Elsevier

Psychiatry Research

Volume 177, Issue 3, 30 May 2010, Pages 299-304
Psychiatry Research

How persistent is ADHD? A controlled 10-year follow-up study of boys with ADHD

https://doi.org/10.1016/j.psychres.2009.12.010Get rights and content

Abstract

The main aim of this study was to examine the age-dependent persistence of attention-deficit hyperactivity disorder (ADHD) in boys transitioning from adolescence into early adulthood attending to different definitions of persistence. We conducted a 10-year follow-up study (mean follow-up time = 11 years) of 110 boys with ADHD and 105 non-ADHD controls. Both groups were 6–17 years of age at ascertainment. ADHD was considered persistent at follow-up if subjects met full or subthreshold (more than half of the symptoms required for a full diagnosis) Diagnostic and Statistical Manual of Mental Disorders, fourth edition, (DSM-IV) diagnostic criteria, failed to attain functional remission (Global Assessment of Functioning, GAF score ≤ 60) or were receiving treatment for ADHD. While 65% of children with ADHD no longer met full DSM-IV criteria for ADHD at the 10-year follow-up, 78% of subjects met at least one of our definitions of persistence. Persistence as described above was associated with more psychiatric co-morbidity, more familiality with mood disorders and higher levels of educational and interpersonal impairments than controls. This 10-year longitudinal follow-up study shows that the majority of ADHD boys experience persistent symptoms and functional impairments into early adulthood. Persistence of ADHD is associated with greater psychiatric comorbidity, familiality and functional impairments.

Introduction

Despite the existence of several prospective studies of children with attention-deficit hyperactivity disorder (ADHD) growing up, very few longitudinal studies examined the adult outcome of this disorder and those that did reported inconsistent results (Barkley et al., 1990, Barkley et al., 2008, Mannuzza et al., 1993, Weiss et al., 1985). For example, in independent samples of hyperactive boys grown up, Mannuzza et al. (1998) reported only 4% persistence of ADHD by a mean age of 24.1 years, while Weiss et al. (1985) reported 66% persistence of ADHD by a mean age of 25.1 years. Hill and Schoener (1996) fit a mathematical model to the rates of persistence of ADHD reported in previous studies that had followed ADHD children from childhood to adolescence or adulthood. Their analyses suggested that ADHD is a highly remitting disorder. These findings are difficult to reconcile with emerging epidemiological data that estimates the prevalence of adult ADHD to be up to 5% (Faraone and Biederman, 2005, Fayyad et al., 2007, Kessler et al., 2006). Given that long-term outcome studies are the touchstone for judging the course of a disorder, a better understanding of the true course of ADHD from childhood into adulthood is critical to evaluate whether ADHD is a lifelong disorder for children afflicted with this disorder and helps link the paediatric and adult literature on the subject.

In a previous report of our large longitudinal sample of boys with ADHD ascertained from paediatric and psychiatric sources (Biederman et al., 2000), our group examined patterns of persistence and remission at the 4-year follow-up using different definitions of remission. We found that the proportion of subjects experiencing remission varied considerably with the definition used (highest for syndromatic remission, lowest for functional remission). Our prior study also found that persistence of ADHD was associated with higher rates of psychiatric co-morbidity and familiality (Biederman et al., 1996b).

Similar findings were reported by Faraone et al. (2006a) who used a meta-analysis regression model to separately assess the syndromatic and symptomatic persistence of ADHD from the published literature. They found that while the rate of syndromatic persistence (subjects meeting full criteria for ADHD) was quite low (15% at age 25 years), the rate of symptomatic persistence (subjects meeting subthreshold criteria for ADHD) was much higher (65%). These results further supported the idea that estimates of ADHD's persistence are heavily dependent on how one defines persistence. Yet, regardless of definition, these analyses show that ADHD lessens with age, supporting the need for additional studies examining this issue.

