ADHD treatment has positive effects on behavioral symptoms and psychosocial functioning, but studies that follow children treated for ADHD into adulthood are rare.
Method:
This follow-up study assessed symptom severity and functional outcomes of adults (n = 70) who had received individualized ADHD treatment in the Cologne Adaptive Multimodal Treatment (CAMT) Study at ages 6 to 10 years.
Results:
Despite symptomatic improvement, participants reported poorer educational and occupational outcomes than expected (e.g., currently unemployed: 17%). They had also been in contact with the justice system more often than expected (e.g., lifetime convictions: 33%) and were impaired on health-related outcomes (e.g., substance use problems: 15%). Several social outcomes were favorable (e.g., long-term relationship/married: 63%).
Conclusion:
Compared to the general population or norm samples, CAMT participants had a higher relative risk (RR) of functional impairments, demonstrating the need for continued support for a substantial proportion of the young adults.
AchenbachT. M.RescorlaL. A. (2001). Manual for the ASEBA school-age forms & profiles. University of Vermont, Research Center for Children, Youth, & Families.
2.
AchenbachT. M.RescorlaL. A. (2003). Manual for the ASEBA adult forms & profiles. University of Vermont, Research Center for Children, Youth & Families.
3.
American Academy of Pediatrics. (2011). ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 128, 1–17.
4.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
5.
Arbeitsgruppe Deutsche Child Behavior Checklist. (2009a). ASR/18-59. Fragebogen für Erwachsene. Deutschsprachige Fassung des US-Originals von T.M. Achenbach von 2003 [German version of the Adult Self Report for Ages 18-59 (ASR/18-59)]. Arbeitsgruppe Kinder-, Jugendlichen- und Familiendiagnostik (KJFD).
6.
Arbeitsgruppe Deutsche Child Behavior Checklist. (2009b). ABCL/18-59. Fragebogen über das Verhalten Erwachsener. Deutschsprachige Fassung des US-Originals von T.M. Achenbach von 2003 [German version of the Adult Behavior Checklist for Ages 18-59 (ABCL/18-59)]. Arbeitsgruppe Kinder-, Jugendlichen- und Familiendiagnostik (KJFD).
7.
ArnoldL. E.HodgkinsP.CaciH.KahleJ.YoungS. (2015). Effect of treatment modality on long-term outcomes in attention-deficit/hyperactivity disorder: A systematic review. PLoS One, 10(2), e0116407.
8.
BarkleyR. A.FischerM.SmallishL.FletcherK. (2006). Young adult outcome of hyperactive children: Adaptive functioning in major life activities. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 192–202.
9.
BarnowS.StopsackM.UlrichI.FalzS.DudeckS.SpitzerC.GrabeH.-J.FreybergerH. J. (2010). Prävalenz und Familiarität von Persönlichkeitsstörungen in Deutschland: Ergebnisse der Greifswalder Familienstudie [Prevalence and familiarity of personality disorders in Germany: Results of the Greifswald Family Study]. Psychotherapie - Psychosomatik - Medizinische Psychologie, 60, 334–341.
BussingR.MasonD. M.BellL.PorterP.GarvanC. (2010). Adolescent outcomes of childhood attention-deficit/hyperactivity disorder in a diverse community sample. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 595–605.
16.
DaleyD.van der OordS.FerrinM.DanckaertsM.DöpfnerM.CorteseS.Sonuga-BarkeE. J. S., & European ADHD Guidelines Group. (2014). Behavioral interventions in attention-deficit/hyperactivity disorder: A meta-analysis of randomized controlled trials across multiple outcome domains. Journal of the American Academy of Child & Adolescent Psychiatry, 53, 835–847.
17.
DaleyD.van der OordS.FerrinM.CorteseS.DanckaertsM.DoepfnerM.Van den HoofdakkerB. J.CoghillD.ThompsonM.AshersonP.BanaschewskiT.BrandeisD.BuitelaarJ.DittmannR. W.HollisC.HoltmannM.KonofalE.LecendreuxM.RothenbergerA.SantoshP.. . . Sonuga-BarkeE. J. (2018). Practitioner Review: Current best practice in the use of parent training and other behavioral interventions in the treatment of children and adolescents with attention deficit hyperactivity disorder. Journal of Child Psychology and Psychiatry, 59, 932–947.
18.
Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie (DGKJP), Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psycho-somatik und Nervenheilkunde (DGPPN), & Deutsche Gesellschaft für Sozialpädiatrie und Jugendmedizin (DGPSJ). (2018). Langfassung der interdisziplinären evidenz- und konsensbasierten (S3) Leitlinie “Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Kindes-, Jugend- und Erwachsenenalter” [Guideline on ADHD by the German Association of the Scientific Medical Societies]. Retrieved October 8, 2019, from https://www.awmf.org/uploads/tx_szleitlinien/028-045l_S3_ADHS_2018-06.pdf
19.
DöpfnerM.BreuerD.SchürmannS.Wolff MetternichT.RademacherC.LehmkuhlG. (2004). Effectiveness of an adaptive multimodal treatment in children with attention-deficit hyperactivity disorder - global outcome. European Child and Adolescent Psychiatry, 13(Suppl 1), I/117–I/129.
20.
DöpfnerM.Görtz-DortenA.LehmkuhlG.BreuerD.GoletzH. (2008). Diagnostik-System für psychische Störungen nach ICD-10 und DSM-IV für Kinder und Jugendliche-II (DISYPS-II) [Diagnostic System for the Assessment of Mental Disorders in Children and Adolescents according to ICD-10 and DSM-IV: DISYPS-II]. Huber.
21.
DöpfnerM.IseE.Wolff Metternich-KaizmanT.SchürmannS.RademacherC.BreuerD. (2015). Adaptive multimodal treatment for children with Attention-Deficit / Hyperactivity Disorder: An 18 month follow-up. Child Psychiatry & Human Development, 46, 44–56.
22.
DöpfnerM.IseE.BreuerD.RademacherC.Wolff Metternich-KaizmanT.SchürmannS. (2020). Long-term course after adaptive multimodal treatment for children with Attention-Deficit / Hyperactivity Disorder: An 8-year follow-up. Journal of Attention Disorders, 24, 145–162.
23.
DöpfnerM.SchürmannS.FrölichJ. (2013). Therapieprogramm für Kinder mit hyperkinetischem und oppositionellem Problemverhalten (THOP) (5. Aufl.) [Therapy program for children with hyperactive and oppositional problem behavior: THOP, 5th ed.]. Beltz.
24.
DöpfnerM.van der OordS. (2018). Cognitive-behavioural treatment in childhood and adolescence. In BanaschewskiT.CoghillD.ZuddasA. (Eds.), Oxford Textbook of Attention Deficit Hyperactivity Disorder (pp. 340–347). University Press.
25.
ErhartM.DöpfnerM.Ravens-SiebererU., & Bella Study Group. (2008). Psychometric properties of two ADHD questionnaires: Comparing the Conners’ scale and the FBB-HKS in the general population of German children and adolescents – results of the BELLA study. European Child and Adolescent Psychiatry, 17(Suppl 1), 106–115.
26.
ErskineH. E.NormanR. E.FerrariA. J.ChanG. C. K.CopelandW. E.WhitefordH. A.ScottJ. G. (2016). Long-term outcomes of attention-deficit/hyperactivity disorder and conduct disorder: A systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 55, 841–850.
27.
EvansS. W.OwensJ. S.WymbsB. T.RayA. R. (2018). Evidence-based psychosocial treatments for children and adolescents with attention deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 47, 157–198.
28.
FaraoneS. V.BiedermanJ.MickE. (2006). The age-dependent decline of attention deficit hyperactivity disorder: A meta-analysis of follow-up studies. Psychological Medicine, 36, 159–165.
FahrenbergJ.MyrtekM.SchumacherJ.BrählerE. (2000). FLZ. Fragebogen zur Lebenszufriedenheit[Life Satisfaction Rating Scale]. Hogrefe.
31.
FischerN.SteffensT. (2012). Betriebliche Gesundheitsförderung in der Diakonie. Dokumentation der Arbeitstagung am 3. Februar 2012 in Berlin [Workplace health promotion in the welfare and social work]. Diakonisches Werk der Evangelischen Kirche in Deutschland e. V.
32.
FrankeB.MicheliniG.AshersonP.BanaschewskiT.BilbowA.BuitelaarJ. K.CormandB.FaraoneS. V.GinsbergY.HaavikJ.KuntsiJ.LarssonH.LeschK.-P.Ramos-QuirogaJ. A.RéthelyiJ. M.RibasesM.ReifA. (2018). Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. European Neuropsychopharmacology, 28, 1059–1088.
33.
FrederiksenM.HalmoyA.FaraoneS.HaavikJ. (2013). Long-term efficacy and safety of treatement with stimulants and atomoxetine in adult ADHD: A review of controlled and naturalistic studies. European Neuropsychopharmacology, 23, 508–527.
34.
