[The course of attention deficit/hyperactivity disorder in an outpatient sample]

Attention Deficit Hyperactivity Disorder may be a disorder of with a poor prognosis and more so when associated with psychosocial risk factors. The aim of this study is to identify clinical and psychosocial risk factors associated with poor prognosis of this disorder.

In a sample of 88 patients was followed up at our Child and Adolescent Mental Health Centres for two or more years. We classified subjects using the Clinical Global Impression Scale of Improvement following the clinical course in three categories (improved, worsened and unchanged). We performed bivariate and univariate logistic regressions to study the association between the variables and outcome.

Worsened and unchanged groups (30% of the sample) had more psychiatric comorbidity, a higher percentage of individuals with no drug treatment, and presence of the following social risk factors: inadequate parenting, adverse social and family environment and psychosocial stress. The highest degree of association is related to the absence of drug treatment (OR=15.8, 95% CI 2.71 to 92.19, P=.002) and the presence of two comorbidities (OR=4.8, 95% CI 1.02 to 22.64, P=.047).

In our sample of ADHD outpatients, there was a subgroup that was unchanged or worsened. Drug therapy, psychological treatment, detection and clinical management of comorbidity and some of the psychosocial risk factors can influence the course and outcome of ADHD and therefore the standard treatment of these patients needs to be considered.