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Persistence and remission of ADHD during adulthood: a 7-year clinical follow-up study

Published online by Cambridge University Press:  23 January 2015

R. G. Karam ,
V. Breda ,
F. A. Picon ,
D. L. Rovaris ,
M. M. Victor ,
C. A. I. Salgado ,
E. S. Vitola ,
K. L. Silva ,
P. O. Guimarães-da-Silva  and
N. R. Mota
...Show all authors
R. G. Karam
Affiliation:
ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Psychiatry, Faculdade de Medicina, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
V. Breda
Affiliation:
ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Psychiatry, Faculdade de Medicina, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
F. A. Picon
Affiliation:
ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Psychiatry, Faculdade de Medicina, Federal University of Rio Grande do Sul, Porto Alegre, Brazil National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
D. L. Rovaris
Affiliation:
ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Genetics, Instituto de Biociências, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
M. M. Victor
Affiliation:
ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Psychiatry, Faculdade de Medicina, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
C. A. I. Salgado
Affiliation:
ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Psychiatry, Faculdade de Medicina, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
E. S. Vitola
Affiliation:
ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Psychiatry, Faculdade de Medicina, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
K. L. Silva
Affiliation:
ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Psychiatry, Faculdade de Medicina, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
P. O. Guimarães-da-Silva
Affiliation:
ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Psychiatry, Faculdade de Medicina, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
N. R. Mota
Affiliation:
ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Genetics, Instituto de Biociências, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
A. Caye
Affiliation:
ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
P. Belmonte-de-Abreu
Affiliation:
ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Psychiatry, Faculdade de Medicina, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
L. A. Rohde
Affiliation:
ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Psychiatry, Faculdade de Medicina, Federal University of Rio Grande do Sul, Porto Alegre, Brazil National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
E. H. Grevet
Affiliation:
ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Psychiatry, Faculdade de Medicina, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
C. H. D. Bau*
Affiliation:
ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Department of Genetics, Instituto de Biociências, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
*
* Address for correspondence: Dr. C. Bau, Department of Genetics, Instituto de Biociências, UFRGS, Porto Alegre 91501-970, RS, Brazil. (Email: claiton.bau@ufrgs.br)
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Abstract

Background

Course and predictors of persistence of attention deficit hyperactivity disorder (ADHD) in adults are still largely unknown. Neurobiological and clinical differences between child and adult ADHD raise the need for follow-up studies of patients diagnosed during adulthood. This study investigates predictors of ADHD persistence and the possibility of full remission 7 years after baseline assessment.

Method

A 7-year follow-up study of adults with ADHD (n = 344, mean age 34.1 years, 49.9% males) was conducted. Variables from different domains (social demographics, co-morbidities, temperament, medication status, ADHD measures) were explored with the aim of finding potential predictors of ADHD persistence.

Results

Retention rate was 66% (n = 227). Approximately a third of the sample (n = 70, 30.2%) did not maintain ADHD criteria and 28 (12.4%) presented full remission (<4 symptoms), independently of changes in co-morbidity or cognitive demand profiles. Baseline predictors of diagnostic persistence were higher number of inattention symptoms [odds ratio (OR) 8.05, 95% confidence interval (CI) 2.54–25.45, p < 0.001], number of hyperactivity/impulsivity symptoms (OR 1.18, 95% CI 1.04–1.34, p = 0.01), oppositional defiant disorder (OR 3.12, 95% CI 1.20–8.11, p = 0.02), and social phobia (OR 3.59, 95% CI 1.12–11.47, p = 0.03).

Conclusions

Despite the stage of brain maturation in adults suggests stability, approximately one third of the sample did not keep full DSM-IV diagnosis at follow-up, regardless if at early, middle or older adulthood. Although full remission is less common than in childhood, it should be considered as a possible outcome among adults.

Keywords

Adultsattentionco-morbiditydiagnosishyperactivitylongitudinal studypredictorsprospective

Information

Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 10 , July 2015 , pp. 2045 - 2056
Copyright
Copyright © Cambridge University Press 2015 

