Functional Adult Outcomes 16 Years After Childhood Diagnosis of Attention-Deficit/Hyperactivity Disorder: MTA Results
Open accessAbstract
Objective To compare educational, occupational, legal, emotional, substance use disorder, and sexual behavior outcomes in young adults with persistent and desistent attention-deficit/hyperactivity disorder (ADHD) symptoms and a local normative comparison group (LNCG) in the Multimodal Treatment Study of Children with ADHD (MTA). Method Data were collected 12, 14, and 16 years postbaseline (mean age 24.7 years at 16 years postbaseline) from 476 participants with ADHD diagnosed at age 7 to 9 years, and 241 age- and sex-matched classmates. Probands were subgrouped on persistence versus desistence of DSM-5 symptom count. Orthogonal comparisons contrasted ADHD versus LNCG and symptom-persistent (50%) versus symptom-desistent (50%) subgroups. Functional outcomes were measured with standardized and demographic instruments. Results Three patterns of functional outcomes emerged. Post-secondary education, times fired/quit a job, current income, receiving public assistance, and risky sexual behavior showed the most common pattern: the LNCG group fared best, symptom-persistent ADHD group worst, and symptom-desistent ADHD group between, with the largest effect sizes between LNCG and symptom-persistent ADHD. In the second pattern, seen with emotional outcomes (emotional lability, neuroticism, anxiety disorder, mood disorder) and substance use outcomes, the LNCG and symptom-desistent ADHD group did not differ, but both fared better than the symptom-persistent ADHD group. In the third pattern, noted with jail time (rare), alcohol use disorder (common), and number of jobs held, group differences were not significant. The ADHD group had 10 deaths compared to one death in the LNCG. Conclusion Adult functioning after childhood ADHD varies by domain and is generally worse when ADHD symptoms persist. It is important to identify factors and interventions that promote better functional outcomes.
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The study utilized a previously validated definition of persistence applying the DSM-5 symptom threshold and an impairment threshold.
“We utilized a previously validated definition of persistence,3,10 which applied the DSM-5 symptom threshold (5 or 6 symptoms of either Inattention or Hyperactivity/Impulsivity, depending on age) using the CAARS (or SNAP) and impairment threshold of “3 or higher” on the IRS (or CIS).”
From Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD (2022) · cites this paper as [10]
The Method section, under “Determination of ADHD Symptom Persistence,” says the study used DSM-5 symptom-count criteria on the CAARS, but explicitly states that impairment was not used to define persistence or desistence. It therefore contradicts the claim that this paper’s definition also applied an impairment threshold of 3 or higher on the IRS or CIS. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredHyperactivity/inattention is related to long-term poorer educational attainment, substance use disorders, and poorer quality of life.
“Overall, this potential protective association between reading and hyperactivity is important given that hyperactivity/inattention is related to long-term poorer educational attainment, substance use disorders, and poorer quality of life (Danckaerts et al., 2010; Hechtman et al., 2016; Pingault et al., 2011).”
From Longitudinal associations between reading for pleasure and child maladjustment: Results from a propensity score matching analysis (2020) · cites this paper as Hechtman et al., 2016
The Discussion (page unavailable) links persistent ADHD symptoms to poorer educational outcomes, and the Results report higher substance use disorder rates in the symptom-persistent subgroup. The study found no significant substance-use difference between the overall ADHD and comparison groups, however, and the passages do not establish poorer quality of life as an outcome. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe high prevalence of partial remission is consistent with the finding of Hechtman et al. that many MTA ADHD group participants who failed to meet ADHD symptom criteria in adulthood still suffered significant impairments.
“The high prevalence of partial remission is consistent with the finding of Hechtman et al. that many MTA ADHD group participants who failed to meet ADHD symptom criteria in adulthood still suffered significant impairments.”
From Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD (2022) · cites this paper as [10]
ADHD is considered a life-course disorder.
“even though ADHD is considered a life-course disorder.”
From Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD (2022) · cites this paper as [10]
There is virtually no scientific information on the extent to which individuals sustain remission long-term, experience recurrence of ADHD post-remission, or fluctuate between full remission, partial remission, and ADHD persistence.
