Three-Year Latent Class Trajectories of Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms in a Clinical Sample Not Selected for ADHD

Abstract

Objective This study aims to examine trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms in the Longitudinal Assessment of Manic Symptoms (LAMS) sample. Method The LAMS study assessed 684 children aged 6-12 with Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) and rating scales semi-annually for 3 years. Though selected for elevated manic symptoms, 526 had baseline ADHD diagnoses. With growth mixture modeling (GMM), we separately analyzed inattentive and hyperactive/impulsive symptoms, covarying baseline age. Multiple standard methods determined optimal fit. Chi-square and Kruskal-Wallis analysis of variance (ANOVA) compared resulting latent classes/trajectories on clinical characteristics and medication. Results Three latent class trajectories best described inattentive symptoms; 4 classes best described hyperactive/impulsive symptoms. Inattentive trajectories maintained their relative position over time. Hyperactive/impulsive symptoms had 2 consistent trajectories (least and most severe). Another (4.5%) started mild, then escalated; and a fourth (14%) started severe but improved dramatically. The improving trajectory had the highest rate of ADHD and lowest rate of bipolar diagnoses. Three-fourths of the mildest inattention class were also in the mildest hyperactive/impulsive class; 72% of the severest inattentive class were in the severest hyperactive/impulsive class; but the severest inattention class also included 62% of the improving hyperactive-impulsive class. Conclusion An ADHD rather than bipolar diagnosis prognosticates a better course of hyperactive/impulsive, but not inattentive, symptoms. High overlap of relative severity between inattention and hyperactivity/impulsivity confirms the link between these symptom clusters. Hyperactive/impulsive symptoms wane more over time. Group means are insufficient to understand individual ADHD prognosis. A small subgroup deteriorates over time in hyperactivity/impulsivity and needs better treatments than currently provided.

Should We Subtype ADHD According to the Context in Which Symptoms Occur? Criterion Validity of Recognising Context-Based ADHD Presentations

“…Five classes is a larger number than those generally identified for either inattention or hyperactivity/impulsivity in previous studies of ADHD developmental trajectories [e.g. 23,44,51,52]. Previous studies have, however, only included symptoms as reported by a single informant in their models and could, therefore, not identify distinctions between individuals with different patterns of expression across school and home contexts.…”

Academic and Social Functioning Associated with Attention-Deficit/Hyperactivity Disorder: Latent Class Analyses of Trajectories from Kindergarten to Fifth Grade

“…Given that Arnold et al (2014) found ADHD medication treatment to be associated with milder symptom trajectories, this variable was included as a covariate in our analysis. In the fifth-grade survey, parents were asked whether their child was currently receiving any prescription medication (e.g., methylphenidate, amphetamine, atomoxetine) related to ADHD.…”

“…Such impairments are a defining feature of the disorder because children’s behavioral symptoms must be accompanied by academic and/or social difficulties to receive an ADHD diagnosis (American Psychiatric Association, 2013). Yet, and although prior studies have examined trajectories of children’s ADHD behavioral symptoms generally (e.g., Arnold et al, 2014), very few have specifically examined variability in the trajectories of the children’s academic and social functioning. Examining whether and to what extent there is heterogeneity in ADHD children’s achievement and social impairment trajectories is important because children with ADHD typically are referred for treatment primarily on the basis of impairment exhibited in school settings (Angold, Costello, Farmer, Burns, & Erkranli, 1999).…”

“…Specifically, researchers have reported latent classes based on ADHD symptom counts and/or symptom severity at one point in time (e.g., Elia et al, 2009; Neuman et al, 1999; Volk, Todorov, Hay, & Todd, 2009), trajectories of symptoms over time (Arnold et al, 2014; Larsson, Dilshad, Lichtenstein, & Barker, 2011), and presence of comorbid symptoms (e.g., Acosta et al, 2008; Ostrander, Herman, Sikorski, Mascendaro, & Lambert, 2008). Children’s latent class membership in regards to relative reading and writing achievement varies with respect to risk for ADHD (Cogo-Moreira et al, 2013).…”

Risk for emerging bipolar disorder, variants, and symptoms in children with attention deficit hyperactivity disorder, now grown up

“…The gradual abatement of NSM symptoms may facilitate distinguishing between ADHD and BD in older adolescents and adults; conversely the distinction may be obfuscated at earlier ages. The clinical impli cation is to observe over time in doubtful cases, as recommended by the LAMS group [41] . Although the differences in PM and NSM counts between ADHD and LNCG subjects were small, they appeared twice as large for NSM as for PM (mean symptom difference between ADHD and LNCG was 0.4 for PM and 0.9 for NSM) with both counts higher in ADHD than LNCG subjects.…”