Thursday, September 8, 2016

ADHD Symptoms From Childhood May Lead to Greater Challenges for Adults

Although adults who were diagnosed with attention-deficit/hyperactivity disorder (ADHD) as children generally tend to report greater social and emotional challenges than those who were not diagnosed with ADHD, these outcomes can vary widely. A study in the Journal of the American Academy of Child and Adolescent Psychiatry now suggests that persisting ADHD symptoms in adulthood are associated with greater functional impairments.

The study also underscores the importance of treating people with ADHD to remission and not just improvement because symptom remission appears to be somewhat protective against anxiety, depression, and substance use disorder, according to the authors.

As part of the Multimodal Treatment Study of Children With ADHD (MTA), researchers tracked 579 children aged 7 to 9 with ADHD and 258 age- and sex-matched classmates without ADHD through childhood and adolescence and into adulthood (when participants were aged 19 to 28).

At age 18 and after, participants and their parents completed Conners’ Adult ADHD Rating Scale (CAARS) and the Diagnostic Interview Schedule for Children–Parent version (DISC-P) and Young Adult version (DISC-YA). From these assessments, researchers obtained information on educational, occupational, emotional outcomes, and more. DSM-5 symptom-count criteria—five symptoms reported either by the participant or the parent in either the Inattention and/or Hyperactive-Impulsive domain on the CAARS—were used to identify participants with persistent symptoms of ADHD; those who did not meet the ADHD threshold in either the Inattention and/or Hyperactive-Impulsive domain were considered to be in remission (symptom desistence). 

Overall, participants with persistent symptoms of ADHD tended to fare worse with regard to educational and occupational outcomes (including post-secondary education and income), followed by those whose ADHD symptoms were in remission, and controls. Participants in the symptom-persistent ADHD subgroup also scored worse on impulsivity/emotional lability (self- and parent-report) and neuroticism, and endorsed higher rates of mood (7.8% versus 1.8%) and anxiety disorders (14.2% vs. 5.0%) than the symptom-desistent subgroup, which exhibited outcomes similar to the controls.

“These findings suggest that functional outcomes in adults who were diagnosed with ADHD in childhood are not uniform but differ across domains, giving rise to different patterns of outcomes,” Lily Hechtman, M.D., and colleagues wrote. “[B]oth ADHD symptoms and functioning need to be targets of appropriate, innovative, and ongoing intervention in this chronic condition.”

For related information, see the Psychiatric News article “Better Ways to Treat Child ADHD, New Thinking for Adults Needed.”

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