According to findings in a recent multicenter study, 89% of preschool-aged children with moderate to severe attention-deficit/hyperactivity disorder continued to experience serious symptoms and impairment after their original diagnoses and, in several cases, despite undergoing treatment.
“ADHD is becoming a more common diagnosis in early childhood, so understanding how the disorder progresses in this age group is critical,” Mark A. Riddle, MD, a pediatric psychiatrist at the Johns Hopkins Children’s Center, said in a press release. “We found that ADHD in preschoolers is a chronic and rather persistent condition, one that requires better long-term behavioral and pharmacological treatments than we currently have.”
Mark A. Riddle
To evaluate the clinical course of ADHD symptom severity and diagnosis, Riddle and colleagues enrolled 180 children (aged 3 to 5 years) with ADHD, treated them for several months and then referred them to their community pediatricians for ongoing care.
During the next 6 years, the researchers used comprehensive reports from parents and teachers to catalogue the children’s behavior, school performance and the frequency and severity of hallmark ADHD symptoms, including inattention, hyperactivity and impulsivity. In addition, the children underwent full diagnostic workups at the beginning, midpoint and end of the study period.
According to study results, parent- and teacher-rated symptom severity decreased from baseline to the third year but remained comparatively stable and in the moderate-to-severe clinical range through the sixth year.
In the sixth year of follow-up, 89% of remaining participants met ADHD symptom and impairment diagnostic criteria.
The researchers observed that symptom severity scores did not vary significantly between the more than two-thirds of children on medication and those off medication. In particular, 62% of children receiving anti-ADHD medications exhibited clinically significant hyperactivity and impulsivity vs. 58% of patient not receiving medication.
Additionally, 65% of children on medication had clinically significant inattention vs. 62% of their medication-free counterparts. However, the data remained inconclusive on whether the lack of medication efficacy was due to suboptimal drug choice or dosage, poor adherence or medication ineffectiveness.
“Our study was not designed to answer these questions, but whatever the reason may be, it is worrisome that children with ADHD, even when treated with medication, continue to experience symptoms, and what we need to find out is why that is and how we can do better,” Riddle said in the press release.
Disclosure: The researchers reported no relevant financial disclosures.