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Deficits in attention, motor control and perception childhood to age 30 years: prospective case-control study of
Valdemar Landgren1,2, Elisabeth Fernell2, Christopher Gillberg2
1Psychiatry, Skaraborg Hospital Skövde, Skövde, Sweden valdemar.landgren@gu.se.
Insights
Children with ADHD and DCD face adverse outcomes in adulthood, predicted by early neurodevelopmental symptoms. Early identification and intervention for conditions like ADHD and DCD are crucial for better long-term results.
Area of Science:
- Child and Adolescent Psychiatry
- Neurodevelopmental Disorders
- Longitudinal Studies
Background:
- Attention-deficit/hyperactivity disorder (ADHD) and developmental coordination disorder (DCD) frequently co-occur in children.
- Predictors of long-term adverse outcomes in children with combined ADHD and DCD require further investigation.
Purpose of the Study:
- To identify predictors of adverse adult outcomes in children diagnosed with ADHD and DCD at age 6.
- To compare predictors between children with and without ADHD+DCD.
Main Methods:
- A prospective, population-based cohort study followed 62 children with ADHD+DCD and 51 controls from age 6 to 30-31 years.
- Neuropsychiatric symptoms, cognitive function (Continuous Performance Test), and motor skills at age 9 predicted adult outcomes.
- Adult outcomes included educational attainment, occupation, psychiatric disorders, medication use, social benefits, and criminal convictions.
Main Results:
- At age 9, conduct disorder, oppositional defiant disorder, ADHD symptoms, and motor dysfunction were the strongest predictors of adverse adult outcomes (R² ≈ 25%).
- Autistic traits (R²=15%) and depressive symptoms (R²=8%) also predicted outcomes.
- A multivariable model combining the strongest predictors explained 38% of the variance in adverse outcomes.
Conclusions:
- Early neurodevelopmental symptoms, including ADHD severity, significantly predict adverse adult outcomes.
- Broad neurodevelopmental profiling, beyond diagnostic thresholds, is recommended for research and clinical practice.
- Associated comorbidities in ADHD are critical to consider for improving long-term prognoses.
Objective:
Investigate predictors of adverse outcome in children with and without attention-deficit/hyperactivity disorder (ADHD) combined with developmental coordination disorder (DCD) at 6 years of age.
Design:
Prospective population-based cohort study.
Setting:
Western Sweden.
Participants:
From a screening-based population cohort of 589 individuals, 62 (11 female) diagnosed with ADHD+DCD at mean age 6.6 years, and a comparison group of 51 population-matched (10 female) children were followed prospectively.
Outcome Measures:
Drawn from a clinical reassessment at age 9 years of 110 of the 113 individuals, neuropsychiatric symptoms, continuous performance test results and measures of motor function were used as predictors of outcome in linear regression models. Participants were followed in national registers up to 30-31 years of age for outcomes in adulthood. Predictors were regressed onto an adverse outcome score (range 0-7) comprising seven binary endpoints, and when applicable onto each continuous outcome separately (low educational attainment, low occupation level, psychiatric disorder, psychotropic medication prescription, sick pension, high dependence on social benefits and criminal conviction).
Results:
Of the 110 individuals, 3 had died. In univariable regression onto the adverse outcome score, the strongest predictors at age 9 years were symptoms of conduct disorder, oppositional defiant disorder, ADHD and motor dysfunction, with an R2 around 25%, followed by autistic traits (R2=15%) and depressive symptoms (R2=8%). Combining these six strongest predictors in a multivariable model yielded an adjusted R2=38%. Subgroup analyses were similar, except for a strong association of autistic traits with the adverse outcome score in females (n=20, R2=50%).
Conclusion:
Several neurodevelopmental symptoms, including ADHD severity at age 9 years, accounted for a considerable amount of the variance in terms of adulthood adverse outcome. Broad neurodevelopmental profiling irrespective of diagnostic thresholds should inform research and clinical practice. The study highlights the importance of considering associated comorbidities and problems in ADHD.
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