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There is no question that ADHD can disrupt lives. Kids with the disorder frequently have few friends. Their parents may be ostracized by neighbors and relatives, who blame them for failing to control the child. "I've got criticism of my parenting skills from strangers," says the mother of a hyperactive boy in New Jersey. "When you're out in public, you're always on guard. Whenever I'd hear a child cry, I'd turn to see if it was because of Jeremy."
School can be a shattering experience for such kids. Frequently reprimanded and tuned out, they lose any sense of self-worth and fall ever further behind in their work. More than a quarter are held back a grade; about a third fail to graduate from high school. ADHD kids are also prone to accidents, says neurologist Roseman. "These are the kids I'm going to see in the emergency room this summer. They rode their bicycle right into the street and didn't look. They jumped off the deck and forgot it was high."
But the psychological injuries are often greater. By ages five to seven, says Barkley, half to two-thirds are hostile and defiant. By ages 10 to 12, they run the risk of developing what psychologists call "conduct disorder" -- lying, stealing, running away from home and ultimately getting into trouble with the law. As adults, says Barkley, 25% to 30% will experience substance- abuse problems, mostly with depressants like marijuana and alcohol. One study of hyperactive boys found that 40% had been arrested at least once by age 18 -- and these were kids who had been treated with stimulant medication; among those who had been treated with the drug plus other measures, the rate was 20% -- still very high.
It is an article of faith among ADHD researchers that the right interventions can prevent such dreadful outcomes. "If you can have an impact with these kids, you can change whether they go to jail or to Harvard Law School," says psychologist James Swanson at the University of California at Irvine, who co-authored the study of arrest histories. And yet, despite decades of research, no one is certain exactly what the optimal intervention should be.
TREATMENT
The best-known therapy for ADHD remains stimulant drugs. Though Ritalin is the most popular choice, some patients do better with Dexedrine or Cylert or even certain antidepressants. About 70% of kids respond to stimulants. In the correct dosage, these uppers surprisingly "make people slow down," says Swanson. "They make you focus your attention and apply more effort to whatever you're supposed to do." Ritalin kicks in within 30 minutes to an hour after being taken, but its effects last only about three hours. Most kids take a dose at breakfast and another at lunchtime to get them through a school day.
When drug therapy works, says Utah's Wender, "it is one of the most dramatic effects in psychiatry." Roseman tells how one first-grader came into his office after trying Ritalin and announced, "I know how it works." "You do?" asked the doctor. "Yes," the child replied. "It cleaned out my ears. Now I can hear the teacher." A third-grader told Roseman that Ritalin had enabled him to play basketball. "Now when I get the ball, I turn around, I go down to the end of the room, and if I look up, there's a net there. I never used to see the net, because there was too much screaming."