Further Outpatient Care

Regular follow-up is needed long-term for patients with attention deficit hyperactivity disorder (ADHD). Like diabetes or hypertension, ADHD is not an illness for which one can hand the patient a prescription for pills and assume recovery is automatic with the medication.

Further Inpatient Care

Psychiatric hospitalization is indicated if the person becomes suicidal or homicidal.

Prognosis

Childhood ADHD may confer a higher risk of diagnosis with conduct disorders and substance abuse into adolescence and adulthood. These may be primary coexisting disorders or disorders secondary to untreated or undertreated ADHD.

Klein and colleagues looked at 135 male youths with ADHD free of a conduct disorder and another group of 135 males without ADHD in a 33-year longitudinal study. The youths with ADHD did not have increased anxiety or mood disorders in adulthood, but they did have more divorces; higher rates of antisocial personality disorder, substance use disorders, and ongoing ADHD; and worse educational, occupational, economic, and social outcomes. The authors concluded that beginning in adolescence, ADHD predicts significant disadvantages that last well into adulthood. Extended monitoring and treatment of ADHD remains an important aspect of care.^[61]

Most children with ADHD have relatively good psychiatric outcomes once they reach adulthood.

At least 15-20% continue to have full ADHD as adults, and as many as 65% may continue to have problematic symptoms of ADHD that interfere with full realization of academic or work potential.

ADHD can be comorbid with the following conditions:

Other developmental learning disorders
Conduct disorder or oppositional defiant disorder
Bipolar disorder
Tourette syndrome
Pervasive developmental disorder
Mental retardation

When evaluating a patient with any of these disorders, special care should also be made to evaluate for ADHD thoroughly. ADHD, like bipolar disorder, is readily treatable.

ADHD is a heterogeneic disorder that carries significant comorbidity. Symptoms consistent with ADHD can present as other disorders, or these signs and symptoms could be a precursor in childhood to later disorders such as bipolar disorder or schizophrenia.

The diagnosis of ADHD in young children results in the risk of depression and suicidal behavior adolescence. The depression and suicide attempt risk occur 5-13 years following the diagnosis. Being female, having been exposed to maternal depression, and having other symptoms leads to an even higher risk for depression and suicidal behavior.^[62]

Patient Education

The educational requirements of these patients and their family members are high. Family members include parents and siblings of children, spouses and children of adults, and grown children of elderly patients. Encouragement of medication use, education on time structuring and behavioral control, social skill training, and frequent cognitive redirecting is needed.

For patient education resources, see the Mental Health and Behavior Center, as well as Attention Deficit Hyperactivity Disorder.

In addition there is http://www.webmd.com/add-adhd/default.htm

Some useful Web sites are as follows:

WebMD, ADD and ADHD Health Center
National Institute of Mental Health, Attention Deficit Hyperactivity Disorder (ADHD)
Centers for Disease Control and Prevention, ADHD
National Institute of Neurological Disorders and Stroke, Attention Deficit-Hyperactivity Disorder Information Page
The Mayo Clinic, Attention-deficit/hyperactivity disorder (ADHD) in children
In addition, the CDC support the National Resource Center (NRC) on AD/HD: A Program of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). The NRC is a national information resource center dedicated to providing evidence-based information about ADHD to the public. If you have a question about ADHD for yourself, your child, or a family member, please contact the NRC. Call 1-800-233-4050 to speak with a knowledgeable health information specialist.

Questions

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