Hyperactive boys almost grown up. IV. Criminality and its relationship to psychiatric status

Attention-deficit disorder with hyperactivity is believed, by some, to be a developmental antecedent (predisposing factor) to antisocial personality disorder and criminality. However, evidence supporting this association has not been consistent. We report on a prospective follow-up study of 103 males (ages 16 to 23 years), who were diagnosed as hyperactive (attention-deficit disorder with hyperactivity) between ages 6 and 12 years, and 100 normal controls. The official arrest records of all subjects who resided in New York State during the follow-up interval were obtained. Blind diagnoses (based on structured interviews with subjects and their parents) were made on 98% of the initial cohort at follow-up. Although other investigators have reported on the delinquent behavior of hyperactive children in a prospective design, to our knowledge, follow-up mental status has not been studied previously in relation to official arrest records. Significantly more probands than controls had been arrested (39% vs 20%), convicted (28% vs 11%), and incarcerated (9% vs 1%). The presence of an antisocial/conduct disorder in young adulthood almost completely accounted for the increased risk for criminal activities in the former hyperactive children whether or not it was accompanied by a substance use disorder. Continuing attention-deficit disorder with hyperactivity at follow-up, by itself, was not associated with arrest history. The findings support the view that childhood attention-deficit disorder with hyperactivity is a risk factor for later criminality, but that this relationship is almost exclusively mediated by the development of an antisocial disorder in early adulthood.     

Lifetime criminality among boys with attention deficit hyperactivity disorder: a prospective follow-up study into adulthood using official arrest records

This study investigates the relationship between childhood attention deficit hyperactivity disorder (ADHD) and later criminality. White boys (n=207, ages 6-12) with ADHD, free of conduct disorder, were assessed at ages 18 and 25 by clinicians who were blind to childhood status. A non-ADHD group served as comparisons. Lifetime arrest records were obtained when subjects were 38 years old for subjects who resided in New York State throughout the follow-up interval (93 probands, 93 comparisons). Significantly more ADHD probands than comparisons had been arrested (47% vs. 24%), convicted (42% vs. 14%), and incarcerated (15% vs. 1%). Rates of felonies and aggressive offenses also were significantly higher among probands. Importantly, the development of an antisocial or substance use disorder in adolescence completely explained the increased risk for subsequent criminality. Results suggest that even in the absence of comorbid conduct disorder in childhood, ADHD increases the risk for developing antisocial and substance use disorders in adolescence, which, in turn, increases the risk for criminal behavior in adolescence and adulthood.     

Psychophysiological responses in ADHD boys with and without conduct disorder: implications for adult antisocial behavior

OBJECTIVE: Several studies have demonstrated that the presence of attention-deficit/hyperactivity disorder (ADHD) in childhood increases the risk of antisocial behavior developing in adulthood. However, because previous research did not consider comorbid conduct disorder (CD), the question of whether ADHD by itself or only the association of ADHD with CD implies a risk of adult antisocial behavior developing is still under discussion. METHOD: Because several characteristics of psychophysiological response had been shown to be associated with future increased likelihood of adult antisocial behavior, autonomic arousal as well as electrodermal responses to orienting and aversive stimuli were assessed in 26 boys with ADHD+CD compared with 21 boys with ADHD alone and 21 controls. RESULTS: Boys with a comorbid condition of ADHD+CD showed a decrement of autonomic responses and a more rapid habituation to orienting and aversive startling stimuli compared with age-matched children with ADHD alone. CONCLUSIONS: Boys with ADHD+CD show a psychophysiological response pattern that is very similar to that reported in antisocial personalities. These findings give further support for a high persistence of antisocial behavior from childhood to adulthood, while no evidence was found that ADHD itself is associated with a predisposition to antisocial behavior.     

