Predictive utility of childhood diagnosis of ICD-10 hyperkinetic disorder: adult outcomes in the MTA and effect of comorbidity
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Diagnostic guidelines differ between DSM attention-deficit/hyperactivity disorder (ADHD) and ICD hyperkinetic disorder (HKD). Only 145 of 579 children age 7–9 in the Multimodal Treatment Study of ADHD (the MTA) with combined-type DSM-IV ADHD met criteria for ICD-10 HKD, because major internalizing comorbidities and more stringent symptom count/pervasiveness requirements excluded most. The 145 HKD had significantly better 14-month medication response than the rest. We explored whether HKD had greater adult symptom persistence and/or impairment than other ADHD. Multi-informant assessments were done for 16 years. We used the 12/14/16-year assessments, in young adulthood. The post-attrition 109 with baseline HKD had no greater adult persistence of ADHD symptoms/impairment than 367 without HKD, but had more cumulative stimulant use, more job losses, lower emotional lability, and fewer car crashes. However, those excluded for internalizing comorbidity but otherwise meeting HKD criteria had significantly more persistence. Only 6 of the 109 (5.5%) with baseline HKD met ICD-10 criteria for HKD in adulthood, compared to 25 of 367 (6.8%) without a childhood HKD diagnosis. Despite greater initial symptom severity, HKD had no worse 16-year young adult outcome than others, except for job losses, balanced by less emotional lability and fewer crashes. Comorbid internalizing disorder seems to have worse prognosis than initial severity/pervasiveness of ADHD symptoms.
KeywordsInternational classification of diseases (ICD) Diagnostic and statistical manual of mental disorders (DSM) Adult outcomes Attention-deficit/hyperactivity disorder (ADHD) Hyperkinetic disorder
The Multimodal Treatment Study of Children with ADHD (MTA) was a National Institute of Mental Health (NIMH) cooperative agreement randomized clinical trial, continued under an NIMH contract as a follow-up study and finally under a National Institute on Drug Abuse (NIDA) contract. Collaborators from NIMH: Benedetto Vitiello, M.D., Joanne B. Severe, M.S., Peter S. Jensen, M.D. (currently at REACH Institute and University of Arkansas), L. Eugene Arnold, M.D., M.Ed. (currently at Ohio State University), Kimberly Hoagwood, Ph.D. (currently at Columbia); previous contributors from NIMH to the early phases: John Richters, Ph.D. (currently at National Institute of Nursing Research); Donald Vereen, M.D. (currently at NIDA). Principal investigators and co-investigators from the sites are: University of California, Berkeley/San Francisco: Stephen P. Hinshaw, Ph.D. (Berkeley), Glen R. Elliott, Ph.D., M.D. (San Francisco); Duke University: Karen C. Wells, Ph.D., Jeffery N. Epstein, Ph.D. (currently at Cincinnati Children’s Hospital), Desiree W. Murray, Ph.D.; previous Duke contributors: C. Keith Conners, Ph.D. (former PI); John March, M.D., M.P.H.; University of California, Irvine: James Swanson, Ph.D., Timothy Wigal, Ph.D.; previous contributor from UCLA to early phases: Dennis P. Cantwell, M.D. (deceased); New York University School of Medicine: Howard B. Abikoff, Ph.D.; Montreal Children’s Hospital/McGill University: Lily Hechtman, M.D.; New York State Psychiatric Institute/Columbia University/Mount Sinai Medical Center: Laurence L. Greenhill, M.D. (Columbia), Jeffrey H. Newcorn, M.D. (Mount Sinai School of Medicine). University of Pittsburgh: Brooke Molina, Ph.D., Betsy Hoza, Ph.D. (currently at University of Vermont), William E. Pelham, Ph.D. (PI for early phases, currently at Florida International University). Follow-up phase statistical collaborators: Robert D. Gibbons, Ph.D. (University of Illinois, Chicago); Sue Marcus, Ph.D. (Mt. Sinai College of Medicine); Kwan Hur, Ph.D. (University of Illinois, Chicago). Original statistical and design consultant: Helena C. Kraemer, Ph.D. (Stanford University). Collaborator from Office of Special Education Programs/US Department of Education: Thomas Hanley, Ed.D. Collaborator from Office of Juvenile Justice and Delinquency Prevention/Department of Justice: Karen Stern, Ph.D. We gratefully acknowledge Rachel Bergman’s assistance with manuscript handling.
Compliance with ethical standards
Conflict of interest
Dr. Arnold has received research funding from Forest, Lilly, Noven, Shire, Supernus, Roche, and YoungLiving, consulted with Pfizer, Tris Pharma, and Waypoint, and been on advisory boards for Arbor, Ironshore, Otsuka, Pfizer, Roche, Seaside Therapeutics, and Shire. Dr. Taylor has consulted for South London and Maudsley NHS Foundation Trust and received book royalties from Wiley Blackwell and Oxford University Press. Dr. Hechtman has received research support, served on advisory boards, and been a speaker for Lilly, GlaxoSmithKline, Ortho-Janssen, Purdue, Shire, and Ironshore, and received book royalties from Guilford, APA, John Hopkins, and Oxford University Press. Dr. Sibley receives royalties from Guilford Press. Dr. Swanson received support years from NLS Pharma and Medice expert board meetings. Dr. Mitchell received royalties from New Harbinger Press. Dr. Rohde was on speakers’ bureau and/or consulted for Eli-Lilly, Janssen-Cilag, Medice, Novartis and Shire, and received royalties from Oxford Press and ArtMed and travel awards to 2015 WFADHD and 2016 AACAP; Outpatient Programs chaired by him received unrestricted educational/research support from: Eli-Lilly, Janssen-Cilag, Novartis, and Shire. Dr. Molina and Dr. Roy have no disclosures.
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