Evaluation of the Persistence, Remission, and Emergence of Attention-Deficit/Hyperactivity Disorder in Young Adulthood.
Evaluation of the Persistence, Remission, and Emergence of Attention-Deficit/Hyperactivity Disorder in Young Adulthood.
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DOI：
10.1001/jamapsychiatry.2016.0465
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发表时间：
2016-07-01
期刊：
影响因子：
25.8
通讯作者：
Arseneault L
中科院分区：
文献类型：
--
作者：
Agnew-Blais JC;Polanczyk GV;Danese A;Wertz J;Moffitt TE;Arseneault L
ADHD现在被认为发生在成年期，并与一系列负面结果有关。然而，对ADHD进入成年期的预期过程、其在童年期后持续存在的风险因素以及其在非临床人群中出现在青年期的可能性知之甚少。调查儿童期危险因素和年轻成人功能的持续性，缓解和迟发性ADHD的个人。研究样本是环境风险（E-Risk）纵向双胞胎研究，这是一项具有英国全国代表性的出生队列，包括1994-1995年在英格兰和威尔士出生的2，232对双胞胎。ADHD的诊断在儿童时期的5岁、7岁、10岁和12岁以及成年后的18岁进行评估。儿童期预测因素包括产前/围产期因素、儿童临床特征和家庭环境方面。18岁的结果包括ADHD症状和相关的损害，整体功能和其他精神健康障碍。在患有儿童ADHD的个体中（n=247），21.1%在18岁时符合诊断标准。坚持与儿童时期较高的症状水平和较低的智商有关。与那些缓解的人相比，持久性个体在18岁时有更多的功能障碍和更高的其他精神健康障碍率。在成人ADHD患者（n=162）中，67.9%的人在12岁或之前的任何评估中都不符合ADHD标准。在童年时期，与持续性组相比，迟发性ADHD患者表现出更少的行为问题和更高的智商;在18岁时，与持续性组相比，他们表现出类似的ADHD症状和损害，并且心理健康障碍的发生率也类似地升高。在这个普通人群队列中，ADHD的持续性主要是由儿童ADHD的严重程度和较差的神经心理功能驱动的。此外，我们确定了成人ADHD人群的异质性，例如该组包括一个大型的迟发性ADHD组，没有儿童诊断和最小的神经心理损伤，以及一个较小的组，持续性ADHD和相关的神经心理损伤。我们的研究结果质疑成人ADHD作为儿童期发病的神经发育障碍的概念。
ADHD is now recognized to occur in adulthood and is associated with a range of negative outcomes. However, less is known about the prospective course of ADHD into adulthood, the risk factors for its persistence past childhood, and the possibility of its emergence in young adulthood in non-clinical populations. To investigate childhood risk factors and young adult functioning of individuals with persistent, remitted and late-onset ADHD. The study sample is the Environmental Risk (E-Risk) Longitudinal Twin Study, a UK nationally-representative birth cohort of 2,232 twins born in England and Wales in 1994–1995. ADHD diagnoses were assessed in childhood at ages 5, 7, 10, and 12 and in young adulthood at age 18. Childhood predictors included pre/perinatal factors, child clinical characteristics and aspects of the family environment. Age-18 outcomes included ADHD symptoms and associated impairment, overall functioning and other mental health disorders. Among individuals with childhood ADHD (n=247), 21.1% met diagnostic criteria for the disorder at age 18. Persistence was associated with higher levels of symptoms and lower IQ in childhood. Persistent individuals had more functional impairment and higher rates of other mental health disorders at age 18 compared to those who remitted. Among individuals with adult ADHD (n=162), 67.9% did not meet criteria for ADHD at any assessment at or prior to age 12. In childhood, individuals with late-onset ADHD showed fewer behavior problems and higher IQ compared to the persistent group; at age 18, they showed comparable ADHD symptoms and impairment and similarly elevated rates of mental health disorders compared to the persistent group. In this general population cohort, the persistence of ADHD was largely driven by childhood ADHD severity and poorer neuropsychological functioning. Additionally, we identified heterogeneity in the adult ADHD population such that this group consisted of a large late-onset ADHD group with no childhood diagnosis and minimal neuropsychological impairment, and a smaller group with persistent ADHD and associated neuropsychological impairment. Our findings call into question the conceptualization of adult ADHD as a childhood-onset neurodevelopmental disorder.