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References

APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV). American Psychiatric Association: Washington, DC.Google Scholar
Barbaresi, WJ, Colligan, RC, Weaver, AL, Voigt, RG, Killian, JM, Katusic, SK (2013). Mortality, ADHD, and psychosocial adversity in adults with childhood ADHD: a prospective study. Pediatrics 131, 637–644.Google Scholar
Barkley, RA, Murphy, KR (1998). Attention-Deficit Hyperactivity Disorder, 2nd edn. Guilford Press: New York, NY.Google Scholar
Barkley, RA, Murphy, KR, Fischer, M (2008). ADHD in Adults: What the Science Says. Guilford Press: New York, NY.Google Scholar
Biederman, J, Faraone, SV (2004). The Massachusetts General Hospital studies of gender influences on attention-deficit/hyperactivity disorder in youth and relatives. Psychiatric Clinics of North America 27, 225–232.Google Scholar
Biederman, J, Mick, E, Faraone, SV (2000). Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. American Journal of Psychiatry 157, 816–818.Google Scholar
Biederman, J, Petty, CR, Clarke, A, Lomedico, A, Faraone, SV (2011). Predictors of persistent ADHD: an 11-year follow-up study. Journal of Psychiatric Research 45, 150–155.Google Scholar
Castells, X, Ramos-Quiroga, JA, Rigau, D, Bosch, R, Nogueira, M, Vidal, X, Casas, M (2011). Efficacy of methylphenidate for adults with attention-deficit hyperactivity disorder. CNS Drugs 25, 157–169.CrossRefGoogle ScholarPubMed
Cloninger, CR, Svrakic, DM (1993). A psychobiological model of temperament and character. Archives of General Psychiatry 50, 975–990.Google Scholar
Cortese, S, Imperati, D, Zhou, J, Proal, E, Klein, RG, Mannuzza, S, Ramos-Olazagasti, MA, Milham, MP, Kelly, C, Castellanos, FX (2013). White matter alterations at 33-year follow-up in adults with childhood attention-deficit/hyperactivity disorder. Biological Psychiatry 74, 591–598.CrossRefGoogle ScholarPubMed
Cubillo, A, Halari, R, Smith, A, Taylor, E, Rubia, K (2012). A review of fronto-striatal and fronto-cortical brain abnormalities in children and adults with Attention Deficit Hyperactivity Disorder (ADHD) and new evidence for dysfunction in adults with ADHD during motivation and attention. Cortex 48, 194–215.Google Scholar
Faraone, SV, 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.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, J (1998). Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition (SCID-I/P, Version 2.0, 8/98 revision). Biometrics Research Department, New York State Psychiatric Institute: New York, NY.Google Scholar
Gaub, M, Carlson, CL (1997). Gender differences in ADHD: a meta-analysis and critical review. Journal of the American Academy of Child and Adolescent Psychiatry 36, 1036–1045.Google Scholar
Grevet, EH, Bau, CH, Salgado, CA, Fischer, AG, Kalil, K, Victor, MM, Garcia, CR, Sousa, NO, Rohde, LA, Belmonte-de-Abreu, P (2006). Lack of gender effects on subtype outcomes in adults with attention–deficit/hyperactivity disorder. European Archives of Psychiatry and Clinical Neuroscience 256, 311–319.Google Scholar
Grevet, EH, Bau, CH, Salgado, CA, Fischer, A, Victor, MM, Garcia, C, de Sousa, NO, Nerung, L, Belmonte-De-Abreu, P (2005). Interrater reliability for diagnosis in adults of attention deficit hyperactivity disorder and oppositional defiant disorder using K-SADS-E. Arquivos de Neuro-Psiquiatria 63, 307–310.Google Scholar
Hart, H, Radua, J, Nakao, T, Mataix-Cols, D, Rubia, K (2013). Meta-analysis of functional magnetic resonance imaging studies of inhibition and attention in attention-deficit/hyperactivity disorder. JAMA Psychiatry 70, 185–198.Google Scholar
Hoekzema, E, Carmona, S, Ramos-Quiroga, JA, Richarte Fernández, V, Picado, M, Bosch, R, Soliva, JC, Rovira, M, Vives, Y, Bulbena, A, Tobeña, A, Casas, M, Vilarroya, O (2012). Laminar thickness alterations in the fronto-parietal cortical mantle of patients with attention-deficit/hyperactivity disorder. PLoS ONE 7, e48286.CrossRefGoogle ScholarPubMed
