Predictors of adolescent outcomes among 4-6-year-old children with attention-deficit/hyperactivity disorder

Abstract

Children who met Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criteria for attention-deficit/hyperactivity disorder (ADHD) with functional impairment in at least one setting at 4-6 years of age were followed prospectively through age 18 years. On average, the 125 children (107 boys) with ADHD at baseline improved over time, but still continued to exhibit more symptoms, functional impairment, and risky behavior through adolescence than demographically matched healthy comparison children. These findings support the predictive validity of the diagnosis of ADHD at younger ages by demonstrating that the symptoms and impairment are enduring. Nonetheless, there were marked variations in developmental outcomes. Among children with ADHD, higher numbers of inattention and hyperactivity-impulsivity symptoms and higher number of concurrent symptoms (oppositional, conduct disorder, anxiety, and depression) measured at baseline each predicted higher future levels of the same dimension of symptoms. In addition, higher baseline levels of inattention, oppositional, conduct disorder, and anxiety symptoms predicted greater future functional impairment. Among children with ADHD, girls and children from families with lower family incomes had relatively poorer outcomes. Although outcomes varied along a continuum, approximately 10% of the children with ADHD at 4-6 years could be classified as functioning in the normative range on multiple measures during 15-18 years. Although this finding awaits replication, lower levels of hyperactivity-impulsivity symptoms at 4-6 years predicted more normative functioning during adolescence. These findings suggest that ADHD identified in early childhood predicts an increased likelihood of functional impairment through adolescence for most, but not all, children.

Figure 1

Mean numbers of nine dimensions of symptoms across ages 4–18 years in children who met DSM-IV symptom criteria for ADHD and exhibited impairment in at least one setting at 4–6 years of age and in non-ADHD comparison children who were approximately matched on age, sex, and race-ethnicity.

Figure 2

Mean parent and interviewer ratings on the Children’s Global Assessment Scale (CGAS) across ages 4–18 years in children who met DSM-IV symptom criteria for ADHD and exhibited impairment in at least one setting at 4–6 years of age and in non-ADHD comparison children who were approximately matched on age, sex, and race-ethnicity.

Figure 3

The proportions of children who met criteria for ADHD at 4–6 years of age who were classified as functioning in the normative range (defined in text) at 15–18 years of age at each level of parent- and teacher-reported hyperactivity-impulsivity symptoms (left panel) and parent-reported anxiety symptoms (right panel) measured in the baseline assessment.