Skip to main content

Advertisement

SpringerLink
Log in

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

  • Published:
Journal of Abnormal Child Psychology Aims and scope Submit manuscript

Abstract

The persistence of attention-deficit/hyperactivity disorder (ADHD) into adulthood, particularly in women, is an unresolved question. Using a diverse, prospectively followed female sample (ADHD: n = 140; comparison: n = 88), we examined (a) informant (parent- vs. self-report) and (b) symptom threshold (DSM-IV cutoffs vs. a developmentally referenced criterion [DRC]) with respect to estimates of ADHD persistence into young adulthood (M = 19.6 years). We also ascertained the linkages of ADHD status (as measured by each informant and via the different symptom cutoffs) with impairment in key outcome domains. Informant diagnostic concordance was significant but small (κ = 0.22). Via parent report, more childhood-ascertained probands (44 %) than comparison participants (1 %) met full ADHD criteria in adulthood (p < 0.001, ϕ = 0.47); parallel results were found via self-report (22 % vs. 2 %; p < 0.001, ϕ = 0.28). As expected, DRC designations yielded higher persistence estimates than DSM cutoffs. With control of key covariates, parent-reported ADHD was independently associated with poor outcomes on eight of nine measures but self-reported ADHD was associated only with low math scores. Also, participants who met the DRC cutoff but not the higher DSM threshold showed similar impairment to DSM-diagnosed participants, far greater than that of participants who met neither cutoff. A lowered symptom threshold in adulthood compared to childhood appears justified.

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

Fig. 1

Similar content being viewed by others

References

  • Achenbach, T. M. (1991). Manual for the child behavior checklist/4–18 and 1991 profile. Burlington: University Associates in Psychiatry.

    Google Scholar 

  • Achenbach, T. M. (2009). The Achenbach system of empirically based assessment (ASEBA): development, findings, theory and applications. Burlington: University of Vermont Research Center for Children, Youth, and Families.

    Google Scholar 

  • Achenbach, T.M. (2016). ASEBA research updates from around the world. Retrieved from ASEBA website: http://www.aseba.org/research/research.html.

  • Achenbach, T. M., & Rescorla, L. A. (2003). Manual for the ASEBA adult forms & profiles. Burlington: University of Vermont, Research Center for Children, Youth, & Families.

    Google Scholar 

  • Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101, 213–232. doi:10.1037/0033-2909.101.2.213.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders-3rd ed.-revised (DSM-III-R). Washington, D.C.: Author.

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders-4th ed. (DSM-IV). Washington, D.C.: Author.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders-5th ed. (DSM-5). Washington, D.C.: Author.

  • Babinski, D. E., Pelham, W. E., Molina, B. S. G., Gnagy, E. M., Waschbusch, D. A., Yu, J., …Karch, K. M. (2011). Late adolescent and young adult outcomes of girls diagnosed with ADHD in childhood: an exploratory investigation. Journal of Attention Disorders, 15, 204–214. doi: 10.1177/1087054710361586

  • Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2002). The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. Journal of Abnormal Psychology, 111, 279–289. doi:10.1037/0021-843X.111.2.279.

    Article  PubMed  Google Scholar 

  • Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults: what the science says. New York: Guilford.

    Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck depression inventory-II. San Antonio: Psychological Corporation.

    Google Scholar 

  • Bell, A. S. (2011). A critical review of ADHD diagnostic criteria: what to address in the DSM-V. Journal of Attention Disorders, 15, 3–10. doi:10.1177/1087054710365982.

    Article  PubMed  Google Scholar 

  • Biederman, J., Monuteaux, M. C., Mick, E., Spencer, T., Wilens, T. E., Silva, J. M., …Faraone, S. V. (2006). Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychological Medicine, 36, 167–179. doi: 10.1017/S0033291705006410

  • Biederman, J., Petty, C. R., Monuteaux, M. C., Fried, R., Byrne, D., Mirto, T., …Faraone, S. V. (2010). Adult psychiatric outcomes of girls with attention deficit hyperactivity disorder: 11-year follow-up in a longitudinal case-control study. American Journal of Psychiatry, 167, 409–417. doi: 10.1176/appi.ajp.2009.09050736

  • Bird, H. R. (1999). The assessment of functional impairment. In D. Shaffer, C. P. Lucas, & J. E. Richters (Eds.), Diagnostic assessment in child and adolescent psychopathology (pp. 209–229). New York: Guilford Press.

