Childhood predictors of persistent ADHD in early adulthood: Results from the first follow-up study in China

Longitudinal Associations Between Symptoms of ADHD and Life Success: From Emerging Adulthood to Early Middle Adulthood

OBJECTIVE

To expand on current adult ADHD literature by investigating the stability of ADHD symptomatology (i.e., inattention and hyperactivity-impulsivity) across a 15-year period (from emerging adulthood to early middle adulthood) and the relative contributions of ADHD symptomatology to life success.

METHOD

A sample of 320 post-secondary students was initially assessed for ADHD symptomatology using the Conners' Adult ADHD Rating Scale (CAARS). Fifteen years later, participants were re-assessed using the CAARS and several measures of life success (e.g., relationship satisfaction, career satisfaction, and stress levels).

RESULTS

Inattention and hyperactivity-impulsivity symptoms showed strong stability across the 15-year period. Additionally, inattention symptoms during emerging adulthood and early middle adulthood were consistently associated with poorer life success (i.e., lower relationship and career satisfaction), particularly for men. Associations for hyperactivity-impulsivity symptoms were less consistent.

CONCLUSION

ADHD symptomatology can be conceptualized as a stable, dimensional trait across adulthood, with important impacts on life success.

Clinical and Cognitive Features of Attention Deficit Hyperactivity Disorder with Intellectual Giftedness: A Systematic Review

A systematic review was carried out on publications from the last 15 years that have studied the effect of intellectual giftedness, defined as IQ > 115, on the clinical and cognitive features of ADHD. Studies indicate that about 15% of people with high IQ meet ADHD criteria. IQ has shown no effect on the pharmacological treatment, and comorbidity does not differ from that of other children with ADHD. High IQ-ADHD, compared to average IQ-ADHD, tends to show less severity in cognitive and behavioral symptoms, as well as a better prognosis; however high IQ may mask ADHD symptoms delaying diagnosis and treatment.

Neuropsychological and Symptom Predictors of Diagnostic Persistence in ADHD: A 25-Year Follow-up Study

BACKGROUND

This study extends long-term predictive research on ADHD by including both neuropsychological and symptom measures at baseline in adolescence as predictors of diagnostic persistence 25 years later.

METHODS

Nineteen males with ADHD and 26 healthy controls (HC; M/F = 13/13), were assessed in adolescence and 25 years later. Measurements at baseline included a comprehensive test battery measuring eight neuropsychological domains, an IQ estimate, the Child Behavior Checklist (CBCL), and the Global Assessment Scale of Symptoms. Differences between ADHD Retainers, Remitters, and HC were calculated with ANOVAs, and potential predictions of differences in the ADHD group by linear regression analyses.

RESULTS

Eleven (58%) participants retained their ADHD diagnoses at follow-up. Motor Coordination and Visual perception at baseline predicted diagnosis at follow-up. CBCL Attention problems at baseline in the ADHD group predicted variance in diagnostic status.

CONCLUSION

Lower-order neuropsychological functions related to motor function and perception are important long-time predictors of persistence of ADHD.

Attention Deficit Hyperactivity Disorder (ADHD) among elementary students in rural China: Prevalence, correlates, and consequences

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a widely recognized mental health problem in developed countries but remains under-investigated in developing settings. This study examines the prevalence, correlates, and consequences of ADHD symptoms among elementary school students in rural China.

METHODS

Cross-sectional data were collected from 6,719 students across 120 rural primary schools in China on ADHD symptoms, demographic characteristics, and academic performance in reading and math. ADHD symptoms were evaluated using the caregiver-reported ADHD Rating Scale-IV.

RESULTS

The prevalence of ADHD symptoms was 7.5% in our sample. Male students, students in lower grade levels, and students with lower cognitive ability showed a significantly higher prevalence of ADHD symptoms (ORs = 2.56, 2.06, and 1.84, respectively; p<0.05). Left-behind children showed a significantly lower prevalence of ADHD symptoms than did children who were living with their parents (OR = 0.74, p < 0.05). Adjusted regressions show that students with ADHD symptoms scored 0.12 standardized deviations lower in reading (p < 0.05) and 0.19 standardized deviations lower in math (p < 0.01).

LIMITATIONS

The ADHD Rating Scale-IV is a screening scale rather than a diagnostic test. Caregiver self-report measures also may underestimate ADHD symptoms for our sample.

