Three-Year Latent Class Trajectories of Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms in a Clinical Sample Not Selected for ADHD - 21/06/14
, Stephen J. Ganocy, PhD b, Katherine Mount, BA a, Eric A. Youngstrom, PhD c, Thomas Frazier, PhD d, Mary Fristad, PhD a, Sarah M. Horwitz, PhD e, Boris Birmaher, MD f, Robert Findling, MD, MBA g, Robert A. Kowatch, MD, PhD h, Christine Demeter, MA b, David Axelson, MD h, Mary Kay Gill, MSN f, Linda Marsh, BS bAbstract |
Objective |
This study aims to examine trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms in the Longitudinal Assessment of Manic Symptoms (LAMS) sample.
Method |
The LAMS study assessed 684 children aged 6 to 12 years with the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) and rating scales semi-annually for 3 years. Although they were selected for elevated manic symptoms, 526 children had baseline ADHD diagnoses. With growth mixture modeling (GMM), we separately analyzed inattentive and hyperactive/impulsive symptoms, covarying baseline age. Multiple standard methods determined optimal fit. The χ2 and Kruskal–Wallis analysis of variance compared resulting latent classes/trajectories on clinical characteristics and medication.
Results |
Three latent class trajectories best described inattentive symptoms, and 4 classes best described hyperactive/impulsive symptoms. Inattentive trajectories maintained their relative position over time. Hyperactive/impulsive symptoms had 2 consistent trajectories (least and most severe). A third trajectory (4.5%) started mild, then escalated; and a fourth (14%) started severe but improved dramatically. The improving trajectory was associated with the highest rate of ADHD and lowest rate of bipolar diagnoses. Three-fourths of the mildest inattention class were also in the mildest hyperactive/impulsive class; 72% of the severest inattentive class were in the severest hyperactive/impulsive class, but the severest inattention class also included 62% of the improving hyperactive-impulsive class.
Conclusion |
An ADHD rather than bipolar diagnosis prognosticates a better course of hyperactive/impulsive, but not inattentive, symptoms. High overlap of relative severity between inattention and hyperactivity/impulsivity confirms the link between these symptom clusters. Hyperactive/impulsive symptoms wane more over time. Group means are insufficient to understand individual ADHD prognosis. A small subgroup deteriorates over time in hyperactivity/impulsivity and needs better treatments than currently provided.
Le texte complet de cet article est disponible en PDF.Key Words : ADHD, GMM, longitudinal symptoms, inattention, hyperactivity/impulsivity
Plan
| Clinical guidance is available at the end of this article. |
|
| This article was reviewed under and accepted by deputy editor Stephen V. Faraone, PhD. |
|
| This study was supported by the National Institute of Mental Health (NIMH) (R01 MH073801, M.F.; R01 MH073953, B.B.; R01 MH073816, R.K.; R01 MH073967, R.F.). The authors thank NIMH for its support but acknowledge that the findings and conclusions presented in this paper are those of the authors alone and do not necessarily reflect the opinions of NIMH. |
|
| Drs. Ganocy and Youngstrom served as the statistical experts for this research. |
|
| Disclosure: Dr. Arnold has received research funding from CureMark, Forest, Eli Lilly and Co., and Shire; advisory board honoraria from Biomarin, Novartis, Noven, Roche, Seaside Therapeutics, and Shire; consulting fees from Tris Pharma, Pfizer, and Gowlings; and travel support from Noven. Dr. Ganocy has received research support from AstraZeneca and Eli Lilly and Co. Dr. Youngstrom has served as a consultant for Lundbeck. Dr. Frazier has received federal funding or research support from, acted as a consultant to, received travel support from, and/or received a speaker's honorarium from the Simons Foundation, Ingalls Foundation, Forest Laboratories, Ecoeos, IntegraGen, Shire Development, Bristol-Myers Squibb, National Institutes of Health (NIH), and the Brain and Behavior Research Foundation (formerly NARSAD). Dr. Fristad has received royalties from Guilford Press, American Psychiatric Publishing (APPI), and CFPSI. Dr. Birmaher has received research support from NIMH and receives royalties from Random House, Inc., Lippincott Williams and Wilkins, and Up-To-Date. Dr. Findling has received research support, acted as a consultant and/or served on a speaker's bureau for Alexza Pharmaceuticals, American Academy of Child and Adolescent Psychiatry, American Physician Institute, APPI, AstraZeneca, Bracket, Bristol-Myers Squibb, Clinsys, Cognition Group, Coronado Biosciences, Dana Foundation, Forest, GlaxoSmithKline, Guilford Press, Johns Hopkins University Press, Johnson and Johnson, KemPharm, Eli Lilly and Co., Lundbeck, Merck, NIH, Novartis, Otsuka, Oxford University Press, Pfizer, Physicians Postgraduate Press, Rhodes Pharmaceuticals, Roche, Sage, Shire, Stanley Medical Research Institute, Sunovion, Supernus Pharmaceuticals, Transcept Pharmaceuticals, Validus, and WebMD. Dr. Kowatch has served as a consultant to the REACH Foundation, AstraZeneca, and Sunovion. Drs. Horwitz and Axelson and Mss. Mount, Demeter, Gill, and Marsh report no biomedical financial interests or potential conflicts of interest. |
Vol 53 - N° 7
P. 745-760 - juillet 2014 Retour au numéro
Article précédent
- Impact of the DSM-5 Attention-Deficit/Hyperactivity Disorder Age-of-Onset Criterion in the US Adolescent Population
- Jennifer L. Vande Voort, Jian-Ping He, Nicole D. Jameson, Kathleen R. Merikangas
- Biological Overlap of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: Evidence From Copy Number Variants
- Joanna Martin, Miriam Cooper, Marian L. Hamshere, Andrew Pocklington, Stephen W. Scherer, Lindsey Kent, Michael Gill, Michael J. Owen, Nigel Williams, Michael C. O'Donovan, Anita Thapar, Peter Holmans
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?