Norman Luke J, Price Jolie, Ahn Kwangmi, Sudre Gustavo, Sharp Wendy, Shaw Philip
National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA.
Section on Neurobehavioral and Clinical Research, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
EClinicalMedicine. 2023 Jun 6;60:102021. doi: 10.1016/j.eclinm.2023.102021. eCollection 2023 Jun.
Attention deficit/hyperactivity disorder (ADHD) is usually conceptualized as a childhood-onset neurodevelopmental disorder, in which symptoms either decrease steadily into adulthood or remain stable. A recent study challenged this view, reporting that for most with ADHD, diagnostic status fluctuates with age. We ask if such a 'fluctuating' ADHD symptom trajectory subgroup is present in other population-based and clinic-based cohorts, centered on childhood and adolescence.
Cohorts were the population-based Adolescent Brain Cognitive Development (ABCD: N = 9735), Neurobehavioral Clinical Research (NCR: N = 258), and the Nathan Kline Institute-Rockland (NKI-Rockland: N = 149). All participants had three or more assessments spanning different age windows. Participants were categorized into developmental diagnostic subgroups: fluctuant ADHD (defined by two or more switches between meeting and not meeting ADHD criteria), remitting ADHD, persisting ADHD, emerging ADHD and never affected. Data were collected between 2011 and 2022. Analyses were performed between May 2022 and April 2023.
A subgroup with fluctuant child and adolescent ADHD diagnoses was found in all cohorts (29.3% of participants with ADHD in ABCD, 26.6% in NCR and 17% in NKI-Rockland). While the proportion of those with fluctuant ADHD increased with the number of assessments, it never constituted the dominant subgroup.
We provide further evidence in three cohorts for the existence of a fluctuant ADHD diagnostic subgroup during childhood and adolescence, albeit in a minority of cases. Such fluctuant child and adolescent ADHD diagnoses may suggest a natural history more akin to relapsing-remitting mood disorders and/or a marked sensitivity to environmental shifts that occur across development.
Intramural programs of the NHGRI and NIMH.
注意力缺陷多动障碍（ADHD）通常被视为一种起病于儿童期的神经发育障碍，其症状在成年期要么逐渐减轻，要么保持稳定。最近一项研究对这一观点提出了挑战，报告称，对于大多数ADHD患者而言，诊断状态会随年龄波动。我们探究在以儿童期和青少年期为中心的其他基于人群和基于临床的队列中，是否存在这样一个“波动型”ADHD症状轨迹亚组。
队列包括基于人群的青少年大脑认知发展研究（ABCD：N = 9735）、神经行为临床研究（NCR：N = 258）以及内森·克莱因研究所-罗克兰研究（NKI-Rockland：N = 149）。所有参与者都有跨越不同年龄阶段的三次或更多次评估。参与者被分类为发育诊断亚组：波动型ADHD（定义为在符合和不符合ADHD标准之间有两次或更多次转变）、缓解型ADHD、持续型ADHD、新发ADHD以及从未受影响。数据收集于2011年至2022年期间。分析于2022年5月至2023年4月进行。
在所有队列中均发现了儿童和青少年ADHD诊断波动的亚组（ABCD中ADHD参与者的29.3%，NCR中为26.6%，NKI-Rockland中为17%）。虽然波动型ADHD患者的比例随着评估次数的增加而上升，但它从未构成主要亚组。
我们在三个队列中进一步证明了在儿童期和青少年期存在波动型ADHD诊断亚组，尽管是少数情况。这种儿童和青少年期波动型ADHD诊断可能表明其疾病自然史更类似于复发缓解型情绪障碍和/或对发育过程中发生的环境变化具有显著敏感性。
国家人类基因组研究所（NHGRI）和国家精神卫生研究所（NIMH）的内部项目。
