- Email: [email protected]
Hyperactivity Disorder a Childhood-Onset Neurodevelopmental Disorder? Evidence from a Four-Decade Longitudinal Cohort Study
SYMPOSIA 7.0 – 7.2
Patients (N ¼ 137) and parents (N ¼ 136) completed inflammatory back pain (IBP) assessment for the Calin, Rudwaleit, and Assessment in SpondyloArthritis International Society criteria. Results: HLA analysis shows that HLA-B 52, 38, and 55 are associated positively with PANS compared with the control cohort (p < 0.001, p ¼ 0.0011, p ¼ 0.0404, respectively). The prevalences of back pain among patients and parents are 48 percent and 64 percent, with 3–32 percent and 11–42 percent meeting criteria for IBP, respectively. The prevalences of positive histone (1.0 U) and antinuclear antibodies (1:160) among patients are 26 percent and 10 percent, respectively. The prevalences of arthritis and autoimmune disease among patients are 25 percent and 18 percent, respectively. Of those patients with an autoimmune disease, nine percent meet criteria for Hashimoto’s thyroiditis, four percent for celiac disease, four percent for psoriasis, and three percent for some other autoimmune disease. Furthermore, the average length of PANS flares is significantly shorter when treated with NSAIDS and/or prednisone bursts. Conclusions: The high prevalence of arthritis and autoimmune/inflammatory diseases among patients who met PANS symptom criteria, coupled with the positive HLA-B association and improvement with NSAIDs and prednisone, suggests a strong connection between inflammation and neuropsychiatric disease.
DIAG NI Supported by the PANS Physician Network http://dx.doi.org/10.1016/j.jaac.2016.07.156
SYMPOSIUM 7 IS ATTENTION-DEFICIT/HYPERACTIVITY DISORDER ONSET LIMITED TO CHILDHOOD? Guilherme V. Polanczyk, MD, PhD, Department of Psychiatry, ~ o Paulo, Rua Dr Ovidio Pires de Campos 785, Sao University of Sa Paulo, 05403-010, Brazil; E. Costello, PhD; W. Philip Shaw, MD, PhD Objectives: The trajectory of ADHD is not fully understood, especially in individuals from the community. Although ADHD is conceptualized as a childhood-onset neurodevelopmental disorder, no prospective longitudinal study has described the childhoods of the adult ADHD population or tested the hypothesis that ADHD onset can occur in adulthood. This symposium will discuss recent findings from three populational sample groups describing the trajectories of ADHD across development and its predictors. Methods: Findings from three populational longitudinal studies from New Zealand (Dunedin Longitudinal Study), United Kingdom (E-Risk Study), and Brazil (Pelotas Study) showing the trajectories of ADHD from childhood to adulthood (ages 18–38 years) and its predictors will be presented. Results: The three studies revealed that 67.5 to 90 percent of adults with ADHD lacked a history of childhood ADHD. Conclusions: Evidence suggest that adults with ADHD may not have a childhood-onset neurodevelopmental disorder. Discussants will address the data presented critically, first integrating results and evaluating to what extent they replicate the same finding and finally discussing neurobiological implications.
ADHD DIAG LONG http://dx.doi.org/10.1016/j.jaac.2016.07.158
7.1 IS ADULT ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER A CHILDHOOD-ONSET NEURODEVELOPMENTAL DISORDER? EVIDENCE FROM A FOUR-DECADE LONGITUDINAL COHORT STUDY Terrie Moffitt, PhD, Department of Psychology and Neuroscience, Psychiatry and Behavioral Sciences, Duke University, Suite 201, Grey House, 2020 West Main Street, Durham, NC, 27708
S268
www.jaacap.org
Objectives: Despite a prevailing assumption that adult ADHD is a childhoodonset neurodevelopmental disorder, no prospective longitudinal study has described the childhoods of the adult population with ADHD. The authors report follow-back analyses of subjects with ADHD diagnosed in adulthood, alongside follow-forward analyses of subjects with ADHD diagnosed in childhood, in one cohort. Methods: Participants belonged to a representative birth cohort of 1,037 individuals born in Dunedin, New Zealand, in 1972 and 1973 and followed to age 38 years, with 95 percent retention. Symptoms of ADHD, associated clinical features, comorbid disorders, neuropsychological deficits, genome-wide association study-derived polygenic risk, and life impairment indicators were assessed. Sources of data were participants, parents, teachers, informants, neuropsychological test results, and administrative records. Adult ADHD diagnoses used DSM-5 criteria, apart from onset age and cross-setting corroboration, which included study outcome measures. Results: As expected, childhood ADHD had a prevalence of 6 percent (predominantly male) and was associated with childhood comorbid disorders, neurocognitive deficits, polygenic risk, and residual adult life impairment. Also as expected, adult ADHD had a prevalence of 3 percent (gender balanced) and was associated with adult substance dependence, adult life impairment, and treatment contact. Unexpectedly, the groups of childhood ADHD and adult ADHD comprised virtually nonoverlapping sets; 90 percent of adult ADHD cases lacked a history of childhood ADHD. Also unexpectedly, the adult ADHD group did not show tested neuropsychological deficits in childhood or adulthood, nor did they show polygenic risk for childhood ADHD. Conclusions: The findings raise the possibility that adults presenting with the ADHD symptom picture may not have a childhood-onset neurodevelopmental disorder. If this finding is replicated, the disorder’s place in the classification system must be reconsidered, and research must investigate the etiology of adult ADHD.
