Objective: Little is known of factors that influence the course of childhood attentiondeficit/hyperactivity disorder (ADHD). Objectives were to identify early features predictive of the adult outcome of children with ADHD. In the longest prospective follow-up to date of children with ADHD, we examined predictors of multiple functional domains: social, occupational, and overall adjustment, and educational and occupational attainment. Method: White boys (6-12 years, mean, 8) with ADHD (N=135), selected to be free of conduct disorder, were assessed longitudinally through adulthood (mean age, 41), by clinicians, blind to all previous characteristics. Predictors had been recorded in childhood, and adolescence (mean age, 18). Results: Childhood IQ was positively associated with several outcomes: educational attainment, occupational rank, social and occupational adjustment. Two other childhood features that had positive associations with adult adjustment were SES and reading ability, which predicted educational attainment. In spite of their low severity, conduct problems in childhood were negatively related to overall function, educational attainment, and occupational functioning. Among multiple adolescent characteristics, four were significant predictors: antisocial behaviors predicted poorer educational attainment; educational goals were related to better overall function; early job functioning had a positive relationship with social functioning, and early social functioning was positively related to occupational functioning. Conclusion: Besides childhood IQ, which predicted better outcomes in several domains, there were no consistent prognosticators of adult function among children with ADHD. Providing additional supports to children with relatively lower IQ might improve the adult functional outcome of children with ADHD. However, predicting the course of children with ADHD remains a challenge.

Introduction

Follow-up studies of children with attention-deficit/hyperactivity disorder (ADHD) document relative deficits in multiple functional domains in early adulthood. On average, children with ADHD achieve relatively lower levels of education1-9, have poorer social functioning 3,5,6and worse occupational outcomes3,5-9. The longest follow-up study of children with ADHD (33 years) found that these deficits persisted well into adulthood (mean age 41): men diagnosed with ADHD in childhood had completed an average of two and a half fewer years of schooling, had lower occupational attainment, and had worse occupational and social functioning scores than their peers who did not have ADHD in childhood3 . However, there was variability in the outcome of childhood ADHD, ranging from very poor to benign. The present study examines whether characteristics in the childhood and adolescence of those children are associated with their functioning in adulthood. Identifying early risks for future disability among children with ADHD has significant public health importance, as it has the potential to provide parents information regarding prognosis, identify mechanisms that influence longitudinal course, inform prevention and therapeutic efforts, and support theories about the disorder’s developmental trajectory that may inform the disorder’s pathophysiology10 . Table 1 lists the few prospective studies6,11-13 that have reported on early (in childhood or adolescence) predictors of adult outcome in children with ADHD. Excluded are longitudinal studies whose first diagnosis of ADHD occurred during adolescence (i.e., beyond age 12), since, by definition, they are enriched for persistent ADHD 14.