Decline in attention-deficit hyperactivity disorder traits over the life course in the general population: trajectories across five population birth cohorts spanning ages 3 to 45 years

Robyn E Wootton; Lucy Riglin; Rachel Blakey; Jessica Agnew-Blais; Arthur Caye; Tim Cadman; Alexandra Havdahl; Helen Gonçalves; Ana M B Menezes; Fernando C Wehrmeister; Kaili Rimfeld; George Davey Smith; Thalia C Eley; Luis Augusto Rohde; Louise Arseneault; Terrie E Moffitt; Evie Stergiakouli; Anita Thapar; Kate Tilling

doi:10.1093/ije/dyac049

Decline in attention-deficit hyperactivity disorder traits over the life course in the general population: trajectories across five population birth cohorts spanning ages 3 to 45 years

Int J Epidemiol. 2022 Jun 13;51(3):919-930. doi: 10.1093/ije/dyac049.

Authors

Robyn E Wootton^{1

2

3}, Lucy Riglin^{4

5}, Rachel Blakey^{1

2}, Jessica Agnew-Blais⁶, Arthur Caye^{7

8

9}, Tim Cadman^{1

2}, Alexandra Havdahl^{3

10

11}, Helen Gonçalves¹², Ana M B Menezes¹², Fernando C Wehrmeister¹², Kaili Rimfeld^{13

14}, George Davey Smith^{1

2}, Thalia C Eley¹³, Luis Augusto Rohde^{8

9}, Louise Arseneault¹³, Terrie E Moffitt^{13

15}, Evie Stergiakouli^{1

2}, Anita Thapar^{4

5}, Kate Tilling^{1

2}

Affiliations

¹ MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
² Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
³ Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway.
⁴ Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.
⁵ Wolfson Centre for Young People's Mental Health, Cardiff University, UK.
⁶ Department of Psychology, School of Biological and Chemical Science, Queen Mary University of London, London, UK.
⁷ Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
⁸ National Institute of Developmental Psychiatry for Children and Adolescents, Brazil.
⁹ ADHD and Developmental Psychiatry Programs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
¹⁰ Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.
¹¹ PROMENTA Research Centre, Department of Psychology, University of Oslo, Oslo, Norway.
¹² Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil.
¹³ Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
¹⁴ Department of Psychology, Royal Holloway University of London, London, UK.
¹⁵ De partment of Psychology and Neuroscience, Duke University, Durham, NC, USA.

Abstract

Background: Trajectories of attention-deficit hyperactivity disorder (ADHD) traits spanning early childhood to mid-life have not been described in general populations across different geographical contexts. Population trajectories are crucial to better understanding typical developmental patterns.

Methods: We combined repeated assessments of ADHD traits from five population-based cohorts, spanning ages 3 to 45 years. We used two measures: (i) the Strengths and Difficulties Questionnaire (SDQ) hyperactive-inattentive subscale (175 831 observations, 29 519 individuals); and (ii) scores from DSM-referenced scales (118 144 observations, 28 685 individuals). Multilevel linear spline models allowed for non-linear change over time and differences between cohorts and raters (parent/teacher/self).

Results: Patterns of age-related change differed by measure, cohort and country: overall, SDQ scores decreased with age, most rapidly declining before age 8 years (-0.157, 95% CI: -0.170, -0.144 per year). The pattern was generally consistent using DSM scores, although with greater between-cohort variation. DSM scores decreased most rapidly between ages 14 and 17 years (-1.32%, 95% CI: -1.471, -1.170 per year). Average scores were consistently lower for females than males (SDQ: -0.818, 95% CI: -0.856, -0.780; DSM: -4.934%, 95% CI: -5.378, -4.489). This sex difference decreased over age for both measures, due to an overall steeper decrease for males.

Conclusions: ADHD trait scores declined from childhood to mid-life, with marked variation between cohorts. Our results highlight the importance of taking a developmental perspective when considering typical population traits. When interpreting changes in clinical cohorts, it is important to consider the pattern of expected change within the general population, which is influenced by cultural context and measurement.

Keywords: ADHD; ALSPAC; Attention-deficit hyperactivity disorder; Dunedin; E-Risk; Pelotas; TEDS; neurodevelopment; trajectories.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Attention Deficit Disorder with Hyperactivity* / epidemiology
Birth Cohort
Child
Child, Preschool
Cohort Studies
Female
Humans
Life Change Events
Male
Middle Aged
Phenotype
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding