Three-year latent class trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms in a clinical sample not selected for ADHD

L. Eugene Arnold, Stephen J. Ganocy, Katherine Mount, Eric A. Youngstrom, Thomas Frazier, Mary Fristad, Sarah M. Horwitz, Boris Birmaher, Robert L Findling, Robert A. Kowatch, Christine Demeter, David Axelson, Mary Kay Gill, Linda Marsh

Research output: Contribution to journalArticle

Abstract

Objective This study aims to examine trajectories of attention-deficit/ hyperactivity disorder (ADHD) symptoms in the Longitudinal Assessment of Manic Symptoms (LAMS) sample. Method The LAMS study assessed 684 children aged 6 to 12 years with the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) and rating scales semi-annually for 3 years. Although they were selected for elevated manic symptoms, 526 children had baseline ADHD diagnoses. With growth mixture modeling (GMM), we separately analyzed inattentive and hyperactive/impulsive symptoms, covarying baseline age. Multiple standard methods determined optimal fit. The χ2 and Kruskal-Wallis analysis of variance compared resulting latent classes/trajectories on clinical characteristics and medication. Results Three latent class trajectories best described inattentive symptoms, and 4 classes best described hyperactive/impulsive symptoms. Inattentive trajectories maintained their relative position over time. Hyperactive/impulsive symptoms had 2 consistent trajectories (least and most severe). A third trajectory (4.5%) started mild, then escalated; and a fourth (14%) started severe but improved dramatically. The improving trajectory was associated with the highest rate of ADHD and lowest rate of bipolar diagnoses. Three-fourths of the mildest inattention class were also in the mildest hyperactive/impulsive class; 72% of the severest inattentive class were in the severest hyperactive/impulsive class, but the severest inattention class also included 62% of the improving hyperactive-impulsive class. Conclusion An ADHD rather than bipolar diagnosis prognosticates a better course of hyperactive/impulsive, but not inattentive, symptoms. High overlap of relative severity between inattention and hyperactivity/impulsivity confirms the link between these symptom clusters. Hyperactive/impulsive symptoms wane more over time. Group means are insufficient to understand individual ADHD prognosis. A small subgroup deteriorates over time in hyperactivity/impulsivity and needs better treatments than currently provided.

Original languageEnglish (US)
Pages (from-to)745-760
Number of pages16
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume53
Issue number7
DOIs
StatePublished - 2014

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Attention Deficit Disorder with Hyperactivity
Symptom Assessment
Impulsive Behavior
Mood Disorders
Schizophrenia
Analysis of Variance
Appointments and Schedules
Growth
Therapeutics

Keywords

  • ADHD
  • GMM
  • hyperactivity/impulsivity
  • inattention
  • longitudinal symptoms

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Developmental and Educational Psychology

Cite this

Three-year latent class trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms in a clinical sample not selected for ADHD. / Arnold, L. Eugene; Ganocy, Stephen J.; Mount, Katherine; Youngstrom, Eric A.; Frazier, Thomas; Fristad, Mary; Horwitz, Sarah M.; Birmaher, Boris; Findling, Robert L; Kowatch, Robert A.; Demeter, Christine; Axelson, David; Gill, Mary Kay; Marsh, Linda.

In: Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 53, No. 7, 2014, p. 745-760.

Research output: Contribution to journalArticle

Arnold, LE, Ganocy, SJ, Mount, K, Youngstrom, EA, Frazier, T, Fristad, M, Horwitz, SM, Birmaher, B, Findling, RL, Kowatch, RA, Demeter, C, Axelson, D, Gill, MK & Marsh, L 2014, 'Three-year latent class trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms in a clinical sample not selected for ADHD', Journal of the American Academy of Child and Adolescent Psychiatry, vol. 53, no. 7, pp. 745-760. https://doi.org/10.1016/j.jaac.2014.03.007
Arnold, L. Eugene ; Ganocy, Stephen J. ; Mount, Katherine ; Youngstrom, Eric A. ; Frazier, Thomas ; Fristad, Mary ; Horwitz, Sarah M. ; Birmaher, Boris ; Findling, Robert L ; Kowatch, Robert A. ; Demeter, Christine ; Axelson, David ; Gill, Mary Kay ; Marsh, Linda. / Three-year latent class trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms in a clinical sample not selected for ADHD. In: Journal of the American Academy of Child and Adolescent Psychiatry. 2014 ; Vol. 53, No. 7. pp. 745-760.
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abstract = "Objective This study aims to examine trajectories of attention-deficit/ hyperactivity disorder (ADHD) symptoms in the Longitudinal Assessment of Manic Symptoms (LAMS) sample. Method The LAMS study assessed 684 children aged 6 to 12 years with the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) and rating scales semi-annually for 3 years. Although they were selected for elevated manic symptoms, 526 children had baseline ADHD diagnoses. With growth mixture modeling (GMM), we separately analyzed inattentive and hyperactive/impulsive symptoms, covarying baseline age. Multiple standard methods determined optimal fit. The χ2 and Kruskal-Wallis analysis of variance compared resulting latent classes/trajectories on clinical characteristics and medication. Results Three latent class trajectories best described inattentive symptoms, and 4 classes best described hyperactive/impulsive symptoms. Inattentive trajectories maintained their relative position over time. Hyperactive/impulsive symptoms had 2 consistent trajectories (least and most severe). A third trajectory (4.5{\%}) started mild, then escalated; and a fourth (14{\%}) started severe but improved dramatically. The improving trajectory was associated with the highest rate of ADHD and lowest rate of bipolar diagnoses. Three-fourths of the mildest inattention class were also in the mildest hyperactive/impulsive class; 72{\%} of the severest inattentive class were in the severest hyperactive/impulsive class, but the severest inattention class also included 62{\%} of the improving hyperactive-impulsive class. Conclusion An ADHD rather than bipolar diagnosis prognosticates a better course of hyperactive/impulsive, but not inattentive, symptoms. High overlap of relative severity between inattention and hyperactivity/impulsivity confirms the link between these symptom clusters. Hyperactive/impulsive symptoms wane more over time. Group means are insufficient to understand individual ADHD prognosis. A small subgroup deteriorates over time in hyperactivity/impulsivity and needs better treatments than currently provided.",
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AU - Youngstrom, Eric A.

