Girls With Childhood ADHD as Adults: Cross-Domain Outcomes by Diagnostic Persistence

Objective: To ascertain adult outcomes in 10 domains reflecting symptomatology (internalizing, externalizing, self-injury, substance use), attainment (education, employment), and impairment (health, social, driving, overall) as a function of both childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and persistence of ADHD symptoms across time. Method: We prospectively followed 140 grade-school-aged girls with rigorously diagnosed childhood ADHD and 88 age- and ethnicity-matched comparison girls for 16 years. Outcome measures were obtained via self- and parent-report questionnaires, interviews, and objective tests. Results: Childhood ADHD, whether it remitted or persisted, was a pernicious risk factor for a limited number of poor outcomes, including low educational attainment, unplanned pregnancy, body mass index (BMI), and clinician-rated impairment. Childhood ADHD that persisted over time, whether completely or partially, was associated with a number of additional detrimental outcomes in the externalizing, internalizing, self-injury, occupational, social, and overall impairment domains. Finally, in this all-female sample, ADHD was not associated with objective measures of employment, substance use, or driving outcomes. Conclusions: We discuss the considerable impairments accruing from both childhood-limited and adult-persisting ADHD, with major implications for the health and well-being of females with this neurodevelopmental disorder. What is the public health significance of this article? Although a minority of girls no longer meet symptom criteria for ADHD in adulthood, they still show substantial educational underachievement over time, as well as increased body mass index and much greater likelihood of at least 1 unplanned pregnancy. Among girls, childhood ADHD that persists into adulthood is associated with these educational and health problems (increased body mass index and unplanned pregnancy) as well as substantially increased risk for internalizing problems (e.g., anxiety and depression), externalizing problems (e.g., aggression and defiance), self-injury, and occupational impairment. On average, however, girls with childhood ADHD are not at increased risk for later substance use problems, at least in the present sample.