The persistence of ADHD into adolescence may be predicted by child psychopathology, parental stress and impairment, suggests a recent Spanish study.
Children diagnosed with the combined hyperactive/impulsive-inattentive presentation of ADHD (n=61; mean age 8.7 years)*, were evaluated in order to determine the rates of persistence and remittance of ADHD into adolescence, and to analyse possible personal and family predictor variables.
ADHD symptoms and impairment were measured at baseline and at 30 months using the CSR – R:L† and the SDQ‡; and a variety of validated computerised tasks§ were used to measure verbal working memory, visuo-spatial working memory and inhibition. Parenting characteristics were assessed using the Parenting Stress Index and the Parenting Scale. At follow-up, ADHD status was identified as persistent (met DSM-IV-TR** ADHD criteria according to both parents’ and teachers’ ratings), contextually persistent (met ADHD criteria according to one informant – parent or teacher) or remitted (subthreshold clinical symptomatology).
Results showed that according to parents’ (and teachers’) ratings at 30 months: 52.7% (34.0%) retained combined-presentation ADHD, 23.7% (30.2%) had moved to predominantly inattentive presentation, 3.6% (1.8%) had moved to the predominantly hyperactive-impulsive presentation, and 20.0% (34.0%) did not meet ADHD DSM-IV-TR criteria, suggesting that the core manifestations of ADHD changed over time.
According to combined parent and teacher ratings; 14.8% of children presented with remission, 29.5% presented with contextual persistence, and 55.7% continued to meet ADHD criteria. Children with persistent and contextually persistent ADHD had more concomitant psychological comorbidities, with significantly (p<0.001) higher Conners’ Global Index scores (73.65 and 72.39, respectively) than the remitted children (60.11) at Month 30. Parental stress was also significantly (p<0.005) higher for children with persistent ADHD than for those who experienced remission.
Researchers concluded that children with ADHD may persist with symptoms in adolescence, with persistence associated with child psychopathology, parental stress and impairment. Understanding of these personal and family factors is important to facilitate appropriate treatment strategies to speed up remission.
Read more about the persistence of ADHD in adolescence here
*Children formed part of the Spanish sample of families from the International Multicentre ADHD Genetic Project (IMAGE).
†Conners’ Rating Scales – Revised, long version (CRS – R:L) ; completed by parents and teachers.
‡Strengths and Difficulties Questionnaire for Parents; the “impact supplement” section was used by parents to rate whether their child had difficulties with concentration, behaviour or social interaction.
§The WISC-R Digit-Span Subtest, backward; the Temporo-Spatial Retrieval Task; and the Continuous Performance Test.
**DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition Text Revision
Miranda A, Colomer C, Fernández MA, et al. Analysis of personal and family factors in the persistence of attention deficit hyperactivity disorder: results of a prospective follow-up study in childhood. PLoS One 2015; 10(5): e0128325.