Persistence Of ADHD Research Articles

Persistence of ADHD into adulthood and associated factors: a prospective study.

BackgroundAttention deficit hyperactivity disorder (ADHD) is one of the most prevalent disorders in child and adolescent psychiatry. The aims of this study are to describe the persistence of ADHD into adulthood and to explore factors associated with persistence.Methods: This is a prospective study conducted in a clinical sample of Spanish children and adolescents diagnosed with ADHD. After a baseline interview in which a battery of standardized scales was administered (e.g., Strengths and Difficulties Questionnaire (SDQ). A review of the digital medical history was carried out ten years after recruitment. The persistence of the ADHD diagnosis into adulthood and the end-point diagnoses were described. We carried out logistic regression to explore the factors associated with ADHD persistence.Results: Most of the patients (87.5%) kept the ADHD diagnosis into adulthood. Factors associated with ADHD persistence was high SDQ hyperactivity/inattention subscale scores at baseline (OR = 1.197), high scores on the SDQ peer relationship problems subscale (OR = 0.823), number of diagnoses at baseline (OR = 0.490).Conclusions: Our findings show that ADHD diagnosed in children often persists into adulthood. An appropriate transition between child and adolescent mental health services and adult services needs to be mapped out, as a large proportion of children with ADHD will continue to need mental health care during their adulthood.

Is prevention of ADHD and comorbid conditions in adolescents possible?

Objectives: To examine how the concept of prevention is applicable to adolescent ADHD, which preventive interventions may be feasible, and which methods can be used to evaluate effectiveness. Method: Following a literature search for prevention clinical trials relevant to adolescent ADHD, selected studies are critically reviewed to identify suitable targets and promising interventions. Results: There is some evidence from controlled studies that interventions delivered to prepubertal children at high risk for ADHD or diagnosed with ADHD may decrease the incidence or persistence of ADHD in adolescence. Uncontrolled follow-up of clinical samples and population studies suggest that treatment of adolescents with ADHD can decrease the risk for several negative functional outcomes in youth. A controlled trial found a specific cognitive training intervention to decrease risky driving. Conclusions: Prevention of ADHD and associated negative outcomes is possible and of high clinical relevance. Assessing prevention effects is methodologically challenging, but feasible.

Association between relative age at school and persistence of ADHD in prospective studies: an individual participant data meta-analysis

The youngest children in a school class are more likely than the oldest to be diagnosed with ADHD, but this relative age effect is less frequent in older than in younger school-grade children. However, no study has explored the association between relative age and the persistence of ADHD diagnosis at older ages. We aimed to quantify the association between relative age and persistence of ADHD at older ages. For this meta-analysis, we searched MEDLINE, Embase, CINAHL, PsycINFO, and PubPsych up to April 1, 2022, with terms related to "cohort" and "ADHD" with no date, publication type, or language restrictions. We gathered individual participant data from prospective cohorts that included at least ten children identified with ADHD before age 10 years. ADHD was defined by either a clinical diagnosis or symptoms exceeding clinical cutoffs. Relative age was recorded as the month of birth in relation to the school-entry cutoff date. Study authors were invited to share raw data or to apply a script to analyse data locally and generate anonymised results. Our outcome was ADHD status at a diagnostic reassessment, conducted at least 4 years after the initial assessment and after age 10 years. No information on sex, gender, or ethnicity was collected. We did a two-stage random-effects individual participant data meta-analysis to assess the association of relative age with persistence of ADHD at follow-up. This study was registered with PROSPERO, CRD42020212650. Of 33 119 studies generated by our search, we identified 130 eligible unique studies and were able to gather individual participant data from 57 prospective studies following up 6504 children with ADHD. After exclusion of 16 studies in regions with a flexible school entry system that did not allow confident linkage of birthdate to relative age, the primary analysis included 41 studies in 15 countries following up 4708 children for a period of 4 to 33 years. We found that younger relative age was not statistically significantly associated with ADHD persistence at follow-up (odds ratio 1·02, 95% CI 0·99-1·06; p=0·19). We observed statistically significant heterogeneity in our model (Q=75·82, p=0·0011, I2=45%). Participant-level sensitivity analyses showed similar results in cohorts with a robust relative age effect at baseline and when restricting to cohorts involving children with a clinical diagnosis of ADHD or with a follow-up duration of more than 10 years. The diagnosis of ADHD in younger children in a class is no more likely to be disconfirmed over time than that of older children in the class. One interpretation is that the relative age effect decreases the likelihood of children of older relative age receiving a diagnosis of ADHD, and another is that assigning a diagnostic label of ADHD leads to unexplored carryover effects of the initial diagnosis that persist over time. Future studies should be conducted to explore these interpretations further. None.

