Clinical and Functional Outcome of Childhood Attention-Deficit/Hyperactivity Disorder 33 Years Later

Klein, Rachel G.; Mannuzza, Salvatore; Olazagasti, María A. Ramos; Roizen, Erica R.; Hutchison, Jesse A.; Lashua, Erin C.; Castellanos, F. Xavier

doi:10.1001/archgenpsychiatry.2012.271

Cited by 530 publications

(478 citation statements)

References 39 publications

(42 reference statements)

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“…The authors noted that the exclusion of children with primary aggression or other antisocial behavior might have resulted in a baseline sample with low overall impairment, with consequently improved adult outcomes. In the 33-year follow up (mean age = 41), the authors reported a 22.2% prevalence of ADHD in probands, who also showed poorer educational and occupational outcomes than comparisons, as well as higher rates of divorce, incarceration, and death (Klein et al, 2012). Probands did not differ from comparisons, though, in rates of mood or anxiety disorders or adult-onset psychopathology.…”

Section: Prospective Investigations In Malesmentioning

confidence: 92%

How Persistent is ADHD into Adulthood? Informant Report and Diagnostic Thresholds in a Female Sample

Guelzow

Loya

Hinshaw

2016

J Abnorm Child Psychol

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Although the notion that Attention-Deficit/Hyperactivity Disorder (ADHD) often persists into adulthood is increasingly accepted, important diagnostic questions remain. Using a large (baseline proband n = 140, comparison n = 88) prospectively followed, ethnically diverse female sample, I examined the impacts of (a) informant (i.e., parent-vs. self-report) and (b) diagnostic symptom threshold (i.e., the DSM-IV 6/9 symptoms of inattention [IA] or hyperactivity/impulsivity [H/I] vs. a developmentally referenced criterion [DRC]) on estimates of ADHD persistence from childhood (age range 6-12) into young adulthood (mean age = 19.6 years). Further, I assessed and compared the predictive validity of ADHD status per each informant, as well as via the two different symptom cutoffs, on measures assessing functioning in a number of important domains (e.g., depression, academic achievement, global impairment).Separate 2 x 2 (Wave 1 diagnostic status x Wave 3 diagnostic status) chi-square analyses revealed that per parent report, significantly more probands (44%) than baseline comparison participants (1%) met full ADHD criteria (χ 2 [187] = 42.51, p< 0.001, φ = 0.47). Significantly more probands (22%) than comparisons (2%; χ 2 [209] = 15.97, p< 0.001, φ = 0.28) met full criteria via young adult self-report as well. Informant diagnostic concordance was significant, but of a small effect size (κ = .22). Using a series of hierarchical multiple regression analyses and controlling for key covariates, parent-reported ADHD was found to be independently associated with poorer outcomes on eight of nine considered measures (|β|'s ranging from 0.18 to 0.61). Self-reported ADHD was independently associated only with lower math scores (|β| = .18).As in past research, the DRC was set at two SD above the comparison participants' mean symptom number, yielding a diagnostic threshold of 4/9 H/I and 5/9 IA symptoms. Via the DSM-IV cutoff, ADHD was estimated to persist in 55.9% of baseline probands; via the DRC, this estimate rose to 61.4%. One-way ANCOVA models were used to test mean differences on outcome measures for participants who met the DSM-IV threshold, those who only met the DRC ("DRC-only"), and those who met neither threshold. All models were significant (all Fs >6.50, all ps < .01). DRC-only participants endorsed poorer outcomes of large to very large effect sizes 2 across seven of the study's nine outcome measures, compared to participants who met neither cutoff. Further, DRC-only participants did not differ on any outcome measure from those who met the higher DSM-IV threshold.The present findings add to extant research in suggesting that (a) parent-report yields higher ADHD persistence estimates than young adult self-report and (b) parent-reported persistence remains a more potent predictor of young adult functioning than self-report. Findings also suggest that self-reported ADHD persistence rates may be higher in young adult females than in males, although this suggestion merits further investigation. Further, findings suggest th...

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Section: Prospective Investigations In Malesmentioning

confidence: 92%

How Persistent is ADHD into Adulthood? Informant Report and Diagnostic Thresholds in a Female Sample

Guelzow

Loya

Hinshaw

2016

J Abnorm Child Psychol

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“…Aggression is a well‐established adverse, potentially harmful outcome in individuals with ADHD (Klein et al., 2012; Thapar, Langley, Owen, & O'Donovan, 2007). It also indexes an important ADHD clinical subtype characterised by greater clinical severity and poorer prognosis even after treatment (Klein et al., 2012; Thapar et al., 2007) .…”

Section: Introductionmentioning

confidence: 99%

“…It also indexes an important ADHD clinical subtype characterised by greater clinical severity and poorer prognosis even after treatment (Klein et al., 2012; Thapar et al., 2007) . Thus, it is a priority to identify novel psychological and biological targets for informing the future development of effective interventions.…”

Section: Introductionmentioning

confidence: 99%

Identifying mechanisms that underlie links between COMT genotype and aggression in male adolescents with ADHD

