Childhood Predictors of Adult Attention-Deficit/Hyperactivity Disorder: Results from the World Health Organization World Mental Health Survey Initiative

Received 29 April 2008; received in revised form 23 September 2008; accepted 2 October 2008. published online 13 November 2008.

Background

Although it is known that childhood attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood, childhood predictors of this persistence have not been widely studied.

Methods

Childhood history of ADHD and adult ADHD were assessed in 10 countries in the World Health Organization World Mental Health Surveys. Logistic regression analysis was used to study associations of retrospectively reported childhood risk factors with adult persistence among the 629 adult respondents with childhood ADHD. Risk factors included age; sex; childhood ADHD symptom profiles, severity, and treatment; comorbid child/adolescent DSM-IV disorders; childhood family adversities; and child/adolescent exposure to traumatic events.

Results

An average of 50% of children with ADHD (range: 32.8%–84.1% across countries) continued to meet DSM-IV criteria for ADHD as adults. Persistence was strongly related to childhood ADHD symptom profile (highest persistence associated with the attentional plus impulsive-hyperactive type, odds ratio [OR] = 12.4, compared with the lowest associated with the impulsive-hyperactive type), symptom severity (OR = 2.0), comorbid major depressive disorder (MDD; OR = 2.2), high comorbidity (≥3 child/adolescent disorders in addition to ADHD; OR = 1.7), paternal (but not maternal) anxiety mood disorder (OR = 2.4), and parental antisocial personality disorder (OR = 2.2). A multivariate risk profile of these variables significantly predicts persistence of ADHD into adulthood (area under the receiving operator characteristic curve = .76).

Conclusions

A substantial proportion of children with ADHD continue to meet full criteria for ADHD as adults. A multivariate risk index comprising variables that can be assessed in adolescence predicts persistence with good accuracy.

Key Words: Adult ADHD, Attention-deficit/hyperactivity disorder (ADHD), course of illness, epidemiology, risk factors for disorder persistence

a Department of Psychiatry, Autonomous University of Puebla, Puebla, Mexico

b Institute for Development, Research, Advocacy, and Applied Care, Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical Center, Beirut, Lebanon

c Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands

d Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts

e Center for Reducing Health Disparities, School of Medicine, University of California, Davis, California

f Center for Public Mental Health, Gösing am Wagram, Austria

g Department of Neurosciences and Psychiatry, University Hospital Gasthuisburg, Leuven, Belgium

h Regional Health Care Agency, Emile-Romagna Region, Bologna, Italy

i Sant Joan de Déu-Serveis de Salut Mental, Barcelona, Spain

j Department of Psychiatry, Lariboisière Hospital Fernand Widal, Paris, France

k Division of Epidemiological and Social Research, Mexican Institute of Psychiatry, Mexico City, Mexico

l Department of Psychiatry and Department of Epidemiology and Bioinformatics, University Medical Center Groningen, the Netherlands

m Graduate School of Behavioural and Cognitive Neurosciences and Graduate School for Experimental Psychopathology, University of Groningen, the Netherlands

n Ministry of Social Protection, Colegio Mayor de Cundinamarca University, Bogota, Colombia

Address reprint requests to Ronald C. Kessler, Ph.D., Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115

PII: S0006-3223(08)01203-1

doi:10.1016/j.biopsych.2008.10.005

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