Kids Diagnosed With ADHD Often Remit

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Kids Diagnosed With ADHD Often Remit

By: MITCHEL L. ZOLER, Internal Medicine News Digital Network

11/12/10

NEW YORK – A diagnosis of ADHD might not be forever.

In fact, it can be pretty fleeting. Analysis of serial assessments of more than

8,000 U.S. children and adolescents for attention-deficit/hyperactivity disorder

(ADHD) showed that the diagnosis often did not persist after follow-up of 1 year

or longer, J. Blake , Ph.D., said at the annual meeting of the American

Academy of Child & Adolescent Psychiatry.

ADHD diagnoses " are extremely transient over a 1-year period. Generally, loss of

the diagnosis is more likely than persistence, " said Dr. , a researcher in

the division of child and adolescent psychiatry at Columbia University in New

York.

The findings suggest that problems exist with current nosology for ADHD, and

that current prevalence estimates from community studies may be inflated. " We

need to examine the predictors of ADHD persistence over time, " he said. " We need

to look at what’s going on here and what predicts the persistence of disruptive

disorders.

" If patients are diagnosed with ADHD and it is transient – if it is reactive

distress that is likely to go away – do we want to identify them? " he asked in

an interview. " If a diagnosis is made of ADHD, do you let it go because it will

likely resolve on its own, or will treatment help it resolve more quickly? " We

think of ADHD as something that lasts, not something that comes and goes.

Perhaps we need [a diagnosis] that’s more stable, " possibly by basing it on a

larger number of symptoms. " That would mean changing the ADHD diagnosis, " he

said.

Preliminary analysis of serial assessments for oppositional defiance disorder

and conduct disorder in the same data set of 8,714 children and adolescents

showed similar, transient patterns after an initial diagnosis, Dr. added.

" It troubles me that the [ADHD] phenotype looks so unstable, " commented Dr.

S. Pine, chief of the Section on Development and Affective Neuroscience

at the National Institute of Mental Health. " A lot of people are struggling with

the threshold for [diagnosing] ADHD. This is a very different conceptualization

of ADHD; we don’t usually think of it as something that’s gone in 2 years. If

this is [children having] a transient reaction to stress, I don’t want to talk

about it [in] the same way as clinical ADHD.

Dr. Pine suggested that Dr. ’s new finding might help explain the high

reported prevalence rates of ADHD, and that the results also raised issues about

using stimulants to treat newly diagnosed ADHD.

" I look at some of the prevalences [reported], and it’s absurd. I find it very

hard to believe that 20% of American boys have ADHD, " but that is what some

recent reports documented, Dr. Pine said. Other reports said that about 6% of

all American children and about 12% of boys receive stimulant treatment for

ADHD. " When I look at these data [in Dr. ’s report], the question of

stimulant use is right behind there. "

Dr. used data collected by 4 of the 16 studies done by researchers in the

DISC (Diagnostic Interview Schedule for Children) Nosology Group. All of the

studies used the DISC to assess a group of children, adolescents, or both. The

four studies used by Dr. included serial assessments using the DISC for

ADHD a year or more apart. Depending on the study and whether the diagnostic

criteria included the age of onset, the range of ADHD prevalence at the initial

examination was 5%-40%, with roughly 1,200 total cases identified.

At a follow-up visit at least 1 year following the initial examination, loss of

the ADHD diagnosis occurred in roughly 55%-75% of the patients who had been

diagnosed with inattention ADHD the first time. In patients who were initially

diagnosed with hyperactive ADHD, the loss rate at follow-up ran 55%-65%. Those

who were first diagnosed with combined ADHD had a more stable course, with about

18%-35% not maintaining the diagnosis at follow-up.

Additional analysis showed that lost ADHD diagnoses usually did not occur as a

small change in an initially marginal diagnosis. Patients who changed from

having ADHD to not having it lost five ADHD symptoms, on average. And the

remitters and nonremitters all had a similar pattern of disease severity at

their initial diagnosis. Patients’ age had no association with whether or not an

ADHD diagnosis disappeared. And patients who received treatment had a higher

likelihood of retaining their ADHD diagnosis at follow-up than did those who did

not receive treatment, possibly because the patients who were treated generally

had more chronic ADHD.

Dr. had no disclosures.

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