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Open Access Research article

A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment

Monica Shaw1, Paul Hodgkins2*, Hervé Caci3, Susan Young4, Jennifer Kahle5, Alisa G Woods6 and L Eugene Arnold7

Author affiliations

1 Clinical Development & Medical Affairs, Shire Pharmaceuticals, Ltd, Basingstoke, UK

2 Global Health Economics & Outcomes Research, Shire Development LLC, 725 Chesterbrook Boulevard, Wayne, PA, 19087, USA

3 Child and Adolescent Psychiatry Hôpitaux Pédiatriques de Nice CHU Lenval, 57, Avenue de la Californie, F-06200 Nice, France

4 King's College London, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK

5 BPS International, 3830 Valley Centre #705 PMB503, San Diego, CA 92130, USA

6 Biochemistry and Proteomics Laboratory, Chemistry and Biomolecular Science, Science Center, Room 158, Clarkson University, Potsdam, New York, 13699, USA

7 Research Unit on Pediatric Psychopharmacology, 207 McCampbell Hall, Ohio State University, Ohio, 43219-1257, USA

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Citation and License

BMC Medicine 2012, 10:99  doi:10.1186/1741-7015-10-99

Published: 4 September 2012

Abstract

Background

In childhood, attention deficit/hyperactivity disorder (ADHD) is characterized by age-inappropriate levels of inattentiveness/disorganization, hyperactivity/impulsiveness, or a combination thereof. Although the criteria for ADHD are well defined, the long-term consequences in adults and children need to be more comprehensively understood and quantified. We conducted a systematic review evaluating the long-term outcomes (defined as 2 years or more) of ADHD with the goal of identifying long-term outcomes and the impact that any treatment (pharmacological, non-pharmacological, or multimodal) has on ADHD long-term outcomes.

Methods

Studies were identified using predefined search criteria and 12 databases. Studies included were peer-reviewed, primary studies of ADHD long-term outcomes published between January 1980 to December 2010. Inclusion was agreed on by two independent researchers on review of abstracts or full text. Published statistical comparison of outcome results were summarized as poorer than, similar to, or improved versus comparators, and quantified as percentage comparisons of these categories.

Results

Outcomes from 351 studies were grouped into 9 major categories: academic, antisocial behavior, driving, non-medicinal drug use/addictive behavior, obesity, occupation, services use, self-esteem, and social function outcomes. The following broad trends emerged: (1) without treatment, people with ADHD had poorer long-term outcomes in all categories compared with people without ADHD, and (2) treatment for ADHD improved long-term outcomes compared with untreated ADHD, although not usually to normal levels. Only English-language papers were searched and databases may have omitted relevant studies.

Conclusions

This systematic review provides a synthesis of studies of ADHD long-term outcomes. Current treatments may reduce the negative impact that untreated ADHD has on life functioning, but does not usually 'normalize' the recipients.

Keywords:
ADHD; adult; childhood; outcomes; psychiatry; systematic