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. 2022 Aug;31(8):1-11.
doi: 10.1007/s00787-021-01764-z. Epub 2021 Apr 3.

Characterizing the heterogeneous course of inattention and hyperactivity-impulsivity from childhood to young adulthood

Melissa Vos  1 , Nanda N J Rommelse  2   3 , Barbara Franke  2   4 , Jaap Oosterlaan  5   6 , Dirk J Heslenfeld  5 , Pieter J Hoekstra  7 , Marieke Klein  4   8 , Stephen V Faraone  9   10   11 , Jan K Buitelaar  3   12 , Catharina A Hartman  13
Affiliations

Characterizing the heterogeneous course of inattention and hyperactivity-impulsivity from childhood to young adulthood

Melissa Vos et al. Eur Child Adolesc Psychiatry. 2022 Aug.

Abstract

To advance understanding of the heterogeneity in the course of ADHD, joint symptom trajectories of inattention and hyperactivity-impulsivity from childhood to young adulthood were modelled and associated with genetic, demographic, and clinical characteristics. Data were obtained from the NeuroIMAGE cohort which includes 485 individuals with ADHD, their 665 siblings, and 399 typically developing children. Trajectories were based on scores of the Conners Parent Rating Scale Revised and estimated over seven homogeneous age bins (from 5 to 28 years) using parallel process latent class growth analysis on data collected across 2-4 time points. Multilevel multinomial logistic regression was used to identify characteristics that differentiated between the derived classes. A seven-class solution revealed "severe combined stable" (4.8%), "severe combined decreasing" (13%), "severe inattentive stable" (4.8%), "moderate combined increasing" (7.5%), "moderate combined decreasing" (12.7%), "stable mild" (12.9%), and "stable low" (44.3%) classes. Polygenic risk for depression, ADHD diagnosis, ADHD medication use, IQ, comorbid symptom levels (foremost oppositional behaviour), and functional impairment levels differentiated classes with similar ADHD symptom levels in childhood but a diverging course thereafter. The course of ADHD is highly heterogeneous, with stable, decreasing, and increasing trajectories. Overall, severe symptom levels in childhood are associated with elevated-to-severe symptom levels in adolescence and young adulthood, despite substantial symptom reductions. Beyond symptom severity in childhood, genetic, demographic, and clinical characteristics distinguish the heterogeneous course.

Keywords: ADHD; Heterogeneity; Late-onset; Polygenic risk scores; Trajectories.

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Conflict of interest statement

BF has received educational speaking fees from Shire and Medice. JO has been on the advisory board of Shire and UCB and received unrestricted investigator initiated research Grants from Shire. SVF received income, travel expenses, and/or research support from and/or has been on an advisory board for Akili Interactive Labs, Alcobra, CogCubed, Impax, Ironshore, NeuroLifeSciences, Neurovance, Pfizer, Shire, and VAYA Pharma and has received research support from the K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway. With his institution, he has US patent US20130217707 A1 for the use of sodium-hydrogen exchange inhibitors in the treatment of attention-deficit/hyperactivity disorder. In previous years, he received consulting fees or was on advisory boards or participated in continuing medical education programmes sponsored by Alcobra, Eli Lilly, Janssen, McNeil, Novartis, Otsuka, Pfizer, and Shire. SVF receives royalties from books published by Guilford Press (Straight Talk about Your Child’s Mental Health), Oxford University Press (Schizophrenia: The Facts), and Elsevier (ADHD: Non-Pharmacologic Treatments). JKB has been a consultant to/member of advisory board of/and/or speaker for Janssen Cilag BV, Eli Lilly, Lundbeck, Shire, Roche, Medice, Novartis, and Servier. He has received research support from Roche and Vifor. He is not an employee of any of these companies, and not a stock shareholder of any of these companies. He has no other financial or material support, including expert testimony, patents, and royalties. All other authors report no biomedical financial interests or potential conflict of interest.

Figures

Fig. 1
Fig. 1
Dimensional symptom trajectories of parent-rated inattention and hyperactivity-impulsivity scores in participants of the longitudinal NeuroIMAGE study. Maximum possible score for CPRS inattention domain = 36; Maximum possible score for CPRS hyperactivity-impulsivity domain = 27. Dark blue = severe combined stable class (N = 48) with high levels and rather stable trajectories for both symptom domains. Light blue = severe combined decreasing class (N = 145) with high levels and decreasing trajectories for both symptom domains. Purple = severe inattentive stable class (N = 47) with a high level and stable trajectory for the inattention domain and a moderate level and decreasing trajectory for the hyperactivity-impulsivity domain. Dark green = moderate combined increasing class (N = 77) with a moderate level and increasing trajectory for the inattention domain and a moderate level and stable trajectory for the hyperactivity-impulsivity domain. Light green = moderate combined decreasing class (N = 128) with moderate levels and decreasing trajectories for both symptom domains. Orange = stable mild class (N = 137) with mild levels and rather stable trajectories for both symptom domains. Grey = stable low class (N = 482) with low levels and stable trajectories for both symptom domains
Fig. 2
Fig. 2
Polygenic risk scores (mean ± SE) for the seven identified dimensional symptom trajectories of parent-rated inattention and hyperactivity-impulsivity scores in participants of the longitudinal NeuroIMAGE study. Dark blue = severe combined stable class (N = 48) with high levels and rather stable trajectories for both symptom domains. Light blue = severe combined decreasing class (N = 145) with high levels and decreasing trajectories for both symptom domains. Purple = severe inattentive stable class (N = 47) with a high level and stable trajectory for the inattention domain and a moderate level and decreasing trajectory for the hyperactivity-impulsivity domain. Dark green = moderate combined increasing class (N = 77) with a moderate level and increasing trajectory for the inattention domain and a moderate level and stable trajectory for the hyperactivity-impulsivity domain. Light green = moderate combined decreasing class (N = 128) with moderate levels and decreasing trajectories for both symptom domains. Orange = stable mild class (N = 137) with mild levels and rather stable trajectories for both symptom domains. Grey = stable low class (N = 482) with low levels and stable trajectories for both symptom domains
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