Clinical symptoms and performance on the continuous performance test in children with attention deficit hyperactivity disorder between subtypes: a natural follow-up study for 6 months The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. Young adult outcomes in the follow‐up of the multimodal treatment study of attention‐deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression Neurocognitive performance and behavioral symptoms in patients with attention-deficit/hyperactivity disorder during twenty-four months of treatment with methylphenidate. Long-term stimulant treatment of children with attention-deficit hyperactivity disorder symptoms. A randomized, double-blind, placebo-controlled trial. Evaluation of the Persistence, Remission, and Emergence of Attention-Deficit/Hyperactivity Disorder in Young Adulthood. Clinical and functional outcome of childhood attention-deficit/hyperactivity disorder 33 years later. Preschool children with disruptive behavior: three-year outcome as a function of adaptive disability. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. A randomized, controlled trial of integrated home-school behavioral treatment for ADHD, predominantly inattentive type. Combined ω3 and ω6 Supplementation in Children With Attention-Deficit Hyperactivity Disorder (ADHD) Refractory to Methylphenidate Treatment Impact of early school-based screening and intervention programs for ADHD on children's outcomes and access to services: follow-up of a school-based trial at age 10 years. Adult outcome of attention-deficit/hyperactivity disorder: a controlled 16-year follow-up study. Educational and occupational outcome of hyperactive boys grown up. Long-Term Follow-Up of Children with Mental Retardation/Borderline Intellectual Functioning and ADHD Adolescent substance use in the multimodal treatment study of attention-deficit/hyperactivity disorder (ADHD) (MTA) as a function of childhood ADHD, random assignment to childhood treatments, and subsequent medication. Adult outcome of hyperactive boys. Educational achievement, occupational rank, and psychiatric status.
Background The aims of this study were to determine the time course of improvements in attention deficit hyperactivity disorder ( ADHD ) clinical symptoms and neurocognitive function in a realistic clinical setting , and the differences in ADHD symptom improvement using different classifications of ADHD subtypes . Methods The Child Behavior Checklist ( CBCL ) was completed by parents of ADHD children at the initial visit . The  computerized Continuous Performance Test ( CPT ) , Swanson , Nolan , and Pelham , and Version IV Scale for ADHD ( SNAP-IV ) , and  ADHD Rating Scale ( ADHD-RS ) were performed at baseline , one month , three months , and six months later , respectively . Patient care including drug therapy was performed at the discretion of the psychiatrist . The ADHD patients were divided into DSM-IV subtypes ( Inattentive , Hyperactive-impulsive and Combined type ) , and were additionally categorized into aggressive and non-aggressive subtypes by aggression scale in CBCL for comparisons . Results There were 50 ADHD patients with a mean age of 7.84 ± 1.64 years ; 15 of them were inattentive type , 11 were hyperactive-impulsive type , and 24 were combined type . In addition , 28 of the ADHD patients were grouped into aggressive and 22 into non-aggressive subtypes . There were significant improvements in clinical symptoms of hyperactivity and inattention , and impulsivity performance in CPT during the 6-month treatment . The clinical hyperactive symptoms were significantly different between ADHD patients sub-grouping both by DSM-IV and aggression . Non-aggressive patients had significantly greater changes in distraction and impulsivity performances in CPT from baseline to month 6 than aggressive patients . Conclusions We found that ADHD symptoms , which included impulsive performances in CPT and clinical inattention and hyperactivity dimensions , had improved significantly over 6 months under pragmatic treatments . The non-aggressive ADHD patients might have a higher potential for improving in CPT performance than aggressive ones . However , it warrant further investigation whether the different classifications of ADHD patients could be valid for predicting the improvements in ADHD patients ' clinical symptoms and neurocognitive performance OBJECTIVES To determine any long-term effects , 6 and 8 years after childhood enrollment , of the r and omly assigned 14-month treatments in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder ( MTA ; N = 436 ) ; to test whether attention-deficit/hyperactivity disorder ( ADHD ) symptom trajectory through 3 years predicts outcome in subsequent years ; and to examine functioning level of the MTA adolescents relative to their non-ADHD peers ( local normative comparison group ; N = 261 ) . METHOD Mixed-effects regression