Persistence of Attention-Deficit/Hyperactivity Disorder into adulthood: What have we learned from the prospective follow-up studies?

Mannuzza, Salvatore; Klein, Rachel G.; Moulton, John L.

doi:10.1177/108705470300700203

Cited by 146 publications

(114 citation statements)

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“…By young adulthood, rates of DSM-III-R (American Psychiatric Association, 1987) ADHD had declined precipitously (Mannuzza, Klein, Bessler, Malloy, & LaPadula, 1993. Persistence rates of 6% and 1% were reported in probands and controls, respectively, a far lower estimate than those observed in other longitudinal studies (Mannuzza, Klein, & Moulton, 2003). The authors noted that the exclusion of children with primary aggression or other antisocial behavior might have resulted in a baseline sample with low overall impairment, with consequently improved adult outcomes.…”

Section: Prospective Investigations In Malesmentioning

confidence: 75%

“…Broadly, a lack of parental and young adult attunement regarding ADHD status may be associated with particularly poor outcomes. These findings underscore the importance of obtaining both self-and other-report in young adulthood (e.g., Gibbins and Weiss, 2007;Hechtman et al, 2011;Mannuzza et al, 2003). As longitudinal research samples move further into adulthood and parent-young adult interactions become less salient, it will be important to assess the relative predictive usefulness of other collaterals (e.g., spouse, roommates).…”

Section: Effects Of Symptom Thresholds On Adhd Persistencementioning

confidence: 91%

“…Via parent-reported DSM-IV criteria, ADHD was found to persist in 58% of probands in young adulthood. Mannuzza et al (2003) discussed methodological differences that may have contributed to the disparate persistence estimates across extant longitudinal studies (i.e., the Montreal, New York, Swedish, and Milwaukee studies). Only the Milwaukee Study had interviewed both young adults and caregivers, with parent assessments yielding dramatically higher persistence estimates.…”

Section: Prospective Investigations In Malesmentioning

confidence: 99%

“…Not only did parents report higher levels of persistent ADHD, but parentreported diagnostic status predicted current impairment across a wider array of measures than did young adult self-reported status. Indeed, the importance of including collateral report into young adulthood has been established in a number of longitudinal investigations (e.g., Babinski et al, 2011;Barkley et al, 2002;Mannuzza et al, 2003;Sibley et al, 2012). Sole reliance on selfreport may result in under-reporting of current symptomatology and consequent underestimates of ADHD persistence into adulthood (e.g., Barkley et al, 2002).…”

Section: Effects Of Symptom Thresholds On Outcomementioning

confidence: 99%

“…Estimates of the persistence of ADHD from childhood into adulthood in males range hugely from 5%-66% (Mannuzza, Klein, & Moulton, 2003), due in part to crucial methodological differences between extant longitudinal studies. Furthermore, study of the persistence of ADHD into young adulthood is complicated by a number of nosological difficulties, related to the fact that ADHD was first conceptualized as a disorder of childhood and adolescence (Adler, Barkley, & Newcorn, 2008;Kessler et al, 2010;McGough & Barkley, 2004;McGough & McCracken, 2006).…”

Section: Introductionmentioning

confidence: 99%

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How Persistent is ADHD into Adulthood? Informant Report and Diagnostic Thresholds in a Female Sample