CONCLUSIONS

ADHD is a common disorder among rural students in China and appears to be contributing to poor academic outcomes. The higher prevalence of ADHD among students with low cognitive ability also suggests that many rural children in China face multifactorial learning challenges. Taken together, the findings indicate a need for educators and policymakers in rural China to develop programs to reduce risk and support students with ADHD symptoms.

Retrospective symptoms and learning difficulties predicting ADHD in adults: Differences between prison inmates and the clinical population

People who suffer from ADHD in their childhood are more likely to be involved in criminal acts in late adolescence and adulthood. This study analyses the association between retrospective ADHD symptoms and associated problems (somatic and learning difficulties), and current symptoms in a sample of adults from imprisoned and clinical populations. Four hundred and fifty-seven participants, aged between 17 and 69 years, were divided into four groups: ADHD prison group without clinical history of symptoms (n = 61), prison group (n = 162), ADHD clinical group (n = 176) and clinical group (n = 58). The ADHD-IV scale and Wender Utah Rating Scale (WURS) were administered to the four groups and demonstrated high rates of persistence of ADHD symptoms into adulthood. ADHD groups reported significantly higher impairment both during childhood (symptoms, somatic and learning difficulties) and at present, with the ADHD clinical group being the most severely impaired. Finally, current symptoms of ADHD, along with childhood ADHD symptoms and learning difficulties, significantly predicted current impairments, but only in the clinical group. These findings represent some initial steps into the identification of predictors of ADHD symptomatology in adulthood in order to elucidate its etiopathogenesis and better identify high-risk groups for targeted prevention.

Predicting the Adult Clinical and Academic Outcomes in Boys With ADHD: A 7- to 10-Year Follow-Up Study in China

Background: Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood and causes adverse effects on social functioning. The present study aimed to widely investigate the predictors, particularly childhood intelligence quotient (IQ) and family environment factors, on adult clinical and academic outcomes in boys with ADHD. Methods: A total of 101 boys with ADHD in a Chinese Han ADHD cohort were followed up 7-10 years later. Baseline ADHD symptoms were evaluated using the parent version of the ADHD Rating Scale-IV (ADHD-RS-IV) and the Chinese version of the Conners' Parent Rating Scale-Revised (CPRS-48). The intelligence of the child was tested by the China-Wechsler Intelligence Scale for Children (C-WISC), and family function was assessed by the Family Environment Scale-Chinese Edition (FES-CV). Adult ADHD persistence was defined using DSM-IV criteria for ADHD, and academic outcome fell into two categories: higher academic level group (studying in senior middle school or above) and lower academic level group (studying in vocational secondary schools or below). Results: Stepwise multiple logistic regression analysis revealed that the father's character, impulsive-hyperactive index as measured by the CPRS-48, and intellectual-cultural index as measured by the FES-CV independently predicted clinical outcomes in adults, with an AUC of 0.770 (p < 0.001, 95% CI = 0.678-0.863). The corresponding sensitivity and specificity were 0.743 and 0.727, respectively. The father's education level, family economic level, and verbal IQ (VIQ) on the C-WISC independently predicted adult academic outcomes, with an AUC of 0.870 (p < 0.001, 95% CI = 0.796-0.944). The corresponding sensitivity and specificity were 0.813 and 0.783, respectively. Conclusion: Initial ADHD symptom severity and IQ, father's character and education level, and family atmosphere and function affect adult clinical and academic outcomes. Addressing these areas early may help to improve the prognosis of ADHD into adulthood.

Cognitive correlates of attention-deficit hyperactivity disorder in children and adolescents with high intellectual ability

BACKGROUND

There is an ongoing debate as to whether attention-deficit hyperactivity disorder (ADHD) in highly intelligent individuals has a similar presentation as in average intelligent individuals. The aim of this study was to examine the cognitive correlates of ADHD in highly intelligent children and adolescents with ADHD.

METHOD

Two independent samples (N = 204 and N = 84) of (1) high intelligence quotient (IQ) (IQ ≥ 120) children and adolescents with ADHD were used, carefully matched on age, gender, ADHD severity, and IQ with (2) control participants with high intelligence, (3) participants with ADHD with an average intelligence (IQ 90-110), and (4) control participants with an average intelligence. These samples were selected from the Dutch node of the International Multicenter ADHD Genetics (NeuroIMAGE) and Tracking Adolescents' Individual Lives Survey (TRAILS) cohorts, respectively, in which a large battery of cognitive tasks was administered. Linear mixed models were used to examine the main effects of ADHD and IQ and their interaction on cognitive performance.

