ADHD: What is the developmental course?

ADHD behavioral characteristics are often seen as early as the preschool years. Some of behaviors associated with ADHD such as "moves too much during sleep" have even been noticed as early as the age of one and a half years old. Some of these behaviors are frequently followed by the appearance of "difficulty playing quietly" and "excessive climbing/running" by the age of three years old. Attentional problems seem to occur after the hyperactive behavior. It may be likely however, that these problems are present early on but are not reported until the child enters school, at which time there is more structure and more environmental and cognitive demands. Hyperactivity and attentional problems seem to emerge gradually and sometimes overlap with some of the emerging oppositional behaviors, which may give the appearance that behaviors are developing simultaneously rather than sequentially. It is now becoming recognized and validated by continuing studies, that hyperactivity and to a lesser extent, attentional problems, decline with many individuals as they continue into their adolescence and early adulthood, although it is now being confirmed that ADHD may continue with attentional, behavioral and emotional problems well into adolescence and adulthood. Usually, adults with ADHD manifest fewer of the hyperactive symptoms but continue with a subjective sense of restlessness, with impairment resulting more often as a result of inattention, disorganization, and frequently impulsive behavior.

Frequently, ADHD behaviors overlap with behaviors defined as more oppositional. The developmental course of these oppositional behaviors show much greater variability. It is important, however, to define these overlapping behaviors and differentiate between oppositional behaviors, conduct disorders and ADHD. During the preschool years, transient oppositional behaviors may be common. However, when the oppositional behavior persists in a severe way beyond the preschool years, the escalation toward more disruptive behaviors may be more likely. Research data continues to identify possibly two developmental trajectories. In most oppositional children who are not physically aggressive, oppositional behavior seemed to peak right around the age of eight years old and then declined thereafter. In a second group of children, oppositional behaviors are then followed by delinquent behaviors. One of the keys to this development may be the early development of physical aggression, with physically aggressive children being much more apt to progress from early oppositional behaviors to much more severe and disabling conduct problems. When children have coexistent ADHD problems, it seems to escalate some of the more severe conduct problems and potentially the development of antisocial personality disorder in adulthood.

The most severe behavioral problems are defined as conduct problems or conduct disorders. Usually severe conduct problems begin appearing in middle childhood. It seems that the progression of conduct problems is usually from rule violations, such as poor school attendance, to aggression toward animals and frequently people. In males, the progression to serious criminal offenses such as mugging, robbery, rape and other serious violations of societal laws usually begin after the age of 13. A different group of children show conduct problems for the first time during their adolescent years without pre-existing oppositional or aggressive behaviors. This group tends to have disorders that are transient and relatively nonaggressive. When conduct disorders are first seen in adolescence without much aggression, the problems tend to diminish as a child enters adulthood. However, if the conduct disorder is present from middle childhood, there is a much greater degree of persistence of aggression through adulthood, frequently resulting ultimately, in a history of arrest, and frequently incarceration.

Various studies indicate that a subgroup of children with ADHD of the hyperactive type show high rates of delinquency and substance abuse during adolescence, which may continue into adulthood. However, it is also very likely that because of the comorbidity of conduct disorders or bipolar disorder, that higher rates of substance abuse are found among adolescents with ADHD. Also, studies indicate that families of children with conduct disorders and bipolar disorders tend to be less stable, have high rates of divorce, and frequently move more often. First-degree relatives (immediate family) of these other disorders have also been found to have higher rates of antisocial behaviors, substance abuse, and depression. The difficulties which these adolescents and adults seem to experience frequently fall into the categories of poor self-esteem, difficulty in relationships with others, holding onto jobs, and assault and armed robbery in a minority of cases. Individuals with childhood symptoms of both ADHD and conduct disorder are frequently overrepresented in this latter group.

Some information from DSM-IV-TR Mental Disorders Diagnosis, Etiology & Treatment

Additional Information and webpage by Paul Susic  MA Licensed Psychologist   Ph.D. Candidate  (Health and Geriatric Psychologist)

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