Guelzow

Loya

Hinshaw

2016

J Abnorm Child Psychol

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Although the notion that Attention-Deficit/Hyperactivity Disorder (ADHD) often persists into adulthood is increasingly accepted, important diagnostic questions remain. Using a large (baseline proband n = 140, comparison n = 88) prospectively followed, ethnically diverse female sample, I examined the impacts of (a) informant (i.e., parent-vs. self-report) and (b) diagnostic symptom threshold (i.e., the DSM-IV 6/9 symptoms of inattention [IA] or hyperactivity/impulsivity [H/I] vs. a developmentally referenced criterion [DRC]) on estimates of ADHD persistence from childhood (age range 6-12) into young adulthood (mean age = 19.6 years). Further, I assessed and compared the predictive validity of ADHD status per each informant, as well as via the two different symptom cutoffs, on measures assessing functioning in a number of important domains (e.g., depression, academic achievement, global impairment).Separate 2 x 2 (Wave 1 diagnostic status x Wave 3 diagnostic status) chi-square analyses revealed that per parent report, significantly more probands (44%) than baseline comparison participants (1%) met full ADHD criteria (χ 2 [187] = 42.51, p< 0.001, φ = 0.47). Significantly more probands (22%) than comparisons (2%; χ 2 [209] = 15.97, p< 0.001, φ = 0.28) met full criteria via young adult self-report as well. Informant diagnostic concordance was significant, but of a small effect size (κ = .22). Using a series of hierarchical multiple regression analyses and controlling for key covariates, parent-reported ADHD was found to be independently associated with poorer outcomes on eight of nine considered measures (|β|'s ranging from 0.18 to 0.61). Self-reported ADHD was independently associated only with lower math scores (|β| = .18).As in past research, the DRC was set at two SD above the comparison participants' mean symptom number, yielding a diagnostic threshold of 4/9 H/I and 5/9 IA symptoms. Via the DSM-IV cutoff, ADHD was estimated to persist in 55.9% of baseline probands; via the DRC, this estimate rose to 61.4%. One-way ANCOVA models were used to test mean differences on outcome measures for participants who met the DSM-IV threshold, those who only met the DRC ("DRC-only"), and those who met neither threshold. All models were significant (all Fs >6.50, all ps < .01). DRC-only participants endorsed poorer outcomes of large to very large effect sizes 2 across seven of the study's nine outcome measures, compared to participants who met neither cutoff. Further, DRC-only participants did not differ on any outcome measure from those who met the higher DSM-IV threshold.The present findings add to extant research in suggesting that (a) parent-report yields higher ADHD persistence estimates than young adult self-report and (b) parent-reported persistence remains a more potent predictor of young adult functioning than self-report. Findings also suggest that self-reported ADHD persistence rates may be higher in young adult females than in males, although this suggestion merits further investigation. Further, findings suggest th...

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Section: Prospective Investigations In Malesmentioning

confidence: 75%

Section: Effects Of Symptom Thresholds On Adhd Persistencementioning

confidence: 91%

Section: Prospective Investigations In Malesmentioning

confidence: 99%

Section: Effects Of Symptom Thresholds On Outcomementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

How Persistent is ADHD into Adulthood? Informant Report and Diagnostic Thresholds in a Female Sample

Guelzow

Loya

Hinshaw

2016

J Abnorm Child Psychol

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Structure and Diagnosis of Adult Attention-Deficit/Hyperactivity Disorder

Kessler¹,

Green²,

Adler³

et al. 2010

Arch Gen Psychiatry

268

103

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CONTEXT Controversy exists about the appropriate criteria for a diagnosis of adult attention-deficit/hyperactivity disorder (ADHD) OBJECTIVES To examine the structure and symptoms most predictive of DSM-IV adult ADHD. DESIGN Data come from clinical interviews in enriched sub-samples of the National Comorbidity Survey Replication (NCS-R) (n = 131) and a survey of a large managed healthcare plan (n = 214). The clinician-administered Adult ADHD Clinical Diagnostic Scale (ACDS) was used to assess childhood ADHD and expanded symptoms of current adult ADHD. Analyses examined stability of symptoms from childhood to adulthood, the structure of adult ADHD, and the adult symptoms most predictive of current clinical diagnoses. SETTING The ACDS was administered telephonically by clinical research interviewers with extensive experience in diagnosis and treatment of adult ADHD. PARTICIPANTS An enriched sample of community respondents MAIN OUTCOME MEASURES DSM-IV/ACDS diagnoses of adult ADHD RESULTS Almost half (45.7%) of respondents who had childhood ADHD continued to meet full DSM-IV criteria for current adult ADHD, with 94.9% of these cases having current attention-deficit disorder and 34.6% current hyperactivity disorder. Adult persistence was much greater for inattention than hyperactivity-impulsivity. Additional respondents met full criteria for current adult ADHD despite not having met full childhood criteria. A three-factor structure of adult symptoms included executive functioning, inattention-hyperactivity, and impulsivity. Stepwise logistic regression found executive functioning problems to be the most consistent and discriminating predictors of adult DSM-IV/ACDS ADHD. CONCLUSIONS These findings document the greater persistence of inattentive than hyperactive/impulsive childhood symptoms of ADHD in adulthood, but also show that inattention in not specific to ADHD, as it is strongly associated with other adult mental disorders. Executive functioning problems, in comparison, are more specific and consistently important predictors of DSM-IV adult ADHD despite not being in DSM-IV, suggesting that the number of executive functioning symptoms should be increased in DSM-V/ICD-11.

