Karam R G, Breda V, Picon F A, Rovaris D L, Victor M M, Salgado C A I, Vitola E S, Silva K L, Guimarães-da-Silva P O, Mota N R, Caye A, Belmonte-de-Abreu P, Rohde L A, Grevet E H, Bau C H D
ADHD Outpatient Clinic,Hospital de Clínicas de Porto Alegre,Porto Alegre,Brazil.
Psychol Med. 2015 Jul;45(10):2045-56. doi: 10.1017/S0033291714003183. Epub 2015 Jan 23.
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 possibility of full remission 7 years after baseline assessment.
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.
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), oppositional 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).
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 remission is less common than in childhood, it should be considered as a possible outcome among adults.
成人注意力缺陷多动障碍（ADHD）的病程及持续存在的预测因素仍 largely 未知。儿童与成人 ADHD 在神经生物学和临床方面的差异，使得对成年期确诊患者进行随访研究很有必要。本研究调查了 ADHD 持续存在的预测因素以及基线评估 7 年后完全缓解的可能性。
对患有 ADHD 的成人（n = 344，平均年龄 34.1 岁，49.9%为男性）进行了为期 7 年的随访研究。探索了来自不同领域的变量（社会人口统计学、共病情况、气质、用药状况、ADHD 测量指标），旨在寻找 ADHD 持续存在的潜在预测因素。
保留率为 66%（n = 227）。大约三分之一的样本（n = 70，30.2%）未维持 ADHD 诊断标准，28 例（12.4%）实现完全缓解（症状少于 4 项），这与共病情况或认知需求特征的变化无关。诊断持续存在的基线预测因素包括更多的注意力不集中症状[优势比（OR）8.05，95%置信区间（CI）2.54 - 25.45，p < 0.001]、多动/冲动症状数量（OR 1.18，95%CI 1.04 - 1.34，p = 0.01）、对立违抗障碍（OR 3.12，95%CI 1.20 - 8.11，p = 0.02）以及社交恐惧症（OR 3.59，95%CI 1.12 - 11.47，p = 0.03）。
尽管成人的大脑成熟阶段表明病情趋于稳定，但大约三分之一的样本在随访时未保持完整的 DSM - IV 诊断，无论处于成年早期、中期还是晚期。虽然完全缓解在成人中不如在儿童中常见，但仍应将其视为成人可能出现的一种结果。
