Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, Washington.
Corresponding Author: Margaret H. Sibley, PhD, Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA 98101 (
J Clin Psychiatry. 2024 Oct 16;85(4):24m15395. doi: 10.4088/JCP.24m15395.
Recent studies report a fluctuating course of attention-deficit/ hyperactivity disorder (ADHD) across development characterized by intermittent periods of remission and recurrence. In the Multimodal Treatment of ADHD (MTA) study, we investigated fluctuating ADHD including clinical expression over time, childhood predictors, and between- and within-person associations with factors hypothesized as relevant to remission and recurrence. Children with ADHD, combined type (N 483), participating in the MTA adult follow-up were assessed 9 times from baseline (mean age = 8.46) to 16-year follow-up (mean age = 25.12). The fluctuating subgroup (63.8% of sample) was compared to other MTA subgroups on variables of interest over time. The fluctuating subgroup experienced multiple fluctuations over 16 years (mean 3.58 SD = 1.36) with a 6- to 7-symptom within-person difference between peaks and troughs. Remission periods typically first occurred in adolescence and were associated with higher environmental demands (both between- and within-person), particularly at younger ages. Compared to other groups, the fluctuating subgroup demonstrated moderate clinical severity. In contrast, the stable persistent group (10.8%) was specifically associated with early and lasting risk for mood disorders, substance use problems in adolescence/ young adulthood, low medication utilization, and poorer response to childhood treatment. Protective factors were detected in the recovery group (9.1%; very low parental psychopathology) and the partial remission group (15.6%; higher rates of comorbid anxiety). In the absence of specific risk or protective factors, individuals with ADHD demonstrated meaningful within-individual fluctuations across development. Clinicians should communicate this expectation and monitor fluctuations to trigger as-needed return to care. During remission periods, individuals with ADHD successfully manage increased demands and responsibilities. ClinicalTrials.gov identifier: NCT00000388.
最近的研究报告称，注意缺陷多动障碍 (ADHD) 在整个发展过程中呈现波动的病程，其特征是间歇性缓解和复发。在 ADHD 的多模式治疗 (MTA) 研究中，我们研究了 ADHD 的波动性，包括随时间的临床表现、儿童期预测因素以及与假设与缓解和复发相关的因素之间的个体内和个体间关联。 参加 MTA 成人随访的 ADHD 混合表型（N 483）儿童从基线（平均年龄 = 8.46）到 16 年随访（平均年龄 = 25.12）进行了 9 次评估。波动亚组（样本的 63.8%）与其他 MTA 亚组在随时间变化的感兴趣变量上进行了比较。 波动亚组在 16 年内经历了多次波动（平均 3.58 SD = 1.36），在高峰和低谷之间存在 6-7 个症状的个体内差异。缓解期通常首先出现在青春期，与更高的环境需求（个体内和个体间）相关，尤其是在年龄较小的时候。与其他组相比，波动亚组表现出中等的临床严重程度。相比之下，稳定持续组（10.8%）与情绪障碍、青少年/成年早期的物质使用问题、低药物利用率以及对儿童治疗的反应较差等早期和持续的风险特别相关。在恢复组（9.1%；父母精神病理学非常低）和部分缓解组（15.6%；更高的共病焦虑率）中发现了保护因素。 在没有特定风险或保护因素的情况下，ADHD 个体在整个发展过程中表现出显著的个体内波动。临床医生应传达这种期望并监测波动，以在需要时重新开始治疗。在缓解期，ADHD 患者成功地管理了增加的需求和责任。 ClinicalTrials.gov 标识符：NCT00000388。
