Attention-Deficit/Hyperactivity Disorder Trajectories From Childhood to Young Adulthood: Evidence From a Birth Cohort Supporting a Late-Onset Syndrome.

IMPORTANCE: The requirement of a childhood onset has always been a key criterion for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults, but recently this requirement has become surrounded by controversy. OBJECTIVE: To investigate whether impaired young adults with ADHD symptoms always have a childhood-onset disorder in a population-based longitudinal study. DESIGN, SETTING, AND PARTICIPANTS: Participants belonged to the 1993 Pelotas Birth Cohort Study, including 5249 individuals born in Pelotas, Brazil, in 1993. They were followed up to 18 to 19 years of age, with 81.3% retention. The data analysis was performed between August 8, 2015, and February 5, 2016. MAIN OUTCOMES AND MEASURES: The ADHD status was first ascertained at 11 years of age using a screening instrument (hyperactivity subscale of the Strength and Difficulties Questionnaire) calibrated for a DSM-IV ADHD diagnosis based on clinical interviews with parents using the Development and Well-Being Assessment. At 18 to 19 years of age, ADHD diagnosis was derived using DSM-5 criteria, except age at onset. We estimated the overlap between these groups assessed at 11 and 18 to 19 years of age and the rates of markers of impairment in these 2 groups compared with those without ADHD. RESULTS: At 11 years of age, childhood ADHD (C-ADHD) was present in 393 individuals (8.9%). At 18 to 19 years of age, 492 individuals (12.2%) fulfilled all DSM-5 criteria for young adult ADHD (YA-ADHD), except age at onset. After comorbidities were excluded, the prevalence of YA-ADHD without comorbidities decreased to 256 individuals (6.3%). Children with C-ADHD had a male preponderance not observed among children without ADHD (251 [63.9%] vs 1930 [47.9%] male, P < .001), whereas the YA-ADHD group had a female preponderance (192 [39.0%] vs 1786 [50.4%] male, P < .001). Both groups had increased levels of impairment in adulthood, as measured by traffic incidents, criminal behavior, incarceration, suicide attempts, and comorbidities. However, only 60 children (17.2%) with ADHD continued to have ADHD as young adults, and only 60 young adults (12.6%) with ADHD had the disorder in childhood. CONCLUSIONS AND RELEVANCE: The findings of this study do not support the assumption that adulthood ADHD is necessarily a continuation of childhood ADHD. Rather, they suggest the existence of 2 syndromes that have distinct developmental trajectories.

Fetal alcohol spectrum disorders in young adulthood.

OBJECTIVE: To test the hypothesis that fetal alcohol syndrome (FAS), with the full phenotype, and fetal alcohol effect (FAE), with some but not all of the features, can be combined under the umbrella term fetal alcohol spectrum disorders (FASD). STUDY DESIGN: We investigated the long-term sequelae of intrauterine alcohol exposure using physical examination, psychosocial interviews, and a behavioral checklist in a 20-year follow-up study of 37 patients with FASD originally diagnosed as having FAS or FAE in infancy and childhood. RESULTS: Although the characteristic craniofacial malformations of FAS/FAE diminish over time, microcephaly, a poorly developed philtrum and a thin upper lip, and, to a lesser degree, short stature and underweight (in boys) persist. In females, adult body weight increases. Persistent mental handicaps, including intellectual disability, limited occupational options, and dependent living, are the major sequelae, and the scores for various behavioral problems are significantly increased. CONCLUSIONS: The devastating effects of intrauterine exposure to alcohol persist into early adulthood and severely limit careers and independent living.