    Google Scholar 

  • Bussing, R., Fernandez, M., Harwood, M., Hou, W., Garvan, C. W., Eyberg, S. M., et al. (2008). Parent and teacher SNAP-IV ratings of attention deficit/hyperactivity disorder symptoms. Psychometric properties and normative ratings from a school district sample. Assessment, 15, 317–328. doi:10.1177/1073191107313888.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chronis-Tuscano, A., Molina, B. S. G., Pelham, W. E., Applegate, B., Dahlke, A., Overmyer, M., et al. (2010). Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 67, 1044–1051. doi:10.1001/archgenpsychiatry.2010.127.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cicchetti, D. V., & Feinstein, A. R. (1990). High agreement but low kappa: II. Resolving the paradoxes. Journal of Clinical Epidemiology, 43, 551–558.

    Article  PubMed  Google Scholar 

  • Coghill, D., & Seth, S. (2011). Do the diagnostic criteria for ADHD need to change? Comments on the preliminary proposals of the DSM-5 ADHD and disruptive behavior disorders committee. European Child and Adolescent Psychiatry, 20, 75–81. doi:10.1007/s00787-010-0142-4.

    Article  PubMed  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Mahwah: Lawrence Erlbaum Associates.

    Google Scholar 

  • Faraone, S. V., Biederman, J., & Mick, E. (2006). The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychological Medicine, 36, 159–165. doi:10.1017/S003329170500471X.

    Article  PubMed  Google Scholar 

  • Fedele, D. A., Lefler, E. K., Hartung, C. M., & Canu, W. H. (2012). Sex differences in the manifestation of ADHD in emerging adults. Journal of Attention Disorders, 16, 109–117. doi:10.1177/1087054710374596.

    Article  PubMed  Google Scholar 

  • Feinstein, A. R., & Cicchetti, D. V. (1990). High agreement but low kappa: I. The problems of two paradoxes. Journal of Clinical Epidemiology, 43, 543–549.

    Article  PubMed  Google Scholar 

  • Fleming, J. S., & Courtney, B. E. (1984). The dimensionality of self-esteem: II. Hierarchical facet model for revised measurement scales. Journal of Personality and Social Psychology, 46, 404–421. doi:10.1037/0022-3514.46.2.404.

    Article  Google Scholar 

  • Gershon, J. (2002). A meta-analytic review of gender differences in ADHD. Journal of Attention Disorders, 5, 143–154. doi:10.1177/108705470200500302.

    Article  PubMed  Google Scholar 

  • Gibbins, C., & Weiss, M. (2007). Clinical recommendations in current practice guidelines for diagnosis and treatment of ADHD in adults. Current Psychiatry Reports, 9, 420–426. doi:10.1007/s11920-007-0055-1.

    Article  PubMed  Google Scholar 

  • Hechtman, L., French, L. R., Mongia, M., & Cherkasova, M. V. (2011). Diagnosing ADHD in adults: limitations to DSM-IV and DSM-V proposals and challenges ahead. Neuropsychiatry, 1, 579–590. doi:10.2217/npy.11.65.

    Article  Google Scholar 

  • Heiligenstein, E., & Langheim, F. (2012). ADHD in adults; best practices for psychiatrists. The Wisconsin Psychiatrist, 53, 1–3.

    Google Scholar 

  • Heiligenstein, E., Conyers, L. M., Berns, A. R., & Miller, M. A. (1998). Preliminary data on DSM-IV attention deficit hyperactivity disorder in college students. Journal of American College Health, 46, 185–188. doi:10.1080/07448489809595609.

    Article  PubMed  Google Scholar 

  • Hinshaw, S. P. (2002). Preadolescent girls with attention-deficit/hyperactivity disorder: I. Background characteristics, comorbidity, cognitive and social functioning and parenting practices. Journal of Consulting and Clinical Psychology, 70, 1086–1098. doi:10.1037/0022-006X.70.5.1086.

    Article  PubMed  Google Scholar 

  • Hinshaw, S. P., & Scheffler, R. M. (2014). The ADHD explosion: Myths, medication, money, and today’s push for performance. New York: Oxford University Press.

