Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan

Barbara Franke, Giorgia Michelini, Philip Asherson, Tobias Banaschewski, Andrea Bilbow, Jan K Buitelaar, Bru Cormand, Stephen V Faraone, Ylva Ginsberg, Jan Haavik, Jonna Kuntsi, Henrik Larsson, Klaus-Peter Lesch, J Antoni Ramos-Quiroga, János M Réthelyi, Marta Ribases, Andreas Reif, Barbara Franke, Giorgia Michelini, Philip Asherson, Tobias Banaschewski, Andrea Bilbow, Jan K Buitelaar, Bru Cormand, Stephen V Faraone, Ylva Ginsberg, Jan Haavik, Jonna Kuntsi, Henrik Larsson, Klaus-Peter Lesch, J Antoni Ramos-Quiroga, János M Réthelyi, Marta Ribases, Andreas Reif

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is highly heritable and the most common neurodevelopmental disorder in childhood. In recent decades, it has been appreciated that in a substantial number of cases the disorder does not remit in puberty, but persists into adulthood. Both in childhood and adulthood, ADHD is characterised by substantial comorbidity including substance use, depression, anxiety, and accidents. However, course and symptoms of the disorder and the comorbidities may fluctuate and change over time, and even age of onset in childhood has recently been questioned. Available evidence to date is poor and largely inconsistent with regard to the predictors of persistence versus remittance. Likewise, the development of comorbid disorders cannot be foreseen early on, hampering preventive measures. These facts call for a lifespan perspective on ADHD from childhood to old age. In this selective review, we summarise current knowledge of the long-term course of ADHD, with an emphasis on clinical symptom and cognitive trajectories, treatment effects over the lifespan, and the development of comorbidities. Also, we summarise current knowledge and important unresolved issues on biological factors underlying different ADHD trajectories. We conclude that a severe lack of knowledge on lifespan aspects in ADHD still exists for nearly every aspect reviewed. We encourage large-scale research efforts to overcome those knowledge gaps through appropriately granular longitudinal studies.

Keywords: Adult-onset ADHD; Cognitive impairment; Comorbidity; Developmental trajectory; Genetics; Treatment.

Copyright © 2018 Radboud University Medical Center. Published by Elsevier B.V. All rights reserved.

Figures

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Fig. 1
Theoretical developmental trajectories of ADHD across the lifespan. Details are given in the text.

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