Systematic Review and Meta-Analysis: Predictors of Adult Psychiatric Outcomes of Childhood Attention-Deficit/Hyperactivity Disorder

Noa E van der Plas; Siri D S Noordermeer; Jaap Oosterlaan; Marjolein Luman

doi:10.1016/j.jaac.2025.04.012

Systematic Review and Meta-Analysis: Predictors of Adult Psychiatric Outcomes of Childhood Attention-Deficit/Hyperactivity Disorder

Noa E van der Plas, Siri D S Noordermeer, Jaap Oosterlaan, Marjolein Luman

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

OBJECTIVE: Psychiatric disorders are highly prevalent in adults with childhood-onset attention-deficit/hyperactivity disorder (ADHD). Currently, little is known about childhood predictors for these outcomes.

METHOD: PubMed, PsychInfo, WoS, and EMBASE were searched until June 2024. Eligible studies investigated childhood predictors of persistent ADHD, substance use disorders (SUD), conduct disorder, antisocial personality disorder, major depressive disorder (MDD), and/or anxiety disorders in adults diagnosed with childhood ADHD (PROSPERO #CRD42022320887). Meta-analytic models were tested when N ≥3 for a predictor with similar effect measures, otherwise predictors were discussed narratively when N ≥2. Newcastle-Ottawa scale was used to assess study quality.

RESULTS: The selected 36 studies included 119 predictors, with 10 predictors eligible for meta-analyses. History of stimulant treatment (OR = 1.88, 95% CI 1.28-2.75, p = .001) was associated with increased, and higher childhood IQ with decreased (OR = 0.99, 95% CI 0.98-1.00, p =.039), risk of ADHD persistence in adulthood. ADHD persistence was associated with increased risk of SUDs (OR = 2.12, 95% CI 1.53-3.17, p =.004) and MDD (OR = 3.19, 95% CI 1.71-5.95, p <.001). Narratively reviewed predictors of fair/good quality studies showed potential predictors for ADHD persistence (i.e., ADHD combined type, hyperactive/impulsive symptoms, anxiety disorders, externalizing problems, social dysfunctioning, and socioeconomic status).

CONCLUSION: We confirmed earlier reported childhood predictors (i.e., stimulant treatment history, ADHD persistence) and identified potential new predictors (i.e., childhood anxiety disorders, social problems, socioeconomic status) for psychiatric outcomes of ADHD. However, the available literature is hampered by methodological shortcomings. Future studies should focus on studying combined effects of potential predictors.

Original language	English
Number of pages	19
Journal	Journal of the American Academy of Child and Adolescent Psychiatry
DOIs	https://doi.org/10.1016/j.jaac.2025.04.012
Publication status	E-pub ahead of print - 24 Apr 2025

Bibliographical note

Funding

This project was funded by the ZonMw grant 2020 (#55500302) and Stichting tot Steun grant 2020 (#279).

Funders	Funder number
ZonMw	55500302
Stichting tot Steun	279

Keywords

ADHD
cohort studies
comorbidity
mental disorders
risk factors

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@article{e0411013ae0c4928a9746122c4aba892,

title = "Systematic Review and Meta-Analysis: Predictors of Adult Psychiatric Outcomes of Childhood Attention-Deficit/Hyperactivity Disorder",

abstract = "OBJECTIVE: Psychiatric disorders are highly prevalent in adults with childhood-onset attention-deficit/hyperactivity disorder (ADHD). Currently, little is known about childhood predictors for these outcomes.METHOD: PubMed, PsychInfo, WoS, and EMBASE were searched until June 2024. Eligible studies investigated childhood predictors of persistent ADHD, substance use disorders (SUD), conduct disorder, antisocial personality disorder, major depressive disorder (MDD), and/or anxiety disorders in adults diagnosed with childhood ADHD (PROSPERO #CRD42022320887). Meta-analytic models were tested when N ≥3 for a predictor with similar effect measures, otherwise predictors were discussed narratively when N ≥2. Newcastle-Ottawa scale was used to assess study quality.RESULTS: The selected 36 studies included 119 predictors, with 10 predictors eligible for meta-analyses. History of stimulant treatment (OR = 1.88, 95% CI 1.28-2.75, p = .001) was associated with increased, and higher childhood IQ with decreased (OR = 0.99, 95% CI 0.98-1.00, p =.039), risk of ADHD persistence in adulthood. ADHD persistence was associated with increased risk of SUDs (OR = 2.12, 95% CI 1.53-3.17, p =.004) and MDD (OR = 3.19, 95% CI 1.71-5.95, p <.001). Narratively reviewed predictors of fair/good quality studies showed potential predictors for ADHD persistence (i.e., ADHD combined type, hyperactive/impulsive symptoms, anxiety disorders, externalizing problems, social dysfunctioning, and socioeconomic status).CONCLUSION: We confirmed earlier reported childhood predictors (i.e., stimulant treatment history, ADHD persistence) and identified potential new predictors (i.e., childhood anxiety disorders, social problems, socioeconomic status) for psychiatric outcomes of ADHD. However, the available literature is hampered by methodological shortcomings. Future studies should focus on studying combined effects of potential predictors.",

keywords = "ADHD, cohort studies, comorbidity, mental disorders, risk factors",

author = "{van der Plas}, {Noa E} and Noordermeer, {Siri D S} and Jaap Oosterlaan and Marjolein Luman",

note = "Copyright {\textcopyright} 2025. Published by Elsevier Inc.",

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doi = "10.1016/j.jaac.2025.04.012",

language = "English",

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T2 - Predictors of Adult Psychiatric Outcomes of Childhood Attention-Deficit/Hyperactivity Disorder