Childhood predictors of male criminality: a prospective population-based follow-up study from age 8 to late adolescence

OBJECTIVE: To study childhood predictors for late adolescence criminality. METHOD: The follow-up sample included 2,713 Finnish boys born in 1981. Information about the 8-year-old boy' problem behavior was obtained from parents, teachers, and the children themselves. The follow-up information about criminal offenses was based on the national police register between the years 1998 and 2001 when the subjects were 16 to 20 years old. RESULTS: According to the national police register, 22.2% of boys had at least one criminal offense other than a minor traffic violation during the 4-year study period. Living in nonintact family, low parental education level, parent reports of conduct problems, and teacher reports of hyperkinetic problems when the child was 8 independently predicted a high level (more than five) of offenses. Living in nonintact family at age 8 predicted all types of criminal offenses. Low parental education level and parent or teacher reports of conduct problems independently predicted violence, property, traffic, and drunk driving offenses. Teacher reports of hyperkinetic problems independently predicted all types of criminal offenses except drunk driving. Self-reports of bullying others independently predicted violent offenses. CONCLUSIONS: Living in a broken home, low parental education level, conduct problems, and hyperactivity in middle childhood predict criminal offenses in late adolescence. Efforts to prevent later criminality already in childhood are emphasized.     

Dietary intake of fish, omega-3, omega-6 polyunsaturated fatty acids and vitamin D and the prevalence of psychotic-like symptoms in a cohort of 33 000 women from the general population

Background

ADHD is a common and disabling disorder, with an increased risk for coexisting disorders, substance abuse and delinquency. In the present study, we aimed at exploring ADHD and criminality. We estimated the prevalence of ADHD among longer-term prison inmates, described symptoms and cognitive functioning, and compared findings with ADHD among psychiatric outpatients and healthy controls.

Methods

At Norrtälje Prison, we approached 315 male inmates for screening of childhood ADHD by the Wender Utah Rating Scale (WURS-25) and for present ADHD by the Adult ADHD Self-Report Screener (ASRS-Screener). The response rate was 62%. Further, we assessed 34 inmates for ADHD and coexisting disorders. Finally, we compared findings with 20 adult males with ADHD, assessed at a psychiatric outpatient clinic and 18 healthy controls.

Results

The estimated prevalence of adult ADHD among longer-term inmates was 40%. Only 2 out of 30 prison inmates confirmed with ADHD had received a diagnosis of ADHD during childhood, despite most needed health services and educational support. All subjects reported lifetime substance use disorder (SUD) where amphetamine was the most common drug. Mood and anxiety disorders were present among half of subjects; autism spectrum disorder (ASD) among one fourth and psychopathy among one tenth. Personality disorders were common; almost all inmates presented conduct disorder (CD) before antisocial personality disorder (APD). Prison inmates reported more ADHD symptoms during both childhood and adulthood, compared with ADHD psychiatric outpatients. Further, analysis of executive functions after controlling for IQ showed both ADHD groups performed poorer than controls on working memory tests. Besides, on a continuous performance test, the ADHD prison group displayed poorer results compared with both other groups.

Conclusions

This study suggested ADHD to be present among 40% of adult male longer-term prison inmates. Further, ADHD and coexisting disorders, such as SUD, ASD, personality disorders, mood- and anxiety disorders, severely affected prison inmates with ADHD. Besides, inmates showed poorer executive functions also when controlling for estimated IQ compared with ADHD among psychiatric outpatients and controls. Our findings imply the need for considering these severities when designing treatment programmes for prison inmates with ADHD.     

Response to emotional stimuli in boys with conduct disorder

OBJECTIVE: Boys with conduct disorder are at risk of persistently showing antisocial behavior in adult life, particularly if they have an additional diagnosis of attention deficit hyperactivity disorder (ADHD). In the search for biological risk factors that predispose children to the development of antisocial personality disorder, research has provided substantial data suggesting that autonomic hyporesponsiveness indicates a greater likelihood of future antisocial behavior. The purpose of this study was to examine autonomic arousal in boys with conduct disorder, comorbid conduct disorder and ADHD, and ADHD only. METHOD: In addition to self-ratings, electrodermal responses to pleasant, neutral, and unpleasant slides were obtained for 21 boys with conduct disorder and 54 boys with ADHD plus conduct disorder. Forty-three boys with a diagnosis of ADHD only were recruited as a clinical comparison group, and 43 boys with no conduct disorder or ADHD were included as a healthy comparison group. All subjects were ages 8-13 years. RESULTS: Compared to the healthy subjects and the subjects with ADHD only, the boys with conduct disorder and with ADHD plus conduct disorder reported lower levels of emotional response to aversive stimuli and lower autonomic responses to all slides independent of valence. CONCLUSIONS: Although the self-report data supported a deficit in reactivity to explicit fear cues, the psychophysiological data indicated that boys with conduct disorder both with and without a comorbid condition of ADHD are characterized by a generalized deficit in autonomic responsivity in an experimental situation in which children were exposed to complex visual stimuli of unpredictable affective quality. Psychophysiological findings may point to a deficit in associative information processing systems that normally produce adaptive cognitive-emotional reactions.     

