assistance to ADD youngsters.

"The outcome for children with ADD is best when their parents are advocates for a range of treatments," Wilson said. "It's not hopeless if your child has an attention deficit disorder. However, you need to be involved if your child is diagnosed with ADD."

Most ADD youngsters in the study received some sort of medication to address their disorders. However, Wilson and Marcotte said that medication offers only short-term benefits. They suggest that an ADD child also receive an individualized combination of several treatments. This may include individual or family therapy, educational assistance for reading, writing and studying, and training to learn after-school socialization and communication skills.