Hyperactivity, known formally as Attention Deficit Hyperactivity Disorder, or ADHD, is the leading psychiatric diagnosis in American children. Experts ha long considered it an ephemeral nuisance, more akin to chicken pox than to high blood pressure, but cases like Roy’s are now putting that notion to rest. Clinicians are learning to recognize ADHD in adults, and researchers are discovering that people deemed hyperactive in childhood often suffer lifelong consequences. Last week brought some of the most sobering evidence to date. In a new study, researchers in New York found that when hyperactive kids reach adulthood, they’re disproportionately uneducated, underemployed and plagued by mental problems. “ADHD is a subtle disorder,” says Russell Barkley, director of psychology at the Worcester medical center. “But over years, its impact can be awful.”
No one knows what causes ADHD, or even whether it has a single cause. Like many psychiatric problems, it’s simply a collection of symptoms that some people exhibit more than others. Experts estimate that ADHD affects 10 million Americans, and that three quarters of the sufferers are males. Though some people get their first diagnosis as adults, the problem usually shows up early in life. The classic case involves a school kid who can’t stay in his seat, wait his turn, follow instructions or stick with a chore. if diagnostic tests confirm that the child is markedly more restless and impulsive than other kids his age and more easily distracted from mundane tasks, a psychologist may deem him hyperactive. The cutoff between exuberance and pathology is purely a matter of convention; who qualifies for the diagnosis depends on how the scale is set. Yet ADHD is more than a meaningless label. As several studies have shown, kids who reside on opposite sides of the threshold tend to have very different lives.
One of the largest such studies is still underway. In the mid-1970s researchers at Long Island Jewish Medical Center and the New York State Psychiatric Institute started tracking two groups of preadolescent boys–103 hyperactives and 100 normal controls–to see how they would fare. All the kids were white and middle class, but by late adolescence their paths had diverged sharply. Sixteen percent of those who had been deemed hyperactive (versus 3 percent of the controls) were abusing drugs, and 27 percent (versus 8 percent of the controls) had been diagnosed as having antisocial personalities. By their early 20s, the kids from the hyperactive group were twice as likely to have arrest records, five times as likely to have felony convictions and nine times as likely to have served time in prison.
In the latest update, psychologists Salvatore Mannuzza and Rachel Klein describe the subjects at an average age of 26, and the same themes emerge. According to their new study, published last week in the Archives of General Psychiatry, the 91 childhood hyperactives still responding to researchers’ questions have lagged behind the control group both at school and at work. Fully a quarter of them (versus 2 percent of the controls) dropped out of high school, and only 12 percent (versus 50 percent of the controls) have finished college. Though more than a fifth of the controls have become scientists, lawyers, stockbrokers or accountants, only 4 percent of the childhood hyperactives have cracked those professions. And though their psychiatric ills have diminished somewhat, they’re still twice as likely as the controls to suffer from some mental disorder, and four times as likely to abuse drugs.
To people who work with hyperactive children, these unhappy outcomes are no great surprise. Kids who can’t stifle their impulses are at an obvious disadvantage in the classroom. They’re also likely to live with constant rejection by teachers, parents and peers. Some experts believe such experiences help foster a variety of emotional problems. Others suspect that ADHD and its companion disorders are simply different manifestations of a single hereditary defect. In a series of studies, Dr. Joseph Biederman and his colleagues at Massachusetts General Hospital have found that family members of hyperactive children have elevated rates not only of ADHD but of several other problems, including depression, anxiety, antisocial behavior and substance abuse. Biederman suspects that a single gene may predispose some people to all these maladies.
Whatever the force that leads hyperactive kids into trouble, it doesn’t get them all. Since most are spared long-term problems, specialists are now striving to identify the ones in greatest danger and find ways to help them. Studies have assessed an array of possible risk factors, from poor nutrition to low IQ, but only a couple of reliable patterns have emerged. First, the 20 to 40 percent of hyperactives who are cruel and aggressive as children tend to become antisocial adults. Second, the roughly 30 percent of childhood hyperactives who continue to suffer from ADHD as adults fare considerably worse than those who outgrow the condition.
Turning cruel children into nice adults is still beyond the reach of psychiatry, but relieving the symptoms of ADHD is not. Doctors have long used Ritalin, a common stimulant, to treat hyperactive children. Like an amphetamine, Ritalin produces a high in large doses, and it can cause sleeplessness and weight loss. But for reasons not fully understood, it helps control the kids’ impulsiveness. Mounting evidence suggests it can help adults as well. Dr. Paul Wender of the University of Utah Medical Center has treated more than 400 adults with Ritalin and found that they enjoy nearly the same 70 percent response rate as children. “I’m not a drug pusher,” he says. “But if ADHD is a lifelong disease, lifelong treatment may be necessary.” Russell Barkley, the Worcester, Mass., clinic director, claims only a 50 percent success rate in adults, but he’s no less bullish on the treatment. “We can start people on medication,” he says, “and they will call the next day in tears of joy that they’re alive.” Gary Roy is one such patient. “Right after I started the treatment I saw Awakenings’,” he recalls. “I cried and cried because that was how I felt, like I had awakened.” He has since gotten his ham-radio license and become a Civil Defense radio supervisor. The perennial outsider now belongs to a worldwide radio net. Instead of talking incessantly, he mostly listens.