models with planned contrasts at 6 and 8 years tested a wide range of symptom and impairment variables assessed by  parent , teacher , and youth report . RESULTS In nearly every analysis , the originally r and omized treatment groups did not differ significantly on repeated measures or newly analyzed variables ( e.g. , grade s earned in school , arrests , psychiatric hospitalizations , other clinical ly relevant outcomes ) . Medication use decreased by 62 % after the 14-month controlled trial , but adjusting for this did not change the results . ADHD symptom trajectory in the first 3 years predicted 55 % of the outcomes . The MTA participants fared worse than the local normative comparison group on 91 % of the variables tested . CONCLUSIONS Type or intensity of 14 months of treatment for ADHD in childhood ( at age 7.0 - 9.9 years ) does not predict functioning 6 to 8 years later . Rather , early ADHD symptom trajectory regardless of treatment type is prognostic . This finding implies that children with behavioral and sociodemographic advantage , with the best response to any treatment , will have the best long-term prognosis . As a group , however , despite initial symptom improvement during treatment that is largely maintained after treatment , children with combined-type ADHD exhibit significant impairment in adolescence . Innovative treatment approaches targeting specific areas of adolescent impairment are needed BACKGROUND The Multimodal Treatment Study ( MTA ) began as a 14-month r and omized clinical trial of behavioral and pharmacological treatments of 579 children ( 7 - 10 years of age ) diagnosed with attention-deficit/hyperactivity disorder (ADHD)-combined type . It transitioned into an observational long-term follow-up of 515 cases consented for continuation and 289 classmates ( 258 without ADHD ) added as a local normative comparison group ( LNCG ) , with assessment s 2 - 16 years after baseline . METHODS Primary ( symptom severity ) and secondary ( adult height ) outcomes in adulthood were specified . Treatment was monitored to age 18 , and naturalistic subgroups were formed based on three patterns of long-term use of stimulant medication ( Consistent , Inconsistent , and Negligible ) . For the follow-up , hypothesis-generating analyses were performed on outcomes in early adulthood ( at 25 years of age ) . Planned comparisons were used to estimate ADHD-LNCG differences reflecting persistence of symptoms and naturalistic subgroup differences reflecting benefit ( symptom reduction ) and cost ( height suppression ) associated with extended use of medication . RESULTS For ratings of symptom severity , the ADHD-LNCG comparison was statistically significant for the parent/self-report average ( 0.51 ± 0.04 , p < .0001 , d = 1.11 ) , documenting symptom persistence , and for the parent/self-report difference ( 0.21 ± 0.04 , p < .0001 , d = .60 ) , documenting source discrepancy , but the comparisons of naturalistic subgroups reflecting medication effects were not significant . For adult height , the ADHD group was 1.29 ± 0.55 cm shorter than the LNCG ( p < .01 , d = .21 ) , and the comparisons of the naturalistic subgroups were significant : the treated group with the Consistent or Inconsistent pattern was 2.55 ± 0.73 cm shorter than the subgroup with the Negligible pattern ( p < .0005 , d = .42 ) , and within the treated group , the subgroup with the Consistent pattern was 2.36 ± 1.13 cm shorter than the subgroup with the Inconsistent pattern ( p < .04 , d = .38 ) . CONCLUSIONS In the MTA follow-up into adulthood , the ADHD group showed symptom persistence compared to local norms from the LNCG . Within naturalistic subgroups of ADHD cases , extended use of medication was associated with suppression of adult height but not with reduction of symptom severity OBJECTIVE This study investigated the trends in neurocognitive function and behavioral symptoms among patients with attention-deficit/hyperactivity disorder ( ADHD ) during 24 months of treatment with methylpheni date in a clinical setting . METHODS Study participants consisted of 181 ADHD patients with a mean age of 13.4±2.5 years ( ages ranged from 8 to 18 years ; 151 boys and 30 girls ) who were prescribed oral short-acting methylpheni date two or three times daily , with each dose ranging between 0.3 and 1.0 mg/kg . At baseline and 6 , 12 , 18 , and 24 months from baseline , neurocognitive function was assessed using the  Test of Variables of Attention ( TOVA ) on the day the patient was off medication , and behavioral symptoms were evaluated using the Swanson , Nolan , and Pelham Version IV Scale for ADHD ( SNAP-IV ) parent form , the SNAP-IV teacher form , and the ADHD-Rating Scale ( completed by a child psychiatrist ) . RESULTS Of the 181 ADHD patients at the initial visit , 103 ( 56.9 % ) completed the study . During the 24-month methylpheni date treatment , only the commission errors in TOVA significantly improved ; however , the omission errors , response time , response time variability , response sensitivity , and ADHD score did not . The behavioral symptoms of ADHD , observed by various informants , all declined substantially , and were significantly correlated with each other during the long-term follow-up . The severity of teacher ratings was lower than that of parent and psychiatrist ratings . However , the teacher-rated inattention symptoms showed the strongest correlations with TOVA performance . CONCLUSIONS Findings suggest that neurocognitive deficits in ADHD patients , except inhibition ability , might be long lasting in realistic setting s. In addition , obtaining behavior profile assessment s from multiple informants , especially from teachers , is vital for establishing a complete underst and ing of ADHD patients BACKGROUND We wanted to study the effects of amphetamine on symptoms of attention-deficit hyperactivity disorder ( ADHD ) over a longer period than has been reported in previous studies of central stimulants in this condition . METHODS Sixty-two children , aged 6 to 11 years , meeting DSM-III-R symptom criteria for ADHD participated in a parallel-group design , r and omized , double-blind , placebo-controlled study of amphetamine treatment . Treatment was not restricted to children with " pure " ADHD , ie , some had comorbid diagnoses . In the amphetamine group , children received active treatment for 15 months . RESULTS Amphetamine was clearly superior to placebo in reducing inattention , hyperactivity , and other disruptive behavior problems and tended to lead to improved results on the Wechsler Intelligence Scale for Children -- Revised . Treatment failure rate was considerably lower and time to treatment failure was longer in the amphetamine group . Adverse effects were few and relatively mild . CONCLUSION The results of this long-term , placebo-controlled study of the central stimulant amphetamine in the treatment of ADHD indicate that there are remaining positive effects of the drug 15 months after starting treatment IMPORTANCE Attention-deficit/hyperactivity disorder ( ADHD ) is now recognized to occur in adulthood and is associated with a range of negative outcomes . However , less is known about the prospect i ve course of ADHD into adulthood , the risk factors for its persistence , and the possibility of its emergence in young adulthood in non clinical population s. OBJECTIVE To investigate childhood risk factors and young adult functioning of individuals with persistent , remitted , and late-onset young adult ADHD . DESIGN , SETTING , AND PARTICIPANTS The study sample was the Environmental Risk ( E-Risk ) Longitudinal Twin Study , a nationally representative birth cohort of 2232 twins born in Engl and and Wales from January 1 , 1994 , to December 4 , 1995 . Evaluation of childhood ADHD ( ages 5 , 7 , 10 , and 12 years ) included prenatal and perinatal factors , clinical characteristics , and aspects of the family environment .  Among participants aged 18 years , ADHD symptoms and associated impairment , overall functioning , and other mental health disorders were examined . Data analysis was conducted from February 19 to September 10 , 2015 . MAIN OUTCOMES AND MEASURES Attention-deficit/hyperactivity disorder according to DSM-IV diagnostic criteria in childhood and DSM-5 diagnostic criteria in young adulthood . RESULTS Of 2232 participants in the E-Risk Study , 2040 were included in the present analysis . In total , 247 individuals met diagnostic criteria for childhood ADHD ; of these , 54 ( 21.9 % ) also met diagnostic criteria for the disorder at age 18 years . Persistence was associated with more symptoms ( odds ratio [ OR ] , 1.11 [ 95 % CI , 1.04 - 1.19 ] ) and lower IQ ( OR , 0.98 [ 95 % CI , 0.95 - 1.00 ] ) . At age 18 years , individuals with persistent ADHD had more functional impairment ( school/work : OR , 3.30 [ 95 % CI , 2.18 - 5.00 ] , home/with friends : OR , 6.26 [ 95 % CI , 3.07 - 12.76 ] ) , generalized anxiety disorder ( OR , 5.19 [ 95 % CI , 2.01 - 13.38 ] ) , conduct disorder ( OR , 2.03 [ 95 % CI , 1.03 - 3.99 ] ) , and marijuana dependence ( OR , 2.88 [ 95 % CI , 1.07 - 7.71 ] ) compared with those whose ADHD remitted . Among 166 individuals with adult ADHD , 112 ( 67.5 % ) did not meet criteria for ADHD at any assessment in childhood . Results from logistic regressions indicated that individuals with late-onset ADHD showed fewer externalizing problems ( OR , 0.93 [ 95 % CI , 0.91 - 0.96 ] ) and higher IQ ( OR , 1.04 [ 95 % CI , 1.02 - 1.07 ] ) in childhood compared with the persistent group . However , at age 18 years , those with late-onset ADHD demonstrated comparable ADHD symptoms and impairment as well as similarly elevated rates of mental health disorders . CONCLUSIONS AND RELEVANCE We identified heterogeneity in