Neuropsychological and Symptom Predictors of Diagnostic Persistence in ADHD: A 25-Year Follow-up Study

Background: This study extends long-term predictive research on ADHD by including both neuropsychological and symptom measures at baseline in adolescence as predictors of diagnostic persistence 25 years later. Methods: Nineteen males with ADHD and 26 healthy controls (HC; M/F = 13/13), were assessed in adolescence and 25 years later. Measurements at baseline included a comprehensive test battery measuring eight neuropsychological domains, an IQ estimate, the Child Behavior Checklist (CBCL), and the Global Assessment Scale of Symptoms. Differences between ADHD Retainers, Remitters, and HC were calculated with ANOVAs, and potential predictions of differences in the ADHD group by linear regression analyses. Results: Eleven (58%) participants retained their ADHD diagnoses at follow-up. Motor Coordination and Visual perception at baseline predicted diagnosis at follow-up. CBCL Attention problems at baseline in the ADHD group predicted variance in diagnostic status. Conclusion: Lower-order neuropsychological functions related to motor function and perception are important long-time predictors of persistence of ADHD.

Associations Between Dimensional Persistence of ADHD and Adult Sleep Quality in a Prospective Study of Girls

Objectives: We investigated the prospective association between (a) ADHD symptom dimensions, including their persistence and (b) adult sleep quality in a female sample, covarying adult depressive symptoms. Methods: Participants comprised four persistence groups (persisters, partials, desisters, and comparison) based on overall ADHD diagnosis and separate dimensions of inattention and hyperactivity/impulsivity (HI) in childhood, late adolescence, and early adulthood, featuring girls with (n = 140) and without (n = 88) carefully diagnosed ADHD. Results: Only persistence of inattention predicted lower adult sleep quality when covarying young-adult depression, which was also a significant predictor. When additionally covarying stimulant medication use in adulthood, inattention persistence lost significance, although depression maintained significance, with medication use predicting worse sleep quality. Conclusions: Persistence of inattentive (but not HI) symptoms was significantly related to adult sleep quality in the context of concurrent depression. Sleep quality is an important outcome for research on and treatment for ADHD.

Short Research Article: Impact of a prolonged lockdown on the symptoms of paediatric ADHD and common associated disorders.

Our objective is to explore the change in the severity of ADHD, ODD and anxiety during a two-month lockdown among children in France and the moderating role of behavioural regulation. In 235 children with ADHD, the symptom severity of ADHD, ODD and anxiety was investigated one and two months after the beginning of lockdown, and one month after its end. Behavioural regulation skills were estimated with the Behaviour Regulation Index. ADHD, ODD and anxiety scores were increasing or decreasing depending on BRI. Baseline behavioural regulation skills may act as a moderating factor for the persistence of ADHD, ODD and anxiety symptoms related to the lockdown.

Influence of the month of birth on persistence of ADHD in prospective studies: protocol for an individual patient data meta-analysis

IntroductionAttention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with symptoms, especially the hyperactive ones, that tend to decrease in severity with age. Interestingly, children born just before the school-entry cut-off date...

