Prognosis of Attention Deficit Disorder and Its Management in Adolescence
Rachel Gittelman Klein PhD1
1 Professor of Clinical Psychology (Psychiatry), Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, 722 W 168th St, New York, NY 10032
Historical Background
The disorder now called attention deficit disorder with hyperactivity (ADDH), which will soon be renamed attention deficit/hyperactivity disorder, was first delineated by behaviorally oriented pediatricians. Their clinical descriptions are strikingly up-to-date.1,2 Moreover, their early clinical observations of the effectiveness of psychostimulants such as dextroamphetamine and methylphenidate have been amply substantiated by extensive investigations.3
Probably the major shift in our understanding of the disorder has occurred with regard to its prognosis. The standard expectation was that the disorder was self-limited, becoming attenuated with time and eventually remitting completely. Understandably, the clinical management of such children was affected by the perception of its natural history. As a result, psychostimulants were not recommended during adolescence when they were believed to cease to be antihyperactivity drugs and to have the typical stimulating effects well known in adults. As a matter of fact, the stimulants were believed to be potentially dangerous drugs in adolescence because of the expectation that they would lead to euphoria, tolerance, and addiction, in those who had previously been quieted with the drugs. There is now considerable evidence indicating that ADDH is not a maturational disorder that bears a benign prognosis. However, like many observations of astute practitioners, the opinion that children with hyperactivity regularly outgrow theirdifficulties in adolescence was not altogether wrong. The condition is not static; a proportion of affected children do improve, some to the point of being free of significant behaviour problems, but many do not.