the DSM-5 young adult ADHD population such that this group consisted of a large , late-onset ADHD group with no childhood diagnosis , and a smaller group with persistent ADHD . The extent to which childhood-onset and late-onset adult ADHD may reflect different causes has implication s for genetic studies and treatment of ADHD CONTEXT Prospect i ve studies of childhood attention-deficit/hyperactivity disorder ( ADHD ) have not extended beyond early adulthood . OBJECTIVE To examine whether children diagnosed as having ADHD at a mean age of 8 years ( prob and s ) have worse educational , occupational , economic , social , and marital outcomes and higher rates of ongoing ADHD , antisocial personality disorder ( ASPD ) , substance use disorders ( SUDs ) , adult-onset psychiatric disorders , psychiatric hospitalizations , and incarcerations than non-ADHD comparison participants at a mean age of 41 years . DESIGN Prospect i ve , 33-year follow-up study , with masked clinical assessment s. SETTING Research clinic . PARTICIPANTS A total of 135 white men with ADHD in childhood , free of conduct disorder , and 136 men without childhood ADHD ( 65.2 % and 76.4 % of original cohort , respectively ) . MAIN OUTCOME MEASURES Occupational , economic , and educational attainment ; marital history ; occupational and social functioning ; ongoing and lifetime psychiatric disorders ; psychiatric hospitalizations ; and incarcerations . RESULTS Prob and s had significantly worse educational , occupational , economic , and social outcomes ; more divorces ; and higher rates of ongoing ADHD ( 22.2 % vs 5.1 % , P < .001 ) , ASPD ( 16.3 % vs 0 % , P < .001 ) , and SUDs ( 14.1 % vs 5.1 % , P = .01 ) but not more mood or anxiety disorders ( P = .36 and .33 ) than did comparison participants . Ongoing ADHD was weakly related to ongoing SUDs ( ϕ = 0.19 , P = .04 ) , as well as ASPD with SUDs ( ϕ = 0.20 , P = .04 ) . During their lifetime , prob and s had significantly more ASPD and SUDs but not mood or anxiety disorders and more psychiatric hospitalizations and incarcerations than comparison participants . Relative to comparisons , psychiatric disorders with onsets at 21 years or older were not significantly elevated in prob and s. Prob and s without ongoing psychiatric disorders had worse social , but not occupational , functioning . CONCLUSIONS The multiple disadvantages predicted by childhood ADHD well into adulthood began in adolescence , without increased onsets of new disorders after 20 years of age . Findings highlight the importance of extended monitoring and treatment of children with ADHD A significant discrepancy between intelligence and daily adaptive functioning , or adaptive disability ( AD ) , has been previously found to be a associated with significant psychological morbidity in preschool children with disruptive behavior ( DB ) . The utility of AD as a predictor of later developmental risks was examined in a 3-year longitudinal study of normal ( N = 43 ) and DB preschool children . The DB children were grouped into those with AD ( DB+AD ; N = 28 ) and those without AD ( DB-only ; N = 98 ) . All children were followed with annual evaluations to the end of second grade . Both DB groups demonstrated substantial and pervasive psychological and educational morbidity at 3-year follow-up . In comparison to DB-only children , DB+AD children had more symptoms of attention-deficit hyperactivity disorder ( ADHD ) and conduct disorder ( CD ) , more severe and pervasive behavior problems at home , more parent-rated externalizing and internalizing , and lower academic competence and more behavioral problems at school . Parents of DB+AD children also reported greater parenting stress than did parents in the other groups . A significant contribution of AD to adverse outcomes in the DB group remained on some measures even after controlling for initial severity of DB . AD also contributed significantly to CD symptoms at follow-up after controlling for initial DB severity and initial CD symptoms . The results corroborate and extend earlier findings of the utility of AD as a risk indicator above severity of DB alone . They also imply that AD in the context of normal intellectual development may arise from both the deficient self-regulation associated with ADHD and from disrupted parenting . with exposure to kindergarten moderating these adverse effects BACKGROUND Previous studies have demonstrated the short-term efficacy of pharmacotherapy and behavior therapy for attention-deficit/hyperactivity disorder ( ADHD ) , but no longer-term ( i.e. , > 4 months ) investigations have compared these 2 treatments or their combination . METHODS A group of 579 children with ADHD Combined Type , aged 7 to 9.9 years , were assigned to 14 months of medication management ( titration followed by monthly visits ) ; intensive behavioral treatment ( parent , school , and child components , with therapist involvement gradually reduced over time ) ; the two combined ; or st and ard community care ( treatments by community providers ) . Outcomes were assessed in multiple domains before and during treatment and at treatment end point ( with the combined treatment and medication management groups continuing medication at all assessment points ) . Data were analyzed through intent-to-treat r and om-effects regression procedures . RESULTS All 4 groups showed sizable reductions in symptoms over time , with significant differences among them in degrees of change . For most ADHD symptoms , children in the combined treatment and medication management groups showed significantly greater improvement than those given intensive behavioral treatment and community care . Combined and medication management treatments did not differ significantly on any direct comparisons , but in several instances ( oppositional/aggressive symptoms , internalizing symptoms , teacher-rated social skills , parent-child relations , and reading achievement )  combined treatment proved superior to intensive behavioral treatment and /or community care while medication management did not . Study medication strategies were superior to community care treatments , despite the fact that two thirds of community-treated subjects received medication during the study period . CONCLUSIONS For ADHD symptoms , our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication . Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms , but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes OBJECTIVE To evaluate the efficacy of a behavioral psychosocial treatment integrated across home and school ( Child Life and Attention Skills Program ) with attention-deficit/hyperactivity disorder ( ADHD ) predominantly inattentive type ( ADHD-I ) . METHOD Sixty-nine children ages 7 to 11 years were r and omized to the Child Life and Attention Skills Program or a control group who did not receive the intervention .  We compared groups posttreatment and at 3- to 5-month follow-up on parent and teacher ratings of inattention , sluggish cognitive tempo , and functional impairment . RESULTS Children r and omized to the Child Life and Attention Skills Program were reported to have significantly fewer inattention and sluggish cognitive tempo symptoms , and significantly improved social and organizational skills , relative to the control group . Gains were maintained at follow-up . CONCLUSIONS Behavioral psychosocial treatment , when specifically adapted for ADHD-I and coordinated among parents , teachers , and children , appears efficacious in reducing symptoms and impairment associated with Children ( 6 - 12 years ) with attention-deficit hyperactivity disorder ( ADHD ) being treated with methylpheni date and st and ard behavior therapy for more than 6 months , whose parents reported no improvement in behavior and academic learning , were r and omly assigned to receive supplementation with a combined ω3 and ω6 preparation or a placebo . Outcome was measured at 3 and 6 months after treatment using a self- assessment checklist completed by the parents . Statistically significant improvement was found in the treatment group compared with the placebo group ( P < .01 ) in the following measures : restlessness , aggressiveness , completing work , and academic performance . Statistically significant improvement was not found at 3 months of treatment between groups but was evident at 6 months of treatment ( P < .05 ) with inattention , impulsiveness , and cooperation with parents and teachers . Distractibility failed to show improvement . Effect sizes ranged from 0.3 to 1.1 at 3 months and 0.2 to 1.4 at 6 months for individual symptom variables OBJECTIVES To investigate the impact of early school-based screening and educational interventions on longer-term outcomes for children at risk for attention-deficit/hyperactivity disorder ( ADHD ) and the predictive utility of teacher ratings . DESIGN A population -based 5-year follow-up of a r and omized , school-based intervention . SETTING Schools in Engl and . PARTICIPANTS Children between 4 and 5 years of age with high teacher-rated hyperactivity/inattention scores . Follow-up data were collected on 487 children in 308 schools . INTERVENTIONS Following screening , using a 2 x 2 factorial design , schools r and omly received an educational intervention ( books about ADHD for teachers ) , the names of children with high hyperactivity/inattention scores between ages 4 and 5 years ( identification ) , both educational intervention and identification , or no intervention . OUTCOME MEASURES Parent-rated hyperactivity/inattention , impairment in classroom learning , and access to specialist health services for mental health or behavioral problems . RESULTS None of the interventions were associated with improved outcomes . However , children