NEW YORK -- A diagnosis of attention-deficit/hyperactivity disorder might not be forever.
In fact, it can be pretty fleeting. Analysis of serial assessments of more than 8,000 U.S. children and adolescents for attention-deficit/hyperactivity disorder (ADHD) showed that the diagnosis often did not persist after follow-up of 1 year or longer, J. Blake Turner, Ph.D., said at the meeting.
ADHD diagnoses "are extremely transient over a 1-year period. Generally, loss of the diagnosis is more likely than persistence," said Dr. Turner, a researcher in the division of child and adolescent psychiatry at Columbia University in New York.
The findings suggest that problems exist with current nosology for ADHD, and that current prevalence estimates from community studies may be inflated. "We need to examine the predictors of ADHD persistence over time," he said. "We need to look at what's going on here and what predicts the persistence of disruptive disorders.
"If patients are diagnosed with ADHD and it is transient - if it is reactive distress that is likely to go away -do we want to identify them?" he asked in an interview. "If a diagnosis is made of ADHD, do you let it go because it will likely resolve on its own, or will treatment help it resolve more quickly?" We think of ADHD as something that lasts, not something that comes and goes. Perhaps we need [a diagnosis] that's more stable," possibly by basing it on a larger number of symptoms. "That would mean changing the ADHD diagnosis," he said.
Preliminary analysis of serial assessments for oppositional defiance disorder and conduct disorder in the same data set of 8,714 children and adolescents showed similar, transient patterns after an initial diagnosis, Dr. Turner added.
"It troubles me that the [ADHD] phenotype looks so unstable," commented Dr. Daniel S. Pine, chief of the Section on Development and Affective Neuroscience at the National Institute of Mental Health. "A lot of people are struggling with the threshold for [diagnosing] ADHD. This is a very different conceptualization of ADHD; we don't usually think of it as something that's gone in 2 years. If this is [children having] a transient reaction to stress, I don't want to talk about it [in] the same way as clinical ADHD.
Dr. Pine suggested that Dr. Turner's new finding might help explain the high reported prevalence rates of ADHD, and that the results also raised issues about using stimulants to treat newly diagnosed ADHD. …