The developmental trajectory of unmanaged ADHD is precarious. What is meant precisely by unmanaged is two-fold: (1) that the condition is either undiagnosed and the individual’s symptoms are negatively impacting their everyday life or (2) that the individual has a diagnosis but the symptoms are unmanaged. Unmanaged ADHD normally occurs due to a lack of community or clinical support. The main support services for ADHD are either: local child and adolescent mental health services (CAMHS); educational support at school; social services or any other organisation committed to the health and well-being of a child with ADHD. Unfortunately, there are severe consequences to unmanaged child and adult ADHD and that is why appropriate intervention at critical stages of developmental are crucial to avoid an increased risk of adverse outcomes across a wide range of domains.
Adolescents with ADHD, primarily as a direct result of educational failure are at risk of gravitating towards delinquent peer groups. The enrolment into a delinquent peer group or gang can place individuals at risk for conduct disorder-related, anti-social behaviours and potential development of addictions to nicotine, alcohol, marihuana and cocaine. In adulthood, common problems are found in inter-personal and marital relationships and across both health and occupational domains.
The addictive nature of ADHD is described as the gateway hypothesis and is theorized as a form of self-medicating. More on this is discussed in the Adult ADHD section. Although not impossible, it is a huge challenge to turn-around a teenager once they have reached this point. However, the greatest tragedy is that a young person has reached this point. There is arguably a collective – moral, societal, social, political and educational – responsibility for directly or indirectly allowing a young person’s life to breakdown to this stage because prevention is possible at every step of this precarious but all too common journey into delinquency. Further discussion on this topic can be found in the Education section of the website.
An increasing number of clinical research studies are reporting that a disproportionate number of incarcerated adults meet criteria for ADHD but had not received a diagnosis during childhood. For example, a recent Swedish prison study found approximately 40% of the adults met criteria for ADHD . Comparatively, a study conducted in a women’s prison in Rhode Island found 46% of the inmates met criteria for ADHD . Likewise, an Icelandic study found that 50% of males recently incarcerated met DSM-IV criteria for ADHD . These studies collectively highlight the necessity for increased intervention during childhood. It is a gross failure for the symptoms of child ADHD to be either unidentified or inappropriately labelled but worse still is for the condition to be diagnosed but the symptoms not appropriately managed and the child indirectly punished by way of social and educational exclusion resulting in academic failure.
Dietary alterations have in some cases improved behaviour. For example, Gesch et al. (2002) supplemented a young adult prison population with omega-3/6 fatty acids in conjunction with multi-vitamins and minerals and found a 37% reduction in anti-social and violent incidents compared to placebo . This prison study has also been replicated by Zaalberg and colleagues in the Netherlands . The results of these clinical trials are promising given that the intervention is nutritional and not pharmacological. They also highlight the need for closer inspection of the relationship between nutrition and behavior in order to better understand the mechanism of actions at play.
Our research team at King’s College reported associations between low blood levels of omega-3 fatty acids (in particular EPA) and high scores of callous-unemotional (CU) traits in male children (aged 12 – 16 years, mean age of 14 years and 8 months) with ADHD. Approximately 44.4% of these male children were at medium or high risk for conduct disorder . CU traits are considered a sizeable risk factor for the later development of conduct disorder and other forms of anti-social behaviours. The future clinical measurement of these traits in children with symptoms of ADHD, in addition to potential evaluation of omega-3 status, may be worthwhile given the implications of unmanaged ADHD. However, the associations reported in this study were present in a small sample size of children with ADHD and therefore warrant replication in larger, randomized, placebo-controlled, double-blind clinical trials to be truly meaningful.