Margaret H Sibley1, L Eugene Arnold1, James M Swanson1, Lily T Hechtman1, Traci M Kennedy1, Elizabeth Owens1, Brooke S G Molina1, Peter S Jensen1, Stephen P Hinshaw1, Arunima Roy1, Andrea Chronis-Tuscano1, Jeffrey H Newcorn1, Luis A Rohde1. 1. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, and Seattle Children's Research Institute, Seattle (Sibley); Department of Psychiatry and Behavioral Health, Ohio State University, and Nisonger Center, Columbus (Arnold); Child Development Center, School of Medicine, University of California, Irvine (Swanson); Division of Child Psychiatry, McGill University, and Montreal Children's Hospital, Montreal (Hechtman); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Kennedy, Molina); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Owens, Hinshaw); the REACH Institute, New York (Jensen); Department of Psychology, University of California, Berkeley (Hinshaw); Royal's Institute of Mental Health Research, University of Ottawa, Ottawa (Roy); Department of Psychology, University of Maryland, College Park (Chronis-Tuscano); Departments of Psychiatry and Pediatrics, Icahn School of Medicine at Mount Sinai, New York (Newcorn); ADHD and Developmental Psychiatry Programs, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Rohde).
Abstract
OBJECTIVE: It is estimated that childhood attention deficit hyperactivity disorder (ADHD) remits by adulthood in approximately 50% of cases; however, this conclusion is typically based on single endpoints, failing to consider longitudinal patterns of ADHD expression. The authors investigated the extent to which children with ADHD experience recovery and variable patterns of remission by adulthood. METHODS: Children with ADHD (N=558) in the Multimodal Treatment Study of ADHD (MTA) underwent eight assessments over follow-ups ranging from 2 years (mean age, 10.44 years) to 16 years (mean age, 25.12 years) after baseline. The authors identified participants with fully remitted, partially remitted, and persistent ADHD at each time point on the basis of parent, teacher, and self-reports of ADHD symptoms and impairment, treatment utilization, and substance use and mental disorders. Longitudinal patterns of remission and persistence were identified that considered context and timing. RESULTS: Approximately 30% of children with ADHD experienced full remission at some point during the follow-up period; however, a majority of them (60%) experienced recurrence of ADHD after the initial period of remission. Only 9.1% of the sample demonstrated recovery (sustained remission) by study endpoint, and only 10.8% demonstrated stable ADHD persistence across study time points. Most participants with ADHD (63.8%) had fluctuating periods of remission and recurrence over time. CONCLUSIONS: The MTA findings challenge the notion that approximately 50% of children with ADHD outgrow the disorder by adulthood. Most cases demonstrated fluctuating symptoms between childhood and young adulthood. Although intermittent periods of remission can be expected in most cases, 90% of children with ADHD in MTA continued to experience residual symptoms into young adulthood.
OBJECTIVE: It is estimated that childhood attention deficit hyperactivity disorder (ADHD) remits by adulthood in approximately 50% of cases; however, this conclusion is typically based on single endpoints, failing to consider longitudinal patterns of ADHD expression. The authors investigated the extent to which children with ADHD experience recovery and variable patterns of remission by adulthood. METHODS: Children with ADHD (N=558) in the Multimodal Treatment Study of ADHD (MTA) underwent eight assessments over follow-ups ranging from 2 years (mean age, 10.44 years) to 16 years (mean age, 25.12 years) after baseline. The authors identified participants with fully remitted, partially remitted, and persistent ADHD at each time point on the basis of parent, teacher, and self-reports of ADHD symptoms and impairment, treatment utilization, and substance use and mental disorders. Longitudinal patterns of remission and persistence were identified that considered context and timing. RESULTS: Approximately 30% of children with ADHD experienced full remission at some point during the follow-up period; however, a majority of them (60%) experienced recurrence of ADHD after the initial period of remission. Only 9.1% of the sample demonstrated recovery (sustained remission) by study endpoint, and only 10.8% demonstrated stable ADHD persistence across study time points. Most participants with ADHD (63.8%) had fluctuating periods of remission and recurrence over time. CONCLUSIONS: The MTA findings challenge the notion that approximately 50% of children with ADHD outgrow the disorder by adulthood. Most cases demonstrated fluctuating symptoms between childhood and young adulthood. Although intermittent periods of remission can be expected in most cases, 90% of children with ADHD in MTA continued to experience residual symptoms into young adulthood.
Authors: 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 Journal: J Child Psychol Psychiatry Date: 2016-09-19 Impact factor: 8.982
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