The majority of children with ADHD may experience a decrease in symptoms between the ages of 7 to 19 years, as indicated by results of a longitudinal, German study.
In this analysis of the BELLA study — investigating mental health issues of children and adolescents in Germany — parent-rated* scores for inattention, hyperactivity-impulsivity and total ADHD symptoms ([as defined by ICD-10 and DSM-IV-TR†] n=2,593 community families; children/adolescents aged 7–17 years assessed at 1- and 2-year follow-up) were analysed using an accelerated longitudinal design, with growth mixture modelling applied to detect distinct symptom trajectory subgroups.
Three trajectory subgroups, with low, moderate and high ADHD symptom levels over time (age 7 to 19 years), were detected. The majority of children and adolescents with ADHD followed a low trajectory over time for inattention (78.3%), hyperactivity-impulsivity (83.8%) and total symptoms (82.7%), while a minority followed a high trajectory over time (2.9%, 2.8% and 3.2%, respectively).
In general, significant inattention, hyperactivity-impulsivity and total symptom reduction was observed over time in all trajectory subgroups, with the exception of the high subgroup for inattention and total symptoms. This finding was considered likely to result from lack of statistical power due to the smaller numbers of individuals in the high-risk group.
While this community sample study is limited by parent-only reports and the relatively short (2-year) observation period, researchers concluded that the findings demonstrate that ADHD can be reliably detected at school age. Furthermore, individuals with low symptom levels during this period are at a low risk for developing severe ADHD symptoms.
*ADHD symptoms rated using the ADHD Symptom Checklist (part of the German Diagnostic System for Psychiatric Disorders in Children and Adolescents), which comprised 18 symptom criteria from both DSM-IV-TR and ICD-10.
†DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition Text Revision; ICD-10, International Classification of Diseases – 10th Edition.
Döpfner M, Hautmann C, Görtz-Dorten A, et al. Long-term course of ADHD symptoms from childhood to early adulthood in a community sample. Eur Child Adolesc Psychiatry 2015; 24: 665-673.