Factors present in childhood which could predict the persistence of ADHD into adulthood have been identified in a recent meta-analysis. Severe ADHD, treatment for ADHD, and comorbid conduct and major depressive disorders during childhood were found to be associated with ADHD symptoms persisting into adulthood.
The researchers from Brazil conducted a systematic literature search and meta-analysis in order to establish current knowledge on childhood factors that have been associated with persistence of ADHD. They identified 16 studies – six retrospective, population-based studies, and ten clinical follow-up studies – which included ADHD assessments in adulthood (before age 18) and childhood (before age 12), as well as clinical, demographic, genetic or neurobiological information in childhood. Factors evaluated by at least three studies were included in the meta-analysis.
Childhood factors of severe ADHD (odds ratio [OR] 2.33; 95% confidence interval [CI] 1.60, 3.39; p<0.001), ADHD treatment (OR 2.09; 95% CI 1.04, 4.18; p=0.037), comorbid conduct disorder (OR 1.85; 95% CI 1.06, 3.24; p=0.030) and comorbid major depressive disorders (OR 1.80; 95% CI 1.10, 2.95; p=0.019) were revealed as predictors of persistence into adulthood.
The researchers noted several limitations, including the methodology of the included studies; no long-term prospective studies were found in the literature search, and the studies included in the meta-analysis could be subject to recall or selection bias (due to retrospective design, or because they were derived from a clinical sample, respectively). In addition, there was only a limited set of factors available for assessment, therefore in many cases sufficient comparisons or meaningful conclusions could not be made.
Overall, these findings have important clinical implications. Identifying children with ADHD who have a tendency to persist could lead to the development of specialised care and preventative measures. The researchers identified a lack of clinical data on this overlooked question in the ADHD literature, and suggested prospective cohort studies could provide useful insight into how ADHD can progress.
Read more about risk factors for the persistence of ADHD into adulthood here
Caye A, Spadini AV, Karam RG, et al. Predictors of persistence of ADHD into adulthood: a systematic review of the literature and meta-analysis. Eur Child Adolesc Psychiatry 2016; 25: 1151-1159.