To this end, the main aim of this study was to reassess the age-dependent decline of ADHD at the 10-year follow-up when most of our sample had reached young adult years. In addition, we compared familiality, psychiatric comorbidity and measures of functioning (educational, legal, driving and sexual history) between persistent ADHD, remittent ADHD and control subjects in order to understand the correlates of persistent ADHD into young adult years. Based on our work and the literature we predicted that ADHD would be persistent at the 10-year follow-up into young adult years, and inattentive symptoms, in particular, would be most persistent. We further hypothesised that persistence of ADHD into young adult years would be associated with higher rates of psychiatric co-morbidity, more family history of ADHD, and poorer functioning. This is one of the very few studies examining patterns of persistence and remission in ADHD children grown up.

Section snippets

Subjects

Detailed study methodology has been previously reported (Biederman et al., 1996a, Biederman et al., 2006). Briefly, subjects were derived from a longitudinal case–control family study of referred youth with and without ADHD. At baseline, we ascertained male Caucasian subjects aged 6–17 years with (N = 140) and without (N = 120) Diagnostic and Statistical Manual of Mental Disorders, third edition, Text Revision (DSM-III-R) ADHD from paediatric and psychiatric clinics. Potential subjects were excluded

Results

Of the 140 ADHD and 120 control subjects recruited at baseline, 112 (80%) and 105 (88%), respectively, were re-assessed at the 10-year follow-up. The rate of successful follow-up did not differ between groups (P = 0.11). The average follow-up time was 11.2 years (S.D. = 0.9 years); ages at follow-up ranged from 15 to 31 years (mean = 22.2, S.D. = 3.7, 90% were 18 years of age or older). There were no significant differences between those successfully followed-up and those lost to follow-up on baseline

Discussion

Results of this prospective and blind 10-year follow-up study of 110 boys with ADHD and 105 non-ADHD controls revealed that, while 65% of boys with ADHD no longer met full DSM-IV criteria for ADHD at the 10-year follow-up, 78% of subjects met at least one of our definitions of persistence: 35% continued to meet full DSM-IV criteria for ADHD, 22% met subthreshold criteria, 15% were functionally impaired and 6% while not meeting criteria for ADHD and functioning well, were treated for the

Conflict of interest

Dr. Joseph Biederman is currently receiving research support from the following sources: Alza, AstraZeneca, Bristol Myers Squibb, Eli Lilly and Co., Janssen Pharmaceuticals Inc., McNeil, Merck, Organon, Otsuka, Shire, NIMH, and NICHD.

In previous years, Dr. Joseph Biederman received research support, consultation fees, or speaker's fees for/from the following additional sources: Abbott, AstraZeneca, Celltech, Cephalon, Eli Lilly and Co., Esai, Forest, Glaxo, Gliatech, Janssen, McNeil, NARSAD,

Acknowledgements

This work was supported, in part, by National Institute of Child Health and Human Development (NICHD) grant 5R01HD036317-10, the Lilly Foundation Fund, and the Pediatric Psychopharmacology Philanthropic Fund.

References (36)

  • R.A. Barkley et al.

    ADHD in Adults: What the Science Says

    (2008)
  • J. Biederman et al.

    Evidence of familial association between attention deficit disorder and major affective disorders

    Archives of General Psychiatry

    (1991)
  • J. Biederman et al.

    A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders

    Archives of General Psychiatry

    (1996)
  • J. Biederman et al.

    Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type

    American Journal of Psychiatry

    (2000)
  • J. Biederman et al.

    Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community

    Journal of Clinical Psychiatry

    (2006)
  • J. Biederman et al.

    Informativeness of maternal reports on the diagnosis of ADHD: an analysis of mother and youth reports

    Journal of Attention Disorders

    (2007)
  • S.V. Faraone

    Attention deficit hyperactivity disorder in adults: implications for theories of diagnosis

    Current Directions in Psychological Science

    (2000)
  • S.V. Faraone et al.

    Do attention deficit hyperactivity disorder and major depression share familial risk factors?

    Journal of Nervous and Mental Disease

    (1997)
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