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Metacognitive and motivation deficits, exposure to trauma, and high parental demands characterize adolescents with late-onset ADHD

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Abstract

The objective of this study is to evaluate support for three hypotheses about the etiology of adolescent-onset ADHD symptoms: (1) a “cool” cognitive load hypothesis, (2) a “hot” rewards processing hypothesis, and (3) a trauma exposure hypothesis. Participants (N = 50) were drawn from two public high schools in a culturally diverse metropolitan area. A detailed procedure for identifying and confirming late-onset ADHD cases is described. Adolescents with late-onset ADHD (n = 15) were identified and compared to childhood-onset (n = 17) and non-ADHD classmates (n = 18). Adolescents and parents completed measures of neurocognition, rewards’ processing, clinical profile, and environmental demands. Late-onset cases were clinically and neurocognitively indistinguishable from childhood-onset cases; however, they experienced higher demands from parents (d = 1.09). Compared to the non-ADHD group, late-onset cases showed significant deficits in metacognition (d = 1.25) and academic motivation (d = 0.80), as well as a pronounced history of multiple trauma exposure (OR 11.82). At 1-year follow-up, ADHD persisted in 67.7% of late-onset cases. Late-onset cases (26.7%) were more likely than childhood-onset cases (0.0%) to transfer to alternative schools by 1-year follow-up. Multiple factors may contribute to adolescent-onset ADHD. Adolescents with metacognition and motivation deficits may be at greatest risk for the late-onset ADHD phenotype, particularly in highly demanding environments. Exposure to traumatic stress may play a key role in the exacerbation of existing deficits or onset of new symptoms. Late-onset ADHD was persistent in most cases and associated with higher risk for school disengagement than childhood-onset ADHD. Further work is needed to better understand the etiologies of late-onset ADHD symptoms.

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Funding

This project was funded by grants from the Institute of Education Sciences (R305A150433; Sibley, PI) and from Chantal D’Adesky Scheinberg, MD to the FIU Foundation. We also acknowledge Dr. Scheinberg’s scientific contributions to the initial conceptualization of this project’s research aims and methodology.

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Authors and Affiliations

  1. Florida International University, Miami, USA

    Margaret H. Sibley, Mercedes Ortiz, Paulo Graziano, Anthony Dick & Elena Estrada

  2. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Center for Child Health, Behavior, and Development, Seattle Children’s Hospital, 2001 8th Ave., Suite 400, Seattle, WA, 98121, USA

    Margaret H. Sibley

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  1. Margaret H. Sibley
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  2. Mercedes Ortiz
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  3. Paulo Graziano
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  4. Anthony Dick
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Correspondence to Margaret H. Sibley.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standards

This study was approved by the local university ethics committee and have, therefore, was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Sibley, M.H., Ortiz, M., Graziano, P. et al. Metacognitive and motivation deficits, exposure to trauma, and high parental demands characterize adolescents with late-onset ADHD. Eur Child Adolesc Psychiatry 29, 537–548 (2020). https://doi.org/10.1007/s00787-019-01382-w

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  • DOI: https://doi.org/10.1007/s00787-019-01382-w

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