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Published in: European Archives of Psychiatry and Clinical Neuroscience 4/2018

Open Access 01-06-2018 | Original Paper

Six-year outcome in subjects diagnosed with attention-deficit/hyperactivity disorder as adults

Authors: Dan Edvinsson, Lisa Ekselius

Published in: European Archives of Psychiatry and Clinical Neuroscience | Issue 4/2018

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Abstract

There are very few studies on the long-term outcome in subjects diagnosed with ADHD as adults. The objective of the present study was to assess this and relate the outcome to whether there was current medication or not and to other potential predictors of favourable outcome. A prospective clinical cohort of adults diagnosed with ADHD according to DSM-IV criteria was followed-up on an average of 6 years after first evaluation (n = 124; mean age 42 years, 51% males). ADHD symptom trajectories were assessed as well as medication, global functioning, disability, health-related quality of life, and alcohol and drug consumption at follow-up. Ninety percent of those diagnosed were initially treated pharmacologically and half of them discontinued treatment. One-third reported remission, defined as not fulfilling any ADHD subtype and a GAF-value last year ≥ 70, which was not affected by comorbidity at baseline. Current medication was not associated with remission. Subjects evaluated and first diagnosed with ADHD as adults are functionally improved at follow-up 6 years later despite a high percentage of psychiatric comorbidity at baseline. Half dropped out of medication, and there was no difference in ADHD remission between subjects with on-going medication at follow-up or subjects without medication, although current medication was related to a higher degree of self-reported global improvement.
Literature
8.
go back to reference Sobanski E, Bruggemann D, Alm B, Kern S, Deschner M, Schubert T, Philipsen A, Rietschel M (2007) Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci 257(7):371–377CrossRefPubMed Sobanski E, Bruggemann D, Alm B, Kern S, Deschner M, Schubert T, Philipsen A, Rietschel M (2007) Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci 257(7):371–377CrossRefPubMed
12.
go back to reference Karam RG, Breda V, Picon FA, Rovaris DL, Victor MM, Salgado CA, Vitola ES, Silva KL, Guimaraes-da-Silva PO, Mota NR, Caye A, Belmonte-de-Abreu P, Rohde LA, Grevet EH, Bau CH (2015) Persistence and remission of ADHD during adulthood: a 7-year clinical follow-up study. Psychol Med 45(10):2045–2056. https://doi.org/10.1017/S0033291714003183 CrossRefPubMed Karam RG, Breda V, Picon FA, Rovaris DL, Victor MM, Salgado CA, Vitola ES, Silva KL, Guimaraes-da-Silva PO, Mota NR, Caye A, Belmonte-de-Abreu P, Rohde LA, Grevet EH, Bau CH (2015) Persistence and remission of ADHD during adulthood: a 7-year clinical follow-up study. Psychol Med 45(10):2045–2056. https://​doi.​org/​10.​1017/​S003329171400318​3 CrossRefPubMed
14.
go back to reference NICE (2008) Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults. NICE clinical guideline 72. Last updated February 2016. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/cg72. Accessed 17 Aug 2016 NICE (2008) Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults. NICE clinical guideline 72. Last updated February 2016. National Institute for Health and Care Excellence. https://​www.​nice.​org.​uk/​guidance/​cg72. Accessed 17 Aug 2016
20.
go back to reference Weisler R, Young J, Mattingly G, Gao J, Squires L, Adler L (2009) Long-term safety and effectiveness of lisdexamfetamine dimesylate in adults with attention-deficit/hyperactivity disorder. CNS Spectr 14(10):573–585CrossRefPubMed Weisler R, Young J, Mattingly G, Gao J, Squires L, Adler L (2009) Long-term safety and effectiveness of lisdexamfetamine dimesylate in adults with attention-deficit/hyperactivity disorder. CNS Spectr 14(10):573–585CrossRefPubMed
