Skip to main content
eScholarship
Open Access Publications from the University of California

UC Berkeley

UC Berkeley Electronic Theses and Dissertations bannerUC Berkeley

How Persistent is ADHD into Adulthood? Informant Report and Diagnostic Thresholds in a Female Sample

  • Author(s): Guelzow, Brian Tate
  • Advisor(s): Hinshaw, Stephen P
  • et al.
Abstract

Although the notion that Attention-Deficit/Hyperactivity Disorder (ADHD) often persists into adulthood is increasingly accepted, important diagnostic questions remain. Using a large (baseline proband n = 140, comparison n = 88) prospectively followed, ethnically diverse female sample, I examined the impacts of (a) informant (i.e., parent- vs. self-report) and (b) diagnostic symptom threshold (i.e., the DSM-IV 6/9 symptoms of inattention [IA] or hyperactivity/impulsivity [H/I] vs. a developmentally referenced criterion [DRC]) on estimates of ADHD persistence from childhood (age range 6-12) into young adulthood (mean age = 19.6 years). Further, I assessed and compared the predictive validity of ADHD status per each informant, as well as via the two different symptom cutoffs, on measures assessing functioning in a number of important domains (e.g., depression, academic achievement, global impairment).

Separate 2 x 2 (Wave 1 diagnostic status x Wave 3 diagnostic status) chi-square analyses revealed that per parent-report, significantly more probands (44%) than baseline comparison participants (1%) met full ADHD criteria (χ2 [187] = 42.51, p< 0.001, φ = 0.47). Significantly more probands (22%) than comparisons (2%; (χ2 [209] = 15.97, p< 0.001, φ = 0.28) met full criteria via young adult self-report as well. Informant diagnostic concordance was significant, but of a small effect size (κ; = .22). Using a series of hierarchical multiple regression analyses and controlling for key covariates, parent-reported ADHD was found to be independently associated with poorer outcomes on eight of nine considered measures (|β|'s ranging from 0.18 to 0.61). Self-reported ADHD was independently associated only with lower math scores (|β| = .18).

As in past research, the DRC was set at two SD above the comparison participants' mean symptom number, yielding a diagnostic threshold of 4/9 H/I and 5/9 IA symptoms. Via the DSM-IV cutoff, ADHD was estimated to persist in 55.9% of baseline probands; via the DRC, this estimate rose to 61.4%. One-way ANCOVA models were used to test mean differences on outcome measures for participants who met the DSM-IV threshold, those who only met the DRC ("DRC-only"), and those who met neither threshold. All models were significant (all Fs >6.50, all ps < .01). DRC-only participants endorsed poorer outcomes of large to very large effect sizes across seven of the study's nine outcome measures, compared to participants who met neither cutoff. Further, DRC-only participants did not differ on any outcome measure from those who met the higher DSM-IV threshold.

The present findings add to extant research in suggesting that (a) parent-report yields higher ADHD persistence estimates than young adult self-report and (b) parent-reported persistence remains a more potent predictor of young adult functioning than self-report. Findings also suggest that self-reported ADHD persistence rates may be higher in young adult females than in males, although this suggestion merits further investigation. Further, findings suggest that a lower symptom threshold than that traditionally used in clinical nomenclatures (i.e., than a threshold identical to that of child-based diagnosis) may be more developmentally appropriate in young adults.

Main Content
Current View