Predictors of stability of attention-deficit/hyperactivity disorder subtypes from childhood to young adulthood.
OBJECTIVE
To determine the 5-year prospective stability of population-based and DSM-IV subtypes of attention-deficit/hyperactivity disorder (ADHD) as well as to explore predictors of stability.


METHODS
A total of 708 twins ages 7 to 19 years who were identified from birth records of the state of Missouri and had participated in a study of ADHD were reassessed 5 years later in a blinded fashion. Stabilities of DSM-IV and population-based ADHD subtypes were compared using percentage of agreement with significance tested by the kappa statistic. Predictors of stability of subtype diagnosis were determined using multivariate logistic regression.


RESULTS
In general, 5-year ADHD subtype stability was poor to modest and ranged from 11.1% to 24.0% for DSM-IV for subtypes and from 14.3% to 35.3% for clinically significant population-derived subtypes. There were no predictors of diagnostic stability that applied across subtypes. There were subtype-specific predictors including a diagnosis of oppositional defiant disorder for DSM-IV primarily inattentive ADHD; lower verbal IQ for DSM-IV combined type ADHD; and younger age, oppositional defiant disorder, and medication use for population-defined severe combined ADHD.


CONCLUSIONS
Population-defined ADHD subtype criteria demonstrated modestly improved diagnostic stability over 5 years compared to DSM-IV subtypes. Few correlates or predictors of stability were identified.
Todd
Richard D
RD
Drs. Todd, Huang, Todorov, Neuman, Reiersen, Henderson, and Reich are with the Department of Psychiatry, Washington University School of Medicine; Dr. Todd is also with the Department of Genetics. Electronic address: toddr@wustl.edu.
Huang
Hongyan
H
Drs. Todd, Huang, Todorov, Neuman, Reiersen, Henderson, and Reich are with the Department of Psychiatry, Washington University School of Medicine; Dr. Todd is also with the Department of Genetics.
Todorov
Alexandre A
AA
Drs. Todd, Huang, Todorov, Neuman, Reiersen, Henderson, and Reich are with the Department of Psychiatry, Washington University School of Medicine; Dr. Todd is also with the Department of Genetics.
Neuman
Rosalind J
RJ
Drs. Todd, Huang, Todorov, Neuman, Reiersen, Henderson, and Reich are with the Department of Psychiatry, Washington University School of Medicine; Dr. Todd is also with the Department of Genetics.
Reiersen
Angela M
AM
Drs. Todd, Huang, Todorov, Neuman, Reiersen, Henderson, and Reich are with the Department of Psychiatry, Washington University School of Medicine; Dr. Todd is also with the Department of Genetics.
Henderson
Cynthia A
CA
Drs. Todd, Huang, Todorov, Neuman, Reiersen, Henderson, and Reich are with the Department of Psychiatry, Washington University School of Medicine; Dr. Todd is also with the Department of Genetics.
Reich
Wendy C
WC
Drs. Todd, Huang, Todorov, Neuman, Reiersen, Henderson, and Reich are with the Department of Psychiatry, Washington University School of Medicine; Dr. Todd is also with the Department of Genetics.
D000293:Adolescent; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000145:classification / Q000175:diagnosis* / Q000235:genetics / Q000523:psychology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000145:classification / Q000175:diagnosis / Q000235:genetics / Q000523:psychology; D002648:Child; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004200:Diseases in Twins / Q000145:classification / Q000175:diagnosis* / Q000235:genetics / Q000523:psychology; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D008297:Male; D010641:Phenotype; D011379:Prognosis; D011446:Prospective Studies