“There is virtually no scientific information on the extent to which individuals sustain remission long-term (i.e., recover from ADHD symptoms and impairments), experience recurrence of ADHD post-remission (i.e., remission is temporary), or fluctuate between full remission, partial remission, and ADHD persistence (whether ADHD might be a waxing and waning disorder).”
From Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD (2022) · cites this paper as [10]
The Discussion says few studies have compared adult outcomes for people whose ADHD symptoms persisted or desisted. It does not address how often remission is sustained, ADHD recurs after remission, or individuals move among remission and persistence states. Searches for recurrence and fluctuating remission found no passage making that broader claim; page numbers were not available in our copy. (LLM, conf=0.72)
Experimental — accuracy not yet measured
Most longitudinal work on ADHD remission and persistence reports only a single-time snapshot of functioning.
“Most longitudinal work on ADHD remission and persistence reports only a single-time snapshot of functioning, even though ADHD is considered a life-course disorder.”
From Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD (2022) · cites this paper as [10]
The Introduction (page unavailable) describes prior prospective follow-up studies and their adult outcomes, but does not say that most report functioning at only one time point. The Discussion (page unavailable) compares this study with previous longitudinal work without addressing that claim. Searches for single-time-point and cross-sectional reporting found no supporting passage in our copy. (LLM, conf=0.70)
Experimental — accuracy not yet measured
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- Authors
- Hechtman, L., Swanson, J. M., Sibley, M. H., Stehli, A., Owens, E. B., Mitchell, J. T., Arnold, L. E., Molina, B. S. G., Hinshaw, S. P., Jensen, P. S., Abikoff, H. B., Perez Algorta, G., Howard, A. L., Hoza, B., Etcovitch, J., Houssais, S., Lakes, K. D., Nichols, J. Q., Vitiello, B., Severe, J. B., Jensen, P. S., Arnold, L. E., Hoagwood, K., Richters, J., Vereen, D., Hinshaw, S. P., Elliott, G. R., Wells, K. C., Epstein, J. N., Murray, D. W., Conners, C. K., March, J., Swanson, J., Wigal, T., Cantwell, D. P., Abikoff, H. B., Hechtman, L., Greenhill, L. L., Newcorn, J. H., Molina, B., Hoza, B., Pelham, W. E., Gibbons, R. D., Marcus, S., Hur, K., Kraemer, H. C., Hanley, T., & Stern, K.
- Affiliations
- Florida International University (US)
- University of California, Irvine (US)
- University of California, Berkeley (US)
- Duke Medical Center (US)
- Carleton University (CA)
- McGill University Health Centre (CA)
- University of Vermont (US)
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2016-11
- Volume
- 55
- Issue
- 11
- Pages
- 945-952.e2
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC5113724
- OpenAlex
- W2512638152
- Cited by
- 292
- References
- 7
- Citations by year
- 2026: 16 · 2025: 27 · 2024: 22 · 2023: 29 · 2022: 28 · 2021: 39 · 2020: 31 · 2019: 28 · 2018: 39 · 2017: 25 · 2016: 7 · 2012: 1
- FWCI
- 25.22
- Type
- journal article
- Language
- en
- Update notices
- Open access
- green
- eprints.lancs.ac.uk
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Lancaster EPrints (Lancaster University) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Funders
- University of California, Irvine (DA-8-5549, DA-8-5551, DA-8-5552, HHSN271200800006- C, N01-MH12007, N01MH 12004, N01MH12011, U01-MH50453, U01MH50440)
- McGill University (DA-8-5548, N01MH12008)
- National Institute on Drug Abuse
- University of California (DA-8-5550, DA-8-5554, N01MH12009, N01MH12012, U01-MH50461, U01-MH50477)
- University of Pittsburgh (DA-8-5553, DA039881, N01 MH 12010, U01-MH50467)
- National Institute of Mental Health
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- attention deficit hyperactivity disorder, adult outcomes, symptom persistence, educational outcomes, occupational outcomes, substance use disorders, alcoholism, sexual behavior, emotional outcomes, income, social assistance, prison sentence
- MeSH terms
- Adolescent, Adult, Aftercare, Attention Deficit Disorder with Hyperactivity, Child, Employment, Female, Humans, Male, Disease Progression, Substance-Related Disorders, Young Adult
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