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Childhood Factors Affecting Persistence and Desistence of Attention-Deficit/Hyperactivity Disorder Symptoms in Adulthood: Results From the MTA

https://doi.org/10.1016/j.jaac.2016.05.027Get rights and content

Objective

To determine childhood factors that predict attention-deficit/hyperactivity disorder (ADHD) persistence and desistence in adulthood.

Method

Regression analyses were used to determine associations between childhood factors and adult ADHD symptom persistence in 453 participants (mean age, 25 years) from the Multimodal Treatment Study of Children with ADHD (MTA). Childhood IQ, total number of comorbidities, child-perceived parenting practices, child-perceived parent−child relationships, parental mental health problems, marital problems of parents, household income levels, and parental education were assessed at a mean age of 8 years in all participants. Adult ADHD persistence was defined using DSM-5 symptom counts either with or without impairment, as well as mean ADHD symptom scores on the Conners’ Adult ADHD Rating Scale (CAARS). Age, sex, MTA site, and childhood ADHD symptoms were covaried.

Results

The most important childhood predictors of adult ADHD symptom persistence were initial ADHD symptom severity (odds ratio [OR] = 1.89, standard error [SE] = 0.28, p = .025), comorbidities (OR = 1.19, SE = 0.07, p = .018), and parental mental health problems (OR = 1.30, SE = 0.09, p = .003). Childhood IQ, socioeconomic status, parental education, and parent−child relationships showed no associations with adult ADHD symptom persistence.

Conclusion

Initial ADHD symptom severity, parental mental health, and childhood comorbidity affect persistence of ADHD symptoms into adulthood. Addressing these areas early may assist in reducing adult ADHD persistence and functioning problems.

Section snippets

Study Sample

This study was based on data from the National Institute of Mental Health–Multimodal Treatment Study of Children With ADHD (MTA) cohort. The MTA was a 14-month randomized treatment study of 579 children with ADHD, aged 7 to 10 years, with naturalistic follow-ups to 16 years after baseline. Follow-up assessments were made in childhood (3 years after baseline), adolescence (6, 8, and 10 years after baseline), and adulthood (12, 14, and 16 years after baseline). The current study uses data from

Results

Based on DSM-5 symptom count, 226 (49.9%) of participants were classified as symptom persisters and 227 (50.1%) as symptom desisters. Table 1 presents distributions of baseline variables in the complete-case dataset (Table S3, available online, presents distributions of variables in the imputed dataset).

Logistic regression analyses on the imputed dataset showed that childhood comorbidity was associated with a 15% likelihood of ADHD symptom persistence (odds ratio [OR] = 1.15, standard error

Discussion

This study investigated childhood factors that predict a risk for persistence of ADHD into adulthood. Childhood psychiatric comorbidity, parental mental health, parental marital relationships, and parenting styles were associated with persisting ADHD symptomatology. Of the four above-mentioned predictors, only childhood comorbidity and parental mental health were consistently associated with adult ADHD symptom persistence. We found no associations of IQ, household income, parental education, or

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  • Cited by (0)

    This article is discussed in an editorial by Dr. James J. McGough on page 925.

    Clinical guidance is available at the end of this article.

    The work reported was supported by cooperative agreement grants and contracts from the National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse (NIDA) to the following: University of California–Berkeley: U01 MH50461, N01MH12009, and HHSN271200800005-C; DA-8-5550; Duke University: U01 MH50477, N01MH12012, and HHSN271200800009-C; DA-8-5554; University of California– Irvine: U01MH50440, N01MH12011, and HHSN271200800006-C; DA-8-5551; Research Foundation for Mental Hygiene (New York State Psychiatric Institute/Columbia University): U01 MH50467, N01 MH12007, and HHSN271200800007-C; DA-8-5552; Long Island–Jewish Medical Center: U01 MH50453; New York University: N01MH 12004 and HHSN271200800004-C; DA-8-5549; University of Pittsburgh: U01 MH50467, N01 MH 12010, and HHSN271200800008-C; DA-8-5553; DA039881; and McGill University: N01MH12008 and HHSN271200800003-C; DA-8-5548. Dr. Roy was supported by the Ter Meulen grant of the Royal Netherlands Academy of Arts and Sciences (KNAW) to participate in this study. Drs. Roy and Hechtman had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have made substantial contributions to this study and qualify for authorship. Study concept and design: Drs. Roy, Hechtman, Arnold, and Howard. Acquisition, analysis, or interpretation of data: all authors. Manuscript drafting: Drs. Roy and Hechtman. Critical revision of the manuscript for important intellectual content: all authors. Final approval of version to be published: all authors. Obtained funding: Drs. Hechtman, Molina, and Swanson.