    Google Scholar 

  • Hinshaw, S. P., Owens, E. B., Sami, N., & Fargeon, S. (2006). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into adolescence: evidence for continuing cross-domain impairment. Journal of Consulting and Clinical Psychology, 74, 489–499. doi:10.1037/0022-006X.74.3.489.

    Article  PubMed  Google Scholar 

  • Hinshaw, S. P., Owens, E. B., Zalecki, C., Huggins, S. P., Montenegro-Nevado, A. J., Shrodek, E., et al. (2012). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of Consulting and Clinical Psychology, 80, 1041–1051. doi:10.1037/a0029451.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kessler, R. C., Green, J. G., Adler, L. A., Barkley, R. A., Chatterji, S., Faraone, S. V., et al. (2010). Structure and diagnosis of adult attention-deficit/hyperactivity disorder: analysis of expanded symptom criteria from the adult ADHD clinical diagnostic scale. Archives of General Psychiatry, 67, 1168–1178. doi:10.1001/archgenpsychiatry.2010.146.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kooij, J. J. S., Buitelaar, J. K., van den Oord, E. J., Furer, J. W., Rijnders, C. A. T., & Hodiamont, P. P. G. (2005). Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychological Medicine, 35, 817–827. doi:10.1017/S003329170400337X.

    Article  PubMed  Google Scholar 

  • Lahey, B. B., Pelham, W. E., Loney, J., Lee, S. S., & Wilcutt, E. (2005). Instability of the DSM-IV subtypes from preschool through elementary school. Archives of General Psychiatry, 62, 896–902. doi:10.1001/archpsyc.62.8.896.

    Article  PubMed  Google Scholar 

  • Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.

    Article  PubMed  Google Scholar 

  • Mannuzza, S., Klein, R. G., Bessler, A., Malloy, P., & LaPadula, M. (1993). Adult outcome of hyperactive boys: educational achievement, occupational rank, and psychiatric status. Archives of General Psychiatry, 50, 565–576.

    Article  PubMed  Google Scholar 

  • Mannuzza, S., Klein, R. G., Bessler, A., Malloy, P., & LaPadula, M. (1998). Adult psychiatric status of hyperactive boys grown up. American Journal of Psychiatry, 155, 493–498.

    Article  PubMed  Google Scholar 

  • McGough, J. J., & McCracken, J. T. (2006). Adult attention deficit hyperactivity disorder: moving beyond DSM-IV. American Journal of Psychiatry, 163, 1673–1675. doi:10.1176/appi.ajp.163.10.1673.

    Article  PubMed  Google Scholar 

  • Miller, M., Ho, J., & Hinshaw, S. P. (2012). Executive functions in girls with ADHD followed prospectively into young adulthood. Neuropsychology, 26, 278–287. doi:10.1037/a0027792.

    Article  PubMed  PubMed Central  Google Scholar 

  • MTA Cooperative Group (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073–1086. doi:10.1001/archpsyc.56.12.1073.

    Article  Google Scholar 

  • Murphy, K. R., & Barkley, R. A. (1996). Prevalence of DSM-IV ADHD symptoms in adult licensed drivers: implications for clinical diagnosis. Journal of Attention Disorders, 1, 147–161. doi:10.1177/108705479600100303.

    Article  Google Scholar 

  • Musso, M. W., & Gouvier, W. D. (2014). “Why is this so hard?”: a review of detection of malingered ADHD in college students. Journal of Attention Disorders, 18, 186–201. doi:10.1177/1087054712441970.

    Article  PubMed  Google Scholar 

  • Nussbaum, N. L. (2012). ADHD and female specific concerns: a review of the literature and clinical implications. Journal of Attention Disorders, 16, 87–100. doi:10.1177/1087054711416909.

    Article  PubMed  Google Scholar 

  • Owens, J. S., Goldfine, M. E., Evangelista, N. M., Hoza, B., & Kaiser, N. M. (2007). A critical review of self-perceptions and the positive illusory bias in children with ADHD. Clinical Child and Family Psychology Review, 10, 335–351. doi:10.1007/s10567-007-0027-3.

