Childhood Predictors of Adult Attention-Deficit/Hyperactivity Disorder: Results from the World Health Organization World Mental Health Survey Initiative
Childhood Predictors of Adult Attention-Deficit/Hyperactivity Disorder: Results from the World Health Organization World Mental Health Survey Initiative
复制标题
DOI：
10.1016/j.biopsych.2008.10.005
复制
发表时间：
2009-01-01
影响因子：
10.6
通讯作者：
Sampson, Nancy
中科院分区：
文献类型：
--
作者：
Lara, Carmen;Fayyad, John;Sampson, Nancy
背景：虽然众所周知，儿童注意缺陷多动障碍(ADHD)通常会持续到成年，但儿童时期这种持续性的预测因素尚未得到广泛研究。方法：在世界卫生组织世界精神卫生调查中，对10个国家的儿童ADHD和成人ADHD病史进行了评估。在629名患有儿童ADHD的成年受试者中，采用Logistic回归分析来研究儿童时期报告的危险因素与成人持续性之间的关系。危险因素包括：年龄；性别；儿童ADHD症状特征、严重程度和治疗；儿童/青少年DSM-IV并存障碍；儿童家庭逆境；儿童/青少年暴露于创伤事件。结果：平均50%的ADHD儿童(范围：32.8%-84.1%)成年后仍符合DSM-IV ADHD标准。持续性与儿童ADHD症状谱(注意力加冲动-多动型的持续性最高，优势比[OR]=12.4，与冲动-多动型的相关性最低)、症状严重程度(OR=2.0)、严重抑郁障碍(MDD；OR=2.2)、高共病(除ADHD外还有3个儿童/青少年障碍；OR=1.7)、父亲(而不是母亲)焦虑情绪障碍(OR=2.4)和父母的反社会人格障碍(OR=2.2)密切相关。这些变量的多变量风险分布显著地预测ADHD持续到成年(接收操作员特征曲线下的面积=0.76)。结论：相当大比例的ADHD儿童在成年后仍符合ADHD的全部标准。一个包含可以在青春期评估的变量的多变量风险指数可以很好地预测持久性。
Background: Although it is known that childhood attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood, childhood predictors of this persistence have not been widely studied.Methods: Childhood history of ADHD and adult ADHD were assessed in 10 countries in the World Health Organization World Mental Health Surveys. Logistic regression analysis was used to study associations of retrospectively reported childhood risk factors with adult persistence among the 629 adult respondents with childhood ADHD. Risk factors included age; sex; childhood ADHD symptom profiles, severity, and treatment; comorbid child/adolescent DSM-IV disorders; childhood family adversities; and child/adolescent exposure to traumatic events.Results: An average of 50% of children with ADHD (range: 32.8%-84.1% across countries) continued to meet DSM-IV criteria for ADHD as adults. Persistence was strongly related to childhood ADHD symptom profile (highest persistence associated with the attentional plus impulsive-hyperactive type, odds ratio [OR] = 12.4, compared with the lowest associated with the impulsive-hyperactive type), symptom severity (OR = 2.0), comorbid major depressive disorder (MDD; OR = 2.2), high comorbidity (>= 3 child/adolescent disorders in addition to ADHD; OR = 1.7), paternal (but not maternal) anxiety mood disorder (OR = 2.4), and parental antisocial personality disorder (OR = 2.2). A multivariate risk profile of these variables significantly predicts persistence of ADHD into adulthood (area under the receiving operator characteristic curve = .76).Conclusions: A substantial proportion of children with ADHD continue to meet full criteria for ADHD as adults. A multivariate risk index comprising variables that can be assessed in adolescence predicts persistence with good accuracy.