Goozen

Langley

Northover

et al. 2015

Child Psychology Psychiatry

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BackgroundThere is a known strong genetic contribution to aggression in those with ADHD. In a previous investigation of a large population cohort, impaired ‘emotional/social cognitive’ processing, assessed by questionnaire, was observed to mediate the link between COMT Val158Met and aggression in individuals with ADHD. We set out to replicate and extend this finding in a clinical sample, using task‐based and physiological assessments of emotional and cognitive processing. Our aim was to test the hypothesis that directly assessed emotional processing mediates the link between COMT Val158Met and aggression in young people with ADHD.MethodsMales aged 10–17 years with ADHD were recruited from UK community clinics (n = 194). Research diagnostic interviews (parent and child) were used to assess psychopathology and generate DSM‐IV Conduct Disorder symptom scores. Participants completed tasks assessing executive function (response inhibition and set shifting), empathy for fear, sadness and happiness, and fear conditioning [measured using skin conductance responses (SCR) to aversive stimuli].Results COMT Val allele carriers showed poorer response inhibition (F = 5.27, p = .02) and set shifting abilities (F = 6.45, p = .01), reduced fear empathy (F = 4.33, p = .04) and reduced autonomic responsiveness (lower SCRs) to the conditioned aversive stimulus (F = 11.74, p = .001). COMT Val158Met did not predict impairments in recognising others' emotions or affective empathy for happiness or sadness. Mediation analysis revealed that impaired fear‐related mechanisms indirectly mediated the link between COMT Val158Met and aggression.ConclusionOur findings suggest fear mechanisms as possible targets for psychological interventions to disrupt links between genetic risk and aggressive outcomes in ADHD. Our findings also reveal the potential of hypothesis‐driven approaches for identifying neuropsychological mechanisms that mediate genetic risk effects on behaviour and psychopathology.

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“…Progress has been made in the acceptance of ADHD in children, however, despite European wide consensus validating ADHD as a condition persisting into adulthood [13], it remains under-diagnosed and under-treated in adults [14]. Having ADHD as an adult can have significant implications for education, work, independent daily living, and social relationships [15]. The consequences of not diagnosing and treating ADHD in adults appropriately can also result in high rates of substance misuse or offending, with broader implications for health and social care, and wider society as a whole [14].…”

Section: B Adult Adhd and Stigmamentioning

confidence: 99%

From Snappy App to Screens in the Wild: Gamifying an Attention Deficit Hyperactivity Disorder Continuous Performance Test for Public Engagement and Awareness

Craven

Young

Simons

et al. 2014

2014 International Conference on Interactive Technologies and Games

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Abstract-Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that is characterised by three core behaviours: inattention, hyperactivity and impulsivity. It is typically thought that around 3-5% of school aged children have ADHD, with lifetime persistence for the majority.A psychometric Continuous Performance Test (CPT) had recently been incorporated into an interactive smartphone application (App), SnappyApp, to allow the measurement of the three ADHD symptom domains. SnappyApp presents a sequence of letters of the alphabet in a pseudo-random manner with responses via the device's touch screen. Following a pilot test in the general population where the CPT showed sensitivity to ADHD-related symptoms (self-reported impulsive behaviour related to CPT measures), a new project was begun to convert the App into a game Attention Grabber based on the functionality of the test, focussing on the attention and impulsivity domains.The Screens in the Wild (SITW) platform is in the process of being employed for public engagement in awareness about ADHD through interactive technology. SITW has deployed a network of four public touch-screens in urban places. Each of the four nodes has a large (46 inch) display, a camera, a microphone and a speaker. The SnappyApp web-app was translated for presentation on to the SITW platform. The browser-based App was redesigned, with the input of a commercial graphics design company, based on an initial proof-of-concept whereby the original App was reprogrammed to present sequences of graphical objects (fruit) and to introduce further engagement features including animations. A shortened video about Adult ADHD and a brief questionnaire were incorporated to form a stand-alone edutainment package.The earlier design and user testing of SnappyApp is briefly described and details are then provided of the process of gamification to produce Attention Grabber. An evaluation process is described whereby awareness of ADHD and its related symptoms are to be probed. In general, finding out whether and how people engage with interactive screen technology can help in the design of future public engagement and health promotion activities. Ethical considerations are discussed, since public access to this kind of game could potentially raise health anxiety related to self-interpretation of game performance. This risk is balanced with the need to provide health information.

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Clinical and Functional Outcome of Childhood Attention-Deficit/Hyperactivity Disorder 33 Years Later

Cited by 530 publications

References 39 publications

How Persistent is ADHD into Adulthood? Informant Report and Diagnostic Thresholds in a Female Sample

How Persistent is ADHD into Adulthood? Informant Report and Diagnostic Thresholds in a Female Sample

Identifying mechanisms that underlie links between COMT genotype and aggression in male adolescents with ADHD

From Snappy App to Screens in the Wild: Gamifying an Attention Deficit Hyperactivity Disorder Continuous Performance Test for Public Engagement and Awareness

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