Adolescent Outcomes of Childhood Attention-Deficit/Hyperactivity Disorder in a Diverse Community Sample
Accepted 16 March 2010. published online 04 May 2010.
Objective
To describe adolescent outcomes of childhood attention-deficit/hyperactivity disorder (ADHD) in a diverse community sample.
Method
ADHD screening of a school district sample of 1,615 students aged 5 to 11 years was followed by a case-control study 8 years later. High-risk youths meeting full (n = 94) and subthreshold (n = 75) DSM-IV ADHD criteria were matched with demographically similar low-risk peers (n = 163). Outcomes domains included symptom, functional impairment, quality of life, substance use, educational outcomes, and juvenile justice involvement.
Results
In all, 44% of youths with childhood ADHD had not experienced remission. Compared with unaffected peers, adolescents with childhood ADHD were more likely to display oppositional defiant disorder (odds ratio [OR] = 12.9, 95% confidence interval [CI] 5.6-30.0), anxiety/depression (OR = 10.3, 95% CI 2.7-39.3), significant functional impairment (OR = 3.4, 95% CI 1.7-6.9), reduced quality of life (OR = 2.5, 95% CI 1.3-4.7), and involvement with the juvenile justice system (OR = 3.1, 95% CI 1.0-9.1). Subthreshold ADHD, but not full ADHD, increased the risk of grade retention, whereas both conditions increased the risk of graduation failure. Oppositional defiant disorder (ODD), but not childhood ADHD, increased the risk of cannabis and alcohol use. None of the adolescent outcomes of childhood ADHD were moderated by gender, race or poverty.
Conclusions
ADHD heralds persistence of ADHD and comorbid symptoms into adolescence, as well as significant risks for functional impairment and juvenile justice involvement. Subthreshold ADHD symptoms typically do not qualify affected students for special educational interventions, yet increase the risk for adverse educational outcomes. Findings stress the importance of early ADHD recognition, especially its comorbid presentation with ODD, for prevention and intervention strategies.
aDivision of Child and Adolescent Psychiatry at the University of Florida in Gainesville, Florida
bCollege of Education at the University of Florida
Correspondence to Dr. Regina Bussing, Box 100234 UFHSC, Gainesville, FL 32610-0234
This work was supported by grant RO1 MH57399 from the National Institute of Mental Health.
Disclosure: Dr. Bussing receives research support from the National Institute of Mental Health and Pfizer. She has received research support from Forest, Pfizer, and Shire. She has served as a consultant to Shire and has served on the advisory board for Eli Lilly. Ms. Mason, Ms. Bell, Mr. Porter, and Dr. Garvan report no biomedical financial interests or potential conflicts of interest.
ABSTRACT