Review: Adult Outcome as Seen Through Controlled Prospective Follow-up Studies of Children With Attention-Deficit/Hyperactivity Disorder Followed Into Adulthood.

Abstract

OBJECTIVE\nTo describe adult outcome of people with childhood diagnosed attention-deficit/hyperactivity disorder (ADHD) and its several key predictors via a review of seven North American controlled prospective follow-up studies: the Montreal, New York, Milwaukee, Pittsburgh, Massachusetts General Hospital (MGH), Berkeley and the seven-site Multimodal Treatment Study of Children with ADHD (MTA).\n\n\nMETHOD\nAll studies were prospective and followed children diagnosed with ADHD and an age and gender-matched control group at regular intervals from childhood (6-12 years) through adolescence into adulthood (20-40 years), evaluating symptom and syndrome persistence, functional outcomes and predictors of these outcomes.\n\n\nRESULTS\nThe rates of the ADHD syndrome persistence ranged from 5.7% to 77%, likely owing to varying diagnostic criteria and the source of information (self-report vs. informant report) across the studies. However, all studies observed high rates of symptomatic persistence ranging from 60% to 86%. The seven studies were largely consistent in finding that relative to control groups, research participants with childhood-diagnosed ADHD had significant impairments in the areas of educational functioning, occupational functioning, mental health and physical health, as well as higher rates of substance misuse, antisocial behavior and unsafe driving. The most consistently observed predictors of functional outcomes included ADHD persistence and comorbidity, especially with disruptive behavior disorders.\n\n\nCONCLUSION\nChildhood ADHD has high rates of symptomatic persistence, which is associated with negative functional outcomes. Characteristics that predict these negative outcomes such as comorbid disruptive behavior disorders may be important targets for intervention.