Hypofrontality in attention deficit hyperactivity disorder during higher-order motor control: a study with functional MRI.

OBJECTIVE: Functional magnetic resonance imaging (MRI) was used to investigate the hypothesis that attention deficit hyperactivity disorder (ADHD) is associated with a dysfunction of prefrontal brain regions during motor response inhibition and motor timing. METHOD: Generic brain activation of seven adolescent boys with ADHD was compared to that of nine comparison subjects equivalent in sex, age, and IQ while they were performing a stop task, requiring inhibition of a planned motor response, and a motor timing task, requiring timing of a motor response to a sensory cue. RESULTS: The hyperactive adolescents showed lower power of response in the right mesial prefrontal cortex during both tasks and in the right inferior prefrontal cortex and left caudate during the stop task. CONCLUSIONS: ADHD is associated with subnormal activation of the prefrontal systems responsible for higher-order motor control. Functional MRI is a feasible technique for investigation of neural correlates of ADHD.     

Boys with ADHD in social interaction with a nonfamiliar adult: an observational study

OBJECTIVE: To clarify the nature of social interaction deficits in boys with attention-deficit hyperactivity disorder (ADHD). METHOD: Twenty Dutch hyperactive boys and 19 peer controls were observed using an ethological method during social interaction with a nonfamiliar adult (a student). Social behavior was operationalized in terms of the duration and frequency of visual and verbal behavior elements and scored during a conversation and a play segment. RESULTS: During the conversation segment, the boy with ADHD and the student were less socially involved in each other. During the play segment, boys with ADHD talked to themselves more and seemed to direct their attention to the student more than control boys did. The students praised the boys with ADHD more frequently and asked them more questions about their play activities than the control boys. CONCLUSIONS: Boys with ADHD demonstrate poor social attention during conversation and elicit structure-providing behavior in nonfamiliar adults. It is postulated that poor self-regulatory mechanisms may mediate their social problems.     

Life Span Studies of ADHD—Conceptual Challenges and Predictors of Persistence and Outcome

There is a renewed interest in better conceptualizing trajectories of attention-deficit/hyperactivity disorder (ADHD) from childhood to adulthood, driven by an increased recognition of long-term impairment and potential persistence beyond childhood and adolescence. This review addresses the following major issues relevant to the course of ADHD in light of current evidence from longitudinal studies: (1) conceptual and methodological issues related to measurement of persistence of ADHD, (2) estimates of persistence rate from childhood to adulthood and its predictors, (3) long-term negative outcomes of childhood ADHD and their early predictors, and (4) the recently proposed new adult-onset ADHD. Estimates of persistence vary widely in the literature, and diagnostic criteria, sample characteristics, and information source are the most important factors explaining variability among studies. Evidence indicates that ADHD severity, comorbid conduct disorder and major depressive disorder, and treatment for ADHD are the main predictors of ADHD persistence from childhood to adulthood. Comorbid conduct disorder and ADHD severity in childhood are the most important predictors of adverse outcomes in adulthood among children with ADHD. Three recent population studies suggested the existence of a significant proportion of individuals who report onset of ADHD symptoms and impairments after childhood. Finally, we highlight areas for improvement to increase our understanding of ADHD across the life span.     

Young adult outcome of hyperactive children: adaptive functioning in major life activities

OBJECTIVE: The authors report the adaptive functioning of hyperactive and control children in southeastern Wisconsin (Milwaukee) followed to young adulthood. METHOD: Interviews with participants concerning major life activities were collected between 1992 and 1996 and used along with employer ratings and high school records at the young adult follow-up (mean = 20 years, range 19-25) for this large sample of hyperactive (H; n = 149) and community control (CC; n = 72) children initially seen in 1978-1980 and studied for at least 13 years. Age, duration of follow-up, and IQ were statistically controlled as needed. RESULTS: The H group had significantly lower educational performance and attainment, with 32% failing to complete high school. H group members had been fired from more jobs and manifested greater employer-rated attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms and lower job performance than the CC group. Socially, the H group had fewer close friends, more trouble keeping friends, and more social problems as rated by parents. Far more H than CC group members had become parents (38% versus 4%) and had been treated for sexually transmitted disease (16% versus 4%). Severity of lifetime conduct disorder was predictive of several of the most salient outcomes (failure to graduate, earlier sexual intercourse, early parenthood) whereas attention-deficit/hyperactivity disorder and oppositional defiant disorder at work were predictive of job performance and risk of being fired. CONCLUSIONS: These findings corroborate prior research and go further in identifying sexual activity and early parenthood as additional problematic domains of adaptive functioning at adulthood.     

