ABSTRACT
ADHD is a particularly serious problem because youngsters with the core difficulties of inattention, overactivity and impulsivity may develop a wide range of secondary academic and relationship problems. Attentional difficulties may lead to poor attainment in school. Impulsivity and aggression may lead to difficulties making and maintaining appropriate peer relationships and developing a supportive peer group. Inattention, impulsivity and overactivity make it difficult for youngsters with these attributes to conform to parental expectations, and so children with ADHD often become embroiled in chronic conflictual relationships with their parents. In adolescence, impulsivity may lead to excessive risk taking with consequent complications such as drug abuse, road traffic accidents and dropping out of school. All of these risk-taking behaviours have knock-on effects and compromise later adjustment. As youngsters with ADHD become aware of their difficulties with regulating attention, activity and impulsivity and the failure that these deficits lead to within the family, peer group and school, they may also develop low self-esteem and depression. In the light of the primary problems and secondary difficulties that may evolve in cases of ADHD, it is not surprising that for some the prognosis is poor (Hinshaw, 1994). For two-thirds of cases, the primary problems of inattention, impulsivity and hyperactivity persist into late adolescence, and for some of these the primary symptoms persist into adulthood. Roughly a third develop significant antisocial behaviour problems in adolescence, including conduct disorder and substance abuse, and for most of this subgroup these problems persist into adulthood, leading
to criminality. Occupational adjustment problems and suicide attempts occur in a small but significant minority of cases.
