• Posted June 6, 2023

Kids With ADHD, Behavior Issues Have Poorer Trajectories as Adults

Kids with poor impulse control -- a common characteristic of ADHD -- may be at higher risk for health, social and criminal problems as adults, a new study indicates.

Researchers found that having attention and behavior problems in childhood was linked to less money, lower educational achievement and poorer health in adulthood when compared to those who could regulate their behavior as kids.

"The ability to control one's attention and behavior is a fundamental life skill, which supports well-being and adjustment in a range of areas," said lead researcher Andrew Koepp, from the human development and family sciences department at the University of Texas at Austin.

"These findings reinforce the idea that characteristics and experiences of individuals in childhood affect them well into adulthood, and that skills learned in childhood are foundational for success in life," Koepp added.

The study is a "conceptual replication" of a New Zealand study published in 2011 that obtained similar results.

For the new study, Koepp and his colleagues collected data on over 15,000 people who took part in the U.K. National Child Development Study. Participants lived in England, Scotland or Wales, and were born during one week in 1958 and followed through age 42.

The researchers also collected data on nearly 1,200 participants in the U.S. Study of Early Childcare and Youth Development, who were born in 1991 at 10 hospitals across the United States and followed through age 26.

In both studies, participants, their parents and their teachers were surveyed many times about the children's impulsivity, inattention and hyperactivity at home and at school. Some of the more impulsive children had attention-deficit/hyperactivity disorder (ADHD) or other problems. As adults, participants answered questions about their lives, including their education, careers, finances, and physical and mental health.

Both studies found that children with a host of attention problems, including poor impulse control, fared worse as adults in all the categories assessed. The investigators found that attention problems predicted lower educational attainment, and impulsivity problems predicted greater involvement in the criminal justice system.

Koepp's team noted that at what age the behavioral problems occurred didn't affect the risks in adulthood.

"Replication is a hallmark of good science, and this methodologically sophisticated research provides a gold standard on how a replication study should be done," said Esme Fuller-Thomson, director of the Institute for Life Course & Aging at the University of Toronto in Canada.

This study provides robust evidence of the increased vulnerability of children with attention and behavior problems to negative outcomes in adulthood, she said.

"The findings also underline the importance of developing evidence-based interventions to assist children and adolescents with attention and impulsivity issues to help them reach their full potential in adulthood," Fuller-Thomson added.

For concerned parents, it's important to realize that despite this increased risk for negative outcomes, most children with attention and behavioral problems did not have serious problems in adulthood. "For example, 95% of those with attention and behavioral problems in childhood did not have problems with the law. Our own research on Canadian samples indicates that many children with ADHD thrive in adulthood," Fuller-Thomson said.

Dr. Ken Duckworth, chief medical officer of the National Alliance on Mental Illness, said that while poor impulse control can be a factor in adult behavior, the study failed to take into account a more important predictor of adult behavior. Namely, trauma suffered during childhood.

Duckworth cited the 1998 Childhood Adverse Experiences study, which found that being exposed to trauma as a child increased the risk for health problems, addiction and other social consequences.

"Trauma could account for some subset of these kids' behavioral problems," he said.

Although not all kids with behavior problems will have trouble as adults, Duckworth believes that having your child diagnosed and treated early can help.

"You may want to consider a kind of intervention to help with impulsivity," he said. Psychotherapy or dialectical behavior therapy can teach coping skills, Duckworth noted. For kids with ADHD, experts often recommend a combination of behavioral therapy and stimulant medication. Other possibilities include martial arts, which emphasizes self-control, he added.

"If you have an impulsive child, getting an evaluation is a good idea," Duckworth said. "Some of those kids will turn out to have ADHD. Some of those kids will have traumatic experiences."

The report was published June 5 in the journal Developmental Psychology.

More information

For more on impulse control, head to the American Psychiatric Association.

SOURCES: Andrew Koepp, EdM, human development and family sciences, University of Texas at Austin; Esme Fuller-Thomson, PhD, director, Institute for Life Course & Aging, University of Toronto, Canada; Ken Duckworth, MD, chief medical officer, National Alliance on Mental Illness; Developmental Psychology, June 5, 2023