Objective This study examined several questions about the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young adults using data from a childhood-diagnosed sample of 200 individuals with ADHD (age M = 20.20 years) and 121 demographically similar non-ADHD controls (total N = 321). Method We examined the use of self-versus informant ratings of current and childhood functioning and evaluated the diagnostic utility of adult-specific items versus items from the Diagnostic and Statistical Manuel of Mental Disorders (DSM). Results Results indicated that although a majority of young adults with a childhood diagnosis of ADHD continued to experience elevated ADHD symptoms (75%) and clinically significant impairment (60%), only 9.6%–19.7% of the childhood ADHD group continued to meet DSM–IV–TR (DSM, 4th ed., text rev.) criteria for ADHD in young adulthood. Parent report was more diagnostically sensitive than self-report. Young adults with ADHD tended to underreport current symptoms, while young adults without ADHD tended to overreport symptoms. There was no significant incremental benefit beyond parent report alone to combining self-report with parent report. Non-DSM-based, adult-specific symptoms of ADHD were significantly correlated with functional impairment and endorsed at slightly higher rates than the DSM-IV-TR symptoms. However, DSM-IV-TR items tended to be more predictive of diagnostic group membership than the non-DSM adult-specific items due to elevated control group item endorsement. Conclusions Implications for the assessment and treatment of ADHD in young adults are discussed (i.e., collecting informant reports, lowering the diagnostic threshold, emphasizing impairment, and cautiously interpreting retrospective reports).

Decreased success at work and educational attainment by adulthood are of concern for children with ADHD given their widely documented academic difficulties; however there are few studies that have examined this empirically and even fewer that have studied predictors and individual variability of these outcomes. The current study compares young adults with and without a childhood diagnosis of ADHD on educational and occupational outcomes and the predictors of these outcomes. Participants were from the Pittsburgh ADHD Longitudinal Study (PALS), a prospective study with yearly data collection. Significant group differences were found for nearly all variables such that educational and occupational attainment was lower for adults with compared to adults without histories of childhood ADHD. Despite the mean difference, educational functioning was wide-ranging. High school academic achievement significantly predicted enrollment in post-high school education and academic and disciplinary problems mediated the relationship between childhood ADHD and post-high school education. Interestingly, ADHD diagnosis and disciplinary problems negatively predicted occupational status while enrollment in post-high school education was a positive predictor. Job loss was positively predicted by a higher rate of academic problems and diagnosis of ADHD. This study supports the need for interventions that target the child and adolescent predictors of later educational and occupational outcomes in addition to continuing treatment of ADHD in young adulthood targeting developmentally appropriate milestones, such as completing post-high school education and gaining and maintaining stable employment.

This study compared the high school academic experience of adolescents with and without childhood ADHD using data from the Pittsburgh ADHD Longitudinal Study (PALS). Participants were 326 males with childhood ADHD and 213 demographically similar males without ADHD who were recruited at the start of the follow-up study. Data were collected yearly from parents, teachers and schools. The current study used assessment points at which the participants were currently in or had recently completed grades 9, 10, 11, and 12. Results indicated that adolescents with ADHD experienced significant academic impairment in high school relative to comparison adolescents, including lower overall and main academic subject grade point averages (GPA), lower levels of class placement (e.g. remedial vs. honors), and higher rates of course failure. In addition, teacher reports indicated that adolescents with ADHD completed and turned in a significantly lower percentage of assignments and were significantly less likely to be working up to their potential. Adolescents with ADHD were also significantly more likely to be absent or tardy during the academic year, and they were over eight times more likely than adolescents without ADHD to drop out of high school. These findings demonstrate that children with ADHD continue to experience severe academic impairment into high school.

