Impact of the Impairment Criterion in the Diagnosis of Adult ADHD: 33-Year Follow-Up Study of Boys With ADHD

New York University Child Study Center, 215 Lexington Avenue, Floor 13, New York, NY 10016, USA.
Journal of Attention Disorders (Impact Factor: 3.78). 04/2010; 15(2):122-9. DOI: 10.1177/1087054709359907
Source: PubMed


To investigate the relationship between ADHD symptoms and impairment among adults diagnosed as having ADHD in childhood (ages 6-12).
Clinicians blindly interviewed 121 White males; the mean age was 41 years across the sample. DSM-IV adult ADHD behaviors were systematically rated, and impairment resulting from symptoms was scored on a 5-point Likert-type scale.
Correlations between degree of impairment and number of behaviors were high (r's = .83 to .85, p < .001). The impairment criterion had no effect on classifying any participants as having, or not having, adult ADHD. All participants who reported experiencing 5 or more inattention or hyperactive-impulsive behaviors as "often" or "very often" in adulthood were significantly impaired by their symptoms.
Contrary to results reported in children, there was a strong relationship between number of ADHD symptoms and degree of impairment. However, for several reasons (discussed in the article), it should not be concluded that the impairment criterion is superfluous.

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    • "Few studies of patients diagnosed with ADHD in adulthood also assessed ADHD symptoms in childhood. In a prospective, follow-up study of males diagnosed with ADHD in childhood, Mannuzza et al. (2011) reported that a high number of ADHD symptoms in adulthood were associated with increased impairment in adulthood. In a retrospective study, Kessler et al. (2010) found that In-symptoms were more frequently persistent into adulthood than H/I-symptoms; the strongest predictor of ADHD persistence into adulthood was childhood ADHD symptom severity. "
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    ABSTRACT: Few studies have examined the impact of childhood attention deficit hyperactivity disorder (ADHD) symptoms on adult ADHD functional outcomes. To address this issue dimensionally, ADHD symptoms in childhood and adulthood and their relation to educational deficits and work disability are studied in a clinical sample of adult patients with previously untreated ADHD. About 250 adults diagnosed systematically with ADHD according to DSM-IV were prospectively recruited. Primary outcomes were high school dropout and being out of the work last year. Childhood ADHD symptoms, sex differences, comorbidities of other mental disorders, and adult ADHD symptoms were examined by historical data, clinician interviews, and questionnaires. High levels of ADHD symptom severity in childhood were related to dropping out of high school [odds ratio (OR) = 3.0], as were higher numbers of hyperactive-impulsive symptoms in childhood. Significantly, more women than men were long-term work disabled (OR = 2.0). After adjusting for age and gender, persisting high levels of ADHD inattention symptoms in adulthood (OR = 2.5), number of comorbid disorders, and particularly anxiety disorders were significantly related to long-term work disability. Childhood hyperactive-impulsive symptoms and overall severity of childhood ADHD symptoms were associated with high school dropout rates; however, persisting ADHD inattention symptoms and comorbid mental disorders in adulthood were more correlated to occupational impairment. These findings underline proposals for studies on early recognition and interventions for ADHD and psychiatric comorbidity. They further suggest that inattentive symptoms be a focus of adult ADHD treatment and that workplace interventions be considered to prevent long-term work disability.
    Full-text · Article · Feb 2014 · ADHD Attention Deficit and Hyperactivity Disorders
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    • "As a diagnosis is only one component of the overall assessment process, and because symptoms and impairment are partly distinct dimensions that do not always correlate [7,26-28], a final issue was to examine whether the global assessment of psychosocial functioning in childhood could enhance outcome predictions. "
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    ABSTRACT: Background Individuals with ADHD have been associated with more employment difficulties in early adulthood than healthy community controls. To examine whether this association is attributable specifically to disturbance of activity and attention (ADHD) or to psychopathology in general, we wanted to extend existing research by comparing the rate of mid-adulthood working disabilities for individuals diagnosed with ADHD as children with the rate for clinical controls diagnosed with either conduct disorder, emotional disorder or mixed disorder of conduct and emotions. Methods Former Norwegian child-psychiatric in-patients (n = 257) were followed up 17–39 years after hospitalization by record linkage to the Norwegian national registry of disability pension (DP) awards. Based on the hospital records, the patients were re-diagnosed according to ICD-10. Associations between the diagnoses, other baseline factors and subsequent DP were investigated using Kaplan–Meier survival analyses and logrank testing. Results At follow-up, 19% of the participants had received a DP award. In the logrank testing, ADHD was the only disorder associated with a subsequent DP, with 30% being disabled at follow-up (p = 0.01). Low psychosocial functioning (assessed by the Children’s Global Assessment Scale) at admission uniquely predicted future DP (p = 0.04). Conclusions ADHD in childhood was highly associated with later receiving a DP. Our finding of worse prognosis in ADHD compared with other internalizing and externalizing disorders in mid-adulthood supports the assumption of ADHD being specifically linked to working disability. Assessment of psychosocial functioning in addition to diagnostic features could enhance prediction of children who are most at risk of future disability.
    Full-text · Article · Oct 2012 · BMC Psychiatry
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    • "009 ; Lewandowski et al . , 2008 ) . Finally , while self - report symptom checklists do not typically assess the degree of impairment experienced by individuals , studies have documented strong significant correlations between degree of impairment and number of ADHD symptoms endorsed by male adults diagnosed with ADHD in childhood ( . 83 - . 85 ; Mannuzza et al . , 2011 ) and males and females diagnosed in adulthood ( . 70 - . 84 ; Barkley et al . , 2008 ) . Thus , some evidence does exist that postsecondary students with self - reported ADHD may present with a similar psychological and educational profile as those with confirmed ADHD ."

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