Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA, 15213, USA.
Department of Psychology, Florida International University, 11200 SW 8th Street, DM 256, Miami, FL, 33199, USA.
J Abnorm Child Psychol. 2020 Oct;48(10):1265-1277. doi: 10.1007/s10802-020-00675-y.
The literature is inconsistent regarding whether childhood ADHD confers risk for adulthood problematic alcohol use, depressive symptoms, and their co-occurrence. These inconsistencies could be due to meaningful heterogeneity in the adulthood outcomes of children with ADHD that were obscured in traditional group-based analyses. The current study tested this possibility, as well as the contribution of adulthood ADHD symptom persistence, in order to clarify long-term risk in this population. Children diagnosed with ADHD and demographically-similar children without ADHD were followed longitudinally into adulthood and repeatedly assessed on heavy drinking, alcohol problems, and depressive symptoms from ages 21-29 (84.1% White (not Hispanic); 86.9% male; 51.2% childhood ADHD; 14.7% adulthood-persistent ADHD; N = 320). Group-based multi-trajectory modeling identified six groups with different combinations of trajectories across these variables. Heterogeneous longitudinal outcomes for those with ADHD were found. Some children with ADHD showed increased risk as typically predicted, with a higher likelihood of membership in a group with stable-moderate alcohol outcomes and stable-severe depression (adulthood persistent ADHD also predicted this group), whereas some children with ADHD were more likely to belong to a group with virtually no alcohol outcomes and low depression. Additionally, adulthood persistent ADHD predicted membership in a group with stable-severe alcohol outcomes and stable-moderate depression. Given the severity associated with co-occurring alcohol and depressive disorders, studies of early risk and protective factors and long-term outcomes for these disparate trajectory patterns are needed, particularly for those with childhood and persisting ADHD.
文献对于儿童 ADHD 是否会增加成年期问题性饮酒、抑郁症状及其共病风险存在不一致。这些不一致可能是由于 ADHD 儿童的成年期结局存在有意义的异质性，而传统的基于群组的分析掩盖了这种异质性。本研究检验了这种可能性，以及成年期 ADHD 症状持续存在的贡献，以澄清该人群的长期风险。被诊断为 ADHD 的儿童和在人口统计学上与之相似的没有 ADHD 的儿童被纵向随访到成年期，并在 21-29 岁时（84.1%为白人（非西班牙裔）；86.9%为男性；51.2%为儿童 ADHD；14.7%为成年期持续 ADHD；N=320）反复评估重度饮酒、酒精问题和抑郁症状。基于群组的多轨迹建模确定了六个具有不同轨迹组合的组。对于 ADHD 患者，发现了具有异质性的纵向结局。一些 ADHD 儿童表现出了如通常所预测的那样的风险增加，他们更有可能属于一组具有稳定中度酒精结局和稳定重度抑郁的组（成年期持续 ADHD 也预测了这一组），而一些 ADHD 儿童更有可能属于一组几乎没有酒精结局和低抑郁的组。此外，成年期持续 ADHD 预测了一组具有稳定重度酒精结局和稳定中度抑郁的组。鉴于共病的酒精和抑郁障碍的严重程度，需要对这些不同轨迹模式的早期风险和保护因素以及长期结局进行研究，特别是对于那些有儿童期和持续 ADHD 的患者。