대학생의 아동기 ADHD의 지속 및 감소와 성인기 ADHD의 발현에 따른 유병률과 부적응: 실행기능 결함, 심리적 부적응 및 대인관계 문제를 중심으로

본 연구에서는 대학생의 아동기 ADHD 증상의 변화와 성인기 ADHD 증상에 따른 네 집단(지속, 감소, 발현, 정상 집단) 간 실행기능 결함, 심리적 부적응 및 대인관계 문제의 차이를 검증하고자 하였다. 이를 위해 지역사회의 1,082명의 남녀 대학생(남 445명, 여 637명)을 대상으로 아동기 ADHD 증상(Childhood Symptom Scale), 성인기 ADHD 증상(Current Symptom Scale, K-AADHDS), 실행기능 결함(KBDEFS), 심리적 부적응(SCL-90-R), 대인관계 문제(KIIP-SC)에 대한 자기보고 평가를 실시하였다.<BR>연구결과, DSM-5의 진단기준에 따라 ADHD 집단을 선별한 결과 대학생 집단에서 아동기 ADHD의 유병률은 7.3% (79명)로 나타났고, 성인기 ADHD의 유병률은 6.2% (67명)로 나타났다. 아동기 ADHD 증상의 변화에 따른 아동기 증상지속 및 감소집단, 성인기의 늦은 발현집단 및 정상집단 간 차이를 검증한 결과, 아동기 ADHD의 지속집단이 실행기능에서 가장 큰 결함을 나타냈고, 발현집단의 실행기능 결함이 감소집단 보다 유의하게 높았고, 정상집단의 실행기능 결함이 유의하게 가장 낮았다. 또한 지속집단과 발현집단의 대인관계 문제와 심리적 부적응 점수가 감소집단과 정상집단보다 유의하게 높았다.

Assessment of Adult ADHD in Clinical Practice: Four Letters—40 Opinions

Objective: Despite guidelines providing detailed recommendations for the assessment of ADHD in adults and increasing clinician awareness of the persistence of ADHD into adulthood, ADHD remains under diagnosed in many countries. Method: A survey of 178 clinicians who regularly perform assessments for adult ADHD was conducted between February 2015 and 2016 to identify possible causes of underdiagnosis related to assessment practices. Results: There was a lack of consensus among clinicians regarding which symptoms are relevant to adult ADHD. Only “difficulties concentrating” was endorsed as a core feature of adult ADHD by a majority of respondents. Few clinicians used (semi-)structured interviews. Psychologists were less likely than physicians to recommend medication. Conclusion: Further clinician training on core symptoms of adult ADHD and diagnostic practices congruent with guideline recommendations may improve symptom recognition among clinicians and diagnostic accuracy. Identification of barriers to the implementation of diagnostic practices recommended by guidelines is needed.

Hyperactive Child Syndrome and Estimated Life Expectancy at Young Adult Follow-Up: The Role of ADHD Persistence and Other Potential Predictors

Objective: We examined if ADHD Combined Type or Presentation (ADHD-C) reduced estimated life expectancy (ELE) at young adulthood and if the persistence of ADHD to adulthood further adversely affected ELE. Method: A young adult follow-up of 131 hyperactive and 71 control cases was used to derive 14 variables that were entered into a life expectancy calculator to generate ELE scores. Both ratings of executive function (EF) in everyday life and tests of EF and IQ were measured along with comorbid psychopathologies. Results: Childhood ADHD-C was associated with a 9.5-year reduction in healthy ELE, and a 8.4-year reduction in total ELE relative to control children by adulthood. The persistence of ADHD to adulthood was linked to a 12.7-year reduction in ELE. Several background traits accounted for more than 39% of variation in ELE. Conclusion: Childhood ADHD-C predicts a significantly reduced ELE by adulthood, which is further reduced by the persistence of ADHD to adult follow-up.