receiving the identification -only intervention were twice as likely as children in the no-intervention group to have high hyperactivity/inattention scores at follow-up ( adjusted odds ratio , 2.11 ; 95 % confidence interval , 1.12 - 4.00 ) . Regardless of intervention , high baseline hyperactivity/inattention scores were associated with high hyperactivity/inattention and specialist health service use at follow-up . CONCLUSIONS We did not find evidence of long-term , generalizable benefits following a school-based universal screening program for ADHD . There may be adverse effects associated with labeling children at a young age OBJECTIVE To estimate the risks for psychopathology and functional impairments in adulthood among a longitudinal sample of youth with and without attention-deficit/hyperactivity disorder ( ADHD ) diagnosed in childhood . METHOD This was a case-controlled , 16-year ( 15 - 19 years ) prospect i ve follow-up study of ADHD . 140 boys with and 120 without DSM-III-R ADHD were recruited from pediatric and psychiatric setting s. The main outcome measures were  structured diagnostic interviews and measures of psychosocial , educational , and neuropsychological functioning . Data were collected from 1988 to 2006 . RESULTS At the 16-year follow-up , subjects with ADHD continued to significantly differ from controls in lifetime rates of antisocial , mood , anxiety , and addictive disorders , but with the exception of a higher interval prevalence of anxiety disorders ( 20 % vs 8 % ; z = 2.32 , P = .02 ) and smoking dependence ( 27 % vs 11 % ; z = 2.30 , P = .02 ) , the incidence of individual disorders in the 6-year interval between the current and prior follow-up did not differ significantly from controls . At follow-up , the ADHD subjects compared with controls were significantly ( P < .05 ) more impaired in psychosocial , educational , and neuropsychological functioning , differences that could not be accounted for by other active psychopathology . CONCLUSIONS These long-term prospect i ve findings provide further evidence for the high morbidity associated with ADHD across the life cycle , stressing the importance of early recognition of this disorder for prevention and early intervention strategies . These findings also indicate that , in adulthood , ADHD confers significant risks for impairment that can not be accounted for by other psychopathology OBJECTIVE Little is known about the adult outcome of attention-deficit hyperactivity disorder ( ADHD ) , a very prevalent childhood disorder that is known to affect deleteriously academic performance and other areas of child functioning . This study represents a third wave of evaluations that examine the long-term educational achievement and occupational rank of children with ADHD . METHOD This is a prospect i ve follow-up of white boys of average intelligence whose ADHD was clinical ly diagnosed according to systematic criteria at an average age of 7 years . Follow-up intervals range from 15 to 21 years ( mean , 17 years ) . At average age 24 years , 85 prob and s ( representing 82 % of the childhood cohort ) and 73 controls ( 84 % ) were directly interviewed by trained clinicians who were blind to group membership . RESULTS First , prob and s completed significantly less formal schooling than controls ( about 2 years less , on average ) . Second , prob and s had lower-ranking occupational positions than controls . Finally , these disadvantages were not accounted for by adult mental status . CONCLUSIONS The present study suggests that childhood ADHD predisposes to specific disadvantages and continues to affect important functional domains unrelated to current psychiatric diagnosis Fifty-two children ( ages 7 to 14 years ) with moderate mental retardation to borderline intellectual functioning were recontacted 12 to 65 months following participation in a double-blind , placebo-controlled trial of methylpheni date ( MPH ) . Sixty-nine percent of subjects continued to be prescribed medication for behavior control at follow-up . While 72 % of the sample evidence d improvement , over two-thirds continued to be rated at or above the 98th percentile on the Hyperactivity Index of the Parent Conners . In fact , 22 % of subjects had received inpatient psychiatric treatment between the time of the initial MPH trial and follow-up . Finally , subjects with high initial ratings on the Parent Conners Conduct Problems scale were more likely to be suspended from school or receive inpatient psychiatric treatment than subjects with low initial ratings . The results suggested that children with ADHD and mental retardation or borderline intellectual functioning continued to exhibit significant symptoms associated with attention deficit hyperactivity disorder ( ADHD ) at follow-up and that early conduct problems were predictive of continuing behavioral difficulties OBJECTIVE To determine