HarpinV.MazzoneL.RaynaudJ. P.KahleJ.HodgkinsP. (2016). Long-term outcomes of ADHD: A systematic review of self-esteem and social function. Journal of Attention Disorders, 20, 295–305.
35.
HechtmanL.SwansonJ. M.SibleyM. H.StehliA.OwensE. B.MitchellJ. T.ArnoldL. E.MolinaB. S. G.HinshawS. P.JensenP. S.AbikoffH. B.AlgortaG. P.HowardA. L.HozaB.EtcovitchJ.HoussaisS.LakesK. D.NicholsJ. Q. (2016). Functional adult outcomes 16 years after childhood diagnosis of attention-deficit/hyperactivity disorder: MTA results. Journal of the American Academy of Child & Adolescent Psychiatry, 55, 945–952.
36.
HennigT.JayaE. S.KoglinU.LincolnT. M. (2017). Associations of attention-deficit/hyperactivity disorder and other childhood disorders with psychotic experiences and disorders in adolescence. European Child & Adolescent Psychiatry, 26, 421–431.
37.
HennigT.JayaE. S.LincolnT. M. (2017). Bullying mediates between attention-deficit/hyperactivity disorder in childhood and psychotic experiences in early adolescence. Schizophrenia Bulletin, 43, 1036–1044.
38.
JensenP. S.ArnoldL. E.SwansonJ. M.VitiellaB.AbikoffH. B.GreenhillL. L.HechtmanL.HinshawS.PelhamW. E.WellsK. C.ConnersC. K.ElliottG. R.ElliottJ. N.HozaB.MarchJ. S.MolinaB.NewcornJ.SevereJ. B.WigalT.. . . HurK. (2007). 3-year follow-up of the NIMH MTA study. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 989–1002.
39.
KleinR. G.MannuzzaS.OlazagastiM. A. R.RoizenE.HutchisonJ. A.LashuaE. C.CastellanosF. X. (2012). Clinical and functional outcome of childhood attention-deficit/hyperactivity disorder 33 years later. Archives of General Psychiatry, 69, 1295–1303.
40.
LobbestaelJ.LeurgansM.ArntzA. (2011). Inter-rater reliability of the structured clinical interview for DSM-IV axis I disorders (SCID I) and axis II disorders (SCID II). Clinical Psychology and Psychotherapy, 18, 75–79.
41.
MensinkG. B. M.SchienkiewitzA.HaftenbergerM.LampertT.ZieseT.Scheidt-NaveC. (2013). Übergewicht und Adipositas in Deutschland – Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1)[Overweight and obesity in Germany – Results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt, 56, 786–794.
42.
Mohr-JensenC.SteinhausenH.-C. (2016). A meta-analysis and systematic review of the risks associated with childhood attention-deficit hyperactivity disorder on long-term outcome of arrests, convictions, and incarcerations. Clinical Psychology Review, 48, 32–42.
43.
MolinaB. S. G.HinshawS. P.SwansonJ. M.ArnoldL. E.VitielloB.JensenP. S.EpsteinJ. N.HozaB.HechtmanL.AbikoffH. B.ElliottG. R.GreenhillL. L.NewcornJ. H.WellsK. C.WigalT.GibbonsR. D.HurK.HouckP. R. (2009). The MTA at 8 years: Prospective follow-up of children treated for combined type ADHD in a multisite study. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 484–500.
44.
MolinaB. S. G.HowardA. L.SwansonJ. M.StehliA.MitchellJ. T.KennedyT. M.EpsteinJ. N.ArnoldL. E.HechtmanL.VitielloB.HozaB. (2018). Substance use through adolescence into early adulthood after childhood-diagnosed ADHD: findings from the MTA longitudinal study. Journal of Child Psychology and Psychiatry, 59(6), 692–702.
45.
MoyaJ.StringarisA. K.AshersonP.SandbergS.TaylorE. (2014). The impact of persisting hyperactivity in social relationships: A community-based, controlled 20-year follow-up study. Journal of Attention Disorders, 18, 52–60.
46.
MTA Cooperative Group. (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073−1086.
47.
MTA Cooperative Group. (2004). National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Pediatrics, 113, 754–761.
48.
PelhamW. E. (1999). The NIMH multimodal treatment study for attention-deficit hyperactivity disorder: Just say yes to drugs alone?The Canadian Journal of Psychiatry, 44, 981–990.
49.
PolanczykG. V.SalumG. A.SugayaL. S.CayeA.RohdeL. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345–365.
50.
RasmussenP.GillbergC. (2000). Natural outcome of ADHD with developmental coordination disorder at age 22 years: A controlled, longitudinal, community-based study. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 1424–1431.
