Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity
Open accessAbstract
Objective: Longitudinal studies of children diagnosed with ADHD report widely ranging ADHD persistence rates in adulthood (5–75%). This study documents how information source (parent vs. self‐report), method (rating scale vs. interview), and symptom threshold (DSM vs. norm‐based) influence reported ADHD persistence rates in adulthood. Method: Five hundred seventy‐nine children were diagnosed with DSM‐IV ADHD‐Combined Type at baseline (ages 7.0–9.9 years) 289 classmates served as a local normative comparison group (LNCG), 476 and 241 of whom respectively were evaluated in adulthood (Mean Age = 24.7). Parent and self‐reports of symptoms and impairment on rating scales and structured interviews were used to investigate ADHD persistence in adulthood. Results: Persistence rates were higher when using parent rather than self‐reports, structured interviews rather than rating scales (for self‐report but not parent report), and a norm‐based (NB) threshold of 4 symptoms rather than DSM criteria. Receiver‐Operating Characteristics (ROC) analyses revealed that sensitivity and specificity were optimized by combining parent and self‐reports on a rating scale and applying a NB threshold. Conclusion: The interview format optimizes young adult self‐reporting when parent reports are not available. However, the combination of parent and self‐reports from rating scales, using an ‘or’ rule and a NB threshold optimized the balance between sensitivity and specificity. With this definition, 60% of the ADHD group demonstrated symptom persistence and 41% met both symptom and impairment criteria in adulthood.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
ADHD is a neurobiological disorder typically first detected in childhood that persists into adulthood in approximately 50% of cases.
“Decades of research characterize Attention-Deficit/Hyperactivity Disorder (ADHD) as a neurobiological disorder typically first detected in childhood that persists into adulthood in approximately 50% of cases.”
From Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD (2022) · cites this paper as [3]
The Discussion (page unavailable) reports approximately 60% symptom persistence under its optimized definition, or 41.1% when impairment is also required, so approximately 50% is a rough characterization rather than the paper’s stated estimate. The study follows children diagnosed with ADHD into adulthood, but the passages do not characterize ADHD as a neurobiological disorder. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe 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 [3]
Methods > Analyses evaluates a DSM-5 threshold of five symptoms, and Methods > Measures uses CAARS ratings and an IRS impairment cutoff of ≥3. However, Results > Analysis 2 and the Discussion identify the optimized persistence definition as a norm-based threshold of four symptoms, not the DSM-5 threshold. The paper therefore supports components of the cited definition, but not its characterization as the definition validated by this study; it also does not establish the stated age-dependent threshold or SNAP/CIS alternatives. (LLM, conf=0.87)
Experimental — accuracy not yet measuredFor many individuals, ADHD causes symptoms and dysfunction over long periods of time, even into adulthood.
“As in the 2 previous guidelines, this recommendation is based on the evidence that for many individuals, ADHD causes symptoms and dysfunction over long periods of time, even into adulthood.”
From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [70]
Impairments persist into adulthood.
“Authors of longitudinal studies have found that ADHD treatments are frequently not maintained over time13 and impairments persist into adulthood.70”
From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [70]
ADHD is a chronic condition.
“ADHD is a chronic condition; therefore, the PCC should manage children and adolescents with ADHD in the same manner that they would children and youth with special health care needs, following the principles of the chronic care model and the medical home (Table 5).”
From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [70]
To prevent false negative symptom and impairment reports due to under-reporting, participants meeting the remitted definition and unimpaired criterion were required to have at least one other informant report corroborating the lack of difficulties.
“To prevent false negative symptom and impairment reports due to under-reporting by participants with ADHD,3,27 we required those meeting the “remitted” definition (and “unimpaired” criterion) to have at least one other informant report to corroborate the lack of difficulties.”
From Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD (2022) · cites this paper as [3]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
DeLong, E. R., DeLong, D. M., & Clarke-Pearson, D. L. (1988) · Biometrics · doi:10.2307/2531595 · Cited by 22,649 · see citing works
(1999) · Archives of General Psychiatry · doi:10.1001/archpsyc.56.12.1073 · Cited by 3,372 · see citing works
Self-citationMolina, B. S. G., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., Epstein, J. N., Hoza, B., Hechtman, L., Abikoff, H. B., et al. (2009) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e31819c23d0 · Cited by 1,182 · see citing works
Self-citationHinshaw, S. P., Owens, E. B., Zalecki, C., Huggins, S. P., Montenegro-Nevado, A. J., Schrodek, E., & Swanson, E. N. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0029451 · Cited by 366 · cited 5× · see citing works
“…& Fischer, 2008; Biederman, Petty, Clarke, Lomedico, & Faraone, 2011; Biederman, Petty, O’Connor, Hyder, & Faraone, 2012; Halperin, Trampush, Miller, Marks, & Newcorn, 2008; Hinshaw et al., 2012; Klein et al., 2012; Mannuzza, Klein, & Moulton Iii, 2002; Sibley et al., 2012; Weiss & Hechtman, 1993).”
