2017 Children’s Mental Health Report

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By adolescence, most youth start pushing for more independence, taking more risks, and challenging adult authority. The teen brain is wired to test limits, in an evolutionary press to separate from parents. Yet children with ADHD often carry this natural tendency to extremes. – Stephen P. Hinshaw and Katherine Ellison

In the teen years, ADHD is linked to impulsive behavior that can result in dangerous risk-taking. Research suggests this is caused by slower development of certain brain regions — and that if teens receive appropriate support and intervention they can cope with the disorder and have few lasting negative effects in adulthood.

  • Teens with ADHD are at risk for school failure, accidents, injury, and even trouble with the law.
    • More than 25% of youth with ADHD repeat a grade, compared with 7% of peers.¹
    • Compared with peers, teens with ADHD are 35% more likely to be arrested, and 25% more likely to be jailed.²
    • Newly licensed drivers with ADHD are 36% more likely to get in a car accident than peers without ADHD.³
    • A study of health insurance records showed that severe injuries like broken bones are three times more likely in adolescents with ADHD, and that were much more likely to have multiple injuries over time.
  • Studies show that the pre-frontal cortex — which is implicated in the development of impulse control — matures later and is less active in children and adolescents with ADHD relative to typically developing peers. Thus, ADHD appears to result in part from slow development of brain systems that naturally inhibit impulsivity.  
  • Analysis of a long-term study comparing girls with ADHD to their typical peers suggests that 22% of girls with ADHD-combined type made at least 1 suicide attempt by the age of 17-24. That’s four times higher than the control group, at 6%. Rates of non-suicidal self-injury (e.g., cutting) were also far higher.
  • Females with ADHD had a 2.5 times higher risk for major depression at adolescent follow-up (65% compared to 21% of controls).
  • Youth with ADHD are 4 times more likely to develop a substance use disorder.¹⁰
  • The symptoms of ADHD often attenuate after adolescence, though risks can remain, particularly for girls.
  • 50% of adolescents with ADHD will no longer have severe emotional or behavioral problems by their mid-20s.¹¹
  • Young adults with ADHD, unless they develop anti-social personality disorder, are at no increased risk for incarceration in adulthood.
  • A recent follow-up study of girls with ADHD in their late 20s found that 42% had unplanned pregnancy, vs. 10% of comparison group, regardless of whether ADHD symptoms persisted into adulthood.¹²

[1] Fried, R., Petty, C., Faraone, S. V., Hyder, L. L., Day, H., & Biederman, J. (2013). Is ADHD a Risk Factor for High School Dropout? A Controlled Study. Journal of Attention Disorders, 20(5), 383-389. doi:10.1177/1087054712473180

[2] Mannuzza, S. & Klein, R.G. (2000). Long-term prognosis in attention-deficit/hyperactivity disorder. Child & Adolescent Psychiatric Clinics of North America, 9, 711-726.

[3] Curry, A.E., Metzger, K.B., Pfeiffer, M.R., Elliott, M.R., Winston, F.K. & Power, T.J. (2017). Motor Vehicle Crash Risk Among Adolescents and Young Adults With Attention-Deficit/Hyperactivity Disorder. JAMA Pediatrics. 171(8), 756–763. doi:10.1001/jamapediatrics.2017.0910

[4] Merrill, R., Lyon, J., Baker, R., & Gren, L. (2009). Attention Deficit Hyperactivity Disorder and Increased Risk of Injury. Advances in Medical Sciences, 54(1). doi:10.2478/v10039-009-0022-7

[5] Dickstein, S.G., Bannon, K., Castellanos, F.X., & Milham, M.P. (2006). Neural correlates of attention deficit hyperactivity disorder: an ALE meta-analysis. Journal of Child Psychology and Psychiatry, 47(10), 1051-62. doi:10.1111/j.1469-7610.2006.01671.x

[6] Vaidya, C. J., & Stollstorff, M. (2008). Cognitive neuroscience of Attention Deficit Hyperactivity Disorder: Current status and working hypotheses. Developmental Disabilities Research Reviews, 14(4), 261-267. doi:10.1002/ddrr.40

[7] Casey & Jones (2010).

[8] Hinshaw, S. P., Owens, E. B., Zalecki, C., Huggins, S. P., Montenegro-Nevado, A. J., Schrodek, E., & Swanson, E. (2012). Prospective follow-up of girls with ADHD into early adulthood. Journal of Consulting and Clinical Psychology, 80(6).

[9] Biederman, J., Ball, S. W., Monuteaux, M. C., Mick, E., Spencer, T. J., McCreary, M., Faraone, S. V. (2008). New Insights Into the Comorbidity Between ADHD and Major Depression in Adolescent and Young Adult Females. Journal of the American Academy of Child & Adolescent Psychiatry, 47(4), 426-434. doi:10.1097/chi.0b013e31816429d3

[10] Casey and Jones (2010).

[11] Mannuzza, S. & Klein, R.G. (2000). Long-term prognosis in attention-deficit/hyperactivity disorder. Child & Adolescent Psychiatric Clinics of North America, 9, 711-726.

[12] Owens, E. B., Zalecki, C., Gillette, P., & Hinshaw, S. P. (2017). Girls with childhood ADHD as adults: Cross-domain outcomes by diagnostic persistence. Journal of Consulting and Clinical Psychology, 85(7), 723-736. doi:10.1037/ccp0000217