25.
go back to reference Klein DN, Ouimette PC, Kelly HS, Ferro T, Riso LP (1994) Test-retest reliability of team consensus best-estimate diagnoses of axis I and II disorders in a family study. Am J Psychiatry 151(7):1043–1047CrossRefPubMed Klein DN, Ouimette PC, Kelly HS, Ferro T, Riso LP (1994) Test-retest reliability of team consensus best-estimate diagnoses of axis I and II disorders in a family study. Am J Psychiatry 151(7):1043–1047CrossRefPubMed
26.
go back to reference American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders: DSM-IV-TR, 4th edn. American Psychiatric Association, Washington, DC American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders: DSM-IV-TR, 4th edn. American Psychiatric Association, Washington, DC
27.
go back to reference Swanson J (1992) School-based assessment and interventions for ADD students. KC Publishing, Irvine Swanson J (1992) School-based assessment and interventions for ADD students. KC Publishing, Irvine
28.
go back to reference First M, Spitzer RL, Gibbon M, Williams JBW (1996) Structured clinical interview for DSM-IV axis I disorders, clinical version (SCID-CV). American Psychiatric Press Inc., Washington, DC First M, Spitzer RL, Gibbon M, Williams JBW (1996) Structured clinical interview for DSM-IV axis I disorders, clinical version (SCID-CV). American Psychiatric Press Inc., Washington, DC
30.
go back to reference First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin LS (1997) Structured clinical interview for DSM-IV axis II personality disorders (SCID-II). American Psychiatric Press Inc, Washington, DC First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin LS (1997) Structured clinical interview for DSM-IV axis II personality disorders (SCID-II). American Psychiatric Press Inc, Washington, DC
31.
go back to reference Leekam SR, Libby SJ, Wing L, Gould J, Taylor C (2002) The diagnostic interview for social and communication disorders: algorithms for ICD-10 childhood autism and Wing and Gould autistic spectrum disorder. J Child Psychol Psychiatry 43(3):327–342CrossRefPubMed Leekam SR, Libby SJ, Wing L, Gould J, Taylor C (2002) The diagnostic interview for social and communication disorders: algorithms for ICD-10 childhood autism and Wing and Gould autistic spectrum disorder. J Child Psychol Psychiatry 43(3):327–342CrossRefPubMed
32.
go back to reference Le Couteur A, Rutter M, Lord C, Rios P, Robertson S, Holdgrafer M, McLennan J (1989) Autism diagnostic interview: a standardized investigator-based instrument. J Autism Dev Disord 19(3):363–387CrossRefPubMed Le Couteur A, Rutter M, Lord C, Rios P, Robertson S, Holdgrafer M, McLennan J (1989) Autism diagnostic interview: a standardized investigator-based instrument. J Autism Dev Disord 19(3):363–387CrossRefPubMed
34.
go back to reference Guy W (1976) ECDEU assessment manual for psychpharmacology. US Department of Health, Education and Welfare, Rockville Guy W (1976) ECDEU assessment manual for psychpharmacology. US Department of Health, Education and Welfare, Rockville
35.
go back to reference Leon AC, Olfson M, Portera L, Farber L, Sheehan DV (1997) Assessing psychiatric impairment in primary care with the Sheehan disability scale. Int J Psychiatry Med 27(2):93–105CrossRefPubMed Leon AC, Olfson M, Portera L, Farber L, Sheehan DV (1997) Assessing psychiatric impairment in primary care with the Sheehan disability scale. Int J Psychiatry Med 27(2):93–105CrossRefPubMed
37.
go back to reference The EuroQol Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208CrossRef The EuroQol Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208CrossRef
38.
go back to reference Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG (2001) AUDIT. The alcohol use disorders identification test. Guidelines for use in primary care, 2nd edn. World Health Organization, Department of Mental Health and Substance Dependence, Geneva Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG (2001) AUDIT. The alcohol use disorders identification test. Guidelines for use in primary care, 2nd edn. World Health Organization, Department of Mental Health and Substance Dependence, Geneva
42.
go back to reference Burstrom K, Johannesson M, Diderichsen F (2001) Swedish population health-related quality of life results using the EQ-5D. Qual Life Res 10(7):621–635CrossRefPubMed Burstrom K, Johannesson M, Diderichsen F (2001) Swedish population health-related quality of life results using the EQ-5D. Qual Life Res 10(7):621–635CrossRefPubMed
44.
go back to reference van Lieshout M, Luman M, Twisk JW, van Ewijk H, Groenman AP, Thissen AJ, Faraone SV, Heslenfeld DJ, Hartman CA, Hoekstra PJ, Franke B, Buitelaar JK, Rommelse NN, Oosterlaan J (2016) A 6-year follow-up of a large European cohort of children with attention-deficit/hyperactivity disorder-combined subtype: outcomes in late adolescence and young adulthood. Eur Child Adolesc Psychiatry 25(9):1007–1017. https://doi.org/10.1007/s00787-016-0820-y CrossRefPubMedPubMedCentral van Lieshout M, Luman M, Twisk JW, van Ewijk H, Groenman AP, Thissen AJ, Faraone SV, Heslenfeld DJ, Hartman CA, Hoekstra PJ, Franke B, Buitelaar JK, Rommelse NN, Oosterlaan J (2016) A 6-year follow-up of a large European cohort of children with attention-deficit/hyperactivity disorder-combined subtype: outcomes in late adolescence and young adulthood. Eur Child Adolesc Psychiatry 25(9):1007–1017. https://​doi.​org/​10.​1007/​s00787-016-0820-y CrossRefPubMedPubMedCentral
47.
go back to reference Polanczyk G, Faraone SV, Bau CH, Victor MM, Becker K, Pelz R, Buitelaar JK, Franke B, Kooij S, van der Meulen E, Cheon KA, Mick E, Purper-Ouakil D, Gorwood P, Stein MA, Cook EH Jr, Rohde LA (2008) The impact of individual and methodological factors in the variability of response to methylphenidate in ADHD pharmacogenetic studies from four different continents. Am J Med Genet B Neuropsychiatr Genet 147B(8):1419–1424. https://doi.org/10.1002/ajmg.b.30855 CrossRefPubMedPubMedCentral Polanczyk G, Faraone SV, Bau CH, Victor MM, Becker K, Pelz R, Buitelaar JK, Franke B, Kooij S, van der Meulen E, Cheon KA, Mick E, Purper-Ouakil D, Gorwood P, Stein MA, Cook EH Jr, Rohde LA (2008) The impact of individual and methodological factors in the variability of response to methylphenidate in ADHD pharmacogenetic studies from four different continents. Am J Med Genet B Neuropsychiatr Genet 147B(8):1419–1424. https://​doi.​org/​10.​1002/​ajmg.​b.​30855 CrossRefPubMedPubMedCentral
52.
54.
58.
go back to reference Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, Howes MJ, Jin R, Secnik K, Spencer T, Ustun TB, Walters EE (2005) The World Health Organization adult ADHD self-report scale (ASRS): a short screening scale for use in the general population. Psychol Med 35(2):245–256CrossRefPubMed Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, Howes MJ, Jin R, Secnik K, Spencer T, Ustun TB, Walters EE (2005) The World Health Organization adult ADHD self-report scale (ASRS): a short screening scale for use in the general population. Psychol Med 35(2):245–256CrossRefPubMed
Metadata
Title
Six-year outcome in subjects diagnosed with attention-deficit/hyperactivity disorder as adults
Authors
Dan Edvinsson
Lisa Ekselius
Publication date
01-06-2018
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Psychiatry and Clinical Neuroscience / Issue 4/2018
Print ISSN: 0940-1334
Electronic ISSN: 1433-8491
DOI
https://doi.org/10.1007/s00406-017-0850-6

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