A 6-year follow-up of a large European cohort of children with attention-deficit/hyperactivity disorder-combined subtype: outcomes in late adolescence and young adulthood

• Published in: European child & adolescent psychiatry Vol. 25; no. 9; pp. 1007 - 1017
• Main Authors: van Lieshout, Marloes, Luman, Marjolein, Twisk, Jos W. R., van Ewijk, Hanneke, Groenman, Annabeth P., Thissen, Andrieke J. A. M., Faraone, Stephen V., Heslenfeld, Dirk J., Hartman, Catharina A., Hoekstra, Pieter J., Franke, Barbara, Buitelaar, Jan K., Rommelse, Nanda N. J., Oosterlaan, Jaap
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2016; Springer Nature B.V
• Subjects: Adolescent; Adolescents; Age; Anxiety; Anxiety disorders; Attention - physiology; Attention Deficit and Disruptive Behavior Disorders - complications; Attention Deficit Disorder with Hyperactivity - complications; Attention Deficit Disorder with Hyperactivity - drug therapy; Attention Deficit Disorder with Hyperactivity - psychology; Attention deficit hyperactivity disorder; Central Nervous System Stimulants - therapeutic use; Child; Child and Adolescent Psychiatry; Children; Comorbidity; Conduct Disorder - complications; Conduct disordered adolescents; Diagnosis; Europe; Female; Follow-Up Studies; Humans; Hyperactivity; Long term; Male; Medical diagnosis; Medicine; Medicine & Public Health; Mood; Oppositional defiant disorder; Original Contribution; Parents; Psychiatry; Questionnaires; Retention; Risk assessment; Risk factors; Severity; Studies; Surveys and Questionnaires; Teenagers; Treatment methods; Treatment Outcome; Young adults; Europe; Persistence; ADHD; Overall functioning; Treatment; Prediction; Symptom severity; Follow-up
• ISSN: 1018-8827; 1435-165X
• DOI: 10.1007/s00787-016-0820-y

There are very few studies on the long-term outcome of children and adolescents with ADHD-combined type in Europe. The objective of the present study is to assess the 6-year outcome (including pharmacological treatment) of a large cohort of participants with ADHD-combined type (
N
 = 347, mean age 11.4 years) in late adolescence and early adulthood. At study entry and follow-up (mean age 17.4 years), participants were comprehensively assessed on ADHD and comorbid disorders by structured psychiatric interviews and multi-informant questionnaires. Overall functioning was assessed by the Children’s Global Assessment Scale. The retention rate was 75.6 %. The majority of participants (86.5 %) persisted in a DSM-5 ADHD diagnosis, 8.4 % had a subthreshold diagnosis, and 5.1 % remitted from the disorder at follow-up. Comorbidities decreased strongly; oppositional defiant disorder: 58 > 31 %, conduct disorder: 19 > 7 %. At follow-up, mood- and anxiety disorders were virtually non-existent following strict criteria (1–3 %). Percentage of children having had pharmacological treatment at any time increased from 79 to 91 %. On the Children’s Global Assessment Scale, 48.5 % of participants were still functionally impaired at follow-up. Parental ADHD, higher ADHD symptom severity at baseline and higher parent-reported impairment at baseline positively predicted current ADHD symptom severity (
R
2
 = 20.9 %). Younger baseline age, higher ADHD symptom severity at baseline and higher parent-reported impairment at baseline were positively associated with poorer overall functioning (
R
2
 = 17.8 %). Pharmacological treatment had no (beneficial) impact on either ADHD symptom severity or overall functioning. Results confirm that ADHD is largely persistent into late adolescence with severity and family history for the disorder as important risk factors.