RESULTS

ADHD-control group differences were not moderated by IQ; mostly equally large ADHD-control differences in cognitive performance were found for high versus average intelligent groups. The small moderating effects found mostly indicated somewhat milder cognitive problems in highly intelligent individuals with ADHD. Overall, highly intelligent children and adolescents with ADHD performed at the level of the average intelligent control children.

CONCLUSIONS

Our findings indicate the cognitive profile of ADHD is similar in highly versus average intelligent individuals with ADHD, although ADHD-related cognitive deficits may be easily overlooked in the high intelligence population when compared to the typical (i.e., average intelligent) control group.

The clinical relevance of asking young psychiatric patients about childhood ADHD symptoms

Aim: The aim of this study was to explore the relevance of asking young psychiatric patients about childhood symptoms of attention deficit hyperactivity disorder (ADHD).Method: A total of 180 young adults (18-25 years of age) from a general psychiatric out-patient clinic in Uppsala filled in the Child and Adolescent Psychiatric Screening Inventory-Retrospect (CAPSI-R) as part of the diagnostic procedure. The study population was divided into groups based on number and subtype of reported ADHD symptoms, inattention (IN) or hyperactivity/impulsivity (HI). The clinical characteristics associated with different symptoms of ADHD were explored.Results: The groups with five or more self-reported ADHD childhood symptoms, of either IN or HI, had more psychiatric comorbid conditions, a significantly higher co-occurrence of substance use disorders and personality disorders, and experienced more psychosocial and environmental problems.Conclusion: High level of self-reported ADHD childhood symptoms in young psychiatric patients identified a group more burdened with psychiatric comorbid conditions and more psychosocial problems. This group should be offered a thorough diagnostic assessment of ADHD.

Neural Correlates of Working Memory Deficits in Different Adult Outcomes of ADHD: An Event-Related Potential Study

BACKGROUND

We investigated working memory (WM) processing in a longitudinal sample of young adults with persistent and remittent childhood-onset ADHD to investigate the neural correlates of working memory with adult outcomes of ADHD.

METHODS

Forty-seven young Chinese adults who had been diagnosed with ADHD during childhood underwent follow-up assessments for an average of 9 years. The ADHD sample consisted of 25 ADHD persisters (mean age =18.38 ± 0.5 years) and 22 remitters (mean age = 18.78 ± 1.10 years), who were compared with 25 sex ratio- and IQ-matched healthy adults (mean age = 19.60 ± 1.22 years) in a verbal n-back task.

RESULTS

No differences in behavioral measures were observed across the three groups. Compared with the healthy controls, the ADHD persisters and remitters had larger N1 amplitudes and smaller P2 amplitudes, while no significant differences between the persistence and remission groups were observed. The P3 amplitudes of the remission and control groups were higher than that of the persistence group, but there was no significant difference between the remitters and healthy controls.

CONCLUSION

The P3 amplitudes reflecting postdecisional processing and/or WM updating were sensitive to ADHD remission, as they might improve concurrently with ADHD symptoms. These results indicate that the N1, P2, and P3 components of WM processing might be potential biomarkers for different ADHD outcomes.

Psychiatric Disorders After Attention-Deficit/Hyperactivity Disorder: A Nationwide Population-Based Study in Taiwan

PURPOSE

To investigate the risk for psychiatric disorders in patients newly diagnosed with attention deficit hyperactive disorder (ADHD) from two longitudinal groups of children with and without ADHD.

STUDY DESIGN

In total, 1,745 children newly diagnosed with ADHD and 6,980 participants without ADHD were identified from Taiwan's National Health Insurance Research Database in 2005 and followed until 2010. Risks for psychiatric disorders in the ADHD and non-ADHD groups were compared.

RESULTS

The ADHD group was 3.82 times more likely to develop psychiatric disorders than their counterparts. The ADHD group showed the highest risk for oppositional defiant disorder, followed by adult ADHD and autism spectrum disorder. Moreover, the time effects of psychiatric disorders in the ADHD group were significant. Patients with ADHD subtypes had a significant risk for psychiatric disorders compared to their counterparts.

