In an attempt to validate self-reporting of ADHD symptoms, this longitudinal, population‑based study aimed to compare predictive associations of parent- and self-rated ADHD symptoms in adolescence across a range of socioeconomic and health outcomes.
Data from the Twin Study of Child and Adolescent Development were linked to several nationwide population-based registers in Sweden (up until 2009) to derive life outcomes. Questionnaires were supplied to both the individual and a parent at two different time points (at age 13–14 years and 16–17 years, N=2960). Associations between parent- and self-rated ADHD symptoms at both time points* and life outcomes in young adulthood† were analysed using logistic regression.
Compared with parental assessment, adolescents rated their ADHD symptoms as more severe at both time points studied.
At age 13–14 years, parent-rated ADHD symptoms indicated significantly higher odds of being in an accident, having a criminal record, not completing higher education and having a substance-use disorder (SUD) (odds ratio [OR] 1.80–2.96) for individuals in the top 10% compared with the lower 90% of ADHD symptom distribution. Conversely, self-rated ADHD symptoms for the same age group predicted significantly higher odds for SUD only (OR 2.56). At age 13–14 years, parent-rated ADHD symptoms significantly predicted incompletion of higher education, unemployment, criminality, unintentional injuries and SUD (OR 1.12–1.21). Self-rated ADHD symptoms predicted similar outcomes (OR 1.07–1.17), although no prediction of unintentional injury or unemployment was made.
At age 16–17 years, parent-rated ADHD symptoms predicted significantly higher odds (OR 2.21–5.27) for criminality, incompletion of higher education and unemployment for the top 10% compared with the lower 90% of the ADHD symptom distribution. Furthermore, all outcomes in early adulthood were significantly predicted (OR 1.13–1.49). Other than employment and unintentional injuries, self-rated ADHD symptoms significantly predicted all other life outcomes (OR 1.035–1.15).
At age 13–14 years, parent-rated ADHD symptoms significantly predicted not completing higher education and a higher likelihood of unemployment, criminality and unintentional injuries (OR 1.11–1.20). A similar result was obtained at age 16–17 years (OR 1.11–1.44). Self-rated ADHD symptoms did not significantly predict outcomes in adolescence at age 13–14 years, and significantly predicted incomplete higher education and SUD (OR 1.06–1.13) at age 16–17 years.
Two major study limitations were highlighted by the authors: firstly, that outcomes were rated subjectively by individuals or their parents, which may have biased the results meaning they may not be generalised to individuals with clinically diagnosed ADHD; and secondly, that large-scale, longitudinal-based studies are required for comparison.
Socioeconomic and health outcomes were found to have a significant association with both parent- and self-rated ADHD symptoms in adolescents, and may provide valuable information on these risks in the future. It is recommended that clinicians prioritise parent- over self-ratings, especially in younger patients.
*Parent- and self-ratings consisted of 11 items from the Attention Problem (AP) Scale of the Child Behaviour Checklist and nine items from the same AP Scale for the Youth Self-Report form, respectively. Items were scored on a 3-point scale (0=not true; 1=sometimes true; and 2=often true)
†Socioeconomic and health outcomes were identified by collation of data based on education, occupation, criminality, unintentional injury and psychiatric outcomes
Du Rietz E, Kuja-Halkola R, Brikell I, et al. Predictive validity of parent- and self-rated ADHD symptoms in adolescence on adverse socioeconomic and health outcomes. Eur Child Adolesc Psychiatry 2017; Epub ahead of print.