AU - van der Plas, Noa E

AU - Noordermeer, Siri D S

AU - Oosterlaan, Jaap

AU - Luman, Marjolein

PY - 2025/4/24

Y1 - 2025/4/24

N2 - OBJECTIVE: Psychiatric disorders are highly prevalent in adults with childhood-onset attention-deficit/hyperactivity disorder (ADHD). Currently, little is known about childhood predictors for these outcomes.METHOD: PubMed, PsychInfo, WoS, and EMBASE were searched until June 2024. Eligible studies investigated childhood predictors of persistent ADHD, substance use disorders (SUD), conduct disorder, antisocial personality disorder, major depressive disorder (MDD), and/or anxiety disorders in adults diagnosed with childhood ADHD (PROSPERO #CRD42022320887). Meta-analytic models were tested when N ≥3 for a predictor with similar effect measures, otherwise predictors were discussed narratively when N ≥2. Newcastle-Ottawa scale was used to assess study quality.RESULTS: The selected 36 studies included 119 predictors, with 10 predictors eligible for meta-analyses. History of stimulant treatment (OR = 1.88, 95% CI 1.28-2.75, p = .001) was associated with increased, and higher childhood IQ with decreased (OR = 0.99, 95% CI 0.98-1.00, p =.039), risk of ADHD persistence in adulthood. ADHD persistence was associated with increased risk of SUDs (OR = 2.12, 95% CI 1.53-3.17, p =.004) and MDD (OR = 3.19, 95% CI 1.71-5.95, p <.001). Narratively reviewed predictors of fair/good quality studies showed potential predictors for ADHD persistence (i.e., ADHD combined type, hyperactive/impulsive symptoms, anxiety disorders, externalizing problems, social dysfunctioning, and socioeconomic status).CONCLUSION: We confirmed earlier reported childhood predictors (i.e., stimulant treatment history, ADHD persistence) and identified potential new predictors (i.e., childhood anxiety disorders, social problems, socioeconomic status) for psychiatric outcomes of ADHD. However, the available literature is hampered by methodological shortcomings. Future studies should focus on studying combined effects of potential predictors.

AB - OBJECTIVE: Psychiatric disorders are highly prevalent in adults with childhood-onset attention-deficit/hyperactivity disorder (ADHD). Currently, little is known about childhood predictors for these outcomes.METHOD: PubMed, PsychInfo, WoS, and EMBASE were searched until June 2024. Eligible studies investigated childhood predictors of persistent ADHD, substance use disorders (SUD), conduct disorder, antisocial personality disorder, major depressive disorder (MDD), and/or anxiety disorders in adults diagnosed with childhood ADHD (PROSPERO #CRD42022320887). Meta-analytic models were tested when N ≥3 for a predictor with similar effect measures, otherwise predictors were discussed narratively when N ≥2. Newcastle-Ottawa scale was used to assess study quality.RESULTS: The selected 36 studies included 119 predictors, with 10 predictors eligible for meta-analyses. History of stimulant treatment (OR = 1.88, 95% CI 1.28-2.75, p = .001) was associated with increased, and higher childhood IQ with decreased (OR = 0.99, 95% CI 0.98-1.00, p =.039), risk of ADHD persistence in adulthood. ADHD persistence was associated with increased risk of SUDs (OR = 2.12, 95% CI 1.53-3.17, p =.004) and MDD (OR = 3.19, 95% CI 1.71-5.95, p <.001). Narratively reviewed predictors of fair/good quality studies showed potential predictors for ADHD persistence (i.e., ADHD combined type, hyperactive/impulsive symptoms, anxiety disorders, externalizing problems, social dysfunctioning, and socioeconomic status).CONCLUSION: We confirmed earlier reported childhood predictors (i.e., stimulant treatment history, ADHD persistence) and identified potential new predictors (i.e., childhood anxiety disorders, social problems, socioeconomic status) for psychiatric outcomes of ADHD. However, the available literature is hampered by methodological shortcomings. Future studies should focus on studying combined effects of potential predictors.

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KW - cohort studies

KW - comorbidity

KW - mental disorders

KW - risk factors

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Systematic Review and Meta-Analysis: Predictors of Adult Psychiatric Outcomes of Childhood Attention-Deficit/Hyperactivity Disorder

Abstract

Bibliographical note

Funding

Keywords

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