Functional Adult Outcomes 16 Years After Childhood Diagnosis of Attention-Deficit/Hyperactivity Disorder: MTA Results.
To compare educational, occupational, legal, emotional, substance use disorder, and sexual behavior outcomes in young adults with persistent and desistent attention-deficit/hyperactivity disorder (ADHD) symptoms and a local normative comparison group (LNCG) in the Multimodal Treatment Study of Children with ADHD (MTA).



Data were collected 12, 14, and 16 years postbaseline (mean age 24.7 years at 16 years postbaseline) from 476 participants with ADHD diagnosed at age 7 to 9 years, and 241 age- and sex-matched classmates. Probands were subgrouped on persistence versus desistence of DSM-5 symptom count. Orthogonal comparisons contrasted ADHD versus LNCG and symptom-persistent (50%) versus symptom-desistent (50%) subgroups. Functional outcomes were measured with standardized and demographic instruments.



Three patterns of functional outcomes emerged. Post-secondary education, times fired/quit a job, current income, receiving public assistance, and risky sexual behavior showed the most common pattern: the LNCG group fared best, symptom-persistent ADHD group worst, and symptom-desistent ADHD group between, with the largest effect sizes between LNCG and symptom-persistent ADHD. In the second pattern, seen with emotional outcomes (emotional lability, neuroticism, anxiety disorder, mood disorder) and substance use outcomes, the LNCG and symptom-desistent ADHD group did not differ, but both fared better than the symptom-persistent ADHD group. In the third pattern, noted with jail time (rare), alcohol use disorder (common), and number of jobs held, group differences were not significant. The ADHD group had 10 deaths compared to one death in the LNCG.



Adult functioning after childhood ADHD varies by domain and is generally worse when ADHD symptoms persist. It is important to identify factors and interventions that promote better functional outcomes.
Division of Child Psychiatry, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada. Electronic address: lily.hechtman@mcgill.ca.
Lily
L
Hechtman
School of Medicine, University of California, Irvine.
James M
JM
Swanson
Florida International University, Miami.
Margaret H
MH
Sibley
University of California, Irvine.
Annamarie
A
Stehli
Institute of Human Development, University of California, Berkeley.
Elizabeth B
EB
Owens
Duke University Medical Center, Durham, NC.
John T
JT
Mitchell
Ohio State University, Nisonger Center, Columbus.
L Eugene
LE
Arnold
University of Pittsburgh School of Medicine.
Brooke S G
BS
Molina
University of California, Berkeley.
Stephen P
SP
Hinshaw
University of Arkansas for Medical Sciences, Little Rock, and The REACH Institute, New York.
Peter S
PS
Jensen
Child Study Center at New York University Langone Medical Center, New York.
Howard B
HB
Abikoff
Division of Health Research, Lancaster University, Lancaster, UK.
Guillermo
G
Perez Algorta
Carleton University, Ottawa, Ontario, Canada.
Andrea L
AL
Howard
University of Vermont, Burlington.
Betsy
B
Hoza
McGill University Health Centre, Montreal, Quebec.
Joy
J
Etcovitch
McGill University Health Centre, Montreal, Quebec.
Sylviane
S
Houssais
University of California, Irvine.
Kimberley D
KD
Lakes
University of Vermont, Burlington.
J Quyen
JQ
Nichols
D000293:Adolescent; D000328:Adult; D000359:Aftercare; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D002648:Child; D018450:Disease Progression; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult
ADHD; MTA; adult outcomes; follow-up; functional outcomes