Hyperactive Boys Grown Up

Abstract

What happens when hyperactive little boys grow up? Drs. Klein, Mannuzza, and their research team have been examining this important question for more than three decades. Ramos-Olazagasti et al., published in this issue of JAACAP, provide details regarding early predictors of adult functioning for children with attention-deficit/hyperactivity disorder (ADHD).¹ Starting with publications in the 1980s, the research team reported on a cohort of boys of white ethnicity, 6 to 12 years of age with what we now call ADHD, of average intelligence, but without conduct disorder, and compared them as older adolescents to boys with no childhood behavior problems. This seminal study was among the first to document that a substantial proportion of boys with ADHD continue to show the core symptoms of inattention, impulsiveness, and hyperactivity at a mean age of 18 years as well as worse educational, social, and psychiatric outcomes, including non-alcohol substance use disorder, than do comparison boys, thus setting the stage for continued poor functioning as adults. Since the 1980s, there have been major efforts to develop interventions to address the difficulties for children with ADHD and to avert negative outcomes, including an explosion in the controversial use of psychostimulant medications to treat what many in the lay public still see as active little boys. In recent years, ADHD as a disorder has remained at the forefront of the nature-versus-nurture discussion in the field of neurodevelopmental psychiatry, as researchers strive to uncover the neuroanatomic, cognitive, physiologic, genetic, and epigenetic etiologies of the disorder.