Prediction of early-onset deviant peer group affiliation: a 12-year longitudinal study

CONTEXT: Deviant peer group involvement is strongly related to onset, aggravation, and persistence of conduct problems during adolescence. OBJECTIVE: To identify early childhood behavioral profiles that predict early-onset deviant peer group involvement. DESIGN: A 12-year longitudinal study of behavioral development. SETTING: Fifty-three inner-city elementary schools in a large Canadian city. PARTICIPANTS: A total of 1037 boys in kindergarten from low socioeconomic neighborhoods. MAIN OUTCOME MEASURES: Annual self-reported deviant peer group involvement from 11 to 17 years of age. RESULTS: Kindergarten boys were at highest risk of following an early adolescence trajectory of deviant peer group affiliation if they were hyperactive, fearless, and low on prosocial behaviors but much less at risk if they scored high on only 2 of these dimensions. Family adversity had no main effect but substantially increased the risk of following an early adolescence trajectory of deviant peer group affiliation for boys with a profile of hyperactivity, fearlessness, and low prosocial behaviors. CONCLUSIONS: Kindergarten boys from low socioeconomic areas who are hyperactive, fearless, infrequently prosocial, and raised in adverse family environments are at much heightened risk of engaging in deviant peer groups early in their development. Boys at high risk can be identified as early as kindergarten and should be targeted for preventive intervention.     

Lifespan attention deficit/hyperactivity disorder and borderline personality disorder symptoms in female patients: a latent class approach

Attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) are frequently comorbid. To contribute to a better understanding of the associations regularly found between ADHD and BPD, on the one hand, and the developmental pathways for these disorders, on the other hand, latent class analyses (LCA) were undertaken to identify classes differing in profiles of childhood symptoms of ADHD and adult symptoms of ADHD and BPD. Diagnostic interviews with 103 female outpatients meeting the criteria for ADHD and/or BPD were used to assess current DSM-IV symptoms; childhood symptoms of ADHD were assessed in parent interviews. The latent classes were examined in relation to the DSM-IV conceptualizations of ADHD and BPD. And relations between childhood and adult classes were examined to hypothesize about developmental trajectories. LCA revealed an optimal solution with four distinct symptom profiles: only ADHD symptoms; BPD symptoms and only ADHD symptoms of hyperactivity; BPD symptoms and ADHD symptoms of inattention and hyperactivity; BPD symptoms and ADHD symptoms of inattention, hyperactivity and impulsivity. All patients with BPD had some ADHD symptoms in both adulthood and childhood. Hyperactivity was least discriminative of adult classes. Adult hyperactivity was not always preceded by childhood hyperactivity; some cases of comorbid ADHD and BPD symptoms were not preceded by significant childhood ADHD symptoms; and some cases of predominantly BPD symptoms could be traced back to combined symptoms of ADHD in childhood. The results underline the importance of taking ADHD diagnoses into account with BPD. ADHD classification subtypes may not be permanent over time, and different developmental pathways to adult ADHD and BPD should therefore be investigated.     

Association Between Colonic Symptoms and Inattention/Hyperactivity in British Children

Background: Functional faecal retention and attention deficit hyperactivity disorder (ADHD) are common in childhood. There is some evidence, mostly from clinical samples, of an association between them. Methods: The association between parental reports of inattention/hyperactivity and colonic symptoms in children between four and ten years of age was examined using the Health Survey for England 2000. Results: Boys were about twice as likely to be rated by their parents as inattentive/hyperactive if they had colon symptoms. Conclusions: This study adds to existing evidence associating bowel function and behavioural symptoms, especially in boys. Given the high prevalence of gastrointestinal symptoms in general, and the increasing personal and societal impact of childhood behavioural problems, further exploration of the relationship is warranted, with particular attention to causal pathways.     