Objective This study examines adolescent-specific practical problems associated with current practice parameters for diagnosing ADHD in order to inform recommendations for the diagnosis of ADHD in adolescents. Specifically, issues surrounding the use of self vs. informant ratings, diagnostic threshold, and retrospective reporting of childhood symptoms were addressed. Method Using data from the Pittsburgh ADHD Longitudinal Study (PALS), parent, teacher, and self-reports of symptoms and impairment were examined for 164 adolescents with a childhood diagnosis of ADHD (age M=14.74) and 119 demographically similar non-ADHD controls (total N=283). Results Results indicated that 70% of the well-diagnosed childhood ADHD group continued to meet DSM-IV-TR diagnostic criteria for ADHD in adolescence; however, an additional 17% possessed clinically significant impairment in adolescence, but did not qualify for a current ADHD diagnosis. The optimal source of information was combined reports from the parent and a core academic teacher. Adolescents with ADHD met criteria for very few symptoms of hyperactivity/impulsivity, suggesting a need to revisit the diagnostic threshold for these items. Additionally, emphasis on impairment, rather than symptom threshold improved identification of adolescents with a gold-standard childhood diagnosis of ADHD and persistent ADHD symptoms. Parent retrospective reports of baseline functioning, but not adolescent self-reports, were significantly correlated with reports collected at baseline in childhood. Conclusions We offer recommendations for diagnosing ADHD in adolescence based upon these findings.

Objective-The study aims to characterize the late adolescent and young adult outcomes of girls diagnosed with ADHD in childhood.Method-The study included 58 females from a larger longitudinal study of ADHD. Thirty-four (M=19.97 years old) met DSM criteria for ADHD in childhood, while the remaining 24 (M=19.83 years old) did not. Self-and parent-reports of psychopathology, delinquency, interpersonal relationships, academic achievement, job performance, and substance use were collected.Results-The findings suggest that girls with ADHD experience difficulties in late adolescence and young adulthood, such as more conflict with their mothers, being involved in fewer romantic relationships, and experiencing more depressive symptoms than comparison women. However, differences did not emerge in all domains, such as job performance, substance use, and selfreported ADHD symptomatology. Conclusion-The findings of this study add to the literature on the negative late adolescent and young adult outcomes associated with childhood ADHD in females.Until recently, ADHD was considered a male disorder, occurring 2 to 9 times more frequently in males than females (Barkley, 2006). Now, researchers have turned their attention to studying ADHD in girls and have found that they manifest psychopathology and impairment similar to boys (Pelham, Walker, Sturges, & Hoza, 1989; Waschbusch, King, & Northern Partners In Action for Children and Youth, 2006). However, developmental outcomes for women with ADHD remain largely unexplored. There are popular books on women with ADHD (e.g. Understanding ADHD in Women by Kathleen Nadeau and Patricia Quinn), but these books typically lack empirical support or are based on case studies of women who present with ADHD for the first time in adulthood, and whether or not they had childhood ADHD is unclear. Although both adult and child ascertained women with ADHD have been reported to experience psychopathology such as high rates of anxiety, mood and substance disorders, (Biederman et al., 2006;Quinn, 2005), some research suggests that women diagnosed in childhood experience more psychopathology and impairment than women referred for the first time in adulthood (Barkley, 2006;Biederman et al., 2004). No study, however, has explored late adolescent and young adult outcomes of girlhood ADHD Send Correspondence to: Dara Babinski, Center for Children and Families, State University of New York at Buffalo, 106 Diefendorf Hall, 3435 Main Street, Building 20, Buffalo, NY 14214, Phone: 716-829-2244x113; Fax: 716-829-3692;deb24@buffalo.edu . Two longitudinal studies have followed girls with ADHD into adolescence. In one study (Hinshaw, 2002), girls with ADHD (mean age approximately 9 years old) were found to experience more psychopathology, and social, academic, and cognitive impairment than girls without ADHD. After five years (mean age approximately 14 years old), similar problems persisted and new difficulties, including substance use and eating problems, also emerged for girls with ADHD (Hinshaw, Owens...

