The role of comorbid childhood mental health conditions in the persistence of ADHD symptoms: Systematic review and Meta-analysis

BackgroundChildren diagnosed with ADHD and other comorbid mental health conditions often exhibit more severe functional impairments than those without comorbid conditions, including a tendency for their ADHD symptoms to persist into later developmental stages. We conducted a systematic review and quantitative analysis to investigate the extent to which specific childhood comorbidities (internalizing, externalizing and neurodevelopmental conditions) predict the persistence of childhood ADHD into later developmental stages. MethodsWe extracted data from 26 studies meeting the criteria for inclusion and applied multilevel random effects models to obtain pooled estimates of Cohens d for selected predictors on ADHD persistence. ResultsChildhood comorbid internalizing and externalizing conditions (d=0.19 and d=0.31, respectively), but not neurodevelopmental disorders, were significantly associated with ADHD persistence. After adjusting for covariates (sex, age and other comorbidities), this association diminished for externalizing conditions (dadj=0.24) and was no longer significant for internalizing conditions (dadj=0.05). The association between comorbid externalizing behavior problems and ADHD persistence was found only in studies that used parent-reported data to measure childhood ADHD and externalizing conditions, but not in studies that included teacher-reported childhood symptoms. ConclusionsChildhood comorbid externalizing and, to a lesser extent, internalizing conditions were associated with the persistence of ADHD, but this association may be partially due to confounders. Childhood comorbidity of neurodevelopmental disorders does not appear to increase the likelihood of ADHD persistence.