Prospective, longitudinal study of tic, obsessive-compulsive, and attention-deficit/hyperactivity disorders in an epidemiological sample

OBJECTIVE: Understanding the interrelatedness of tics, obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD) has been complicated by studying only cross-sectional samples of clinically referred subjects. The authors report the cross-sectional and longitudinal associations of these disorders in an epidemiological sample of children followed prospectively into early adulthood. METHOD: Structured diagnostic interview information was acquired on 976 children, aged 1 to 10 years, who were randomly selected from families living in upstate New York in 1975. Reassessments were acquired in 776 of these subjects 8, 10, and 15 years later. Diagnostic prevalences were estimated at each time point. The associations among tics, OCD, and ADHD were assessed within and across time points, as were their associations with comorbid illnesses and demographic risk factors. RESULTS: In temporal cross-section, tics and ADHD symptoms were associated with OCD symptoms in late adolescence and early adulthood after demographic features and comorbid psychiatric symptoms were controlled. In prospective analyses, tics in childhood and early adolescence predicted an increase in OCD symptoms in late adolescence and early adulthood. ADHD symptoms in adolescence predicted more OCD symptoms in early adulthood, and OCD in adolescence predicted more ADHD symptoms in adulthood. The associations of tics with ADHD were unimpressive in temporal cross-section and were not significant in prospective analyses. Tics, OCD, and ADHD shared numerous complex associations with demographic and psychopathological risk factors. ADHD was associated with lower IQ and lower social status, whereas OCD was associated with higher IQ. CONCLUSIONS: Tics and OCD were significantly associated in this sample, as were OCD and ADHD. These findings are in general consistent with those from family studies, and they help to define the natural history, comorbid illnesses, and interrelatedness of these conditions.     

What predicts illicit drug use versus police-registered drug offending?

AIMS: To study whether drug offenders differ in childhood and in early adulthood from those who only report using illicit drugs. DESIGN: Prospective nationwide birth cohort study. Baseline survey in 1989, follow-up data collection from self-reports, police and military registers in late adolescence and early adulthood. PARTICIPANTS: Two-thousand nine hundred and forty six Finnish boys born in 1981. Information about self-reported drug use at age 18 or police-registered drug offending at age 17-20 was available from 79.3% (n = 2,336) of the subjects. MEASUREMENTS: At age 8, psychopathology was assessed using the parent and teacher Rutter scales and child self-reports (Child Depression Inventory). ICD-10 psychiatric diagnoses at early adulthood according to the military register were based on a medical examination. FINDINGS: Childhood psychopathology did not predict self-reported drug use at age 18. Both conduct and hyperactivity problems at age 8 predicted drug offences at age 16-20. The predictive association with drug offences was strongest with severe level (over 90th percentile cut-off point) of conduct (OR 5.5, 95% CI 2.9-10.5) and hyperactivity problems (OR 5.0, 95% CI 2.7-9.3). Also moderate level of conduct (OR 2.9, 95% CI 1.7-4.9) and hyperactivity problems (OR 3.1, 95% CI 1.9-5.1) predicted drug offending. Having a psychiatric diagnosis in early adulthood associated with both self-reported use (OR 4.1, 95% CI 2.4-6.8) and drug offending (OR 13.2, 95% CI 8.3-21.2). CONCLUSIONS: Drug offending is part of a life-course-persistent deviance, whereas for self-reporters, psychiatric problems arise later in life. Accordingly, the preventive needs, and the age period for intervention are different for boys with divergent illicit drug use involvement.     

Adult outcomes of attention deficit hyperactivity disorder and conduct disorder: are the risks independent or additive?

METHODS: Data were obtained from a longitudinal study sample of 754 adoptees and categorized based on review of the available adoption agency, medical, and psychiatric records of the biological parents. Categorical data were analyzed using chi2 or Fisher's exact tests, as appropriate. Logistic regression analyses were used to assess the relative contribution of variables. RESULTS: There was not a statistically significant difference in the frequency or type of self-reported adult disruptive behavior, arrests, jail stays, felony arrests, or frequency of conduct disorder (CD) when inattentiveness, impulsivity, and hyperactivity were analyzed individually. The contributions of attention deficit hyperactivity disorder (ADHD) were independent and no additional increased risk for future illegal behavior was conferred by the combination of the disorders. While the effect of CD on illegal behavior was correlated with substance abuse and dependence, ADHD continued to be a significant contributor after controlling for substance abuse and dependence. CONCLUSIONS: Data indicated that ADHD and CD are related but different disorders conferring risk for adult illegal behavior or arrest. In this sample, inattention was the most common domain impaired among those with ADHD, followed closely by hyperactivity, with impulsivity reported least often among those endorsing symptoms of ADHD.     