InfluentialSelf-citationHalperin, J. M., Trampush, J. W., Miller, C. J., Marks, D. J., & Newcorn, J. H. (2008) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2008.01926.x · Cited by 252 · see citing works
Flagged first, then by citations
Research works printed but not linked: 17
- Barkley RA Murphy KR Fischer M 2008 ADHD in adults: What the science says Guilford Press
- Barkley RA Fischer M Smallish L Fletcher K 2002 The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder Journal of abnormal psychology 111 279 12003449
- Biederman J Petty CR Clarke A Lomedico A Faraone SV 2011 Predictors of persistent ADHD: an 11-year follow-up study Journal of psychiatric research 45 150 155 20656298 PMC3068747
- Biederman J Petty CR O'Connor KB Hyder LL Faraone SV 2012 Predictors of persistence in girls with attention deficit hyperactivity disorder: results from an 11- year controlled follow- up study Acta Psychiatrica Scandinavica 125 147 156 22097933 PMC3254799
- Fabiano GA Pelham WE Jr Waschbusch DA Gnagy EM Lahey BB Chronis AM Burrows-MacLean L 2006 A practical measure of impairment: psychometric properties of the impairment rating scale in samples of children with attention deficit hyperactivity disorder and two school-based samples Journal of Clinical Child and Adolescent Psychology 35 369 385 16836475
- Hanley JA McNeil BJ 1982 The meaning and use of the area under a receiver operating characteristic (ROC) curve Radiology 143 29 36 7063747
- Jensen PS Arnold LE Swanson JM Vitiello B Abikoff HB Greenhill LL Hur K 2007 3-year follow-up of the NIMH MTA study Journal of the American Academy of Child & Adolescent Psychiatry 46 989 1002 17667478
- Klein RG Mannuzza S Olazagasti MAR Roizen E Hutchison JA Lashua EC Castellanos FX 2012 Clinical and functional outcome of childhood attention-deficit/hyperactivity disorder 33 years later Archives of general psychiatry 69 1295 1303 23070149 PMC3597443
- Mannuzza S Klein RG Moulton JL Iii 2002 Young adult outcome of children with “situational” hyperactivity: a prospective, controlled follow-up study Journal of abnormal child psychology 30 191 198 12008657
- Molina BSG Sibley MH 2014 The Case for Including Informant Reports in the Assessment of Adulthood ADHD The ADHD Report 22 8 1 7 10.1521/adhd.2014.22.8.1 · DOI
- Molina BS Flory K Hinshaw SP Greiner AR Arnold LE Swanson JM Wigal T 2007 Delinquent behavior and emerging substance use in the MTA at 36 months: prevalence, course, and treatment effects Journal of the American Academy of Child & Adolescent Psychiatry 46 1028 1040 17667481
- Molina BS Hinshaw SP Arnold LE Swanson JM Pelham WE Hechtman L MTA Cooperative Group 2013 Adolescent substance use in the multimodal treatment study of attention-deficit/hyperactivity disorder (ADHD)(MTA) as a function of childhood ADHD, random assignment to childhood treatments, and subsequent medication Journal of the American Academy of Child & Adolescent Psychiatry 52 250 263 23452682 PMC3589108
- Newcombe RG 1998 Improved confidence intervals for the difference between binomial proportions based on paired data Statistics in medicine 17 2635 2650 9839354
- Shaffer D Fisher P Lucas CP Dulcan MK Schwab-Stone ME 2000 NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses Journal of the American Academy of Child & Adolescent Psychiatry 39 28 38 10638065
- Sibley MH Pelham WE Jr Molina BS Gnagy EM Waxmonsky JG Waschbusch DA Kuriyan AB 2012 When diagnosing ADHD in young adults emphasize informant reports, DSM items, and impairment Journal of consulting and clinical psychology 80 1052 22774792 PMC3919146
- Swanson JM Arnold LE Molina BSG Sibley MH Hechtman LT the MTA Cooperative Group under review Prospective Follow-up of the Multimodal Treatment Study of ADHD: Effects of Medication, Maturation, and Source on Symptom Severity in Adulthood Paper Submitted for Publication as a companion article to this one
- Weiss G Hechtman LT 1993 Hyperactive children grown up: ADHD in children, adolescents, and adults Guilford Press
Cited by
Sorted by citations
Subcommittee on Attention-Deficit/Hyperactivity Disorder, S. C. O. Q. I. A. M. (2011) · Pediatrics · doi:10.1542/peds.2011-2654 · Cited by 2,185 · see citing works
Wolraich, M. L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., et al. (2019) · Pediatrics · doi:10.1542/peds.2019-2528 · Cited by 1,410 · see citing works
Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD
Sibley, M. H., Arnold, L. E., Swanson, J. M., Hechtman, L. T., Kennedy, T. M., Owens, E., Molina, B. S. G., Jensen, P. S., Hinshaw, S. P., Roy, A., et al. (2022) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2021.21010032 · Cited by 340 · see citing works
Self-citationLate-Onset ADHD Reconsidered With Comprehensive Repeated Assessments Between Ages 10 and 25
Sibley, M. H., Rohde, L. A., Swanson, J. M., Hechtman, L. T., Molina, B. S. G., Mitchell, J. T., Arnold, L. E., Caye, A., Kennedy, T. M., Roy, A., et al. (2018) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2017.17030298 · Cited by 165 · see citing works
Self-citationCherkasova, M. V., Roy, A., Molina, B. S. G., Scott, G., Weiss, G., Barkley, R. A., Biederman, J., Uchida, M., Hinshaw, S. P., Owens, E. B., et al. (2022) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2021.05.019 · Cited by 137 · see citing works
Self-citationMolina, B. S. G., Howard, A. L., Swanson, J. M., Stehli, A., Mitchell, J. T., Kennedy, T. M., Epstein, J. N., Arnold, L. E., Hechtman, L., Vitiello, B., et al. (2018) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12855 · Cited by 130 · see citing works
Self-citationAdult ADHD and romantic relationships: What we know and what we can do to help
Wymbs, B. T., Canu, W. H., Sacchetti, G. M., & Ranson, L. M. (2021) · Journal of Marital and Family Therapy · doi:10.1111/jmft.12475 · Cited by 67 · see citing works
Attention-deficit/hyperactivity disorder and mortality risk in Taiwan.
Chen, V. C.-H., Chan, H.-L., Wu, S.-I., Lee, M., Lu, M.-L., Liang, H.-Y., Dewey, M. E., Stewart, R., & Lee, C. T.-C. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.8714 · Cited by 64 · see citing works
Adult-Onset ADHD: A Critical Analysis and Alternative Explanations
Taylor, L. E., Kaplan-Kahn, E. A., Lighthall, R. A., & Antshel, K. M. (2022) · Child Psychiatry & Human Development · doi:10.1007/s10578-021-01159-w · Cited by 50 · see citing works
Gomez-Sanchez, C. I., Carballo, J. J., Riveiro-Alvarez, R., Soto-Insuga, V., Rodrigo, M., Mahillo-Fernandez, I., Abad-Santos, F., Dal-Ré, R., & Ayuso, C. (2017) · Scientific Reports · doi:10.1038/s41598-017-10912-y · Cited by 24 · see citing works
Kao, P.-H., Ho, C.-H., & Huang, C. L.-C. (2025) · PLOS ONE · doi:10.1371/journal.pone.0315587 · Cited by 13 · see citing works
Buadze, A., Ajdacic-Gross, V., Müller, M., Xu, Y., Seifritz, E., Wagner, E.-Y. N., von Känel, R., Glaus, J., Ranjbar, S., Castelao, E., et al. (2026) · PLOS One · doi:10.1371/journal.pone.0340179 · Cited by 1 · see citing works
- Authors
- Sibley, M. H., Swanson, J. M., Arnold, L. E., Hechtman, L. T., Owens, E. B., Stehli, A., Abikoff, H., Hinshaw, S. P., Molina, B. S. G., Mitchell, J. T., Jensen, P. S., Howard, A. L., Lakes, K. D., Pelham, W. E., & the MTA Cooperative Group
- Affiliations
- Florida International University (US)
- University of California, Irvine (US)
- The Ohio State University (US)
- Montreal Children's Hospital (CA)
- University of California, Berkeley (US)
- NYU Langone Health (US)
- University of Pittsburgh (US)
- Duke Medical Center (US)
- Realistic Education in Action Coalition to Foster Health (US)
- Carleton University (CA)
- Corresponding author
- Sibley, Margaret H.
- ORCID
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2016-09-19
- Volume
- 58
- Issue
- 6
- Pages
- 655-662
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- PMC
- PMC5809153
- OpenAlex
- W2523347043
- Cited by
- 274
- References
- 5
- Citations by year
- 2026: 28 · 2025: 42 · 2024: 36 · 2023: 35 · 2022: 24 · 2021: 30 · 2020: 18 · 2019: 25 · 2018: 10 · 2017: 19 · 2016: 6
- FWCI
- 17.77
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Mental Health
- National Institute on Drug Abuse
- 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, combined type ADHD, parent report, self-report, rating scales, structured interviews, DSM diagnostic criteria, sensitivity and specificity, longitudinal follow-up
- MeSH terms
- Adult, Attention Deficit Disorder with Hyperactivity, Child, Humans, Interview, Psychological, Longitudinal Studies, Parents, Psychiatric Status Rating Scales, Sensitivity and Specificity, Prevalence, Young Adult, Self Report
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