CONCLUSIONS

A high risk for psychiatric disorders was revealed in this study among children with ADHD. Childhood ADHD, the duration after the ADHD diagnosis, and the ADHD subtype were associated with psychiatric disorders.

CLINICAL RELEVANCE

Various psychiatric disorders were observed in children after they had been newly diagnosed with ADHD, indicating a need for integrated care that includes medical practitioners, family members, social workers, and early intervention workers for patients newly diagnosed with ADHD to decrease the risk for comprehensive psychiatric disorders.

Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan

Attention-deficit/hyperactivity disorder (ADHD) is highly heritable and the most common neurodevelopmental disorder in childhood. In recent decades, it has been appreciated that in a substantial number of cases the disorder does not remit in puberty, but persists into adulthood. Both in childhood and adulthood, ADHD is characterised by substantial comorbidity including substance use, depression, anxiety, and accidents. However, course and symptoms of the disorder and the comorbidities may fluctuate and change over time, and even age of onset in childhood has recently been questioned. Available evidence to date is poor and largely inconsistent with regard to the predictors of persistence versus remittance. Likewise, the development of comorbid disorders cannot be foreseen early on, hampering preventive measures. These facts call for a lifespan perspective on ADHD from childhood to old age. In this selective review, we summarise current knowledge of the long-term course of ADHD, with an emphasis on clinical symptom and cognitive trajectories, treatment effects over the lifespan, and the development of comorbidities. Also, we summarise current knowledge and important unresolved issues on biological factors underlying different ADHD trajectories. We conclude that a severe lack of knowledge on lifespan aspects in ADHD still exists for nearly every aspect reviewed. We encourage large-scale research efforts to overcome those knowledge gaps through appropriately granular longitudinal studies.

Temperament in Adulthood Attention Deficit-Hyperactivity Disorder without Bipolar Disorder

OBJECTIVE

We examined whether some temperamental traits would be associated with persistence of attention deficit-hyperacitivty disorder (ADHD) in adulthood independent from bipolar disorder (BD).

METHODS

Eighty-one ADHD patients without a comorbid diagnosis of BD were divided into two groups, those with childhood ADHD (n=46), and those with Adulthood ADHD (n=35). The severity of childhood and adulthood ADHD were assessed by using the Wender Utah Rating Scale (WURS-25) and Turgay's Adult ADD/ADHD Diagnosis and Evaluation Scale (DES). Subjects' temperamental characteristics were examined using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto questionnaire (TEMPS-A).

RESULTS

The mean scores of WURS-25 were higher in adult ADHD group than in childhood ADHD group (p<0.001). Adult ADHD group had significantly higher scores on cyclothymic (p=0.002), irritable (p<0.0001), and anxious (p=0.042) subscales of TEMPS-A. The scores of WURS-25 in adulthood ADHD group were positively correlated with cyclothymia scores (r=0.366, p=0.033). Total scores of Turgay's Adult ADD/ADHD DES were positively correlated with cyclothymic (r=0.354, p=0.040), hyperthymic (r=0.380, p=0.026), and irritable (r=0.380, p=0.026) subscale scores. Cychlothymic and irritable temperaments were significantly associated with the severity of adulthood symptoms of ADHD.

CONCLUSION

We might suggest that cyclothymic and irritable temperaments would predict the diagnosis of adulthood ADHD independent from BD.

Changing ASD-ADHD symptom co-occurrence across the lifespan with adolescence as crucial time window: Illustrating the need to go beyond childhood

Literature on the co-occurrence between Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) is strongly biased by a focus on childhood age. A review of the adolescent and adult literature was made on core and related symptoms of ADHD and ASD. In addition, an empirical approach was used including 17,173 ASD-ADHD symptom ratings from participants aged 0 to 84 years. Results indicate that ASD/ADHD constellations peak during adolescence and are lower in early childhood and old age. We hypothesize that on the border of the expected transition to independent adulthood, ASD and ADHD co-occur most because social adaptation and EF skills matter most. Lower correlations in childhood and older age may be due to more diffuse symptoms reflecting respectively still differentiating and de-differentiating EF functions. We plea for a strong research focus in adolescence which may -after early childhood- be a second crucial time window for catching-up pattern explaining more optimal outcomes. We discuss obstacles and oppportunities of a full lifespan approach into old age.