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Attention‐Deficit/Hyperactivity Disorder

2006

Wiley Handbook of Current and Emerging Drug Therapies

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ABSTRACT. A 3-year-old child was referred to consultation for hyperactivity, attention deficit, impulsivity, and sleep problems. He met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for attentiondeficit/hyperactivity disorder. At baseline, the Conners' Parent Rating Scale and the Conners' Teacher Rating Scale raw total scores were 30 and 32, respectively. The child had low a serum ferritin level (13 ng/mL). After 8 months of treatment with Tardyferon (ferrous sulfate, 80 mg/day), his serum ferritin increased to 102 ng/mL. Both parents and teachers reported considerable behavioral improvement. The Conners' Parent and Teacher Rating Scale raw total scores decreased to 19 and 13, respectively. This is the first report of the effectiveness of iron supplementation in a young child with attention-deficit/hyperactivity disorder. P reliminary evidence supports a significant iron deficiency in children with attention-deficit/ hyperactivity disorder (ADHD). 1 The symptoms of ADHD may be related to a dopamine dysfunction or to an imbalance in dopaminergic function. [2][3][4][5] Iron is a cofactor for tyrosine hydroxylase, the rate-limiting enzyme for dopamine synthesis. Moreover, iron deficiency has been described to alter dopamine D 1 and D 2 receptor density and activity in animals. 6,7 Therefore, brain iron stores might influence dopamine-dependent functions and, consequently, the expression of ADHD symptoms.Previous neuropsychological studies reported an improvement in children' s attention span after iron supplementation. 8,9 However, no study thus far has addressed specifically the effectiveness of iron supplementation in iron-deficient children with ADHD diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. 10 This study reports on the effect of iron supplementation in a 3-year-old child with ADHD. CASE REPORTA 3-year-old male was referred to the outpatient clinic of the child psychopathology unit for symptoms of inattention, hyperactivity, and impulsivity at school and home.His father, a 28-year-old-employee, presented with symptoms of inattention and impulsivity. In childhood, he also was hyperactive. These symptoms caused a functional impairment first at school and subsequently in his work and social life. Therefore, the father was very worried about the symptomatology presented by his son. The mother, a 29-year-old housewife, reported no relevant psychiatric symptoms. The child was the only son in the family. No other relevant psychiatric symptoms or disorders in the family were reported. No medical problems during pregnancy or after the birth of the child were reported. The physical and neurologic development of the child was normal. At the time of the consultation, the child was in his first year of kindergarten. After consultation with the teachers, who also were very worried about the behavior of the child at school, the parents decided to come to our unit.Although the diagnosis of ADHD in preschoolers is complex an...

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Persistence of Attention-Deficit/Hyperactivity Disorder into adulthood: What have we learned from the prospective follow-up studies?

Abstract: Estimates of the proportion of children with ADHD who will experience symptoms of the childhood syndrome in adulthood are likely to vary considerably, as a function of multiple factors. Several recommendations are made for designing future follow-up investigations.

Cited by 146 publications

References 32 publications

How Persistent is ADHD into Adulthood? Informant Report and Diagnostic Thresholds in a Female Sample

How Persistent is ADHD into Adulthood? Informant Report and Diagnostic Thresholds in a Female Sample

Structure and Diagnosis of Adult Attention-Deficit/Hyperactivity Disorder

Attention‐Deficit/Hyperactivity Disorder

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