Patterns and Predictors of Attention-Deficit/Hyperactivity Disorder Persistence into Adulthood: Results from the National Comorbidity Survey Replication

• Published in: Biological psychiatry (1969) Vol. 57; no. 11; pp. 1442 - 1451
• Main Authors: Kessler, Ronald C., Adler, Lenard A., Barkley, Russell, Biederman, Joseph, Conners, C. Keith, Faraone, Stephen V., Greenhill, Laurence L., Jaeger, Savina, Secnik, Kristina, Spencer, Thomas, Üstün, T. Bedirhan, Zaslavsky, Alan M.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-06-2005; Elsevier Science
• Subjects: Adolescent; Adult; Anxiety Disorders - epidemiology; Attention Deficit Disorder with Hyperactivity - epidemiology; Attention Deficit Disorder with Hyperactivity - psychology; Attention deficit disorders. Hyperactivity; Attention-deficit/hyperactivity disorder; Biological and medical sciences; Chi-Square Distribution; Child Behavior Disorders - epidemiology; Child clinical studies; Comorbidity; diagnosis and classification; Disruptive, Impulse Control, and Conduct Disorders - epidemiology; epidemiology; Female; Humans; Interviews as Topic; Male; Medical sciences; Mood Disorders - epidemiology; Odds Ratio; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Retrospective Studies; Risk Factors; Severity of Illness Index; Socioeconomic Factors; Substance-Related Disorders - epidemiology; Attention-deficit/hyperactivity disorder; epidemiology; diagnosis and classification; Human; Hyperactivity; Epidemiology; Concomitant disease; Survey; Attentional disorder; Classification; Adult; Attention disorder with hyperactivity; Diagnosis; Predictive factor; Public health
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/j.biopsych.2005.04.001

Despite growing interest in adult attention-deficit/hyperactivity disorder (ADHD), little is known about predictors of persistence of childhood cases into adulthood.
A retrospective assessment of childhood ADHD, childhood risk factors, and a screen for adult ADHD were included in a sample of 3197 18–44 year old respondents in the National Comorbidity Survey Replication (NCS-R). Blinded adult ADHD clinical reappraisal interviews were administered to a sub-sample of respondents. Multiple imputation (MI) was used to estimate adult persistence of childhood ADHD. Logistic regression was used to study retrospectively reported childhood predictors of persistence. Potential predictors included socio-demographics, childhood ADHD severity, childhood adversity, traumatic life experiences, and comorbid DSM-IV child-adolescent disorders (anxiety, mood, impulse-control, and substance disorders).
Blinded clinical interviews classified 36.3% of respondents with retrospectively assessed childhood ADHD as meeting DSM-IV criteria for current ADHD. Childhood ADHD severity and childhood treatment significantly predicted persistence. Controlling for severity and excluding treatment, none of the other variables significantly predicted persistence even though they were significantly associated with childhood ADHD.
No modifiable risk factors were found for adult persistence of ADHD. Further research, ideally based on prospective general population samples, is needed to search for modifiable determinants of adult persistence of ADHD.