Journal of the American Academy of Child & Adolescent Psychiatry
New researchChildhood Predictors of Adult Functional Outcomes in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (MTA)
Section snippets
Sample
This study is based on the National Institute of Mental Health MTA cohort, a 14-month randomized treatment study of 579 children with ADHD (7–10 years old), with naturalistic follow-ups for up to 16 years after baseline. The MTA also included an age- and sex-matched comparison group of 258 children without ADHD—the local normative comparison group (LNCG)—recruited 2 years after baseline and who were thereafter followed up at similar intervals as the children with ADHD.
Follow-up assessments in
Occupational Functioning
An increase in childhood household income level (odds ratio [OR] 0.85, p < .001) and IQ (OR 0.99, p = .014) was associated with a lower likelihood of receiving public assistance in adulthood, whereas higher baseline ADHD symptom severity (OR 1.50, p = .002) was associated with an increased likelihood of receiving public assistance. Job changes, operationalized as the number of times fired or quit, was predicted by a high baseline IQ (OR 1.01, p < .001) and a high baseline ADHD severity (OR
Discussion
Effects of childhood factors on adult outcomes were generally comparable for the ADHD group and the LNCG. This is partly reassuring because, given supportive environments, functioning can be improved in individuals with ADHD to a similar extent as those with no ADHD. However, functioning is known to be worse in ADHD and the more negative adult outcomes could be a consequence of ADHD symptom severity throughout development. Furthermore, functioning levels throughout development, and not just at
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Review: Adult Outcome as Seen Through Controlled Prospective Follow-up Studies of Children With Attention-Deficit/Hyperactivity Disorder Followed Into Adulthood
2022, Journal of the American Academy of Child and Adolescent PsychiatryCitation Excerpt :In the PALS, ADHD persistence contributed to heavy drinking, alcohol problems, and depression outcomes, but it did not fully account for financial outcomes such as full-time employment, monthly income, and living away from home.15 The MTA Study also looked at predictors of adult ADHD symptom persistence and found that persistence was predicted by childhood ADHD severity, childhood comorbidities, and parental mental health problems,57 while adult functioning levels were predicted not only by childhood ADHD severity and comorbidity, but also by sociodemographic factors of household income, family size, parental educational levels, and family factors of parental marital functioning and parental monitoring.57 The second important predictor that emerged was conduct problems/antisocial behavior.
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2020, Psychiatry ResearchCitation Excerpt :Intelligence quotient (IQ) and ADHD are independently associated with educational and occupational attainment (Cheng and Furnham, 2012; Deary et al., 2007; Halmøy et al., 2009). IQ and ADHD also interact: a low IQ in childhood is associated with worse developmental courses of ADHD symptomatology and related impairment across adolescence and adulthood (Cheung et al., 2015; Ramos-Olazagasti et al., 2018; Roy et al., 2017; Vergunst et al., 2018). Therefore, a high IQ may protect against functional impairment among individuals with ADHD (Park et al., 2011).
A novel digital health intervention to improve patient engagement to stimulants in adult ADHD in the primary care setting: Preliminary findings from an open label study
2020, Psychiatry ResearchCitation Excerpt :Long-term assessments are needed to further evaluate this important issue. While we did not assess functional outcomes, the clear benefits associated with adherence to stimulant treatment can be inferred from the extant literature that documents that when patients are adherent to treatment the likelihood of improved functional outcomes is excellent (Adler et al., 2007; Dalsgaard et al., 2014; Roy et al., 2017). For example, a recent analysis of data derived from very large data sets including registries with hundreds of thousands to millions of participants documented improved functional outcomes in multiple non-overlapping domains of functioning when patients were adherent to treatment further emphasizing the critical importance of adherence to treatment to mitigate many very serious and consequential functional outcomes (Boland et al., 2020).
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Clinical guidance is available at the end of this article.
The work reported was supported by cooperative agreement grants and contracts from the National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse (NIDA) to the University of California–Berkeley: U01 MH50461, N01MH12009, and HHSN271200800005-C; DA-8-5550; Duke University: U01 MH50477, N01MH12012, and HHSN271200800009-C; DA-8-5554; University of California–Irvine: U01MH50440, N01MH12011, and HHSN271200800006- C; DA-8-5551; Research Foundation for Mental Hygiene (New York State Psychiatric Institute and Columbia University): U01 MH50467, N01 MH12007, and HHSN271200800007-C; DA-8-5552; Long Island–Jewish Medical Center: U01 MH50453; New York University: N01MH 12004, and HHSN271200800004-C; DA-8-5549; University of Pittsburgh: U01 MH50467, N01 MH 12010, and HHSN271200800008-C; DA-8-5553; DA 039881; and McGill University: N01MH12008, and HHSN271200800003-C; DA-8-5548. Dr. Roy was supported by the Ter Meulen grant from the Royal Netherlands Academy of Arts and Sciences (KNAW) to participate in this study.
This study was presented as an abstract at the American Academy of Child and Adolescent Psychiatry’s 63rd Annual Meeting, October 24–29, 2016, New York, and at the 6th World Congress on ADHD, April 20-23, 2017, Vancouver.
All authors were responsible for conception and design of the study, interpretation of the data, drafting and revision of the manuscript, and final approval. Drs. Hechtman, Arnold, Swanson, and Molina were responsible for data acquisition. Drs. Roy, Sibley, and Howard were responsible for data analysis. Drs. Hechtman, Swanson, and Molina obtained funding.
The MTA was an NIMH cooperative agreement randomized clinical trial, continued under an NIMH contract as a follow-up study and under a National Institute on Drug Abuse (NIDA) contract. Collaborators from NIMH: Benedetto Vitiello, MD (Child and Adolescent Treatment and Preventive Interventions Research Branch), Joanne B. Severe, MS (Clinical Trials Operations and Biostatistics Unit, Division of Services and Intervention Research), Peter S. Jensen, MD (currently at REACH Institute and Mayo Clinic), L. Eugene Arnold, MD, MEd (currently at Ohio State University), Kimberly Hoagwood, PhD (currently at Columbia); previous contributors from the NIMH to the early phases: John Richters, PhD (currently at National Institute of Nursing Research); Donald Vereen, MD (currently at NIDA). Principal investigators and co-investigators from the sites: University of California, Berkeley/San Francisco: Stephen P. Hinshaw, PhD (Berkeley), Glen R. Elliott, PhD, MD (San Francisco); Duke University: Karen C. Wells, PhD, Jeffery N. Epstein, PhD (currently at Cincinnati Children’s Hospital Medical Center), Desiree W. Murray, PhD; previous Duke contributors to early phases: C. Keith Conners, PhD (former PI); John March, MD, MPH; University of California, Irvine: James Swanson, PhD, Timothy Wigal, PhD; previous contributor from UCLA to the early phases: Dennis P. Cantwell, MD (deceased); New York University School of Medicine: Howard B. Abikoff, PhD; Montreal Children’s Hospital/McGill University: Lily Hechtman, MD; New York State Psychiatric Institute, Columbia University, and Mount Sinai Medical Center: Laurence L. Greenhill, MD (Columbia), Jeffrey H. Newcorn, MD (Mount Sinai School of Medicine). University of Pittsburgh: Brooke Molina, PhD, Betsy Hoza, PhD (currently at University of Vermont), William E. Pelham, PhD (PI for early phases, currently at Florida International University). Follow-up phase statistical collaborators: Robert D. Gibbons, PhD (University of Illinois, Chicago); Sue Marcus, PhD (Mt. Sinai College of Medicine); Kwan Hur, PhD (University of Illinois, Chicago). Original study statistical and design consultant: Helena C. Kraemer, PhD (Stanford University). Collaborator from the Office of Special Education Programs, U.S. Department of Education: Thomas Hanley, EdD. Collaborator from Office of Juvenile Justice and Delinquency Prevention/Department of Justice: Karen Stern, PhD.
Disclosure: Dr. Hechtman has received research support, served on advisory boards, and been a speaker for Eli Lilly and Co., GlaxoSmithKline, Ortho-Janssen, Purdue, Shire, and Ironshore. Dr. Arnold has received research funding from Forest, Eli Lilly and Co., Noven, Shire, Supernus, Roche, YoungLiving, the National Institutes of Health, and Autism Speaks; has consulted with Pfizer, Tris Pharma, and Waypoint; and has been on advisory boards for Arbor, Ironshore, Otsuka, Pfizer, Roche, Seaside Therapeutics, and Shire. Drs. Roy, Swanson, Molina, Sibley, and Howard report no biomedical financial interests or potential conflicts of interest.