The effects are large, with effect sizes relative to placebo around 0.9 SD ( Faraone & Buitelaar, 2010 NICE, 2009 SIGN, 2009). The beneficial effects of psychostimulants over the short term have been clear since the 1930s ( Taylor, 2009). The picture summarized above of persisting disability for many is disappointing, not the least because a very effective therapy is available and widely used. Table 1 summarizes some of the possible limitations, not all of which may apply to everyone, and the potential implications for clinical practice that would arise if they did apply. This perspective article seeks to identify some potential limitations of treatment in the long term and to indicate how they might be overcome. This is encouraging, but the persistence of problems in the face of effective treatment remains a challenge to clinicians and researchers. That review also suggested that those adverse outcomes are less common in those who have been treated than for untreated people with ADHD. (2012) found evidence for a wide range of adverse outcomes being more common in ADHD than in unaffected people over the lifespan. Nevertheless, a systematic review by Shaw et al. Some children do escape the developmental problems or learn to live with them. Emotional dysregulation is very common and leads to later relationship problems and mood disorders ( Stringaris et al., 2009). Substance misuse is more common in those with ADHD than in the general population. Aggressive and antisocial behaviors and delinquency can complicate impulsiveness and overactivity (but not so much inattentiveness alone). In adolescence, motor accidents become a considerable risk, and there may be academic underachievement ( Faraone et al., 2006). The effects in childhood include lack of friends, poor performance in school, and few constructive leisure activities. Impulsiveness declines in absolute terms but remains deviant relative to age-matched peers ( Taylor et al., 1996). Even unreferred cases in the community and those with high levels of the behavior problems not meeting the diagnosis criteria can continue to show impaired social development. Inattentiveness, impulsiveness, and overactivity are the defining characteristics. ADHD is a disability that often persists into adulthood.
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