A recent study published in the American Journal of Psychiatry presents data that suggests that up to 90% of children diagnosed as having attention-deficit/hyperactivity disorder (ADHD) may continue to experience intermittent residual symptoms of the disorder into young adulthood. This finding runs counter to general clinical consensus that only one-third to one-half of youth persist with issues of attention and focusing beyond their late adolescent years.
The researchers present a new perspective with the view that ADHD should be considered a chronic disorder that may wax and wane beyond the point of apparent remission. This concept is a bit of a game changer as regards its implications for management of youth with an ADHD diagnosis.
The report is of a follow-up of participants in the respected Multimodal Treatment Study of ADHD (MTA) that did assessments over a 16-year period, with participants averaging in the mid-twenties at the close of the study.
The study data identified four sub-groups.
- Approximately 10% of the youth cohort study experienced full and sustained remission of symptoms beyond their adolescent years.
- Approximately 15% experienced partial remission of symptoms that endured without major change over the study period
- Another ~65% of participants were reported to exhibit a profile of fluctuating symptomatology with periods of partial remission alternating with periods of problematic functionality.
- Another ~10% of the cohort showed persistent symptomatology.
Of particular clinical relevance of these findings is the implication that both patient education and continued monitoring with periodic screening would seem warranted for youth who appear to have grown out of the handicapping symptoms of the disorder so as to identify those whose remission may be time- limited. The study further concludes that “assessing factors that may influence symptom fluctuations (e.g., environmental fit, physical health) should be central to evaluation and treatment of ADHD across the lifespan.”
A corollary of the study findings, would suggest that, when relevant, on-going treatment may be indicated for a larger number of youth, particularly in the transition into their adult years—this a time when access and continuity of care is often more difficult to sustain as young adult patients transition away from their primary care pediatric providers without linkage to adult primary care support.