ADHD DIAG LONG Supported by the New Zealand Health Research Council and the NIH National Institute on Aging Grant AG032282, the UK Medical Research Council Grant MR/K00381X, and the Jacobs Foundation http://dx.doi.org/10.1016/j.jaac.2016.07.159
7.2 PERSISTENCE, REMISSION, AND EMERGENCE OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER IN YOUNG ADULTHOOD: RESULTS FROM A LONGITUDINAL, PROSPECTIVE, POPULATION-BASED COHORT Louise Arseneault, PhD, Medical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Box Number P080, De Crespigny Park, London, SE5 8AF, United Kingdom Objectives: ADHD is now recognized as a disorder that occurs in adulthood. However, less is known about the prospective course of ADHD into adulthood, the risk factors for its persistence past childhood, and the possibility of its emergence in young adulthood in nonclinical populations. The aim of this study was to investigate childhood risk factors and young adult functioning of individuals with persistent, remitted, and lateonset ADHD. Methods: The study sample group is the Environmental Risk (E-Risk) Longitudinal Twin Study, a birth cohort of 2,232 twins born in England and Wales from 1994 to 1995. ADHD diagnoses were assessed in childhood at ages 5, 7, 10, and 12 years and in young adulthood at age 18 years. Results: The results showed that, among the individuals with childhood ADHD, 21.1 percent met criteria for ADHD at age 18 years. Persistence was associated with higher levels of symptoms and lower IQ in childhood. At age 18 years, persistent individuals had increased functional impairment and higher rates of other mental health problems compared to those who remitted. Among individuals with adult ADHD, 67.5 percent did
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Patients (N ¼ 137) and parents (N ¼ 136) completed inflammatory back pain (IBP) assessment for the Calin, Rudwaleit, and Assessment in SpondyloArthritis International Society criteria. Results: HLA analysis shows that HLA-B 52, 38, and 55 are associated positively with PANS compared with the control cohort (p < 0.001, p ¼ 0.0011, p ¼ 0.0404, respectively). The prevalences of back pain among patients and parents are 48 percent and 64 percent, with 3–32 percent and 11–42 percent meeting criteria for IBP, respectively. The prevalences of positive histone (1.0 U) and antinuclear antibodies (1:160) among patients are 26 percent and 10 percent, respectively. The prevalences of arthritis and autoimmune disease among patients are 25 percent and 18 percent, respectively. Of those patients with an autoimmune disease, nine percent meet criteria for Hashimoto’s thyroiditis, four percent for celiac disease, four percent for psoriasis, and three percent for some other autoimmune disease. Furthermore, the average length of PANS flares is significantly shorter when treated with NSAIDS and/or prednisone bursts. Conclusions: The high prevalence of arthritis and autoimmune/inflammatory diseases among patients who met PANS symptom criteria, coupled with the positive HLA-B association and improvement with NSAIDs and prednisone, suggests a strong connection between inflammation and neuropsychiatric disease.
DIAG NI Supported by the PANS Physician Network http://dx.doi.org/10.1016/j.jaac.2016.07.156
SYMPOSIUM 7 IS ATTENTION-DEFICIT/HYPERACTIVITY DISORDER ONSET LIMITED TO CHILDHOOD? Guilherme V. Polanczyk, MD, PhD, Department of Psychiatry, ~ o Paulo, Rua Dr Ovidio Pires de Campos 785, Sao University of Sa Paulo, 05403-010, Brazil; E. Costello, PhD; W. Philip Shaw, MD, PhD Objectives: The trajectory of ADHD is not fully understood, especially in individuals from the community. Although ADHD is conceptualized as a childhood-onset neurodevelopmental disorder, no prospective longitudinal study has described the childhoods of the adult ADHD population or tested the hypothesis that ADHD onset can occur in adulthood. This symposium will discuss recent findings from three populational sample groups describing the trajectories of ADHD across development and its predictors. Methods: Findings from three populational longitudinal studies from New Zealand (Dunedin Longitudinal Study), United Kingdom (E-Risk Study), and Brazil (Pelotas Study) showing the trajectories of ADHD from childhood to adulthood (ages 18–38 years) and its predictors will be presented. Results: The three studies revealed that 67.5 to 90 percent of adults with ADHD lacked a history of childhood ADHD. Conclusions: Evidence suggest that adults with ADHD may not have a childhood-onset neurodevelopmental disorder. Discussants will address the data presented critically, first integrating results and evaluating to what extent they replicate the same finding and finally discussing neurobiological implications.