long-term effects on substance use and substance use disorder ( SUD ) , up to 8 years after childhood enrollment , of the r and omly assigned 14-month treatments in the multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder ( MTA ; n = 436 ) ; to test whether medication at follow-up , cumulative psychostimulant treatment over time , or both relate to substance use/SUD ; and to compare substance use/SUD in the ADHD sample to the non-ADHD childhood classmate comparison group ( n = 261 ) . METHOD Mixed-effects regression models with planned contrasts were used for all tests except the important cumulative stimulant treatment question , for which propensity score matching analysis was used . RESULTS The originally r and omized treatment groups did not differ significantly on substance use/SUD by the 8-year follow-up or earlier ( mean age = 17 years ) . Neither medication at follow-up ( mostly stimulants ) nor cumulative stimulant treatment was associated with adolescent substance use/SUD . Substance use at all time points , including use of two or more substances and SUD , were each greater in the ADHD than in the non-ADHD sample s , regardless of sex . CONCLUSIONS Medication for ADHD did not protect from , or contribute to , visible risk of substance use or SUD by adolescence , whether analyzed as r and omized treatment assignment in childhood , as medication at follow-up , or as cumulative stimulant treatment over an 8-year follow-up from childhood . These results suggest the need to identify alternative or adjunctive adolescent-focused approaches to substance abuse prevention and treatment for boys and girls with ADHD , especially given their increased risk for use and abuse of multiple substances that is not improved with stimulant medication . Clinical trial registration information-Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder ( MTA ) ; http:// clinical trials.gov/ ; NCT00000388 OBJECTIVE The paucity of data concerning the long-term natural history of attention-deficit hyperactivity disorder ( ADHD ) , a common childhood psychiatric disorder , prompted a longitudinal study to investigate the adult sequelae of the childhood disorder . DESIGN Prospect i ve study , follow-up intervals ranging from 13 to 19 years ( mean , 16 years ) , with blind systematic clinical assessment s. SUBJECTS Ninety-one white males ( mean age , 26 years ) , representing 88 % of a cohort systematic ally diagnosed as hyperactive in childhood , and 95 ( 95 % ) of comparison cases of similar race , gender , age , whose teachers had voiced no complaints about their school behavior in childhood . RESULTS Prob and s had significantly higher rates than comparisons of ADHD symptoms ( 11 % vs 1 % ) , antisocial personality disorders ( 18 % vs 2 % ) , and drug abuse disorders ( 16 % vs 4 % ) . Significant comorbidity occurred between antisocial and drug disorders . Educational and occupational achievements were significantly compromised in the prob and s. These disadvantages were independent of psychiatric status . We did not find increased rates of affective or anxiety disorders in the prob and s. CONCLUSIONS Childhood ADHD predicts specific adult psychiatric disorders , namely antisocial and drug abuse disorders . In the adolescent outcome of this cohort , we found that these disturbances were dependent on the continuation of ADHD symptoms . In contrast , in adulthood , antisocial and drug disorders appeared , in part , independent of sustained ADHD . In addition , regardless of psychiatric status , ADHD placed children at relative risk for educational and vocational disadvantage . The results do not support a relationship between childhood ADHD and adult mood or anxiety disorders
The following broad trends emerged : ( 1 ) without treatment , people with ADHD had poorer long-term outcomes in all categories compared with people without ADHD , and ( 2 ) treatment for ADHD improved long-term outcomes compared with untreated ADHD , although not usually to normal levels .
Conclusions This systematic review provides a synthesis of studies of ADHD long-term outcomes .
Current treatments may reduce the negative impact that untreated ADHD has on life functioning , but does not usually ' normalize ' the recipients
Background In childhood , attention deficit/hyperactivity disorder ( ADHD ) is characterized by age-inappropriate levels of inattentiveness/disorganization , hyperactivity/impulsiveness , or a combination thereof .
Although the criteria for ADHD are well defined , the long-term consequences in adults and children need to be more comprehensively understood and quantified .
We conducted a systematic review evaluating the long-term outcomes ( defined as 2 years or more ) of ADHD with the goal of identifying long-term outcomes and the impact that any treatment ( pharmacological , non-pharmacological , or multimodal ) has on ADHD long-term outcomes .