A natural history of hyperactivity and conduct problems: self-reported outcome

At the age of 16–18 years, outcome was prospectively assessed in a general population sample of four behavioural groups, defined at 6–7 year old: a pure pervasively hyperactive group (N=31), a mixed hyperactive conduct problem group (N=20), a pure conduct problem group (N=18) and a normal control group (N=29). The objective of the present paper is to describe outcome in those domains for which self-report is recognised as a valid source of information. Differential effects for hyperactivity and conduct problems on outcome were studied. It was found that early hyperactivity and conduct problems predicted different patterns of conduct problems in adolescence. Drug use in adolescence was not predicted by either type of behavioural problem in childhood. Overall social adjustment was worse in the hyperactive groups, whereas no differences in self-esteem were found. Hyperactivity was a strong predictor of relationships problems in adolescence. The results suggest that hyperactivity and conduct problems in childhood are differential predictors of outcome in adolescence. Accepted: 28 April 1999     

Childhood predictors of adolescent and young adult outcome in ADHD

BackgroundAttention-deficit/hyperactivity disorder (ADHD) often persists into adulthood, but it remains unclear which childhood factors predict future outcome.AimTo identify childhood predictors of ADHD outcome using both dimensional and categorical approaches.Methods116 adolescents and young adults with childhood ADHD were followed up on average 6.6 years later. ADHD outcome variables were interview-based parent-reported ADHD symptoms and impairment. Childhood predictors included parent- and teacher-rated ADHD symptoms and co-occurring behaviours; actigraph measures of activity level; socio-economic status (SES); and cognitive measures previously associated with ADHD.ResultsOf the sample, 79% continued to meet clinical criteria of ADHD in adolescence and young adulthood. Higher parent-rated ADHD symptoms and movement intensity in childhood, but not teacher-rated symptoms, predicted ADHD symptoms at follow up. Co-occurring symptoms of oppositional behaviours, anxiety, social and emotional problems were also significant predictors, but these effects disappeared after controlling for ADHD symptoms. IQ and SES were significant predictors of both ADHD symptoms and impairment at follow up, but no other cognitive measures significantly predicted outcome.ConclusionsSES and IQ emerge as potential moderators for the prognosis of ADHD. Childhood severity of ADHD symptoms, as measured by parent ratings and actigraph movement intensity, also predicts later ADHD outcome. These factors should be considered when identifying ADHD children at most risk of poor long-term outcomes and for the development of interventions to improve prognosis.     

Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the national comorbidity survey replication.

BACKGROUND: Despite growing interest in adult attention-deficit/hyperactivity disorder (ADHD), little is known about predictors of persistence of childhood cases into adulthood. METHODS: A retrospective assessment of childhood ADHD, childhood risk factors, and a screen for adult ADHD were included in a sample of 3197 18-44 year old respondents in the National Comorbidity Survey Replication (NCS-R). Blinded adult ADHD clinical reappraisal interviews were administered to a sub-sample of respondents. Multiple imputation (MI) was used to estimate adult persistence of childhood ADHD. Logistic regression was used to study retrospectively reported childhood predictors of persistence. Potential predictors included socio-demographics, childhood ADHD severity, childhood adversity, traumatic life experiences, and comorbid DSM-IV child-adolescent disorders (anxiety, mood, impulse-control, and substance disorders). RESULTS: Blinded clinical interviews classified 36.3% of respondents with retrospectively assessed childhood ADHD as meeting DSM-IV criteria for current ADHD. Childhood ADHD severity and childhood treatment significantly predicted persistence. Controlling for severity and excluding treatment, none of the other variables significantly predicted persistence even though they were significantly associated with childhood ADHD. CONCLUSIONS: No modifiable risk factors were found for adult persistence of ADHD. Further research, ideally based on prospective general population samples, is needed to search for modifiable determinants of adult persistence of ADHD.