ADHD DIAG LONG http://dx.doi.org/10.1016/j.jaac.2016.07.158
7.1 IS ADULT ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER A CHILDHOOD-ONSET NEURODEVELOPMENTAL DISORDER? EVIDENCE FROM A FOUR-DECADE LONGITUDINAL COHORT STUDY Terrie Moffitt, PhD, Department of Psychology and Neuroscience, Psychiatry and Behavioral Sciences, Duke University, Suite 201, Grey House, 2020 West Main Street, Durham, NC, 27708
S268
www.jaacap.org
Objectives: Despite a prevailing assumption that adult ADHD is a childhoodonset neurodevelopmental disorder, no prospective longitudinal study has described the childhoods of the adult population with ADHD. The authors report follow-back analyses of subjects with ADHD diagnosed in adulthood, alongside follow-forward analyses of subjects with ADHD diagnosed in childhood, in one cohort. Methods: Participants belonged to a representative birth cohort of 1,037 individuals born in Dunedin, New Zealand, in 1972 and 1973 and followed to age 38 years, with 95 percent retention. Symptoms of ADHD, associated clinical features, comorbid disorders, neuropsychological deficits, genome-wide association study-derived polygenic risk, and life impairment indicators were assessed. Sources of data were participants, parents, teachers, informants, neuropsychological test results, and administrative records. Adult ADHD diagnoses used DSM-5 criteria, apart from onset age and cross-setting corroboration, which included study outcome measures. Results: As expected, childhood ADHD had a prevalence of 6 percent (predominantly male) and was associated with childhood comorbid disorders, neurocognitive deficits, polygenic risk, and residual adult life impairment. Also as expected, adult ADHD had a prevalence of 3 percent (gender balanced) and was associated with adult substance dependence, adult life impairment, and treatment contact. Unexpectedly, the groups of childhood ADHD and adult ADHD comprised virtually nonoverlapping sets; 90 percent of adult ADHD cases lacked a history of childhood ADHD. Also unexpectedly, the adult ADHD group did not show tested neuropsychological deficits in childhood or adulthood, nor did they show polygenic risk for childhood ADHD. Conclusions: The findings raise the possibility that adults presenting with the ADHD symptom picture may not have a childhood-onset neurodevelopmental disorder. If this finding is replicated, the disorder’s place in the classification system must be reconsidered, and research must investigate the etiology of adult ADHD.
ADHD DIAG LONG Supported by the New Zealand Health Research Council and the NIH National Institute on Aging Grant AG032282, the UK Medical Research Council Grant MR/K00381X, and the Jacobs Foundation http://dx.doi.org/10.1016/j.jaac.2016.07.159
7.2 PERSISTENCE, REMISSION, AND EMERGENCE OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER IN YOUNG ADULTHOOD: RESULTS FROM A LONGITUDINAL, PROSPECTIVE, POPULATION-BASED COHORT Louise Arseneault, PhD, Medical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Box Number P080, De Crespigny Park, London, SE5 8AF, United Kingdom Objectives: ADHD is now recognized as a disorder that occurs in adulthood. However, less is known about the prospective course of ADHD into adulthood, the risk factors for its persistence past childhood, and the possibility of its emergence in young adulthood in nonclinical populations. The aim of this study was to investigate childhood risk factors and young adult functioning of individuals with persistent, remitted, and lateonset ADHD. Methods: The study sample group is the Environmental Risk (E-Risk) Longitudinal Twin Study, a birth cohort of 2,232 twins born in England and Wales from 1994 to 1995. ADHD diagnoses were assessed in childhood at ages 5, 7, 10, and 12 years and in young adulthood at age 18 years. Results: The results showed that, among the individuals with childhood ADHD, 21.1 percent met criteria for ADHD at age 18 years. Persistence was associated with higher levels of symptoms and lower IQ in childhood. At age 18 years, persistent individuals had increased functional impairment and higher rates of other mental health problems compared to those who remitted. Among individuals with adult ADHD, 67.5 percent did
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016