This study examined the association between childhood ADHD and juvenile delinquency by examining data from the Pittsburgh ADHD Longitudinal Study (PALS), a follow-up study of individuals diagnosed with ADHD in childhood (ages 5-12) and recontacted in adolescence and young adulthood for yearly follow-up (age at first follow-up interview M= 17. 26, SD=3.17). Participants were 288 males with childhood ADHD and 209 demographically similar males without ADHD who were recruited into the follow-up study. Delinquency information gathered yearly during the second through eighth follow-up provided a comprehensive history of juvenile delinquency for all participants. Four childhood diagnostic groups [ADHD-only (N=47), ADHD +ODD (N=135), ADHD+CD (N=106), and comparison (N=209)] were used to examine group differences on delinquency outcomes. Analyses were conducted across three dimensions of delinquency (i.e., severity, age of initiation, and variety). Individuals with childhood ADHD+CD displayed significantly worse delinquency outcomes than the other three groups, across almost all indices of offending. When compared to comparison participants, boys with ADHD-only and ADHD+ODD in childhood displayed earlier ages of delinquency initiation, a greater variety of offending, and higher prevalence of severe delinquency. These findings suggest that although childhood ADHD+CD creates the greatest risk for delinquency, boys with ADHD-only and ADHD+ODD also appear at a higher risk for later offending. The patterns of offending that emerged from the PALS are discussed in the context of the relationship between ADHD, comorbidity, and delinquency. Keywords ADHD; Delinquency; Conduct DisorderEvery year thousands of individuals fall victim to criminal acts committed by juveniles in the United States. In 2006, 19.1% of property crimes and 12.1% of violent crimes involved only juveniles (U.S. Department of Justice, 2007). The young individuals who commit these crimes are at a high risk of continuing this criminality into adulthood (Loeber, 1982;Moffitt, Caspi, Harrington, & Milne, 2002), which also incurs a high economic cost to society. By one estimate, a lifetime criminal costs the public between $1.3 million and $1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript (Cohen, 1998). In addition to the increased risk of adult criminality, delinquent adolescents are also more likely to experience multiple negative personal outcomes in adulthood, ranging from substance abuse to work-related problems (Loeber, Stouthamer-Loeber, & White, 1999;Moffitt et al., 2002).Given the gravity of juvenile offending, much attention has been directed toward identifying developmental pathways to serious delinquency in order to identify children who are most at risk for this costly outcome. Although minor delinquency appears to be somewhat normative and transient in adolescence, a subset of offenders display a pattern of severe and persistent offending that begins in childhood (Loeber, 1988;Moffitt 1993;2003). These individuals ...

Objective-Given the risk for adolescent depression in girls to lead to a chronic course of mental illness, prevention of initial onset could have a large impact on reducing chronicity. If symptoms of depression that emerge during childhood were stable and predictive of later depressive disorders and impairment, then secondary prevention of initial onset of depressive disorders would be possible.Method-Drawing from the Pittsburgh Girls Study, an existing longitudinal study, 232 nine-yearold girls were recruited for the present study, half of whom screened high on a measure of depression at age 8 years. Girls were interviewed about depressive symptoms using a diagnostic interview at ages 9, 10, and 11 years. Caregivers and interviewers rated impairment in each year.Results-The stability coefficients for DSM-IV symptom counts for a 1-to 2-year interval were in the moderate range (i.e., intraclass coefficients of 0.40-0.59 for continuous symptom counts and Kendall τ-b coefficients of 0.34-0.39 for symptom level stability). Depressive disorders were also relatively stable at this age. Poverty moderated the stability, but race and pubertal stage did not.©2008 by the American Academy of Child and Adolescent Psychiatry.Correspondence to Dr. Kate Keenan, Department of Psychiatry, MC 3077, Room W-415, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637; e-mail: E-mail: kkeenan@yoda.bsd.uchicago.edu. Disclosure: The authors report no conflicts of interest. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptAmong the girls who did not meet criteria for a depressive disorder at age 9 years, the odds of meeting criteria for depressive disorders and for demonstrating impairment at age 10 or 11 years increased by 1.9 and 1.7, respectively, for every increase in the number of depression symptoms.Conclusions-Early-emerging symptoms of depression in girls are stable and predictive of depressive disorders and impairment. The results suggest that secondary prevention of depression in girls may be accomplished by targeting subthreshold symptoms manifest during childhood. Keywords girls; childhood; depression; DSM-IV; predictionDepressive disorders are one of the most common mental disorders among adolescents. Prevalence of depression increases dramatically from 1% in childhood to 8% in adolescents, with a lifetime prevalence in adolescents of 15% to 20%, which is comparable to that found in adults. 1 It is primarily girls who account for the increase in adolescence, 2,3 evidencing a 2:1 sex difference in depression that continues throughout the reproductive years. 4 Initial episodes of depression are more severe and longer in duration for girls than for boys, 5 and girls who experience depression for the first time in childhood or adolescence, compared with females with onsets later in life, have a prolonged period of risk for future episodes. 6 Depressive disorders continue to be among the most common disorders for females later in life and are cited as the leading ca...

