Adult ADHD
Visual Abstract
Attention-Deficit/Hyperactivity Disorder Trajectories From Childhood to Young Adulthood
Evidence for Late-Onset ADHD
Arthur Caye; Thiago Botter-Maio Rocha, MD, MSc; Luciana Anselmi, PhD; Joseph Murray, PhD; Ana M. B. Menezes, PhD; Fernando C. Barros, PhD; Helen Gonçalves, PhD; Fernando Wehrmeister, PhD; Christina M. Jensen, MSc; Hans-Christoph Steinhausen, MD, PhD, DMSc; James M. Swanson, PhD; Christian Kieling, MD, PhD; Luis Augusto Rohde, MD, PhD
Summarized by:
April 22, 2023
study source
JAMA Psychiatry
May 2016
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Traditionally, experts considered adult ADHD as a continuation of childhood ADHD.
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This study in Brazil found that most with Adult ADHD developed their symptoms later in life.
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These adults had all the symptoms of ADHD and experienced impacts on their quality of life, suggesting that ADHD can develop in adulthood.
Attention-Deficit/Hyperactivity Disorder Trajectories From Childhood to Young Adulthood: Evidence From a Birth Cohort Supporting a Late-Onset Syndrome
Background
Traditionally, researchers have considered adult ADHD a continuation of childhood ADHD. Many definitions of adult ADHD require a person to have had ADHD symptoms as children to qualify as having adult ADHD.
However, not everyone agrees with this definition. Some recent studies have suggested that there may be cases of adult ADHD that do not start during childhood.
Study Quote
The requirement of a childhood onset has always been a key criterion for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults, but recently this requirement has become surrounded by controversy.
Objective
This study wanted to test the theory that young adults with ADHD typically begin showing symptoms as children.
They wanted to see whether there were cases of clinically significant adult ADHD that began in adulthood. Evidence of a significant number of these cases would go against the prevailing theory of ADHD.
Study Quote
To investigate whether impaired young adults with ADHD symptoms always have a childhood-onset disorder in a population-based longitudinal study.
Design, setting, and participants
Researchers followed over 5000 individuals in Brazil from childhood to adulthood. These individuals were initially recruited for another study but offered a suitable cohort for studying ADHD over time.
Study Quote
Participants belonged to the 1993 Pelotas Birth Cohort Study, including 5249 individuals born in Pelotas, Brazil, in 1993. They were followed up to 18 to 19 years of age, with 81.3% retention. The data analysis was performed between August 8, 2015, and February 5, 2016.
Main outcomes and measures
Researchers started screening for ADHD at age 11. They tested for adult ADHD when the children reached ages 18 and 19.
They compared the child data with the adult data to see whether these two groups overlapped. They wanted to see whether those with ADHD symptoms as adults were the same as those with ADHD symptoms as children.
Study Quote
The ADHD status was first ascertained at 11 years of age using a screening instrument (hyperactivity subscale of the Strength and Difficulties Questionnaire) calibrated for a DSM-IV ADHD diagnosis based on clinical interviews with parents using the Development and Well-Being Assessment. ...
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Results
Researchers found similar estimates of ADHD prevalence as previous studies in the field, which supports the accuracy of the results.
Most children with ADHD no longer met the criteria for ADHD when they reached adulthood. Essentially, most cases of childhood ADHD got better over time. This is consistent with some previous studies.
Unexpectedly, the researchers found many adults with clinically significant ADHD symptoms who did not have ADHD as children.
A longitudinal study in Brazil found that most individuals who had clinically significant ADHD symptoms, did not have ADHD as children.
This provides strong evidence that there may be many individuals with significant ADHD symptoms as adults who did not have it as children.
The adults with ADHD symptoms also suffered from many consequences commonly associated with ADHD, including more traffic tickets, mental health issues, suicide attempts, and criminal behavior.
This suggests that the ADHD symptoms experienced by these adults had serious impacts on their lives, even though they would not have met the traditional criteria of ADHD since they did not have ADHD as children.
There was also some evidence that these two groups may have other differences. Children with ADHD were more likely to be male than those without ADHD. Those with significant ADHD symptoms in adulthood were more likely to be female.
A study in Brazil found that boys were more likely to be affected by childhood ADHD, while women were more likely to have ADHD symptoms as adults.
Study Quote
At 11 years of age, childhood ADHD (C-ADHD) was present in 393 individuals (8.9%). At 18 to 19 years of age, 492 individuals (12.2%) fulfilled all DSM-5 criteria for young adult ADHD (YA-ADHD), except age at onset. After comorbidities were excluded, the prevalence of YA-ADHD without como...
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Conclusions and relevance
The authors of this study concluded that the data they found does not support the traditional concept of adult ADHD as solelya continuation of a childhood disorder.
Based on the findings outlined above, there are many adults with significant symptoms of ADHD that impact their lives who did not have it as children.