Consequences of Non-Treatment With ADHD

CONSEQUENCES OF NONTREATMEANT

Failure to manage ADHD could mean serious repercussions later

As this chronic condition persists, it continues to negatively impact many areas of life.¹

Repercussions of Nontreatment

A serious and complex disorder like ADHD requires a comprehensive treatment approach

ADHD is a chronic condition with functional repercussions that increase in severity if left untreated as a child grows into adulthood.

In addition to disease comorbidity, having ADHD as a child increases future risk for:

Financial issues

Employment and economic status are generally lower in adults who had ADHD as children; this may be due to impulsivity in financial management and difficulties adjusting to a workplace environment.²

Motor vehicle accidents

Individuals who had ADHD as children are more likely to be in 2 or more car accidents and/or have a suspended driver’s license as adults.²

Substance use disorder

Alcohol and drug use both occur at higher rates in adolescents and adults with ADHD.²

Legal issues

One longitudinal study of a population with childhood ADHD found that nearly half had been arrested or served some time in jail.²

Clinical guidelines recommend evidence-based multimodal treatment intervention as soon as a diagnosis of ADHD is made^3,4

This includes a combination of pharmacological and nonpharmacological therapies^3,4

Treatment interventions vary based on the individual needs of the patient, as well as the patient’s age and severity of symptoms.³

ADHD is always present

Image: Doctor Talking To Parent And Child

Treating a “24/7” disorder

ADHD is always present. Parents frequently ask about drug “holidays” for their child who takes medications for ADHD. This may be because parents^5,6:

Feel that when school is not in session (eg, over summer break), there is less need for medication coverage of behavioral symptoms
May want the opportunity to monitor their child’s symptoms more closely over the course of a few days or weeks without medication

However, it should be emphasized that ADHD is a complex, chronic disorder; ineffective treatment may exacerbate not only core symptoms of ADHD, but the comorbidities that commonly occur.^7-9

Childhood
ADHD Linked to Personality Disorders

There is an observed link between childhood ADHD and the development of certain personality disorders.

Longitudinal data has shown that children with ADHD are significantly more likely to develop personality disorders later in adolescence than those without the condition.¹⁰

One study found that approximately 60% of adults with personality disorders reported severe ADHD symptoms in childhood¹¹

Cluster B personality disorders occur most commonly in adults with ADHD, including¹⁰:

Narcissistic personality disorder¹⁰
Borderline personality disorder^10,12

Cluster B personality disorders share certain clinical features with ADHD, including¹²:

Disorganization

Emotional and
cognitive
dysregulation

Social
intrusiveness

However, individuals with ADHD do not typically display the fear of abandonment or self-harm tendencies often seen in Cluster B personality disorders¹²

Different hypotheses have been offered to explain the overlap between ADHD and personality disorders^10,12

Personality disorders may be seen as a natural outcome of ADHD in a certain segment of the population
It has been suggested that ADHD causes stress and distortions in important social relationships, leading to the eventual development of personality disorders
A more controversial theory is that, given their high degree of symptom similarity, ADHD and certain personality disorders may represent different manifestations of the same disorder

ADHD has been shown to convey a higher risk for antisocial behavior seen in conduct disorder (truancy, criminality, defiance of authority)—particularly if ADHD symptoms are severe or persist into adulthood.²

A meta-analysis of longitudinal data demonstrated significant linkages between ADHD and impulsive or risky social behaviors, including:

Difficulty maintaining financial stability²
Risky sexual behavior²

Key Takeaways

Undertreated ADHD can have significant, negative downstream effects
ADHD requires a multimodal approach and adherence is key^3,4
There is an observed link between childhood ADHD and serious personality disorders^10,12

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REFERENCES

Shaw M, Hodgkins P, Caci H, et al. A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment. BMC Medicine. 2012;10:99:1-15.
Barkley RA, Fischer M. The Milwaukee longitudinal study of hyperactive (ADHD) children. In: Hechtman L, ed. Attention Deficit Hyperactivity Disorder: Adult Outcome and Its Predictors. New York, NY: Oxford University Press; 2016:63-104.
Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement Management, Wolraich M, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents: Supplement. Pediatrics. 2019;144(4):1-43.
Hervás A, de Santos T, Quintero J, et al. Delphi consensus on attention deficit hyperactivity disorder (ADHD): evaluation by a panel of experts. Actas Esp Psiquiatr. 2016;44(6):231-243.
Felt BT, Biermann BE, Christner JG, et al. Diagnosis and management of ADHD in children. Am Fam Physician. 2014 Oct 1;90(7):456-64.
Briars L, Todd T. A review of pharmacological management of attention-deficit/hyperactivity disorder. J Pediatr Pharmacol Ther. 2016;21(3):192-206.
Brown TE. Developmental complexities of attentional disorders. In: Brown TE, Ed. ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults; Arlington, VA: American Psychiatric Publishing Inc; 2009:3-23.
Koolwijk I, Stein DS, Chan E, Powell C, Driscoll K, Barbaresi WJ. “Complex” attention-deficit hyperactivity disorder, more norm than exception? Diagnoses and comorbidities in a developmental clinic. J Dev Behav Pediatr. 2014;35:591–597.
Banaschewski T, Becker K, Dopfner M, Holtmann M, Rosler M, Romanos M. Attention deficit/hyperactivity disorder. Dtsch Arztebl Int. 2017;114(9):149-159.
Miller CJ, Flory JD, Miller SR, Harty SC, Newcorn JH, Halperin JM. Childhood ADHD and the emergence of personality disorders in adolescence: a prospective follow-up study. J Clin Psych. 2008;69(9): 1477-1489.
Fossati A, Novella L, Donati D, Donini M, Maffei C. History of childhood attention deficit/ hyperactivity disorder symptoms and borderline personality disorder: a controlled study. Compr Psychiatry. 2002;43:369-377.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Publishing, Inc.; 2013.