Assessing Age-Dependent Impairment Progression of Children Adolescents and Adults with ADHD using the TOVA

Background: ADHD clinical symptoms have been reported to decline as children grow into adulthood. We sought to evaluate ADHD impairment in different age groups with ADHD utilizing a computerized assessment.

Method: 58 children (ages 6-11.8), 73 adolescents (ages 12-17.6) and 104 adults (ages 18.1-56.7) with ADHD were evaluated using the Test of Variables of Attention (TOVA) in the ADHD Clinic of the Geha Mental Health Center. Patients with significant psychiatric or neurological comorbidities or psychotropic medications were excluded. TOVA variables were compared between groups with ANOVA and subsequently using ordinal, logistic (O, C, RTV, RT, D`) and linear regression analyses (API).

Results: Considering RTV, adults were 10.6 and 4.0 times more likely to be severely impaired (standard score < 40) than children and adolescents (respectively). Considering D`, all severely impaired subjects were adults (see table 1). Ordinal regression analyses for RTV scores revealed for each 10-year increase in age patients were 1.5 times more likely to be assigned to higher categories of disorder-related impairment (see table 2). Importantly, earlier diagnosis was significantly associated with less impairment (OR = 0.6, p= .048), with similar although marginally significant results for past treatment (OR= 0.6, p= .052). Linear regression analysis revealed significant age-related decrements in API (see figure 1).

Conclusion: Adults with ADHD were more impaired than children and adolescents as measured by the TOVA. The findings suggest that earlier diagnosis, earlier treatment, or both, may attenuate ADHD-related cognitive impairment, and in that sense may be disorder-modifying. Further studies are indicated.