The course and persistence of adhd throughout the life-cycle

An important step in understanding the significance and therapeutic needs of psychiatric syndromes is documenting the course of the disorder. Those individuals who have chronic forms of disorder generally suffer greater consequences as a result, have more severe forms of disorder, and require the most aggressive intervention. Over time, the perception that attention-deficit hyperactivity disorder (ADHD) is a syndrome of childhood misbehavior that wanes throughout puberty and adolescence has been challenged by volumes of research and a continual refinement of standardized diagnostic criteria. Attempting to understand the burden of psychiatric illness across the life span is often complicated by the fact that, with the progression of time and parallel developmental maturation, the core features of a disorder may present differently. Thus the study and treatment of childhood psychopathology often require an interpretation of symptom expression that takes into account normal development. Examining ADHD across the life span presents unique challenges because the diagnostic criteria require that the disorder be evident by 7 years of age. Natural development leads to many behavioral changes throughout childhood, adolescence, and adulthood, requiring that clinically relevant research have a nuanced interpretation of symptom expression of ADHD in older subjects. This chapter describes the history of the disorder and the current longitudinal studies of ADHD children into adulthood, with a special focus on the changing operational definition of the disorder, the reliance on the presence of hyperactivity in diagnosis, the impact of normal developmental maturation on recognizing problem behaviors at different ages, and the clinical significance of the diagnosis in older or adult subjects.