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Possible Complications of ADD/ADHD

By Sanford Newmark, M.D. ; Updated August 14, 2017

Most articles only refer to ADHD in children. This makes sense because most of the diagnosis, treatment and research discussed relates to children. However, children grow up and many of them continue to have ADHD. Obviously, many books could be written about ADHD throughout the life span, so we can touch here on a few major issues.

How many children with ADHD will have ADHD as adults? Studies so far indicate that 30 to 50 percent of children diagnosed as ADHD will retain this diagnosis as adults. This does not mean the rest will be free of ADHD traits, but the severity and impact of these traits will not rise to the level of true ADHD.

ADHD and College Students

Before discussing adult ADHD, it is worth discussing what happens when young adults with ADHD enter college. Those who still have significant ADHD symptoms will still need support and accommodations. Many colleges have very good programs for this, but others do not. The first year of college can be a very difficult time for those with ADHD, as they lose the structure and support of usual family life and are left to organize their lives on their own. Teachers also will expect work to be completed and handed in without reminders or warnings. On the other hand, many ADHD students find it much easier to spend only 45 minutes to an hour in any one class, and have more time on their own. Also, as they take more courses they are truly interested in it becomes easier to focus and pay attention. As one ADHD student said, “I used to take medication and it helped, but now I do what I love and I don’t need medication.”

Medication becomes a trickier problem as well. First, there are many college students without any diagnosis of ADHD who buy medications illicitly in order to improve their ability to focus and raise their grades. It is a reality that these stimulant medications do work even for those without ADHD, much like large doses of caffeine worked for former generations. Unfortunately, it is extremely easy to obtain stimulants illegally on almost any college campus in the country.

A more significant problem on college campuses is the high incidence of abuse of stimulant medication. College students will crush and snort medications like Adderall in order to get high, often mixing them with other drugs. This can lead not only to severe side effects, including psychosis, but to true addictive behavior. It is worth knowing that some ADHD medications, such as Vyvanse and Strattera, cannot be easily abused in this way.

ADHD in Adults

What about ADHD in adults? Adults are one of the fastest-growing groups being diagnosed and treated for ADHD. While some children grow out of their ADHD and have only minor symptoms, others experience continuing difficulties that cause moderate to severe impact on their lives. Employment difficulties, inability to sustain relationships, substance abuse and increased motor vehicle accidents are all possible consequences of adult ADHD. For these adults, medication can be extremely valuable.

On the other hand, in our Internet culture it is very easy for anyone to take an “ADHD quiz,” decide they have ADHD and then ask their doctor for medication. Many primary care doctors are willing to oblige with little diagnostic investigation. One study showed that non-psychiatrists only made an ADHD diagnosis in about a third of the patients for whom they prescribed stimulants. Clearly there is great potential for abuse and incorrect treatment. As with children, serious problems like depression and anxiety can masquerade as ADHD to the untrained eye and result in treatment delay or worsening symptoms.

Although there is less research with adults, I believe that most of the nutrition and lifestyle changes recommended for children will also be helpful for adults with ADHD. Eating well, getting adequate sleep, exercise, yoga and meditation can all have their place in the overall treatment of ADHD, whether or not medications are taken.

Cognitive behavioral therapy, or CBT, is a specific type of psychotherapy that is proven to be of benefit for adults with ADHD. In one very interesting study, adults with ADHD were given CBT and medication or CBT and a placebo. Both groups improved, but the CBT-only group improved just as much as the CBT-plus-medication group. In other words, in that study medication added no benefit beyond that of CBT.

So, as with children, adults should be careful to obtain an accurate diagnosis and use an integrative approach combining nutrition, lifestyle modifications, therapy and medications if necessary to obtain the best possible long-term results.

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