MCMI-III Personality Disorders, Traits, and Profiles in Adult ADHD Outpatients

Objective: To assess prevalence of personality traits and disorders according to Millon’s evolution-based model and to identify the most representative personality profiles among adult ADHD outpatients. Method: Personality traits and disorders were evaluated using the Millon Clinical Multiaxial Inventory–III (MCMI-III) and an exploratory factor analysis (EFA) in a consecutive sample of adult ADHD outpatients (N = 70) diagnosed by the Adult ADHD Self-Report Scale–version 1.1 (ASRS-v1.1) and the Diagnostic Interview for ADHD in Adults (DIVA 2.0). Results: More than half of our sample (57.1%) showed at least one personality disorder (PD). The most prevalent PDs were paranoid, schizotypal and negativistic (18.6% for all three PDs), depressive (17.1%), and sadistic (11.4%). No patient had a borderline PD. The EFA identified three personality profiles (“sadistic-antisocial-negativistic,” “masochistic-depressive-dependent-avoidant,” and “antihistrionic-schizoid”). Conclusion: High prevalence of PDs among adult ADHD patients was confirmed. The personality profiles seemed to reflect the persistence of ADHD and related childhood comorbidities in adulthood.

Commentary: Important design features to consider in observational research on the long-term outcomes of ADHD - reflections on Sibley etal. (2017) and Swanson etal. (2017).

In this issue of the Journal, Sibley etal. (2017) presented some important insights into how different assessment approaches influence the apparent persistence of ADHD into adulthood, while Swanson etal. (2017) presented interesting results regarding the long-term benefits (adult symptom reduction) and costs (adult height suppression) associated with the treatment of ADHD with stimulant medication. This commentary highlights that (a) future studies that attempt to explore the occurrence and predictors of persisting and remitting developmental trajectories of ADHD, as well as late-onset ADHD, need to be based on thorough assessment of ADHD in adulthood using a combination of self-ratings and other informants (parents), and that (b) observational studies of the long-term benefits and risk associated with ADHD medications will play an important role in future research and clinical guidelines.

INVESTIGATING THE RELATIONSHIP BETWEEN ADULT ATTENTION DEFICIT AND HYPERACTIVITY DISORDER (AADHD) AND PERSONALITY CORRELATES RELATED TO SENSATION SEEKING

The scientific literature is proliferated with discussions regarding childhood ADHD and there is great awareness for it in the population. In the last 20 years, however, increasing evidence has emerged to suggest the rising and unremitting persistence of ADHD well into adulthood. Due to its chronic nature, researchers are interested in the possible personality correlates that may underlie the way in which the disorder manifests. The current research examined whether the personality trait of Sensation Seeking, and its accompanying sub-dimensions of: (i) Boredom Susceptibility; (ii) Disinhibition; (iii) Experience Seeking; (iv) Thrill and Adventure Seeking; (v) Novelty; and (vi) Intensity of stimuli can explain a statistically significant amount of adult ADHD variance. In addition to the Sensation Seeking Scale form V (SSS-V), participants were also required to complete the adult ADHD Self-Report Scale (ASRS). Significant positive correlations with adult ADHD were found for the Sensation Seeking sub-dimensions of Disinhibition and Experience Seeking. Thrill and Adventure Seeking on the other hand was found to be unrelated to ADHD in adults. Furthermore, a multiple regression analysis revealed that sensation seeking dimensions can explain a small, yet statistically significant amount of adult ADHD variance. Despite these findings, additional research is necessary to identify other possible factors that could explain adult ADHD variance. The empirical evidence regarding the role of it is scarce and inconsistent. These gaps in our understanding of the relationship between adult ADHD and personality may benefit from the identification of a moderator variable on which these relationships are contingent and that help to predict and understand when these relationships are positive and negative.

Is There an Adult Onset Type of ADHD? Issues in Establishing Persistence and Remission of ADHD from Childhood to Adulthood

Is There an Adult Onset Type of ADHD? Issues in Establishing Persistence and Remission of ADHD from Childhood to Adulthood

Clinical, Sociobiological, and Cognitive Predictors of ADHD Persistence in Children Followed Prospectively Over Time.

