研究6岁时有和没有注意力缺陷/多动障碍(ADHD)合并发育协调障碍(DCD)的儿童不良结局的预测因素。
基于人群的前瞻性队列研究。
瑞典西部。
从589人的基于筛查的人群队列中,62(11名女性)诊断为ADHD+DCD,平均年龄6.6岁,前瞻性随访了一个由51名人口匹配(10名女性)儿童组成的对照组。
从113名患者中110名患者中9岁时的临床重新评估得出,神经精神症状,在线性回归模型中,连续表现测试结果和运动功能测量值被用作结果的预测因子.在30-31岁的国家登记册中对参与者进行随访,以了解成年期的结果。预测因素回归到包括七个二元终点的不良结局评分(范围0-7),当分别适用于每个连续结果时(低教育程度,低职业水平,精神病,精神药物处方,病假养老金,高度依赖社会福利和刑事定罪)。
在110个人中,3已经死了。在不良结果评分的单变量回归中,9岁时最强的预测因素是品行障碍的症状,对立的反抗障碍,多动症和运动功能障碍,R2在25%左右,其次是自闭症特征(R2=15%)和抑郁症状(R2=8%)。将这六个最强的预测因子组合在多变量模型中产生调整后的R2=38%。亚组分析相似,除了孤独症特征与女性不良结局评分密切相关(n=20,R2=50%).
几种神经发育症状,包括9岁时的多动症严重程度,在成年不良结局方面占相当大的差异。无论诊断阈值如何,广泛的神经发育概况都应为研究和临床实践提供信息。该研究强调了考虑ADHD相关合并症和问题的重要性。
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.
Prospective population-based cohort study.
Western Sweden.
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.
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).
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%).
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.