Adolescent Outcomes of Childhood Attention-Deficit/Hyperactivity Disorder in a Diverse Community Sample

Abstract

Objective-To describe adolescent outcomes of childhood attention deficit-/ hyperactivity disorder (ADHD) in a diverse community sample.Method-ADHD screening of a school district sample of 1,615 students ages 5 to 11 years was followed by a case-control study 8 years later. High risk youths meeting full (n=94) and subthreshold (n=75) DSM-IV ADHD criteria were matched with demographically similar low risk peers (n=163). Outcomes domains included symptoms; functional impairment; quality of life; substance use; educational outcomes; and juvenile justice involvement.Results-44% of youths with childhood ADHD had not experienced remission. Compared to unaffected peers, adolescents with childhood ADHD were more likely to display oppositional defiant disorder (OR=12.9; 95% CI 5.6-30.0), anxiety/depression (OR=10.3; 95% CI 2.7-39.3), significant functional impairment (OR=3.4; 95% CI 1.7-6.9), reduced quality of life (OR=2.5, 95% CI 1.3-4.7), and to have been involved with juvenile justice (OR=3.1; 95% CI 1.0-9.1). Subthreshold ADHD, but not full ADHD, increased the risk of grade retention, whereas both conditions increased the risk of graduation failure. Oppositional defiant disorder (ODD), but not childhood ADHD, increased the risk of cannabis and alcohol use. None of the adolescent outcomes of childhood ADHD were moderated by gender, race or poverty.Conclusions-ADHD heralds persistence of ADHD and comorbid symptoms into adolescence, as well as significant risks for functional impairment and juvenile justice involvement. Subthreshold ADHD symptoms typically do not qualify affected students for special educational interventions,

Subthreshold and threshold attention deficit hyperactivity disorder symptoms in childhood: psychosocial outcomes in adolescence in boys and girls

“…Our findings also support previous studies that have found associations between subthreshold levels of ADHD and negative outcomes 26, 31, 37, 38, 45, 46, 84. In this study, more boys and girls at the screen‐intermediate level displayed psychosocial problems than did their screen‐negative peers.…”

“…Another argument for also considering subthreshold ADHD levels is the findings from the Shankman study, which demonstrated that a majority of children with subthreshold psychiatric conditions were at high risk of developing the equivalent full psychiatric syndrome in adulthood 45. The results from our study support the view that ADHD symptoms, as well as their associated negative outcomes, are dimensionally distributed in the population and that girls and boys display different risk profiles 25, 31. Both of these findings are to be expected and may, from one point of view, be considered trivial.…”

“…38). With support systems based only on diagnostic categories 31, children with subthreshold symptom levels may not get access to such support to the degree that is warranted, thus placing them at risk of negative consequences later in life. Another argument for also considering subthreshold ADHD levels is the findings from the Shankman study, which demonstrated that a majority of children with subthreshold psychiatric conditions were at high risk of developing the equivalent full psychiatric syndrome in adulthood 45.…”

“…ADHD affects both boys and girls in all areas of functioning, for example, academically, cognitively, psychosocially, and psychiatrically 14, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30. Even though ADHD is associated with coexisting externalizing and internalizing disorders in both genders, girls with ADHD are significantly more likely to display internalizing disorders than boys with ADHD 25, 31, 32, 33. Internalizing problems is a collective term often used to describe emotional problems (e.g.…”

“…Previous studies indicate that symptoms of ADHD are genetically linked 31, 38, 44, 45, 46 and that subthreshold ADHD symptoms may also be associated with negative outcomes such as poorer academic achievements, lower self‐esteem, and poorer relationships with parents and peers 31, 38, 44, 45, 46. Less is known about the association between different levels of ADHD symptoms and sex differences in psychosocial outcomes.…”