ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Post-Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil.
JAMA Psychiatry. 2016 Jul 1;73(7):705-12. doi: 10.1001/jamapsychiatry.2016.0383.
The requirement of a childhood onset has always been a key criterion for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults, but recently this requirement has become surrounded by controversy.
To investigate whether impaired young adults with ADHD symptoms always have a childhood-onset disorder in a population-based longitudinal study.
DESIGN, SETTING, AND PARTICIPANTS: Participants belonged to the 1993 Pelotas Birth Cohort Study, including 5249 individuals born in Pelotas, Brazil, in 1993. They were followed up to 18 to 19 years of age, with 81.3% retention. The data analysis was performed between August 8, 2015, and February 5, 2016.
The ADHD status was first ascertained at 11 years of age using a screening instrument (hyperactivity subscale of the Strength and Difficulties Questionnaire) calibrated for a DSM-IV ADHD diagnosis based on clinical interviews with parents using the Development and Well-Being Assessment. At 18 to 19 years of age, ADHD diagnosis was derived using DSM-5 criteria, except age at onset. We estimated the overlap between these groups assessed at 11 and 18 to 19 years of age and the rates of markers of impairment in these 2 groups compared with those without ADHD.
At 11 years of age, childhood ADHD (C-ADHD) was present in 393 individuals (8.9%). At 18 to 19 years of age, 492 individuals (12.2%) fulfilled all DSM-5 criteria for young adult ADHD (YA-ADHD), except age at onset. After comorbidities were excluded, the prevalence of YA-ADHD without comorbidities decreased to 256 individuals (6.3%). Children with C-ADHD had a male preponderance not observed among children without ADHD (251 [63.9%] vs 1930 [47.9%] male, P < .001), whereas the YA-ADHD group had a female preponderance (192 [39.0%] vs 1786 [50.4%] male, P < .001). Both groups had increased levels of impairment in adulthood, as measured by traffic incidents, criminal behavior, incarceration, suicide attempts, and comorbidities. However, only 60 children (17.2%) with ADHD continued to have ADHD as young adults, and only 60 young adults (12.6%) with ADHD had the disorder in childhood.
The findings of this study do not support the assumption that adulthood ADHD is necessarily a continuation of childhood ADHD. Rather, they suggest the existence of 2 syndromes that have distinct developmental trajectories.
儿童期发病一直是成人注意缺陷/多动障碍（ADHD）诊断的关键标准，但最近这一要求引起了争议。
在一项基于人群的纵向研究中，调查是否存在伴有 ADHD 症状的年轻成年人总是存在儿童期发病障碍。
设计、地点和参与者：参与者属于 1993 年佩洛塔斯出生队列研究，包括 1993 年在巴西佩洛塔斯出生的 5249 人。他们被随访至 18 至 19 岁，保留率为 81.3%。数据分析于 2015 年 8 月 8 日至 2016 年 2 月 5 日进行。
首次在 11 岁时使用经过校准的 DSM-IV ADHD 诊断筛查工具（基于父母的儿童行为问卷多动分量表）确定 ADHD 状态，该工具基于使用发展和福利评估进行的 DSM-IV 临床访谈。在 18 至 19 岁时，使用 DSM-5 标准诊断 ADHD，除发病年龄外。我们估计了这两组在 11 岁和 18 至 19 岁时的重叠情况，以及这两组与没有 ADHD 的组相比，存在障碍的比例。
11 岁时，393 人（8.9%）存在儿童期 ADHD（C-ADHD）。18 至 19 岁时，492 人（12.2%）符合 DSM-5 青年期 ADHD（YA-ADHD）的所有标准，除发病年龄外。排除合并症后，无合并症的 YA-ADHD 患病率降至 256 人（6.3%）。C-ADHD 患儿中男性比例高于无 ADHD 患儿（251[63.9%] vs 1930[47.9%]男性，P<.001），而 YA-ADHD 组中女性比例较高（192[39.0%] vs 1786[50.4%]男性，P<.001）。两组在成年期都有较高的障碍水平，表现在交通事故、犯罪行为、监禁、自杀未遂和合并症方面。然而，只有 60 名儿童（17.2%）的 ADHD 持续到成年，只有 60 名成年 ADHD 患者（12.6%）在儿童期就患有该疾病。
本研究结果不支持成年 ADHD 必然是儿童期 ADHD 的延续这一假设。相反，它们表明存在两种具有不同发展轨迹的综合征。
