Background. This study examined the persistence of attention deficit hyperactivity disorder (ADHD) into adulthood.Method. We analyzed data from published follow-up studies of ADHD. To be included in the analysis, these additional studies had to meet the following criteria: the study included a control group and it was clear from the methods if the diagnosis of ADHD included subjects who did not meet full criteria but showed residual and impairing signs of the disorder. We used a meta-analysis regression model to separately assess the syndromatic and symptomatic persistence of ADHD.Results. When we define only those meeting full criteria for ADHD as having ‘persistent ADHD’, the rate of persistence is low, ~15% at age 25 years. But when we include cases consistent with DSM-IV's definition of ADHD in partial remission, the rate of persistence is much higher, ~65%.Conclusions. Our results show that estimates of ADHD's persistence rely heavily on how one defines persistence. Yet, regardless of definition, our analyses show that evidence for ADHD lessens with age. More work is needed to determine if this reflects true remission of ADHD symptoms or is due to the developmental insensitivity of diagnostic criteria for the disorder.

The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies

OBJECTIVE: Symptom decline in attention deficit hyperactivity disorder (ADHD) was examined with different definitions of remission.METHOD: Symptoms in 128 boys were measured five times over 4 years. The prevalences of syndromatic (less than full syndrome), symptomatic (less than subthreshold diagnosis), and functional (full recovery) remission were estimated as a function of age with multivariate logistic regression.RESULTS: Age was significantly associated with decline in total ADHD symptoms and symptoms of hyperactivity, impulsivity, and inattention. Symptoms of inattention remitted for fewer subjects than did symptoms of hyperactivity or impulsivity. The proportion of subjects experiencing remission varied considerably with the definition used (highest for syndromatic remission, lowest for functional remission).CONCLUSIONS: These results indicate that differences in reported remission rates reflect the definition used rather than the disorder’s course. They provide systematic support for the clinical o...

Age-Dependent Decline of Symptoms of Attention Deficit Hyperactivity Disorder: Impact of Remission Definition and Symptom Type

Background In spite of the growing literature about adult attention-deficit hyperactivity disorder (ADHD), relatively little is known about the prevalence and correlates of this disorder. Aims To estimate the prevalence of adult ADHD and to identify its demographic correlates using meta-regression analysis. Method We used the MEDLINE, PsycLit and EMBASE databases as well as hand-searching to find relevant publications. Results The pooled prevalence of adult ADHD was 2.5% (95% CI 2.1–3.1). Gender and mean age, interacting with each other, were significantly related to prevalence of ADHD. Metaregression analysis indicated that the proportion of participants with ADHD decreased with age when men and women were equally represented in the sample. Conclusions Prevalence of ADHD in adults declines with age in the general population. We think, however, that the unclear validity of DSM–IV diagnostic criteria for this condition can lead to reduced prevalence rates by underestimation of the prevalence of adult ADHD.

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Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis.

This study examined the persistence of attention-deficit/hyperactivity disorder (ADHD) into young adulthood using hyperactive (N = 147) and community control (N = 71) children evaluated at ages 19-25 years. ADHD was rare in both groups (5% vs. 0%) based on self-report but was substantially higher using parent reports (46% vs. 1.4%). Using a developmentally referenced criterion (+2 SD), prevalence remained low for self-reports (12% vs. 10%) but rose further for parent reports (66% vs. 8%). Parent reports were more strongly associated with major life activities than were self-reports. Recollections of childhood ADHD showed moderate correlations with actual parent ratings collected in childd hood, which suggests some validity for such recollections. The authors conclude that previous follow-up studies that relied on self-reports might have substantially underestimated the persistence of ADHD into adulthood.

The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder.

Objective.— To deal with public and professional concern regarding possible overprescription of attention-deficit/hyperactivity disorder (ADHD) medications, particularly methylphenidate, by reviewing issues related to the diagnosis, optimal treatment, and actual care of ADHD patients and of evidence of patient misuse of ADHD medications. Data Sources.— Literature review using a National Library of Medicine database search for 1975 through March 1997 on the termsattention deficit disorder with hyperactivity, methylphenidate, stimulants, and stimulant abuse and dependence. Relevant documents from the Drug Enforcement Administration were also reviewed. Study Selection.— All English-language studies dealing with children of elementary school through high school age were included. Data Extraction.— All searched articles were selected and were made available to coauthors for review. Additional articles known to coauthors were added to the initial list, and a consensus was developed among the coauthors regarding the articles most pertinent to the issues requested in the resolution calling for this report. Relevant information from these articles was included in the report. Data Synthesis.— Diagnostic criteria for ADHD are based on extensive empirical research and, if applied appropriately, lead to the diagnosis of a syndrome with high interrater reliability, good face validity, and high predictability of course and medication responsiveness. The criteria of what constitutes ADHD in children have broadened, and there is a growing appreciation of the persistence of ADHD into adolescence and adulthood. As a result, more children (especially girls), adolescents, and adults are being diagnosed and treated with stimulant medication, and children are being treated for longer periods of time. Epidemiologic studies using standardized diagnostic criteria suggest that 3% to 6% of the school-aged population (elementary through high school) may suffer from ADHD, although the percentage of US youth being treated for ADHD is at most at the lower end of this prevalence range. Pharmacotherapy, particularly use of stimulants, has been extensively studied and generally provides significant short-term symptomatic and academic improvement. There is little evidence that stimulant abuse or diversion is currently a major problem, particularly among those with ADHD, although recent trends suggest that this could increase with the expanding production and use of stimulants. Conclusions.— Although some children are being diagnosed as having ADHD with insufficient evaluation and in some cases stimulant medication is prescribed when treatment alternatives exist, there is little evidence of widespread overdiagnosis or misdiagnosis of ADHD or of widespread overprescription of methylphenidate by physicians. JAMA. 1998;279:1100-1107

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Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

Objective : This study was undertaken to assess whether the diagnosis of attention deficit hyperactivity disorder (ADHD) is retained from childhood into adulthood. Method : A search of the literature yielded nine prospective studies in which cohorts of children with the disorder were formed and then reexamined 4-16 years later to determine the level of retained ADHD. The resulting data were subjected to nonlinear regression analysis to ascertain the relationship with chronological age. Results : The data followed an exponential decline over time to a high degree of accuracy. Conclusions : The rate of ADHD in a given age group appears to decline by 50% approximately every 5 years. If a prevalence of ADHD in childhood of 4% is assumed and the exponential decline extrapolated the estimated rate of adult ADHD ranges from about 0.8% at age 20 to 0.05% at age 40.

Age-dependent decline of attention deficit hyperactivity disorder.

objective: This study was undertaken to assess whether the diagnosis of attention deficit hyperactivity disorder (ADHD) is retained from childhood into adulthood. Method: A search of the literature yielded nine prospective studies in which cohorts ofchildren with the disorder were formed and then reexamined 4-16 years later to determine the level ofretained ADHD. The resulting data were subjected to nonlinear regression analysis to ascertain the relationship with chronological age. Results: The data followed an exponential decline over time to a high degree of accuracy. Conclusions: The rate of A DHD in a given age group appears to decline by 50% approximately every S years. Ifa prevalence ofADHD in childhood of4% is assumed and the exponentialdecline extrapolated, the estimated rate ofadult ADHD ranges from about 0.8% at age 20 to 0.05% at age 40. (AmJ Psychiatry 1996; 153:1143-1146)

Eugene P. Schoener

Papers

Age-dependent decline of attention deficit hyperactivity disorder.

of Attention Deficit Hyperactivity Disorder