With increasing awareness that ADHD is chronically disabling, a burgeoning literature has examined childhood clinical indicators of ADHD persistence. This study investigates whether childhood factors reflecting biological risk and cognitive reserve have additive predictive value for the persistence of ADHD that is unique beyond childhood indicators of disorder severity. One-hundred thirty children with ADHD (mean age=8.9years, 75% male) were followed into adolescence (mean age=14.0years). Childhood ADHD and co-morbidities were assessed via interviews with parents and teachers; parental psychopathology was assessed via parent interview; exposure to neurobiological and psychosocial adversity were indexed by parent questionnaire; and cognitive reserve was evaluated through children's performance on measures of IQ and executive functioning. Univariate analyses identified childhood inattention and hyperactivity-impulsivity, co-morbid oppositional defiant disorder, overall impairment, and paternal anxiety and depression as more prevalent amongst adolescents with persistent compared with remitted ADHD. Only child-level predictors remained significant in a final multivariate model. These results suggest that children who are most likely to experience persistent ADHD have a more severe clinical presentation in childhood, reflected by increased levels of inattention, oppositional behavior, and impairment. They also are more likely to have fathers with internalizing concerns, but these concerns do not uniquely predict ADHD persistence beyond child-level factors. Contrary to expectations, childhood adversity and cognitive functioning did not predict the course of ADHD.

Persistence and Subtype Stability of ADHD Among Substance Use Disorder Treatment Seekers

Objective: To examine ADHD symptom persistence and subtype stability among substance use disorder (SUD) treatment seekers. Method: In all, 1,276 adult SUD treatment seekers were assessed for childhood and adult ADHD using Conners’ Adult ADHD Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; CAADID). A total of 290 (22.7%) participants met CAADID criteria for childhood ADHD and comprise the current study sample. Results: Childhood ADHD persisted into adulthood in 72.8% (n = 211) of cases. ADHD persistence was significantly associated with a family history of ADHD, and the presence of conduct disorder and antisocial personality disorder. The combined subtype was the most stable into adulthood (78.6%) and this stability was significantly associated with conduct disorder and past treatment of ADHD. Conclusion: ADHD is highly prevalent and persistent among SUD treatment seekers and is associated with the more severe phenotype that is also less likely to remit. Routine screening and follow-up assessment for ADHD is indicated to enhance treatment management and outcomes.

Comparing Methods to Determine Persistence of Childhood ADHD Into Adulthood: A Prospective, Population-Based Study

Objective: To compare the rate of persistence of ADHD into adulthood as determined by a norm-referenced versus non-norm-referenced diagnostic interview, and by standardized questionnaires. Method: Adults from a birth cohort, including research-identified childhood ADHD cases (N = 232; Mage = 27.0 years; 167 males, 65 females) and controls (N = 335; Mage = 28.6 years; 210 males, 125 females), were administered the M.I.N.I. International Neuropsychiatric Interview, the Murphy–Barkley Symptoms Checklist (MB), and the Wender Utah Rating Scale (WURS) Results: Among the childhood ADHD cases, 29.3% fulfilled criteria for adult ADHD using a norm-referenced approach to M.I.N.I. scoring, versus 13.8% using published M.I.N.I. criteria. Among participants meeting norm-referenced diagnostic criteria, 41.8% and 69.1% were classified as adult ADHD using the MB and WURS, respectively. Conclusion: A non-norm-referenced approach resulted in a significant underestimate of the rate of adult ADHD. Reliance on either of two adult ADHD questionnaires would have further reduced this estimate.

