Adolescent outcomes of childhood attention-deficit/hyperactivity disorder in a diverse community sample.
OBJECTIVE
To describe adolescent outcomes of childhood attention-deficit/hyperactivity disorder (ADHD) in a diverse community sample.


METHODS
ADHD screening of a school district sample of 1,615 students aged 5 to 11 years was followed by a case-control study 8 years later. High-risk youths meeting full (n = 94) and subthreshold (n = 75) DSM-IV ADHD criteria were matched with demographically similar low-risk peers (n = 163). Outcomes domains included symptom, functional impairment, quality of life, substance use, educational outcomes, and juvenile justice involvement.


RESULTS
In all, 44% of youths with childhood ADHD had not experienced remission. Compared with unaffected peers, adolescents with childhood ADHD were more likely to display oppositional defiant disorder (odds ratio [OR] = 12.9, 95% confidence interval [CI] 5.6-30.0), anxiety/depression (OR = 10.3, 95% CI 2.7-39.3), significant functional impairment (OR = 3.4, 95% CI 1.7-6.9), reduced quality of life (OR = 2.5, 95% CI 1.3-4.7), and involvement with the juvenile justice system (OR = 3.1, 95% CI 1.0-9.1). Subthreshold ADHD, but not full ADHD, increased the risk of grade retention, whereas both conditions increased the risk of graduation failure. Oppositional defiant disorder (ODD), but not childhood ADHD, increased the risk of cannabis and alcohol use. None of the adolescent outcomes of childhood ADHD were moderated by gender, race or poverty.


CONCLUSIONS
ADHD heralds persistence of ADHD and comorbid symptoms into adolescence, as well as significant risks for functional impairment and juvenile justice involvement. Subthreshold ADHD symptoms typically do not qualify affected students for special educational interventions, yet increase the risk for adverse educational outcomes. Findings stress the importance of early ADHD recognition, especially its comorbid presentation with ODD, for prevention and intervention strategies.
Bussing
Regina
R
Division of Child and Adolescent Psychiatry, University of Florida, Gainesville, Florida 32610-0234, USA. rbussing@ufl.edu
Mason
Dana M
DM
Bell
Lindsay
L
Porter
Phillip
P
Garvan
Cynthia
C
D000124:Achievement; D000293:Adolescent; D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D016022:Case-Control Studies; D002648:Child; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005431:Florida; D005500:Follow-Up Studies; D006801:Humans; D007604:Juvenile Delinquency / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D002189:Marijuana Abuse / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D008403:Mass Screening; D016017:Odds Ratio; D011788:Quality of Life / Q000523:psychology; D012306:Risk; D012917:Social Adjustment; D013332:Student Dropouts / Q000523:psychology / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology