Section III: Population Dynamics

Table 1. Select summary of characteristics and associated problems of ADHD through the lifespan (Continued)
Authors	Major research findings
	Early and Middle Childhood (6-12 years)
Barkley (1998a); Barkley et al. (1990)	40-60% develop ODD 25-40% likely to show signs of CD 25% fight with peers 60-80% placed on a trial of stimulants 50% or more have had individual or family therapy 30-45% formal special education
Barkley (1998a)	Mild cognitive impairments (i.e., working memory, planning, goal-directedness) Deficient academic achievement Delayed motor coordination (52%) Adaptive functioning (1030 points below normal) Increased risk for accidental injuries Delayed onset of language or impaired speech Deficient rule-governed behavior Greater variability of task performance Poor self-regulation of emotion and low frustration tolerance Disruptive classroom behavior
	Late Childhood and Adolescence
Bagwell et al. (2001)	Persistent ADHD compared with non-ADHD youth (13-18 years of age) Parents report: Fewer friends, higher rates of peer rejection, 11% of ADHD teens have no close friends (vs. 1% non-ADHD group) Teachers report: greater peer rejection for ADHD teens Presence of childhood aggression lowered self-reports of social competence, peer acceptance; parents report fewer close friendships for ADHD teens Presence of CD: self reports more friends use substances, friends are engaged in less conventional activities; parents report high rates of disapproval of friends (64%) versus ADHD non-CD (38%) and 28% of non-ADHD group
Barkley et al. (1990); Fischer et al. (1990)	Milwaukee study: 8-year followup of boys with ADHD (12-20 years of age) 71.5% continue to meet criteria for ADHD 60% diagnosed with ODD 43% diagnosed with CD 10% dropped out of school vs. 0% of controls 29.3% failed a grade vs. 10% of controls 46.3% suspended vs. 15.2% of controls 10.6% expelled vs. 1.5% of controls ADHD + CD increases risk for expulsion (21.7%), suspension (67.4%), and dropping out (13%) Stolen without confrontation (49.6%), firesetting (27.6%) 80.5% methylphenidate (36 mos.), 3.3% d-amphetamine (1.1 mos.), 19.5% pemoline (2.6 mos.), 1.6% tranquilizer (0.1 mos.), 14.6% other psychotropic drugs (0.4 mos.)1 63.4% psychotherapy (16.3 mos.), 49.6% family therapy (7.2 mos.), 32.5% in learning disability classes (65.5 mos.), 35.8% in behavior disorder classes (59.1 mos.), 16.3% speech classes (40.2 mos.)²
Biederman et al. (1996)	4-year followup of boys with ADHD (6-17 years of age) 85% continue to have ADHD 15% remitted (half in childhood, half in adolescence)
Biederman et al. (1998)	Adolescent and childhood ADHD (6-17 years of age) Adolescents higher rates of family history of ADHD Similar number of DSM-III-R symptoms of ADHD at baseline (8.9 for children and 9.0 for adolescents) for both children and teens with ADHD Similar number of DSM-III-R symptoms of ADHD at 4-year followup for both children and teens with ADHD Rates of comorbidity for children versus adolescents with ADHD 42% vs. 25% conduct disorder 54% vs. 44% major depression 46% vs. 35% multiple anxiety 46% vs. 33% oppositional defiant 22% vs. 28% dipolar disorder 3% vs. 40% substance abuse²
Satterfield and Schell (1997)	Adolescents with ADHD + oppositional and conduct disorders (ODD/CD) vs. ADHD with no ODD/CD at greater risk for: Increased arrests; 50% of ADHD had a felony arrest Minor antisocial behaviors including aggressiveness and defiance (indicators of CD)
	Adulthood
Barkley and Gordon (2002)	Milwaukee followup study; ADHD vs. control group (mean age 21-22 years) Begin sexual activity at earlier age (15 vs. 16 years) More sexual partners (19 vs. 7) Teenage pregnancy (38% vs. 4%) Contracted sexually transmitted disease (17% vs. 4%)
Fischer et al. (2002)	Milwaukee followup study: 13-year followup study of ADHD children into early adulthood (mean age 21-22 years) Higher risk for nondrug psychiatric disorders vs. controls (59% vs. 36%) More personality disorders (passive-aggressive, histrionic, borderline, antisocial) and major depression than controls Childhood hyperactivity increases later risk for ASPD Severity of childhood conduct problems + ADHD increases risk for ASPD High levels of both hyperactivity with conduct problems have greater antisocial adult outcomes than either disorder alone
Ingram et al. (1999)	Longitudinal study of children with ADHD into adulthood 7080% meet diagnostic criteria for ADHD in adolescence 60% continue to exhibit various symptoms in adulthood (more social, emotional, and impulsive problems than controls) but fewer meet diagnostic criteria Fewer than 10% are grossly disturbed, requiring psychiatric hospitalization or prison 30-40% show fairly normal functioning
Barkley and Gordon (2002) Murphy and Barkley (1996a, 1996b); Murphy, Barkley, and Bush (2001)	Clinic-referred adults compared to community controls Fired more often (53% vs. 31% controls) Quit jobs more frequently (48% vs. 16% controls) Chronic employment difficulties (77% vs. 57% controls) Higher scores on self-report measures of interpersonal sensitivity and hostility Higher rates of divorce and remarriage, less marital satisfaction
¹ Numbers in parentheses represent duration of treatment. ² Rates for children presented before adolescent rates. Control group had 33 percent substance abuse or dependence. Note: ASPD = antisocial personality disorder; CD = conduct disorders; ODD = oppositional defiant disorder.

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