Predictors of persistence and the timing of remission of ADHD at a 4-year follow-up of 128 patients were studied prospectively using DSM-III-R criteria at the Massachusetts General Hospital, Boston. The diagnosis of ADHD had persisted in 109 (85%) and had remitted in 19 (15%). Of those no longer meeting the diagnostic criteria, 9 (47%) were late remitters (after age 12 years), and 10 (53%) were early remitters (by age 12 years). Risk factors for persistence included: 1) genetic familiality of ADHD, 2) environmental psychosocial adversity and exposure to parental conflict, and 3) comorbidity with conduct, mood, and anxiety disorders. 
COMMENT. The majority of children diagnosed with ADHD in childhood will continue to be affected after 12 years of age, into adolescence, and sometimes into adulthood. The frequently repeated prediction that a child will outgrow ADHD by 12 years of age is no longer tenable. These authors also found that the intensity of treatment of ADHD did not alter the incidence of persistence or remission. The prognosis for ADHD seems to be bleaker than previously perceived. By using stimulant medication, special education, and counselling during early grade school years, the improvements in attentiveness and behavior are expected to result in better study habits and academic achievement. To assure continued success in high school and also, in college, ADHD appears to require persistent medical attention. Treatment should also be directed more aggressively toward lessening the influence of environmental and familial adverse factors, which appear to be important in persistence of ADHD. Parents are often oblivious or in denial of their role in the etiology of a child’s attention deficits and behavior problems. Family counselling, often neglected as part of the multimodal therapy for ADHD, should receive greater emphasis.
Psychiatric and developmental disorders in families of children with ADHD were studied in the Department of Pediatrics, Wyler and La Rabida Children’s Hospitals, University of Chicago . Children with ADHD were significantly more likely than control children (with Down syndrome) to have a parent affected by alcoholism, other drug abuse, depression, delinquency, learning disabilities, and ADHD. Anticipatory guidance and psychosocial intervention were recommended for families affected. The Editor, Dr DeAngelis, notes that children with a family history of psychiatric disorders should be screened for ADHD.