When ADHD Goes Untreated

Recently a young man named Dan* came to see me after what his parents decided was the last straw. Dan needed some sort of intervention: He had just been in the hospital after stealing and then crashing their neighbor's car. When I met him he was still wearing a cast. His parents warned me their 23-year-old son was an extreme case, and he certainly sounded like a handful, but I was not surprised by his story. As a child psychologist, I am all too familiar with what happens when kids with psychiatric disorders are left untreated.

Dan had attention-deficit hyper activity disorder, and in many ways he was a textbook example. Most people think of ADHD as a condition that makes it hard for kids to pay attention -- or stay in their seats -- at school. But symptoms of ADHD affect kids outside the classroom, too, much more than is widely understood. And the consequences of untreated ADHD, even after kids are finished with school, can have a profound impact on their lives.

Teenagers and young adults with untreated ADHD are often plagued with impulsivity, failure to think through the consequences of their decisions, an inability to finish what they start and poor judgment. The statistics show that they are more likely to abuse alcohol and drugs, more likely to get addicted, more likely to have early (and unprotected) sex, as well as being more likely to be expelled from school. And Dan's car accident? That was no exception either -- people with ADHD are also more likely to get into accidents, and more likely to be seriously injured.

I think about kids like Dan when I hear politicians and other Americans vowing to roll back the health care reform that was signed into law last year, extending insurance coverage to 30 million Americans who are currently uncovered. What these people brooding over the cost of health care don't seem to realize is that not providing care is already costing us. By not offering adequate treatment to the nation's children, even if we don't know it, we are already paying -- in addition to the price the kids are paying.

Decades of research have shown us that kids with untreated ADHD -- not to speak of anxiety, depression and other very treatable conditions -- struggle just to become productive citizens. These kids have a harder time holding jobs, staying married, raising children and even keeping out of jail. As long as we continue to deprive our youth of the mental health care they need, we are sabotaging our own future as well as theirs. We need their talents and ingenuity and intelligence; we need them to step up and become our nation's entrepreneurs, engineers and political leaders.

What explains this cavalier attitude towards the health of our children? I think that some people believe kids are good at rebounding and, left alone, will grow up more or less okay. In my experience, it is true that kids can be remarkably resilient -- but it's wrong to assume that everyone can "grow out" of their psychiatric disorders without help, and go on to fulfill their potential. But many kids with ADHD, and other conditions, just find their problems compounding as they get older. And they are less and less responsive to treatment. Kids with untreated ADHD often become adults with untreated ADHD, and with that comes a whole host of adult-sized problems.

It doesn't have to be this way. Contrast Dan's story with Laurie, another one of my patients. Laurie first came to me at the age of eight. She also had ADHD, and was always getting into trouble for being disruptive. But unlike Dan, Laurie never got around to stealing anyone's car -- she benefited from behavioral therapy with a psychologist and medication prescribed by a psychiatrist. With treatment she was still the bubbliest, friendliest kid in class, only she could turn it off when she needed. She became popular at school because she learned how to use her dynamic personality to its full potential. She thrived during class discussions and later on a debate team, where she was known for her persuasiveness. Now Laurie is in training to be a teacher, and I know her future will be bright.

Laurie's story is a hopeful one, because she was able to get the help that she needed, and she got it when it could do the most good. We know that many psychiatric disorders are treated more easily in childhood, giving us a window of opportunity to drastically change the lives of young people like Laurie and Dan. With treatment, these kids can learn to control their impulsivity, do well in school and have better relationships with their families -- and the families they would like to form as adults.

Making health care a privilege available only to the well-off does America no favors. When we don't help kids get the mental health treatment they need now, we still pay for it later. Only this time we're passing the emotional (and economic) burden on to our kids. Investing in children's healthy development is something we can't afford not to do.

Steven M.S. Kurtz, Ph.D., ABPP, is director of the Selective Mutism Program and senior director of the Center for ADHD & Disruptive Behavior Disorders at the Child Mind Institute. For more on children's mental health, go to the CMI website, which offers parenting advice and a wealth of information on childhood psychiatric and learning disorders.

*All names have been changed.