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Lifespan Persistence of ADHD: The Life Transition Model and Its Application

J Clin Psychiatry 2012;73(2):192-201
10.4088/JCP.10m06628

Background: The understanding that attention-deficit/hyperactivity disorder (ADHD) often persists throughout life has heightened interest of patients, families, advocates, and professionals in a longitudinal approach to management. Such an approach must recognize and address known patient- and systems-based challenges of long-term mental health treatment, shifting of clinical presentations of ADHD, and commonality of psychiatric comorbidity with ADHD.

Objective: The ADHD Life Transition Model is a step toward developing criteria to optimize recognition and clinical management of ADHD (eg, response, remission) across an individual’s lifespan and across diverse medical subspecialties. To support therapeutic efficiency and adaptability, our proposed model highlights periods when external resources for managing ADHD are reduced, cognitive and behavioral stressors are increased, and individuals may be reevaluating how they perceive, accept, and adhere to ADHD treatment. Such a model aims to support the clinical community by placing in context new findings, which suggest that the prevention of adult psychopathology in individuals with pediatric ADHD may be possible.

Conclusions: The ADHD Life Transition Model seeks to improve care for individuals with ADHD by (1) underscoring that ADHD persists beyond childhood in at least two-thirds of patients, (2) raising awareness of the need to approach ADHD from a chronic illness standpoint, and (3) increasing mental health professionals’ diligence in symptom recognition and management of ADHD across developmental phases from childhood through adulthood.

J Clin Psychiatry

Submitted: October 8, 2010; accepted: November 2, 2011.

Online ahead of print: January 10, 2012 (doi:10.4088/JCP.10m06628).

Deceased

Corresponding author: David W. Goodman, MD, Johns Hopkins at Green Spring Station, 10751 Falls Rd, Ste 306, Lutherville, MD 21093 (dgoodma4@jhmi.edu).