Psychiatric Comorbidity in Adult Attention Deficit Hyperactivity Disorder: Findings From Multiplex Families

Center for Neurobehavioral Genetics, David Geffen School of Medicine, Suite 1414, 300 UCLA Medical Plaza, Los Angeles, CA 90095, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 10/2005; 162(9):1621-7. DOI: 10.1176/appi.ajp.162.9.1621
Source: PubMed


Patterns of psychiatric comorbidity were assessed in adults with and without attention deficit hyperactivity disorder (ADHD) identified through a genetic study of families containing multiple children with ADHD.
Lifetime ADHD and comorbid psychopathology were assessed in 435 parents of children with ADHD. Rates and mean ages at onset of comorbid psychopathology were compared in parents with lifetime ADHD, parents with persistent ADHD, and those without ADHD. Age-adjusted rates of comorbidity were compared with Kaplan-Meier survival curves. Logistic regression was used to assess additional risk factors for conditions more frequent in ADHD subjects.
The parents with ADHD were significantly more likely to be unskilled workers and less likely to have a college degree. ADHD subjects had more lifetime psychopathology; 87% had at least one and 56% had at least two other psychiatric disorders, compared with 64% and 27%, respectively, in non-ADHD subjects. ADHD was associated with greater disruptive behavior, substance use, and mood and anxiety disorders and with earlier onset of major depression, dysthymia, oppositional defiant disorder, and conduct disorder. Group differences based on Kaplan-Meier age-corrected risks were consistent with those for raw frequency distributions. Male sex added risk for disruptive behavior disorders. Female sex and oppositional defiant disorder contributed to risk for depression and anxiety. ADHD was not a significant risk factor for substance use disorders when male sex, disruptive behavior disorders, and socioeconomic status were controlled.
Adult ADHD is associated with significant lifetime psychiatric comorbidity that is not explained by clinical referral bias.

