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Predictors of persistence of ADHD into adulthood: a systematic review of the literature and meta-analysis


Attention-deficit/hyperactivity disorder (ADHD) is traditionally conceptualized as a neurodevelopmental disorder that continues into adulthood in up to half of diagnosed cases. In light of current evidence, factors associated with the course of the disorder remain unknown. We performed a systematic review of the literature searching for risk markers from childhood that predicted the persistence of ADHD into adulthood. We reviewed 26,168 abstracts and selected 72 for full-text review. We identified data from 16 studies, comprising 6 population-based retrospective samples and 10 clinical follow-ups. We performed meta-analyses of factors evaluated by at least three studies. Severity of ADHD (OR 2.33, 95 % CI = 1.6–3.39, p < 0.001), treatment for ADHD (OR 2.09, 95 % CI = 1.04–4.18, p = 0.037), comorbid conduct disorder (OR 1.85, 95 % CI = 1.06–3.24, p = 0.030), and comorbid major depressive disorder (OR 1.8, 95 % CI = 1.1–2.95, p = 0.019) emerged as predictors already presented in childhood for ADHD persistence into adulthood. Further, we suggest that cohort studies should be designed to clarify such an important question for research and clinical practice.

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Correspondence to Christian Kieling.

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Conflict of interest

Dr. Grevet was on the speakers’ bureau of Shire and Novartis. He received travel awards for taking part in a meeting sponsored by Shire and the World Congress on ADHD in 2015. Dr. Rohde was on the speakers’ bureau/advisory board and/or acted as consultant for Eli-Lilly, Janssen-Cilag, Novartis and Shire in the last 3 years. He receives authorship royalties from Oxford Press and ArtMed. He also received travel awards for taking part in the 2014 APA meeting and 2015 WFADHD meeting from Shire. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the last 3 years: Eli-Lilly, Janssen-Cilag, Novartis, and Shire. Dr. Kieling receives authorship royalties from publishers Artmed and Manole.

Funding source

This work was supported by research grants from the Brazilian public funding agencies, Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS), and Hospital de Clínicas de Porto Alegre (HCPA).

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Caye, A., Spadini, A.V., Karam, R.G. et al. Predictors of persistence of ADHD into adulthood: a systematic review of the literature and meta-analysis. Eur Child Adolesc Psychiatry 25, 1151–1159 (2016).

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  • ADHD
  • Adolescence
  • Risk factors
  • Persistence
  • Course
  • Prognosis