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Is ADHD a valid diagnosis in older adults?

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ADHD Attention Deficit and Hyperactivity Disorders


ADHD is a neurodevelopmental syndrome that often persists into adulthood. It is possible that different criteria are necessary for older adults than younger adults: the manifestations of ADHD could change with age; other conditions with onset in later life share presenting symptoms with ADHD; different contextual challenges and patterns of compensatory support may exist. For these reasons, we reviewed evidence for the validity of DSM ADHD criteria in adulthood for individuals over the age of 50. Specifically, we evaluated evidence that the DSM criteria for ADHD identify a valid syndrome in older adults based on clinical presentation, laboratory or testing findings, absence of alternate diagnosis to explain symptoms, course of the syndrome, or familial presence of the condition. We found evidence that various ADHD criteria identify subjects with clinical presentations similar to that seen in younger adults, but only 92 well-described cases have been reported in the literature. ADHD traits also may be less common in the general population of older adults than in younger adults, suggesting that the threshold for an atypical burden of ADHD traits may be lower in older populations. Future research can establish a richer basis for validity of diagnostic criteria for ADHD in older adults.

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We are thankful for administrative and editorial assistance by Lauren Rhodewalt and Heidi Boland with this manuscript.

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Correspondence to Craig B. H. Surman.

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Conflict of interest

Dr. Craig Surman, MD, has received, in his lifetime, consulting fees or honorarium from Ironshore, Mcneil, Nutricia, Pfizer, Rhodes, Shire, Somaxon, and Takeda. He has also received payments for lectures for Alcobra, McNeil, Janssen, Janssen-Ortho, Neos, Novartis, Shire, GME CME, Medscape and Reed/MGH Academy, and Maine Adcare. Royalties have been given to Dr. Surman from Berkeley/Penguin for “FASTMINDS” How to Thrive if You have ADHD (or think you might)” and from Humana/Springer for “ADHD in Adults: A Practical Guide to Evaluation and Management”. Additionally, Dr. Surman has conducted clinical research at Massachusetts General Hospital supported by Abbot, Cephalon, Hilda and Preston Davis Foundation, Eli Lilly, Magceutics, J & J/McNeil, Lundbeck, Merck, Nordic Naturals, Nutricia, Pamlab, Pfizer, Organon, Shire, and Takeda. Dr. David W. Goodman, M.D., FAPA has received consulting fees and honorarium from WebMD, Medscape, Temple University, American Professional Society of ADHD and Related Disorders, Neuroscience Education Institute, Children and Adults with ADHD Association, McNeil, Teva Pharmaceuticals, Lundbeck, Janssen USA and Canada, OptumInsight (Ingenix Pharmaceutical Services, Inc), Sunovion, Otsuka Pharmaceuticals, Novartis, Ironshore Pharmaceuticals, Rhodes Pharmaceuticals, Neos Therapeutics, Thomson Reuters, GuidePoint Global, Med-IQ, Avacat, Pontifax, Healthequity Corporation, American Physician Institute for Advanced Professional Studies, LLC, Prescriber’s Letter, Consumer Reports, Major League Baseball, and National Football League.

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This paper does not reflect research conducted by the authors on human participants or on animals.

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Surman, C.B.H., Goodman, D.W. Is ADHD a valid diagnosis in older adults?. ADHD Atten Def Hyp Disord 9, 161–168 (2017).

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