Summary: Researchers report sixty percent of children with ADHD demonstrate persistent symptoms into their mid 20’s.
Sixty percent of children with ADHD in a recent study demonstrated persistence of symptoms into their mid-20’s, and 41 percent had both symptoms and impairment as young adults.
Investigators noted that rates of ADHD persistence into adulthood have varied greatly in earlier studies, depending on how information is collected and analyzed. In a 16-year follow-up of the Multimodal Treatment Study of Children with ADHD (the “MTA”), they found that a combination of parent and self-reports plus a symptom threshold that is adjusted for adulthood (rather than based on traditional childhood definitions of ADHD) may be optimal.
“There has been a lot of recent controversy over whether children with ADHD continue to experience symptoms into adulthood,” said Dr. Margaret Sibley, lead author of the Journal of Child Psychology and Psychiatry study. “This study found that the way you diagnose ADHD can lead to different conclusions about whether or not an adult still has the disorder that started in childhood. First, if you ask the adult about their continued symptoms, they will often be unaware of them; however, family members or others who know them well often confirm that they still observe significant symptoms in the adult.”
Dr. Sibley added that if the classic childhood definition of ADHD is used when diagnosing adults, many cases will be missed because symptom presentation changes in adulthood. “By asking a family member about the adult’s symptoms and using adult-based definitions of the disorder, you typically find that around half of children with moderate to severe ADHD still show significant signs of the disorder in adulthood.”
Source: Penny Smith – Wiley
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Original Research: Abstract for “Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity” by Margaret H. Sibley, James M. Swanson, L. Eugene Arnold, Lily T. Hechtman, Elizabeth B. Owens, Annamarie Stehli, Howard Abikoff, Stephen P. Hinshaw, Brooke S. G. Molina, John T. Mitchell, Peter S. Jensen, Andrea L. Howard, Kimberley D. Lakes, William E. Pelham, and for the MTA Cooperative Group in Journal of Child Psychology and Psychiatry. Published online September 19 2016 doi:10.1111/jcpp.12620
Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity
Longitudinal studies of children diagnosed with ADHD report widely ranging ADHD persistence rates in adulthood (5–75%). This study documents how information source (parent vs. self-report), method (rating scale vs. interview), and symptom threshold (DSM vs. norm-based) influence reported ADHD persistence rates in adulthood.
Five hundred seventy-nine children were diagnosed with DSM-IV ADHD-Combined Type at baseline (ages 7.0–9.9 years) 289 classmates served as a local normative comparison group (LNCG), 476 and 241 of whom respectively were evaluated in adulthood (Mean Age = 24.7). Parent and self-reports of symptoms and impairment on rating scales and structured interviews were used to investigate ADHD persistence in adulthood.
Persistence rates were higher when using parent rather than self-reports, structured interviews rather than rating scales (for self-report but not parent report), and a norm-based (NB) threshold of 4 symptoms rather than DSM criteria. Receiver-Operating Characteristics (ROC) analyses revealed that sensitivity and specificity were optimized by combining parent and self-reports on a rating scale and applying a NB threshold.
The interview format optimizes young adult self-reporting when parent reports are not available. However, the combination of parent and self-reports from rating scales, using an ‘or’ rule and a NB threshold optimized the balance between sensitivity and specificity. With this definition, 60% of the ADHD group demonstrated symptom persistence and 41% met both symptom and impairment criteria in adulthood.
“Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity” by Margaret H. Sibley, James M. Swanson, L. Eugene Arnold, Lily T. Hechtman, Elizabeth B. Owens, Annamarie Stehli, Howard Abikoff, Stephen P. Hinshaw, Brooke S. G. Molina, John T. Mitchell, Peter S. Jensen, Andrea L. Howard, Kimberley D. Lakes, William E. Pelham, and for the MTA Cooperative Group in Journal of Child Psychology and Psychiatry. Published online September 19 2016 doi:10.1111/jcpp.12620