Skip to main content

Advertisement

SpringerLink
Log in

The stability and persistence of symptoms in childhood-onset ADHD

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

The course of childhood-onset attention deficit hyperactivity disorder (ADHD) varies across individuals; some will experience persistent symptoms while others’ symptoms fluctuate or remit. We describe the longitudinal course of ADHD symptoms and associated clinical characteristics in adolescents with childhood-onset ADHD. Participants (aged 6–12 at baseline) from the Longitudinal Assessment of Manic Symptoms (LAMS) study who met DSM criteria for ADHD prior to age 12 were evaluated annually with the Kiddie Schedule for Affective Disorders and Schizophrenia for eight years. At each timepoint, participants were categorized as meeting ADHD criteria, subthreshold criteria, or not having ADHD. Stability of course was defined by whether participants experienced consistent ADHD symptoms, fluctuating symptoms, or remission. The persistence of the symptoms was defined by symptom status at the final two follow-ups (stable ADHD, stable remission, stable partial remission, unstable). Of 685 baseline participants, 431 had childhood-onset ADHD and at least two follow-ups. Half had a consistent course of ADHD, nearly 40% had a remitting course, and the remaining participants had a fluctuating course. More than half of participants met criteria for ADHD at the end of their participation; about 30% demonstrated stable full remission, 15% had unstable symptoms, and one had stable partial remission. Participants with a persistent course and stable ADHD outcome reported the highest number of symptoms and were most impaired. This work builds on earlier studies that describe fluctuating symptoms in young people with childhood-onset ADHD. Results emphasize the importance of ongoing monitoring and detailed assessment of factors likely to influence course and outcome to help young people with childhood-onset ADHD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

Data available upon request from authors.

References

  1. Polanczyk G et al (2007) The worldwide prevalence of ADHD: A systematic review and metaregression analysis. Am J Psychiatry 164(6):942–948

    Article  PubMed  Google Scholar 

  2. Polanczyk GV et al (2014) ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol 43(2):434–442

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kessler RC et al (2006) The prevalence and correlates of adult ADHD in the United States: results From the National Comorbidity Survey Replication. Am J Psychiatry 163(4):716–723

    Article  PubMed  PubMed Central  Google Scholar 

  4. Barkley RA, Brown TE (2008) Unrecognized attention-deficit/hyperactivity disorder in adults presenting with other psychiatric disorders. CNS Spectr 13(11):977–984

    Article  PubMed  Google Scholar 

  5. Costello EJ, Copeland W, Angold A (2011) Trends in psychopathology across the adolescent years: What changes when children become adolescents, and when adolescents become adults? J Child Psychol Psychiatry 52(10):1015–1025

    Article  PubMed  PubMed Central  Google Scholar 

  6. Biederman J et al (2011) Predictors of persistent ADHD: an 11-year follow-up study. J Psychiatr Res 45(2):150–155

    Article  PubMed  Google Scholar 

  7. Sibley MH et al (2022) Variable patterns of remission from ADHD in the multimodal treatment study of ADHD. Am J Psychiatry 179(2):142–151

    Article  PubMed  Google Scholar 

  8. Cherkasova MV et al (2022) Review: adult outcome as seen through controlled prospective follow-up studies of children with attention-deficit/hyperactivity disorder followed into adulthood. J Am Acad Child Adolesc Psychiatry 61(3):378–391

    Article  PubMed  Google Scholar 

  9. Song P et al (2021) The prevalence of adult attention-deficit hyperactivity disorder: a global systematic review and meta-analysis. J Glob Health 11:04009–04009

    Article  PubMed  PubMed Central  Google Scholar 

  10. London AS, Landes SD (2021) Cohort change in the prevalence of ADHD among U.S. adults: evidence of a gender-specific historical period effect. J Atten Disord 25(6):771–782

    Article  PubMed  Google Scholar 

  11. Biederman J et al (2010) How persistent is ADHD? A controlled 10-year follow-up study of boys with ADHD. Psychiatry Res 177(3):299–304

    Article  PubMed  PubMed Central  Google Scholar 

  12. Biederman J et al (2012) Predictors of persistence in girls with attention deficit hyperactivity disorder: results from an 11-year controlled follow-up study. Acta Psychiatr Scand 125(2):147–156

    Article  CAS  PubMed  Google Scholar 

  13. Horwitz SM et al (2010) Longitudinal Assessment of Manic Symptoms (LAMS) study: background, design, and initial screening results. J Clin Psychiatry 71(11):1511–1517

    Article  PubMed  PubMed Central  Google Scholar 

  14. Youngstrom EA (2008) Developing a 10-item mania scale from the Parent General Behavior Inventory for children and adolescents. J Clin Psychiatry 69(5):831–839

    Article  PubMed  PubMed Central  Google Scholar 

  15. Geller B, Zimmerman B, Williams M (2001) Reliability of the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-UKSADS) mania and rapid cycling sections. J Am Acad Child Adolesc Psychiatry 40:450–455

    Article  CAS  PubMed  Google Scholar 

  16. Kaufman J et al (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36(7):980–988

    Article  CAS  PubMed  Google Scholar 

  17. Findling RL et al (2010) Characteristics of children with elevated symptoms of mania: the Longitudinal Assessment of Manic Symptoms (LAMS) study. J Clin Psychiatry 71(12):1664–1672

    Article  PubMed  PubMed Central  Google Scholar 

  18. Asherson P et al (2012) Under diagnosis of adult ADHD: cultural influences and societal burden. J Atten Disord 16(5 suppl):20S-38S

    Article  PubMed  Google Scholar 

  19. Sawyer SM et al (2018) The age of adolescence. Lancet Child Adolesc Health 2(3):223–228

    Article  PubMed  Google Scholar 

  20. Boland H et al (2020) A literature review and meta-analysis on the effects of ADHD medications on functional outcomes. J Psychiatr Res 123:21–30

