The effect of ADHD on the life of an individual, their family, and community from preschool to adult life

Attention deficit/hyperactivity disorder (ADHD) is a chronic, debilitating disorder which may impact upon many aspects of an individual's life, including academic difficulties, ¹ social skills problems, ² and strained parent-child relationships. ³ Whereas it was previously thought that children eventually outgrow ADHD, recent studies suggest that 30-60% of affected individuals continue to show significant symptoms of the disorder into adulthood. ⁴ Children with the disorder are at greater risk for longer term negative outcomes, such as lower educational and employment attainment. ⁵ A vital consideration in the effective treatment of ADHD is how the disorder affects the daily lives of children, young people, and their families. Indeed, it is not sufficient to merely consider ADHD symptoms during school hours-a thorough examination of the disorder should take into account the functioning and wellbeing of the entire family.

As children with ADHD get older, the way the disorder impacts upon them and their families changes (fig 1). The core difficulties in executive function seen in ADHD ⁷ result in a different picture in later life, depending upon the demands made on the individual by their environment. This varies with family and school resources, as well as with age, cognitive ability, and insight of the child or young person. An environment that is sensitive to the needs of an individual with ADHD and aware of the implications of the disorder is vital. Optimal medical and behavioural management is aimed at supporting the individual with ADHD and allowing them to achieve their full potential while minimising adverse effects on themselves and society as a whole.

The aim of this paper is to follow the natural history of this complex disorder through preschool years, school life, and adulthood and to consider its effect on the family, the community, and society as a whole. In addition, comorbidities and healthcare costs are examined.

THE PRESCHOOL CHILD

Poor concentration, high levels of activity, and impulsiveness are frequent characteristics of normal preschool children. Consequently, a high level of supervision is the norm. Even so, children with ADHD may still stand out. In this age group there is often unusually poor intensity of play and excessive motor restlessness. ^{8, 9} Associated difficulties, such as delayed development, oppositional behaviour, and poor social skills, may also...