Kaplan, E, Fein, D, Morris, R, Delis, DC (1991). WAIS-R as a Neuropsychological Instrument, Manual. The Psychological Corporation: San Antonio, TX.Google Scholar
Karam, RG, Bau, CH, Salgado, CA, Kalil, KL, Victor, MM, Sousa, NO, Vitola, ES, Picon, FA, Zeni, GD, Rohde, LA, Belmonte-de-Abreu, P, Grevet, EH (2009). Late-onset ADHD in adults: milder, but still dysfunctional. Journal of Psychiatric Research 43, 697–701.Google Scholar
Kessler, RC, Adler, LA, Barkley, R, Biederman, J, Conners, CK, Faraone, SV, Greenhill, LL, Jaeger, S, Secnik, K, Spencer, T, Ustün, TB, Zaslavsky, AM (2005). Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the national comorbidity survey replication. Biological Psychiatry 57, 1442–1451.Google Scholar
Kessler, RC, Adler, L, Barkley, R, Biederman, J, Conners, CK, Demler, O, Faraone, SV, Greenhill, LL, Howes, MJ, Secnik, K, Spencer, T, Ustun, TB, Walters, EE, Zaslavsky, AM (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry 163, 716–723.Google Scholar
Kieling, C, Kieling, RR, Rohde, LA, Frick, PJ, Moffitt, T, Nigg, JT, Tannock, R, Castellanos, FX (2010). The age at onset of attention deficit hyperactivity disorder. American Journal of Psychiatry 167, 14–16.CrossRefGoogle ScholarPubMed
Klein, RG, Mannuzza, S, Olazagasti, MAR, Roizen, E, Hutchison, JA, Lashua, EC, Castellanos, FX (2012). Clinical and functional outcome of childhood attention-deficit/hyperactivity disorder 33 years later. Archives of General Psychiatry 69, 1295–1303.Google Scholar
Lara, C, Fayyad, J, de Graaf, R, Kessler, RC, Aguilar-Gaxiola, S, Angermeyer, M, Demytteneare, K, de Girolamo, G, Haro, JM, Jin, R, Karam, EG, Lépine, JP, Mora, ME, Ormel, J, Posada-Villa, J, Sampson, N (2009). Childhood predictors of adult attention-deficit/hyperactivity disorder: results from the World Health Organization World Mental Health Survey Initiative. Biological Psychiatry 65, 46–54.Google Scholar
Mattos, P, Palmini, A, Salgado, CA, Segenreich, D, Grevet, E, Oliveira, IR, Rohde, LA, Romano, M, Louzã, M, Belmonte de Abreu, P, Lima, PP (2006). Brazilian consensus of specialists on the diagnosis of attention-deficit/hyperactivity disorder in adults. Revista de Psiquiatria do Rio Grande do Sul 28, 50–60.Google Scholar
Mannuzza, S, Klein, RG, Bessler, A, Malloy, P, LaPadula, M (1998). Adult psychiatric status of hyperactive boys grown up. American Journal of Psychiatry 155, 493–498.Google Scholar
McGough, JJ, Smalley, SL, McCracken, JT, Yang, M, Del'Homme, M, Lynn, DE, Loo, S (2005). Psychiatric comorbidity in adult attention deficit hyperactivity disorder: findings from multiplex families. American Journal of Psychiatry 162, 1621–1627.CrossRefGoogle ScholarPubMed
Mercadante, MT, Asbahr, F, Rosário, MC, Ayres, AM (1995). K-SADS, entrevista semi-estruturada para diagnóstico em psiquiatria da infância, versão epidemiológica. FMUSP: São Paulo, SP.Google Scholar
Monuteaux, MC, Mick, E, Faraone, SV, Biederman, J (2010). The influence of sex on the course and psychiatric correlates of ADHD from childhood to adolescence: a longitudinal study. Journal of Child Psychology and Psychiatry 51, 233–241.Google Scholar
Moriyama, TS, Polanczyk, GV, Terzi, FS, Faria, KM, Rohde, LA (2013). Psychopharmacology and psychotherapy for the treatment of adults with ADHD—a systematic review of available meta-analyses. CNS Spectrums 18, 296–306.Google Scholar
Nakao, T, Radua, J, Rubia, K, Mataix-Cols, D (2011). Gray Matter volume abnormalities in ADHD: voxel-based meta-analysis exploring the effects of age and stimulant medication. American Journal of Psychiatry 168, 1154–1163.Google Scholar
Nutt, DJ, Fone, K, Asherson, P, Bramble, D (2007). Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology 21, 10–41.Google Scholar
Polanczyk, G, de Lima, MS, Horta, BL, Biederman, J, Rohde, LA (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American Journal of Psychiatry 164, 942–948.Google Scholar
