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 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 - Jul 2014

Keywords

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

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health

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    Arnold, L. E., Ganocy, S. J., Mount, K., Youngstrom, E. A., Frazier, T., Fristad, M., Horwitz, S. M., Birmaher, B., Findling, R., Kowatch, R. A., Demeter, C., Axelson, D., Gill, M. K., & 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, 53(7), 745-760. https://doi.org/10.1016/j.jaac.2014.03.007