ATLANTA, Georgia – As of 2011, approximately 11% of US children have been diagnosed with attention-deficit/hyperactivity disorder (ADHD), and that number continues to grow.1 Additionally, it is estimated that the disorder will persist into adulthood in 50% to 60% of affected individuals. Compared with those for whom the condition remits by adulthood, those with persistent ADHD are more likely to experience social, educational, emotional, and cognitive challenges. It is unclear, however, which factors are associated with an increased risk of long-term ADHD persistence. To that end, researchers at McGill University in Montreal, Canada, and several US universities investigated 8 factors pertaining to childhood functioning and family characteristics to determine whether they are associated with ADHD symptoms in adulthood.2
In the study presented at the 2016 Annual Meeting of the American Psychiatric Association (APA) in Atlanta, Georgia, the researchers used data from the National Institute of Mental Health Multimodal Treatment Study of ADHD (MTA) to assess 453 participants at a mean age of 8 years. They were reassessed at a mean age of 25 years via self- and parent-reports on the Conners’ Adult ADHD Rating Scale (CAARS), and “CAARS DSM item scores were used to determine persistence and desistence of ADHD symptoms in adulthood based on DSM-5 criteria (presence of at least five ADHD symptoms),” the authors reported.
Logistic regression analysis revealed an association of childhood comorbidities, parental mental health problems, and parental marital problems with an increased risk of ADHD persistence. “Both ADHD severity and comorbidity are associated with impairments in functioning and greater difficulty in coping,” explains lead author Arunima Roy, MBBS, a research trainee at McGill University Health Center who is under the supervision of Professor Lily Hechtman, MD. “It is also likely that, in those with higher severity, symptoms are not completely resolved with treatment, and residual symptomatology may lead to a greater likelihood of persistence,” she told Psychiatry Advisor.
When childhood ADHD symptom severity was controlled for, however, the only factors linked to adult ADHD symptoms were parental mental health (OR=1.28, SE=0.09, P=.008) and parenting practices–specifically, a lack of appropriate discipline (OR=−1.38, SE=0.13, P=.017). The other factors explored, which were not found to be associated with ADHD symptom persistence, were IQ, parent-child relationships, socioeconomic status, and parental education.
“Parental mental health problems may be associated with reduced support available to the child and may also affect the child’s treatment levels, adherence to treatment, and overall well-being,” explains Dr Roy, and these factors could account for the connection between parental mental health and continuation of the child’s ADHD symptoms. Clinicians should aim to treat ADHD symptoms to remission, she says, and they should also address comorbid mental health problems. “Third, evaluation–and if necessary, treatment–of parental mental health problems should be carried out,” she advises, and parenting practices should be addressed early in treatment.
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- Centers for Disease Control and Prevention. Attention-Deficit/Hyperactivity Disorder: Data & Statistics. Available at: www.cdc.gov/ncbddd/adhd/data.html. Accessed May 16, 2016.
- Roy A, Hechtman L, Arnold LE, et al. Childhood factors affecting persistence of ADHD in adulthood: results from the 16 year follow-up of the MTA study. Poster presentation at: 2016 Annual Meeting of the American Psychiatric Association; May 14-18, 2016; Atlanta, GA. Young Investigators’ New Research 1-61.