AU - Frazier, Thomas

AU - Fristad, Mary

AU - Horwitz, Sarah M.

AU - Birmaher, Boris

AU - Findling, Robert L

AU - Kowatch, Robert A.

AU - Demeter, Christine

AU - Axelson, David

AU - Gill, Mary Kay

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N2 - Objective This study aims to examine trajectories of attention-deficit/ hyperactivity disorder (ADHD) symptoms in the Longitudinal Assessment of Manic Symptoms (LAMS) sample. Method The LAMS study assessed 684 children aged 6 to 12 years with the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) and rating scales semi-annually for 3 years. Although they were selected for elevated manic symptoms, 526 children had baseline ADHD diagnoses. With growth mixture modeling (GMM), we separately analyzed inattentive and hyperactive/impulsive symptoms, covarying baseline age. Multiple standard methods determined optimal fit. The χ2 and Kruskal-Wallis analysis of variance compared resulting latent classes/trajectories on clinical characteristics and medication. Results Three latent class trajectories best described inattentive symptoms, and 4 classes best described hyperactive/impulsive symptoms. Inattentive trajectories maintained their relative position over time. Hyperactive/impulsive symptoms had 2 consistent trajectories (least and most severe). A third trajectory (4.5%) started mild, then escalated; and a fourth (14%) started severe but improved dramatically. The improving trajectory was associated with the highest rate of ADHD and lowest rate of bipolar diagnoses. Three-fourths of the mildest inattention class were also in the mildest hyperactive/impulsive class; 72% of the severest inattentive class were in the severest hyperactive/impulsive class, but the severest inattention class also included 62% of the improving hyperactive-impulsive class. Conclusion An ADHD rather than bipolar diagnosis prognosticates a better course of hyperactive/impulsive, but not inattentive, symptoms. High overlap of relative severity between inattention and hyperactivity/impulsivity confirms the link between these symptom clusters. Hyperactive/impulsive symptoms wane more over time. Group means are insufficient to understand individual ADHD prognosis. A small subgroup deteriorates over time in hyperactivity/impulsivity and needs better treatments than currently provided.

AB - Objective This study aims to examine trajectories of attention-deficit/ hyperactivity disorder (ADHD) symptoms in the Longitudinal Assessment of Manic Symptoms (LAMS) sample. Method The LAMS study assessed 684 children aged 6 to 12 years with the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) and rating scales semi-annually for 3 years. Although they were selected for elevated manic symptoms, 526 children had baseline ADHD diagnoses. With growth mixture modeling (GMM), we separately analyzed inattentive and hyperactive/impulsive symptoms, covarying baseline age. Multiple standard methods determined optimal fit. The χ2 and Kruskal-Wallis analysis of variance compared resulting latent classes/trajectories on clinical characteristics and medication. Results Three latent class trajectories best described inattentive symptoms, and 4 classes best described hyperactive/impulsive symptoms. Inattentive trajectories maintained their relative position over time. Hyperactive/impulsive symptoms had 2 consistent trajectories (least and most severe). A third trajectory (4.5%) started mild, then escalated; and a fourth (14%) started severe but improved dramatically. The improving trajectory was associated with the highest rate of ADHD and lowest rate of bipolar diagnoses. Three-fourths of the mildest inattention class were also in the mildest hyperactive/impulsive class; 72% of the severest inattentive class were in the severest hyperactive/impulsive class, but the severest inattention class also included 62% of the improving hyperactive-impulsive class. Conclusion An ADHD rather than bipolar diagnosis prognosticates a better course of hyperactive/impulsive, but not inattentive, symptoms. High overlap of relative severity between inattention and hyperactivity/impulsivity confirms the link between these symptom clusters. Hyperactive/impulsive symptoms wane more over time. Group means are insufficient to understand individual ADHD prognosis. A small subgroup deteriorates over time in hyperactivity/impulsivity and needs better treatments than currently provided.

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