51.
PeräläJ.SuvisaariJ.SaarniS. I.KuoppasalmiK.IsometsäE.PirkolaS.PartonenT.Tuulio-HenrikssonA.HintikkaJ.KieseppäT.HärkänenT.KoskinenS.LönnqvistJ. (2007). Lifetime prevalence of psychotic and bipolar I disorders in a general population. Archives of General Psychiatry, 64, 19–28.
52.
RodenackerK.HautmannC.Görtz-DortenA.DöpfnerM. (2016). Bifactor models show superior model fit: Examination of the factorial validity of parent-reported and self-reported symptoms of Attention-Deficit/Hyperactivity Disorders in children and adolescents. Psychopathology, 49, 31–39.
53.
SibleyM. H.SwansonJ. M.ArnoldE. E.HechtmanL. T.OwensE. B.StehliA.AbikoffH. B.HinshawS. P.MolinaB. S. G.MitchellJ. T.JensenP. S.HowardA. L.LakesK. D.PelhamW. E.VitielloB.SevereJ. B.ArnoldL. E.HoagwoodK.RichtersJ. E.. . . SternK. B. (2017). Defining ADHD symptom persistence in adulthood: Optimizing sensitivity and specificity. Journal of Child Psychology and Psychiatry, 58, 655–662.
54.
SobanskiE.BrüggemannD.AlmB.KernS.DeschnerM.SchubertT.PhilipsenA.RietschelM. (2007). Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD). European Archives of Psychiatry and Clinical Neuroscience, 257, 371–377.
55.
SwansonJ. M.KraemerH. C.HinshawS. P.ArnoldL. E.ConnersC. K.AbikoffH. B.ClevengerW.DaviesM.ElliottG. R.GreenhillL. L.HechtmanL.HozaB.JensenP. S.MarchJ. S.NewcornJ. H.OwensE. B.PelhamW. E.SchillerE.SevereJ. B.. . . WuM. (2001). Clinical relevance of the primary findings of the MTA: Success rates based on severity of ADHD and ODD symptoms at the end of treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 168−179.
56.
SwansonJ. M.ArnoldL. E.MolinaB. S. G.SibleyM. H.HechtmanL. T.HinshawS. P.AbikoffH. B.StehliA.OwensE. B.MitchellJ. T.NicholsQ.HowardA.GreenhillL. L.HozaB.NewcornJ. H.JensenP. S.VitielloB.WigalT.EpsteinJ. N., . . . for the MTA Cooperative Group. (2017). Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: Symptom persistence, source discrepancy, and height suppression. Journal of Child Psychology and Psychiatry, 58, 663–678.
57.
TaylorE.DöpfnerM.SergeantJ.AshersonP.BanaschewskiT.BuitelaarJ.CoghillD.DanckaertsM.RothenbergerA.Sonuga-BarkeE.SteinhausenH. C.ZuddasA. (2004) European clinical guidelines for hyperkinetic disorder—first upgrade. European Child & Adolescent Psychiatry, 13(Suppl 1), 17–30.
58.
UchidaM.SpencerT. J.FaraoneS. V.BiedermanJ. (2018). Adult outcome of ADHD: An overview of results from the MGH Longitudinal Family Studies of Pediatrically and Psychiatrically referred youth with and without ADHD of both sexes. Journal of Attention Disorders, 22, 523–534.
59.
van Der OordS.PrinsP. J. M.OosterlaanJ.EmmelkampP. M. G. (2008). Efficacy of methylphenidate, psychosocial treatments and their combination in school-aged children with ADHD: A meta-analysis. Clinical Psychology Review, 28, 783–800.
60.
van LieshoutM.LumanM.TwiskJ. W. R.van EwijkH.GroenmanA. P.ThissenA. J. A. M.FaraoneS. V.HeslenfeldD. J.HartmanC. A.HoekstraP. J.FrankeB.BuitelaarJ. K.RommelseN. N. J.OosterlaanJ. (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. European Child & Adolescent Psychiatry, 25, 1107–1017.
61.
van de Loo-NeusG. H. H.RommelseN.BuitellarJ. K. (2011). To stop or not to stop? How long should medication treatment of attention-deficit hyperactivity disorder be extended?European Neuropsychopharmacology, 21, 584–599.
62.
WittchenH.-U.ZaudigM.FydrichT. (1997). Strukturiertes klinisches Interview für DSM-IV: SKID-I und SKID-II[Structured Clinical Interview for DSM-IV: SCID I and SCID II]. Hogrefe.
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