Original Research J Clin Psychiatry October 2024

Characteristics and Predictors of Fluctuating Attention-Deficit/Hyperactivity Disorder in the Multimodal Treatment of ADHD (MTA) Study

JCP 2024;85(4):10.4088/JCP.24m15395

Full Article Read the complete peer-reviewed article in J Clin Psychiatry. Clinical Summary ADHD is often treated as either persistent or remitted, but many patients do not follow a stable course. In this long-term MTA follow-up, fluctuation was common, meaning a single visit can misclassify trajectory and clinicians need a more longitudinal view of symptoms, impairment, and treatment needs. FAQ How common was fluctuating ADHD in the MTA long-term follow-up?

Key Takeaways Endpoint status was a poor proxy for longitudinal course: among those classified as symptom persistent at study endpoint, 80.1% were actually fluctuating over time, and among endpoint remitters, 62.3% were fluctuating. A single adult follow-up visit may therefore misrepresent a patient's longer-term ADHD trajectory. Clinical Guide How should clinicians monitor patients with ADHD when symptoms may fluctuate rather than persist or remit steadily? Clinical Guide How should clinicians assess environmental demands when following patients with fluctuating ADHD? Clinical Guide How should clinicians monitor ADHD over time so that remission, persistence, and fluctuation are not misclassified from a single visit? Clinical Guide How can clinicians incorporate environmental demands into follow-up planning for patients with fluctuating ADHD?