Adult Outcome of ADHD: An Overview of Results From the MGH Longitudinal Family Studies of Pediatrically and Psychiatrically Referred Youth With and Without ADHD of Both Sexes

Objective: We aimed to provide an overview of the Massachusetts General Hospital (MGH) Longitudinal Studies of ADHD. Methods: We evaluated and followed samples of boys and girls with and without ADHD ascertained from psychiatric and pediatric sources and their families. Results: These studies documented that ADHD in both sexes is associated with high levels of persistence into adulthood, high levels of familiality with ADHD and other psychiatric disorders, a wide range of comorbid psychiatric and cognitive disorders including mood, anxiety, and substance use disorders, learning disabilities, executive function deficits, emotional dysregulation, and autistic traits as well as functional impairments. The MGH studies suggested that stimulant treatment decreased risks of developing comorbid psychiatric disorders, substance use disorders, and functional outcomes. The MGH studies documented the neural basis of persistence of ADHD using neuroimaging. Conclusion: The MGH studies provided various insights on symptoms, course, functions, comorbidities, and neuroscience of ADHD.

Attention Deficit Hyperactivity Disorder in Australian Adults: Prevalence, Persistence, Conduct Problems and Disadvantage

BackgroundThe Prevalence and persistence of ADHD have not been described in young Australian adults and few studies have examined how conduct problems (CP) are associated with ADHD for this age group. We estimate lifetime and adult prevalence and persistence rates for three categories of ADHD for 3795 Australian adults, and indicate how career, health and childhood risk factors differ for people with ADHD symptoms and ADHD symptoms plus CP.MethodologyTrained interviewers collected participant experience of ADHD, CP, education, employment, childhood experience, relationship and health variables. Three diagnostic definitions of ADHD used were (i) full DSM-IV criteria; (ii) excluding the age 7 onset criterion (no age criterion); (iii) participant experienced difficulties due to ADHD symptoms (problem symptoms).ResultsPrevalence rates in adulthood were 1.1%, 2.3% and 2.7% for each categorization respectively. Persistence of ADHD from childhood averaged across gender was 55.3% for full criteria, 50.3% with no age criterion and 40.2% for problem symptoms. ADHD symptoms were associated with parental conflict, poor health, being sexually assaulted during childhood, lower education, income loss and higher unemployment. The lifetime prevalence of conduct problems for adults with ADHD was 57.8% and 6.9% for adults without ADHD. The greatest disadvantage was experienced by participants with ADHD plus CP.ConclusionThe persistence of ADHD into adulthood was greatest for participants meeting full diagnostic criteria and inattention was associated with the greatest loss of income and disadvantage. The disadvantage associated with conduct problems differed in severity and was relevant for a high proportion of adults with ADHD. Women but not men with ADHD reported more childhood adversity, possibly indicating varied etiology and treatment needs. The impact and treatment needs of adults with ADHD and CP and the report of sexual assault during childhood by women and men with ADHD also deserve further study.

The genetics of attention deficit/hyperactivity disorder in adults, a review

The adult form of attention deficit/hyperactivity disorder (aADHD) has a prevalence of up to 5% and is the most severe long-term outcome of this common neurodevelopmental disorder. Family studies in clinical samples suggest an increased familial liability for aADHD compared with childhood ADHD (cADHD), whereas twin studies based on self-rated symptoms in adult population samples show moderate heritability estimates of 30–40%. However, using multiple sources of information, the heritability of clinically diagnosed aADHD and cADHD is very similar. Results of candidate gene as well as genome-wide molecular genetic studies in aADHD samples implicate some of the same genes involved in ADHD in children, although in some cases different alleles and different genes may be responsible for adult versus childhood ADHD. Linkage studies have been successful in identifying loci for aADHD and led to the identification of LPHN3 and CDH13 as novel genes associated with ADHD across the lifespan. In addition, studies of rare genetic variants have identified probable causative mutations for aADHD. Use of endophenotypes based on neuropsychology and neuroimaging, as well as next-generation genome analysis and improved statistical and bioinformatic analysis methods hold the promise of identifying additional genetic variants involved in disease etiology. Large, international collaborations have paved the way for well-powered studies. Progress in identifying aADHD risk genes may provide us with tools for the prediction of disease progression in the clinic and better treatment, and ultimately may help to prevent persistence of ADHD into adulthood.