A large school-based sample of children in Grades 1, 2, 3, and 4 were screened for disruptive behavior and subsequently assessed over a 5-year period for DSM-III-R symptoms of attention deficit hyperactivity disorder (ADHD) and other externalizing and internalizing behavior disorders. Parents completed structured diagnostic interviews in Years 1, 4, and 5, and teachers completed Behavioral Assessment for Children - Teacher Rating Scales behavioral ratings annually. For parent-derived diagnostic data, both inattention and hyperactivity/impulsivity symptom groups declined from Year 1 to Year 4, with hyperactivity showing more significant decline. For teacher- rated behavioral dimensions, the Attention Problems scale declined from Year 1 to Year 3 and stabilized thereafter. The Hyperactivity scale showed stability during the first 3 years before declining in Year 4. Of those children diagnosed with ADHD in Year 1, 69% still met criteria for ADHD in either Year 4 or 5. Persisters were more likely to exhibit coexisting conduct disorder in Year 1 and oppositional defiant disorder in Years 1, 4, and 5. Parents of persisters reported more psychosocial adversity on measures of parenting and marital satisfaction.