31.1 VARIABLE PATTERNS OF REMISSION FROM ADHD IN THE MULTIMODAL TREATMENT STUDY OF ADHD (MTA)

Abstract

It is estimated that childhood ADHD remits by adulthood in approximately 50% of cases; however, this conclusion is typically based on single endpoints, failing to consider longitudinal patterns of ADHD expression. We investigated the extent to which children with ADHD experience recovery and variable patterns of remission by adulthood. Children with ADHD (N = 558) in the MTA study were administered 8 assessments from 2-year (M age = 10.44 years) to 16-year follow-up (AI age = 25.12 years). We identified participants with fully remitted, partially remitted, and persistent ADHD at each time point based on parent, teacher, and self-reports of ADHD symptoms and impairment, treatment utilization, and substance use and mental disorders. Longitudinal patterns of remission and persistence were identified that considered context and timing. Approximately 30% of children with ADHD experienced full remission at some point during the 14-year follow-up period; however, a majority (60% of these) experienced recurrence of ADHD after the initial period of remission. Only 9% of the sample demonstrated recovery from ADHD by study endpoint, and only 10.8% demonstrated stable ADHD persistence across study time points. Instead, most participants with ADHD (64%) demonstrated fluctuating periods of persistence and remission over time. The MTA findings challenge the notion that approximately 50% of children with ADHD outgrow the disorder by adulthood. Most cases demonstrated fluctuating symptoms that may be environmentally modulated. Although 9% of children with ADHD continued to struggle with residual ADHD through young adulthood, intermittent periods of remission can be expected in most cases. We will share visual depiction of longitudinal and cross-sectional patterns of symptom remission, recovery, and persistence in the MTA, as well as case examples for patterns of recovery. These findings emphasize that childhood-onset ADHD is a chronic but waxing/waning disorder with periods of full remission that are more often temporary than sustained.