Adult outcome of child and adolescent attention deficit hyperactivity disorder in a primary care setting
ABSTRACT To determine the adult status of children and adolescents previously diagnosed with attention deficit hyperactivity disorder (ADHD).
From a consecutive sample, a case series from a primary care, private physician, office-based practice was evaluated. Seventy-seven adults were eligible, having been diagnosed with ADHD as children and adolescents by Diagnostic and Statistical Manual of Mental Disorders, Revised Third and Fourth Editions criteria. Seventy-three adults were available for interviews. Parents and/or significant others were also interviewed. The same criteria used originally were employed in the adult follow-up analysis. Main outcome measures included rates of adult ADHD, other psychiatric disorders, and educational attainment.
Of 73 participants, only 4 (5.5%) had retained ADHD into adulthood. Sixty-nine (94.5%) did not have adult ADHD. The majority of the cohort did not exhibit any disabling psychopathology, and most had achieved positive educational attainment.
Adult follow-up of children and adolescents diagnosed with ADHD shows adult ADHD is rare in primary care. The data suggests that clinicians can have the greatest impact on ADHD by concentrating on the evaluation and management of children and adolescents with the disorder.
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ABSTRACT: Introducción: El trastorno por déficit de atención con hiperactividad (TDAH) es el diagnóstico más frecuente en la consulta psiquiátrica infantil en distintas sociedades. Clásicamente, la triada de hiperactividad, déficit de atención e impulsividad es el núcleo y el objetivo de las diferentes estrategias terapéuticas. Sin embargo, son múltiples los motivos de consulta que los pacientes y sus familias establecen, debido al impacto de los síntomas en las dinámicas escolares y de convivencia. Objetivo: Conocer cómo se expresan los motivos de consulta en un medio como el de Bogotá (Colombia). Métodos: Se analizaron 366 encuestas de padres de niños con TDAH, quienes asisten a la reunión mensual de la escuela para padres HIDEA, especializada en TDAH, en la que relatan sus motivos de consulta y las estrategias con las cuales tratan de mejorar estas dificultades. Resultados: Las quejas más frecuentes son la rebeldía, el desacato a la autoridad y el bajo rendimiento escolar. Para ayudar al niño, recurren ante todo a la terapia ocupacional, de acuerdo con la recomendación del colegio. Conclusiones: Para los padres la problemática sentida no se relaciona directamente con los rasgos clínicos principales del TDAH, sino con sus consecuencias desadaptativas en el medio escolar. Paradójicamente, también se hace evidente una relativa debilidad de las estrategias de afrontamiento que implican cambios profundos en los patrones de crianza y convivencia.
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ABSTRACT: To estimate the prevalence of attention deficit hyperactivity disorder (ADHD) pharmacological treatment, and its demographic and clinical details, and to estimate the proportion of patients in the target group who stopped ADHD treatment and investigate possible factors for continuation or cessation of treatment. A pharmacoepidemiological study using an automated database and a qualititative study using patient interviews. Part 1 was a pharmacoepidemiological study that provided accurate data on use and cessation of ADHD drugs. Part 2 was an in-depth interview study to investigate the reasons, processes and outcomes of treatment cessation. Part 1: primary care using the General Practice Research Database (GPRD). Part 2: secondary and tertiary care paediatric clinics, child and adolescent mental health and adult mental health clinics in London, Nottingham, Dundee and Liverpool. Part 1: patients were 15-21 years old during the study period (1 January 2001 and 31 December 2004), had at least one prescription for methylphenidate, dexamfetamine or atomoxetine and had at least 1 year of research-standard data available in the GPRD. Part 2: patients fulfilled Part 1 criteria, had a diagnosis of ADHD as detected by a predefined algorithm and had been treated with methylphenidate, dexamfetamine or atomoxetine for at least 1 year. Child and adolescent psychiatrists, adult psychiatrists and paediatricians involved in the treatment of young people with ADHD were also interviewed as part of the study. Part 1: prevalence of prescribing averaged across all ages increased eightfold, from 0.26 per 1000 patients in 1999 to 2.07 per 1000 patients in 2006. The increase in prevalence in the younger patients was less evident in the older patients. Prevalence in 15-year-old males receiving a study drug prescription increased from 1.32 per 1000 patients in 1999 to 8.31 per 1000 patients in 2006, whereas the prevalence in 21-year-olds rose from 0 per 1000 patients in 1999 to 0.43 per 1000 patients in 2006. Survival analysis showed that the rate of treatment cessation largely exceeded the estimated rate of persistence of ADHD. The reduction in prescribing was most noticeable between 16 and 17 years of age. Kaplan-Meier analysis showed that approximately 18% of patients restarted treatment if they had stopped treatment after the age of 15. Patients who restarted treatment were more likely to restart within the first year following treatment cessation. Part 2: the Child Health and Illness Profile (CHIP) was chosen as the quality of life questionnaire for the Part 2 study because the CHIP-CE scale has been validated in children with ADHD in the UK. Because of the age range of participants, the adolescent version (CHIP-AE) was administered to patients after interview. Of the 15, a total of nine patients finished the questionnaire. Interviews showed that although some young people felt able to cope after stopping medication, others felt the need to restart to control symptoms. Some patients had difficulty re-engaging with services and clinicians recognised the lack of services for young adults. Patients continuing on treatment considered cessation as an option for the future, but were concerned about the process of stopping and its impact on behaviour. Part 1 study demonstrated that the prevalence of prescribing by GPs to patients with ADHD dropped significantly from age 15 to 21. The fall in prescribing was greater than the reported age-related decrease in symptoms, raising the possibility that treatment is prematurely discontinued in some young adults where ADHD symptoms persist. Part 2 of the study identified that some young adults had difficulty in obtaining treatment after discharge from paediatric services. Future work should include randomised placebo-controlled trials into long-term treatment with stimulants, particularly methylphenidate.10/2009; 13(50):iii-iv, ix-xi, 1-120.
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ABSTRACT: Our aim was to provide an overview of prospective studies that have addressed the association between attention problems (AP, i.e. symptoms of hyperactivity and inattentiveness) and academic achievement (AA). We conducted a systematic search in the literature. Normal population studies and clinical studies were included. The methodological quality of each study was evaluated by objective criteria. A best evidence synthesis was used to determine the strengths of the association. Sixteen studies were included. We found convincing evidence for a negative association between AP and AA. After controlling for intelligence, comorbidity, and socioeconomic status (SES), the association between the hyperactive symptoms of AP and AA was non-significant in two studies. Children with AP are at risk for lower AA and subsequent adverse outcomes later in life. Interventions in affected children should focus on their behavioural and educational development.Acta Psychiatrica Scandinavica 10/2010; 122(4):271-84. DOI:10.1111/j.1600-0447.2010.01568.x · 5.55 Impact Factor