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Late-Onset ADHD: Understanding the Evidence and Building Theoretical Frameworks

Abstract

Purpose of Review

The traditional definition of Attention-Deficit/Hyperactivity Disorder (ADHD), assuming onset in childhood, has been challenged by evidence from four recent birth-cohort studies that reported most adults with ADHD lacked a childhood categorical ADHD diagnosis.

Recent Findings

Late onset of symptoms was evaluated in the long-term follow-up of the Multimodal Treatment study of ADHD (MTA). In most cases, other factors were present that discounted the late onset of ADHD symptoms and excluded the diagnosis of ADHD.

Summary

We offer two theoretical frameworks for understanding the ADHD trajectory throughout the life cycle: (1) the complex phenotype model, and (2) the restricted phenotype model. We conclude that (a) late onset (after age 12) is a valid trajectory for ADHD symptoms, (b) the percentage of these cases with onset after adolescence is yet uncertain, and (c) the percentage meeting exclusion criteria for diagnosis of ADHD is influenced by the rigor of the methodology used to obtain evidence and whether or not DSM exclusionary criteria are applied.

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Correspondence to Luis Augusto Rohde.

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Conflict of Interest

Arthur Caye and Margaret H. Sibley each declare no potential conflicts of interest.

James M. Swanson was a member of the advisory board and/or acted as a consultant for Medice and NLS Pharma in 2017.

Luis Augusto Rohde has been a member of the speakers’ bureau/advisory board and/or acted as a consultant for Eli-Lilly, Janssen-Cilag, Medice, Novartis, and Shire in the last 3 years. He receives authorship royalties from Oxford Press and ArtMed. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the last 3 years: Eli-Lilly, Janssen-Cilag, Novartis, and Shire. He also received travel awards from Novartis and Shire to attend the 2015 WFADHD and the 2016 AACAP meetings.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Attention-Deficit Disorder

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Caye, A., Sibley, M.H., Swanson, J.M. et al. Late-Onset ADHD: Understanding the Evidence and Building Theoretical Frameworks. Curr Psychiatry Rep 19, 106 (2017). https://doi.org/10.1007/s11920-017-0858-7

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Keywords

  • ADHD
  • Persistence
  • Late-onset
  • Course
  • Development