    Article  PubMed  Google Scholar 

  21. Van der Oord S et al (2008) Efficacy of methylphenidate, psychosocial treatments and their combination in school-aged children with ADHD: a meta-analysis. Clin Psychol Rev 28(5):783–800

    Article  PubMed  Google Scholar 

  22. Swanson J (2003) Compliance with stimulants for attention-deficit/hyperactivity disorder. CNS Drugs 17(2):117–131

    Article  PubMed  Google Scholar 

  23. Lahey BB et al (2005) Instability of the DSM-IV subtypes of ADHD From preschool through elementary school. Arch Gen Psychiatry 62(8):896–902

    Article  PubMed  Google Scholar 

Download references

Funding

The manuscript is a publication of secondary analyses from a multi-site study supported by the National Institute of Mental Health; Case Western Reserve University: R01 MH073967-06A1, Cincinnati Children’s Hospital Medical Center: R01 MH073816-06A1, The Ohio State University: R01 MH073801-06A1, and University of Pittsburgh: R01 MH073953-06A1. It was additionally supported by K23MH120505.

Author information

Authors and Affiliations

  1. New York University Grossman School of Medicine, New York, NY, 10016, USA

    Anna R. Van Meter & Sarah Horwitz

  2. University of Washington School of Medicine and Seattle Children’s Research Institute, Seattle, WA, USA

    Margaret H. Sibley

  3. Columbia University Irving Medical Center, New York, NY, USA

    Pankhuree Vandana

  4. The University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Boris Birmaher

  5. Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, USA

    Mary A. Fristad

  6. University of North Carolina at Chapel Hill and Helping Give Away Psychological Science, 501c3, Chapel Hill, NC, USA

    Eric A. Youngstrom

  7. Virginia Commonwealth University, Richmond, VA, USA

    Robert L. Findling

  8. The Ohio State University College of Medicine, Columbus, OH, USA

    Mary A. Fristad & L. Eugene Arnold

Authors
  1. Anna R. Van Meter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Margaret H. Sibley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pankhuree Vandana
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Boris Birmaher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mary A. Fristad
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sarah Horwitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eric A. Youngstrom
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Robert L. Findling
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. L. Eugene Arnold
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dr. Van Meter conceived of the study idea, wrote the preliminary manuscript draft, and conducted all analyses. Dr. Sibley conceived of the study idea and contributed to writing and editing. Dr. Vandana conceived of the study idea and contributed to writing and editing. Dr. Findling secured study funding, conceptualized the original study on which this secondary analysis is based, and contributing to editing. Dr. Fristad secured study funding and conceptualized the original study on which this secondary analysis is based, and contributed to editing. Dr. Birmaher secured study funding and conceptualized the original study on which this secondary analysis is based, and contributed to editing. Dr. Horwitz secured study funding and conceptualized the original study on which this secondary analysis is based, and contributed to editing. Dr. Youngstrom secured study funding and conceptualized the original study on which this secondary analysis is based, and contributed to editing. Dr. Arnold conceived of the study idea and contributed to writing and editing. He additionally conceptualized the original study on which this secondary analysis is based.

Corresponding author

Correspondence to Anna R. Van Meter.

Ethics declarations

Conflict of interest

Dr. Van Meter and Dr. Vandana have no conflicts to disclose. Dr. Sibley has received book royalties from Guilford Press for a book on the treatment of ADHD in adolescence and has consulted with Supernus Pharmaceuticals. Dr. Findling receives or has received research support, acted as a consultant and/or has received honoraria from Abbvie, Acadia, Adamas, Afecta, Akili, Alkermes, Allergan, American Academy of Child & Adolescent Psychiatry, American Psychiatric Press, Arbor, Axsome, Idorsia, Intracellular Therapies, Iqvia, Lundbeck, Medavante Prophase, MJH Life Sciences, Neurim, NIH, Novartis, Otsuka, PaxMedica, PCORI, Pfizer, Physicians’ Postgraduate Press, Radius, Receptor Life Sciences, Sage, Signant Health, Sunovion, Supernus Pharmaceuticals, Syneos, Takeda, Tris, and Viatris. Dr. Fristad receives royalties from American Psychiatric Press and Guilford Press, an editorial stipend from the Society of Clinical Child and Adolescent Psychology, and has received research funding from Janssen. Dr. Birmaher reports grants from NIMH, during the conduct of the study; royalties from Random House, Wolters Kluwer (UpToDate) and Lippincott, Williams and Wilkins. Dr. Horwitz receives royalties from American Psychiatric Press. Dr. Youngstrom has consulted with Signant Health about psychological assessment, received royalties from the American Psychological Association and Guilford Press, and is the co-founder and Executive Director of Helping Give Away Psychological Science 501c3. Dr. Arnold has received research funding from Supernus Pharmaceuticals, Roche/Genentech Phanaceuticals, Otsuka Pharmaceuticals, Axial, and YoungLiving Essential Oils and National Institute of Health (USA, R01 MH 100144), has consulted with Pfizer Pharmaceuticals and CHADD, and been on advisory boards for Otsuka and Roche/Genentech.

Ethics approval

All procedures were approved by the participating academic centers’ IRBs.

Consent

All parents/guardians provided written informed consent and children provided assent.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Van Meter, A.R., Sibley, M.H., Vandana, P. et al. The stability and persistence of symptoms in childhood-onset ADHD. Eur Child Adolesc Psychiatry 33, 1163–1170 (2024). https://doi.org/10.1007/s00787-023-02235-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-023-02235-3

Keywords

Search

Navigation