    Article  PubMed  Google Scholar 

  • Ramtekkar, U. P., Reiersen, A. M., Todorov, A. A., & Todd, R. D. (2010). Sex and age differences in attention-deficit/hyperactivity disorder symptoms and diagnoses: implications for DSM-V and ICD-11. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 217–228. doi:10.1097/00004583-201003000-00005.

    PubMed  PubMed Central  Google Scholar 

  • Robins, R. W., Hendin, H. M., & Trzesniewski, K. H. (2001). Measuring global self-esteem: construct validation of a single-item measure and the Rosenberg self-esteem scale. Personality and Social Psychology Bulletin, 27, 151–161. doi:10.1177/0146167201272002.

    Article  Google Scholar 

  • Rosenberg, M. (1965). Society and the adolescent self-image. Princeton: Princeton University Press.

    Book  Google Scholar 

  • Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 28–38. doi:10.1097/00004583-200001000-00014.

    Article  Google Scholar 

  • Sibley, M. H., Pelham Jr., W. E., Molina, B. S. G., Gnagy, E. M., Waxmonsky, J. G., Waschbusch, D. A., et al. (2012). When diagnosing ADHD in young adults emphasize informant reports, DSM items, and impairment. Journal of Consulting and Clinical Psychology, 80, 1052–1061. doi:10.1037/a0029098.

    Article  PubMed  PubMed Central  Google Scholar 

  • Simon, V., Czobor, P., Balint, S., Meszaros, A., & Bitter, I. (2009). Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. British Journal of Psychiatry, 194, 204–211. doi:10.1192/bjp.bp.107.048827.

    Article  PubMed  Google Scholar 

  • Steer, R. A., & Beck, A. T. (2000). The Beck depression inventory-II. In W. E. Craighead & C. B. Nemeroff (Eds.), The Corsini encyclopedia of psychology and behavioral science (Vol. 1, 3rd ed., pp. 178–179). New York: Wiley.

    Google Scholar 

  • Swanson, J. M. (1992). School-based assessments and interventions for ADD students. Irvine: K.C. Press.

    Google Scholar 

  • Wechsler, D. (1991). Wechsler intelligence scales for children (3rd ed.). New York: Psychological Corporation.

    Google Scholar 

  • Wechsler, D. (1992). Manual for the Wechsler individual achievement test. New York: Psychological Corporation/Harcourt Brace.

    Google Scholar 

  • Wechsler, D. (2001). Wechsler individual achievement test, second version. New York: Psychological Corporation.

    Google Scholar 

  • Weiss, G., Hechtman, L., Milroy, T., & Perlman, T. (1985). Psychiatric status of hyperactives as adults: a controlled prospective 15-year follow-up of 63 hyperactive children. Journal of the American Academy of Child Psychiatry, 24, 211–220. doi:10.1016/S0002-7138(09)60450-7.

    Article  PubMed  Google Scholar 

  • Wilens, T. E., Faraone, S. V., & Biederman, J. (2004). Attention-deficit/hyperactivity disorder in adults. Journal of the American Medical Association, 292, 619–623.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We extend our sincere appreciation to all of our participants and their families, as well as the many research associates, graduate students, and study staff who have contributed their time, effort, and expertise to this ongoing research. Work on this project was supported by National Institute of Mental Health Grant R01 MH45064, awarded to Stephen P. Hinshaw.

Author information

Authors and Affiliations

  1. University of California, Berkeley, CA, USA

    B. Tate Guelzow, Fred Loya & Stephen P. Hinshaw

  2. San Francisco VA Medical Center (116C), 1450 Clement St, San Francisco, CA, 94117, USA

    B. Tate Guelzow

  3. Veterans Affairs Northern California Health Care System, Martinez, CA, USA

    Fred Loya

  4. University of California, San Francisco, CA, USA

    Stephen P. Hinshaw

Authors
  1. B. Tate Guelzow
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fred Loya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen P. Hinshaw
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Tate Guelzow.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All waves of data collection were fully approved by the Institutional Review Board of our university; all procedures were performed in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments, or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guelzow, B.T., Loya, F. & Hinshaw, S.P. How Persistent is ADHD into Adulthood? Informant Report and Diagnostic Thresholds in a Female Sample. J Abnorm Child Psychol 45, 301–312 (2017). https://doi.org/10.1007/s10802-016-0174-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-016-0174-4

Keywords

Search

Navigation