Another line of thought, proposed by Stephen Hinshaw, a psychology professor specializing in ADHD at U.C.S.F. and U.C. Berkeley, extends the poor impulse control hypothesis. “It’s plausible that there are biological underpinnings of both ADHD and obesity,” he says, “but the more parsimonious explanation from other research is that ADHD portends problems in self-regulation over time.” In other words, adults who once had ADHD might later be able to sit in a chair and refrain from fidgeting, but emotional and physical regulation issues could linger in the form of less-than-ideal eating habits.
“Devastating” long-term consequences
Hinshaw’s own work with ADHD in girls and other research into long-term outcomes support this idea that the challenges of self-regulation may not fade when the outwardly clinical symptoms of hyperactivity do. His 10-year study of 140 young adult girls who had childhood ADHD found much higher rates of self-cutting, self-burning and suicide attempts in this group than were found in a control group.
Additionally, he says, recent research has found high levels of unemployment and underemployment as well as poorer work productivity among adults who had childhood ADHD than among those who did not. The men with childhood ADHD in the new study also had significantly lower socioeconomic status than did those in the control group, even though the groups had been matched initially for parental socioeconomic status and geography. “ADHD still gets ridiculed in the press—saying it’s a made-up disease or that we just don’t tolerate fidgety kids—but it has really devastating long-term consequences, and we have to take it seriously,” Hinshaw says.
Rising rates of ADHD diagnoses could be related to both improved health care access for more children and possible misdiagnoses due to the inadequate time spent on assessments in pediatricians’ offices. “We need to insist upon a much higher level of diagnosis and evaluation so that we’re really sure that it’s ADHD and not maltreatment or family conflict or normal-range behavior,” Hinshaw says. For those who really suffer from ADHD, this study provides more evidence of the challenges those children will face in adulthood. “ADHD has staying power,” he says, “regardless of whether the symptoms on the surface improve or not.”