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Joseph Biederman, MD; Stephen Faraone, PhD; Sharon Milberger, DSc; Jessica Guite; Eric Mick; Lisa Chen; Douglas Mennin; Abbe Marrs; Cheryl Ouellette; Phoebe Moore; Thomas Spencer, MD; Dennis Norman, EdD; Timothy Wilens, MD; Ilana Kraus, MD; James Perrin, MD

Arch Gen Psychiatry. 1996;53(5):437-446.

Abstract
Background
Previous cross-sectional data showed that children and adolescents with attention-deficit hyperactivity disorder (ADHD) are at increased risk of comorbid conduct, mood, and anxiety disorders as well as impairments in cognitive, social, family, and school functioning. However, longitudinal data were needed to confirm these initial impressions.

Methods
Using DSM-III-R structured diagnostic interviews and raters blinded as to diagnosis, we reexamined psychiatric diagnoses at 1- and 4-year follow-ups in children with ADHD and controls. In addition, subjects were evaluated for cognitive, achievement, social, school, and family functioning.

Results
Analyses of follow-up findings revealed significant differences between children with ADHD and controls in rates of behavioral, mood, and anxiety disorders, with these disorders increasing markedly from baseline to follow-up assessments. In addition, children with ADHD had significantly more impaired cognitive, family, school, and psychosocial functioning than did controls. Baseline diagnosis of conduct disorder predicted conduct disorder and substance use disorders at follow-up, major depression at baseline predicted major depression and bipolar disorder at follow-up, and anxiety disorders at baseline predicted anxiety disorders at follow-up.

Conclusions
These results confirm and extend previous retrospective results indicating that children with ADHD are at high risk of developing a wide range of impairments affecting multiple domains of psychopathology such as cognition, interpersonal, school, and family functioning. These findings provide further support for the value of considering psychiatric comorbidity in both clinical assessment and research protocols involving children with ADHD.

Author Affiliations
From the Pediatric Psychopharmacology Unit, Psychiatry Service (Drs Biederman, Faraone, Milberger, Spencer, and Wilens; Mss Guite, Chen, Marrs, Ouellette, and Moore; and Messers Mick and Mennin), Departments of Child Psychology (Dr Norman) and Pediatrics (Dr Perrin), Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School (Drs Biederman, Faraone, Spencer, and Wilens), Harvard Institute of Psychiatry, Epidemiology, and Genetics, Department of Psychiatry, Harvard Medical School at Brockton—West Roxbury Veterans Affairs Medical Center and Massachusetts Health Center (Dr Faraone), Department of Epidemiology, Harvard School of Public Health (Dr Milberger), and Department of Pediatrics, Harvard Community Health Plan (Dr Kraus), Boston.

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