Persistence and remission of ADHD during adulthood: a 7-year clinical follow-up study R. G. Karam 1,2 , V. Breda 1,2 , F. A. Picon 1,2,3 , D. L. Rovaris 1,4 , M. M. Victor 1,2 , C. A. I. Salgado 1,2 , E. S. Vitola 1,2 , K. L. Silva 1,2 , P. O. Guimarães-da-Silva 1,2 , N. R. Mota 1,4 , A. Caye 1 , P. Belmonte-de-Abreu 1,2 , L. A. Rohde 1,2,3 , E. H. Grevet 1,2 and C. H. D. Bau 1,4 * 1 ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil 2 Department of Psychiatry, Faculdade de Medicina, Federal University of Rio Grande do Sul, Porto Alegre, Brazil 3 National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil 4 Department of Genetics, Instituto de Biociências, Federal University of Rio Grande do Sul, Porto Alegre, Brazil Background. Course and predictors of persistence of attention deficit hyperactivity disorder (ADHD) in adults are still largely unknown. Neurobiological and clinical differences between child and adult ADHD raise the need for follow-up studies of patients diagnosed during adulthood. This study investigates predictors of ADHD persistence and the possi- bility of full remission 7 years after baseline assessment. Method. A 7-year follow-up study of adults with ADHD (n = 344, mean age 34.1 years, 49.9% males) was conducted. Variables from different domains (social demographics, co-morbidities, temperament, medication status, ADHD measures) were explored with the aim of finding potential predictors of ADHD persistence. Results. Retention rate was 66% (n = 227). Approximately a third of the sample (n = 70, 30.2%) did not maintain ADHD criteria and 28 (12.4%) presented full remission (<4 symptoms), independently of changes in co-morbidity or cognitive demand profiles. Baseline predictors of diagnostic persistence were higher number of inattention symptoms [odds ratio (OR) 8.05, 95% confidence interval (CI) 2.54–25.45, p < 0.001], number of hyperactivity/impulsivity symptoms (OR 1.18, 95% CI 1.04–1.34, p = 0.01), opposi- tional defiant disorder (OR 3.12, 95% CI 1.20–8.11, p = 0.02), and social phobia (OR 3.59, 95% CI 1.12–11.47, p = 0.03). Conclusions. Despite the stage of brain maturation in adults suggests stability, approximately one third of the sample did not keep full DSM-IV diagnosis at follow-up, regardless if at early, middle or older adulthood. Although full re- mission is less common than in childhood, it should be considered as a possible outcome among adults. Received 11 July 2014; Revised 15 December 2014; Accepted 16 December 2014; First published online 23 January 2015 Key words: Adults, attention, co-morbidity, diagnosis, hyperactivity, longitudinal study, predictors, prospective. Introduction The knowledge on the course of disorders across the lifespan is essential for planning accurate clinical approaches. Few clinical longitudinal studies have fol- lowed up children and adolescents with attention deficit hyperactivity disorder (ADHD) until adulthood (Faraone et al. 2006), and only five of them retained at least 50% of the original sample (Weiss et al. 1985; Mannuzza et al. 1998; Rasmussen & Gillberg, 2000; Barkley et al. 2008; Biederman et al. 2011). Even less in- formation is available on the course of patients diag- nosed with full ADHD after brain maturation, since only one follow-up study evaluated patients at two time points during adulthood (Klein et al. 2012). The authors followed 135 boys with ADHD assessing the cohort three times, two of these in adulthood (mean age: 25 and 41 years) and found an increase of ADHD persistence rates from first to second evaluation in adulthood (7.4–22%). They attributed this increase to greater awareness due to wide media coverage (Klein et al. 2012). There is, as far as we know, only one population-based, epidemiologic study of ADHD across the lifespan (Barbaresi et al. 2013). Despite the fact that these authors performed the diagnosis of ADHD during childhood based on retrospective assessments, the study has the strength of assessing all individuals in a birth cohort. Unfortunately, the authors did not analyze potential predictive factors for ADHD persistence into adulthood and did not evaluate patients more than once. Therefore, due to the paucity of ADHD follow-up studies during adult- hood, several data for understanding the disorder in this age group are missing, including persistence rates over time and the possibility of remission. The substantial differences between the character- istics of children and adults with ADHD bring doubts if clinical follow-up samples that start in childhood * Address for correspondence: Dr. C. Bau, Department of Genetics, Instituto de Biociências, UFRGS, Porto Alegre 91501-970, RS, Brazil. (Email: claiton.bau@ufrgs.br) Psychological Medicine (2015), 45, 2045–2056. © Cambridge University Press 2015 doi:10.1017/S0033291714003183 ORIGINAL ARTICLE https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0033291714003183 Downloaded from https://www.cambridge.org/core. IP address: 54.191.40.80, on 14 Jul 2017 at 12:56:58, subject to the Cambridge Core terms of use, available at