    The Multimodal Treatment Study of Children with ADHD (MTA) was a National Institute of Mental Health (NIMH) cooperative agreement randomized clinical trial, continued under an NIMH contract as a follow-up study and finally under a National Institute on Drug Abuse (NIDA) contract. Collaborators from NIMH: Benedetto Vitiello, MD (Child and Adolescent Treatment and Preventive Interventions Research Branch), Joanne B. Severe, MS (Clinical Trials Operations and Biostatistics Unit, Division of Services and Intervention Research), Peter S. Jensen, MD (currently at REACH Institute and Mayo Clinic), L. Eugene Arnold, MD, Med (currently at Ohio State University), Kimberly Hoagwood, PhD (currently at Columbia); previous contributors from NIMH to the early phases: John Richters, PhD (currently at National Institute of Nursing Research); Donald Vereen, MD (currently at NIDA). Principal investigators and co-investigators from the sites are: University of California, Berkeley/San Francisco: Stephen P. Hinshaw, PhD (Berkeley), Glen R. Elliott, PhD, MD (San Francisco); Duke University: Karen C. Wells, PhD, Jeffery N. Epstein, PhD (currently at Cincinnati Children's Hospital Medical Center), Desiree W. Murray, PhD; previous Duke contributors to early phases: C. Keith Conners, PhD (former PI); John March, MD, MPH; University of California, Irvine: James Swanson, PhD, Timothy Wigal, PhD; previous contributor from UCLA to the early phases: Dennis P. Cantwell, MD (deceased); New York University School of Medicine: Howard B. Abikoff, PhD; Montreal Children's Hospital/McGill University: Lily Hechtman, MD; New York State Psychiatric Institute/Columbia University/Mount Sinai Medical Center: Laurence L. Greenhill, MD (Columbia), Jeffrey H. Newcorn, MD (Mount Sinai School of Medicine); University of Pittsburgh: Brooke Molina, PhD, Betsy Hoza, PhD (currently at University of Vermont), William E. Pelham, PhD (PI for early phases, currently at Florida International University). Follow-up phase statistical collaborators: Robert D. Gibbons, PhD (University of Illinois, Chicago); Sue Marcus, PhD (Mt. Sinai College of Medicine); Kwan Hur, PhD (University of Illinois, Chicago). Original study statistical and design consultant: Helena C. Kraemer, PhD (Stanford University). Collaborator from the Office of Special Education Programs/US Department of Education: Thomas Hanley, EdD. Collaborator from Office of Juvenile Justice and Delinquency Prevention/Department of Justice: Karen Stern, PhD.

    Disclosure: Dr. Hechtman has received research support, served on advisory boards, and served as a speaker for Eli Lilly and Co., GlaxoSmithKline, Ortho-Janssen, Purdue, Shire, and Ironshore. Dr. Arnold has received research funding from Curemark, Forest, Eli Lilly and Co., Neuropharm, Novartis, Noven, Shire, YoungLiving, the National Institutes of Health, Autism Speaks, and Supernus; has consulted with or been on advisory boards for Arbor, Gowlings, Neuropharm, Novartis, Noven, Organon, Otsuka, Pfizer, Roche, Seaside Therapeutics, Sigma Tau, Shire, Tris Pharma, and Waypoint; and has received travel support from Noven. Drs. Roy, Sibley, Molina, Swanson, and Howard report no biomedical financial interests or potential conflicts of interest.

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