Course and prognosis

AD-HKD can be identified reliably in preschool-aged children, at which time it may be associated with marked impairment, aggression, and language delay. (1.03) Although preschool-aged children are referred for clinical assessment, most cases are referred after children start school.

Originally, AD-HKD was thought to be a largely transient phenomenon. In general, there is a tendency for symptoms, especially restlessness, to diminish when children reach adolescence, although inattentiveness and impulsiveness are more persistent. (1.04) It is now clear that the disorder persists into adolescence in half or more of the affected persons seen in clinics, and into adulthood in half or more of adolescent cases. ^l05.,.!06,and 107)

In many cases, AD-HKD has effects on these children that persist throughout their adolescence and adulthood. Compared with their non-AD-HKD peers, previously affected persons are at approximately five times greater risk for substance use (tobacco, alcohol, illicit drugs), (1°®) antisocial behaviour (arrests, incarceration, aggression, trouble with the law, admission to juvenile facilities), and other psychiatric disorders such as depression and anxiety. (109) Academic and educational problems persist into adolescence; by the time they are adults, hyperactive children have completed significantly less schooling and hold lower-status jobs than their non-hyperactive peers.(39) Even those who no longer meet the criteria for AD-HKD in adolescence are at increased risk for substance abuse and antisocial disorders, suggesting the persistence of some residual or latent deficit. (110)

Poor outcome in adolescence and young adulthood is more likely when the affected child is living in adverse psychosocial circumstances (e.g. poverty, overcrowding, hostility in the parent-child relationship), (!11 or has parents with AD-HKD or other psychiatric disorders. The outcome is also worse when the AD-HKD symptoms are severe and persistent, and when the child exhibits comorbid conduct, or a language or learning disorder in his or her early development. (1!2) Problematic social interactions are a major determinant of a poor outcome in adolescence. ^il1) Nevertheless, the AD-HKD itself increases the risk of a poor outcome, even when due allowance is made for the associated risk factors. (!13)

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