Longitudinal trajectories of childhood and adolescent attention deficit hyperactivity disorder diagnoses in three cohortsResearch in context

Luke J. Norman; Jolie Price; Kwangmi Ahn; Gustavo Sudre; Wendy Sharp; Philip Shaw

EClinicalMedicine (Jun 2023)

Longitudinal trajectories of childhood and adolescent attention deficit hyperactivity disorder diagnoses in three cohortsResearch in context

Luke J. Norman,
Jolie Price,
Kwangmi Ahn,
Gustavo Sudre,
Wendy Sharp,
Philip Shaw

Affiliations

Luke J. Norman: National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA; Section on Neurobehavioral and Clinical Research, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA
Jolie Price: Section on Neurobehavioral and Clinical Research, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA
Kwangmi Ahn: Section on Neurobehavioral and Clinical Research, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA
Gustavo Sudre: Section on Neurobehavioral and Clinical Research, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA
Wendy Sharp: National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
Philip Shaw: National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA; Section on Neurobehavioral and Clinical Research, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA; Corresponding author. National Institutes of Health, Building 31, B1B37, Bethesda, MD, 20892, USA.

Journal volume & issue: Vol. 60
p. 102021

Abstract

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Summary: Background: Attention deficit/hyperactivity disorder (ADHD) is usually conceptualized as a childhood-onset neurodevelopmental disorder, in which symptoms either decrease steadily into adulthood or remain stable. A recent study challenged this view, reporting that for most with ADHD, diagnostic status fluctuates with age. We ask if such a ‘fluctuating’ ADHD symptom trajectory subgroup is present in other population-based and clinic-based cohorts, centered on childhood and adolescence. Methods: Cohorts were the population-based Adolescent Brain Cognitive Development (ABCD: N = 9735), Neurobehavioral Clinical Research (NCR: N = 258), and the Nathan Kline Institute-Rockland (NKI-Rockland: N = 149). All participants had three or more assessments spanning different age windows. Participants were categorized into developmental diagnostic subgroups: fluctuant ADHD (defined by two or more switches between meeting and not meeting ADHD criteria), remitting ADHD, persisting ADHD, emerging ADHD and never affected. Data were collected between 2011 and 2022. Analyses were performed between May 2022 and April 2023. Findings: A subgroup with fluctuant child and adolescent ADHD diagnoses was found in all cohorts (29.3% of participants with ADHD in ABCD, 26.6% in NCR and 17% in NKI-Rockland). While the proportion of those with fluctuant ADHD increased with the number of assessments, it never constituted the dominant subgroup. Interpretation: We provide further evidence in three cohorts for the existence of a fluctuant ADHD diagnostic subgroup during childhood and adolescence, albeit in a minority of cases. Such fluctuant child and adolescent ADHD diagnoses may suggest a natural history more akin to relapsing-remitting mood disorders and/or a marked sensitivity to environmental shifts that occur across development. Funding: Intramural programs of the NHGRI and NIMH.

Published in EClinicalMedicine

ISSN: 2589-5370 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Medicine (General)
Website: https://www.thelancet.com/journals/eclinm/home

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