Polanczyk, G, Caspi, A, Houts, R, Kollins, SH, Rohde, LA, Moffitt, TE (2010). Implications of extending the ADHD age-of-onset criterion to age 12: results from a prospectively studied birth cohort. Journal of the American Academy of Child and Adolescent Psychiatry 49, 210–216.Google Scholar
Ramtekkar, UP, Reiersen, AM, Todorov, AA, Todd, RD (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.Google Scholar
Rasmussen, P, Gillberg, C (2000). Natural outcome of ADHD with developmental coordination disorder at age 22 years: a controlled, longitudinal, community-based study. Journal of the American Academy of Child and Adolescent Psychiatry 39, 1424–1431.Google Scholar
Riddle, MA, Yershova, K, Lazzaretto, D, Paykina, N, Yenokyan, G, Greenhill, L, Abikoff, H, Vitiello, B, Wigal, T, McCracken, JT, Kollins, SH, Murray, DW, Wigal, S, Kastelic, E, McGough, JJ, dos Reis, S, Bauzó-Rosario, A, Stehli, A, Posner, K (2013). The preschool attention-deficit/hyperactivity disorder treatment study (PATS) 6-year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry 52, 264–278.Google Scholar
Rosellini, AJ, Rutter, LA, Bourgeois, ML (2013). The relevance of age of onset to the psychopathology of social phobia. Journal of Psychopathology and Behavioral Assessment 35, 356–365.Google Scholar
Shaw, P, Eckstrand, K, Lerch, JP, Greenstein, D, Clasen, L (2007). Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proceedings of the National Academy of Sciences 104, 19649–19654.Google Scholar
Shaw, P, Malek, M, Watson, B, Sharp, W, Evans, A, Greenstein, D (2012). Development of cortical surface area and gyrification in attention-deficit/hyperactivity disorder. Biological Psychiatry 72, 191–197.Google Scholar
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59(Suppl. 20), 22–33.Google ScholarPubMed
Simon, V, Czobor, P, Bálint, S, Mészáros, A, Bitter, I (2009). Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. British Journal of Psychiatry 194, 204–211.Google Scholar
Souery, D, Oswald, P, Massat, I, Bailer, U, Bollen, J, Demyttenaere, K, Kasper, S, Lecrubier, Y, Montgomery, S, Serretti, A, Zohar, J, Mendlewicz, J (2007). Group for the study of resistant depression: clinical factors associated with treatment resistance in major depressive disorder: results from a European multicenter study. Journal of Clinical Psychiatry 68, 1062–1070.Google Scholar
Stringaris, A, Goodman, R (2009). Longitudinal outcome of youth oppositionality: irritable, headstrong, and hurtful behaviors have distinctive predictions. Journal of the American Academy of Child and Adolescent Psychiatry 48, 404–412.CrossRefGoogle ScholarPubMed
Victor, MM, Grevet, EH, Salgado, CA, Silva, KL, Sousa, NO, Karam, RG, Vitola, ES, Picon, FA, Zeni, GD, Contini, V, Rohde, LA, Belmonte-de-Abreu, P, Bau, CH (2009). Reasons for pretreatment attrition and dropout from methylphenidate in adults with attention-deficit/hyperactivity disorder: the role of comorbidities. Journal of Clinical Psychopharmacology 29, 614–616.Google Scholar
Victor, MM, Rovaris, DL, Salgado, CA, Silva, KL, Karam, RG, Vitola, ES, Picon, FA, Contini, V, Guimarães-da-Silva, PO, Blaya-Rocha, P, Belmonte-de-Abreu, PS, Rohde, LA, Grevet, EH, Bau, CH (2014). Severity but not comorbidities predicts response to methylphenidate in adults with attention-deficit/hyperactivity disorder: results from a naturalistic study. Journal of Clinical Psychopharmacology 34, 212–217.Google Scholar
Vitola, ES, Salgado, CA, Silva, KL, Karam, RG, Victor, MM, Mota, NR, Contini, V, Picon, FA, Guimarães-da-Silva, PO, Giordani, RS, Rohde, LA, Belmonte-de-Abreu, P, Bau, CH, Grevet, EH (2012). The role of a lifetime history of oppositional defiant and conduct disorders in adults with ADHD: implications for clinical practice. CNS Spectrums 17, 94–99.Google Scholar
Volkow, ND, Swanson, JM (2013). Clinical practice: adult attention deficit–hyperactivity disorder. New England Journal of Medicine 369, 1935–1944.Google Scholar
Wechsler, D (1981). WAIS-R, Wechsler Adult Intelligence Scale-Revised, Manual. The Psychological Corporation: New York, NY.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.Google Scholar