Identifying childhood precursors for depression has been challenging and yet important for understanding the rapid increase in the rate of depression among adolescent girls. This study examined the prospective relations of preadolescent girls' emotion regulation and parenting style with depressive symptoms. Participants were 225 children and their biological mothers recruited from a larger longitudinal community study. Girls' observed positive and negative emotion during a conflict resolution task with mothers, their ability to regulate sadness and anger, and their perception of parental acceptance and psychological control were assessed at age 9. Depressive symptoms were assessed by self-report at ages 9 and 10. The results indicated interactions between child emotion characteristics and parenting in predicting later depression. Specifically, low levels of positive emotion expression predicted higher levels of depressive symptoms in the context of moderate to high parental psychological control. Low levels of sadness regulation were predictive of high levels of depressive symptoms in the context of low to moderate parental acceptance. Findings from this study support the hypothesis that the prospective association between vulnerabilities in emotion regulation and depression are moderated by the caregiving environment. Keywords depression; emotion regulation; emotion expression; parenting; preadolescent girls It has been consistently reported that the rate of depression increases rapidly among girls during adolescence (see review by Keenan & Hipwell, 2005), resulting in a prevalence rate of depressive disorders that is twice as high in adult females compared to adult males (Lewinsohn, Clark, Seeley, & Rhode, 1994;Nolen-Hoeksema, 1994). Children and adolescents who experience depression are likely to encounter severe, recurrent depression later in life (Costello, Angold, & Keeler, 1999;Kovacs, Gatsonis, Paulauskas, & Richards, 1989;Pine, Cohen, Gurley, Brook, & Ma, 1998; see Weissman, Wolk, Wickramaratne, Goldstein, Adams, et al., 1999 for exception). Kovacs and colleagues (Kovacs, Obrosky, & Sherrill, 2003) have shown that childhood onset depression is likely to recur in adolescence in 40% to 60% of clinicallyreferred cases. Early-onset depression also has serious consequences for psychosocial functioning (Lewinsohn, Rohde, Seeley, Klein, & Gotlib, 2003 e.g., Cole, Peeke, Martin, Truglio, & Seroczynski, 1998;Nolen-Hoeksema, Girgus, & Seligman, 1992) and predictive of depressive disorders (Keenan, Hipwell, Feng, Babinski, Hinze et al., in press). Thus, identifying preadolescent precursors that predict emerging depressive symptoms in girls is of great importance in understanding the phenomenology of depression in females, as well as for timely prevention and intervention.Dysregulated emotion has been hypothesized to precede the onset of psychological disorders such as depressive disorders (Chaplin, Cole, & Zahn-waxler, 2005;Cole et al., 2003). The importance of studying emotion regulation lies in the f...