9 Reads
  • Source
    • "The influence of impulsiveness on diverse social and occupational impairment was studied in 135 young adults; it was found that when ADHD-symptoms persisted into adulthood, impulsiveness contributed significantly to occupational, educational, and financial impairments (Barkley & Fischer, 2010). A study of 481 adults previously diagnosed with ADHD found that the greater the conduct disorder indicators, the greater the drug consumption (Waschbusch, 2002); this condition has also been observed in other studies (McGough et al., 2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate and describe the performance during the learning process of risk-detection versus risk-benefit processing in adolescents diagnosed with ADHD. Thirty-five adolescents with ADHD and 26 paired controls participated. The tests applied are Iowa-type children version paradigm and Stroop test. Adolescents with ADHD exhibited lower risk-benefit processing capacity and lower ability to detect risk selections; main findings also indicate that adolescents with ADHD were slower to learn to avoid risk choices. In addition, they also presented a deficient inhibitory control. Results confirm the presence of a deficit in advantageous choice in adolescents with ADHD. By providing a measure of risk choice-and not only a net score-we show that adolescents with ADHD also fail to avoid risk choices. This deficit is mainly because they are slower in learning how to avoid risk choices, and not simply deficient. Literature is scarce concerning studies with Iowa-type paradigms in samples intregated exclusively by adolescents. More research is needed to clarify the nature of these deficiencies. © 2015 SAGE Publications.
    Journal of Attention Disorders 04/2015; DOI:10.1177/1087054715573995 · 3.78 Impact Factor
  • Source
    • "Severity of lifetime conduct disorder was predictive of several of the most salient outcomes (failure to graduate, earlier sexual intercourse, early parenthood), whereas attention-deficit/hyperactivity disorder and oppositional defiant disorder at work were predictive of job performance and risk of being fired (Barkley et al., 2006). ADHD is also found to include comorbidity with other psychiatric conditions, like disruptive behaviour, substance use, mood and anxiety disorders, oppositional defiant disorder, and conduct disorder, which also may interact with learning and education (McGough et al., 2005). We have less information on how attention deficits stemming from other psychiatric conditions interfere with the requirements of education (Balint et al., 2008). "
    02/2015; 2(1). DOI:10.15845/jper.v2i1.702
  • Source
    • "The substantial differences between the characteristics of children and adults with ADHD bring doubts if clinical follow-up samples that start in childhood are adequate to investigate the course of ADHD among patients that seek treatment during adulthood. In regard to these differences there are at least six issues: (1) type of referral and source of information in child and adult samples are different (parents and teachers for children v. self-referral for adults), which might imply different clinical and biological characteristics between the two age groups (Weiss et al. 1985; Mannuzza et al. 1998; Barkley et al. 2008); (2) gender ratio in clinical samples tends to differ, while boys have a much higher prevalence than girls in childhood, this difference practically disappears in adults (Gaub & Carlson, 1997; Biederman & Faraone, 2004; Grevet et al. 2006); (3) the age-dependent decline of symptoms, although widely accepted for children and adolescents (Biederman et al. 2000; Faraone et al. 2006), might be less relevant during adulthood, considering the more advanced stage of brain maturation (Shaw et al. 2007; Nakao et al. 2011; Hoekzema et al. 2012; Cortese et al. 2013); (4) the main complaint in childhood is hyperactivity/ impulsivity, while for adults referred to ADHD clinics it is inattention and executive dysfunction, commonly associated with periods of higher cognitive demand (Biederman & Faraone, 2004; Volkow & Swanson, 2013); (5) the profile of co-morbidities tends to be quite distinct, whereas in childhood disruptive behaviors represent the most prevalent co-morbidities, the adult profile is more complex and largely influenced by adolescent-and adult-onset psychiatric disorders (McGough et al. 2005); (6) the prevalence of ADHD in childhood is estimated as 5.3% (Polanczyk et al. 2007) and only 15% of children followed into adulthood remain with a full ADHD diagnosis (Faraone et al. 2006), therefore considering prevalence rates reported in adults of 2.5–4.4% (Kessler et al. 2006; Simon et al. 2009), there is a clear inconsistency between the two estimates (i.e. 5.3% × 0.15 = 0.8% instead of 2.5–4.4%). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Course and predictors of persistence of attention deficit hyperactivity disorder (ADHD) in adults are still largely unknown. Neurobiological and clinical differences between child and adult ADHD raise the need for follow-up studies of patients diagnosed during adulthood. This study investigates predictors of ADHD persistence and the possibility of full remission 7 years after baseline assessment. A 7-year follow-up study of adults with ADHD (n = 344, mean age 34.1 years, 49.9% males) was conducted. Variables from different domains (social demographics, co-morbidities, temperament, medication status, ADHD measures) were explored with the aim of finding potential predictors of ADHD persistence. Retention rate was 66% (n = 227). Approximately a third of the sample (n = 70, 30.2%) did not maintain ADHD criteria and 28 (12.4%) presented full remission (<4 symptoms), independently of changes in co-morbidity or cognitive demand profiles. Baseline predictors of diagnostic persistence were higher number of inattention symptoms [odds ratio (OR) 8.05, 95% confidence interval (CI) 2.54-25.45, p < 0.001], number of hyperactivity/impulsivity symptoms (OR 1.18, 95% CI 1.04-1.34, p = 0.01), oppositional defiant disorder (OR 3.12, 95% CI 1.20-8.11, p = 0.02), and social phobia (OR 3.59, 95% CI 1.12-11.47, p = 0.03). Despite the stage of brain maturation in adults suggests stability, approximately one third of the sample did not keep full DSM-IV diagnosis at follow-up, regardless if at early, middle or older adulthood. Although full remission is less common than in childhood, it should be considered as a possible outcome among adults.
    Psychological Medicine 01/2015; DOI:10.1017/S0033291714003183 · 5.94 Impact Factor
Show more


9 Reads
Available from