Margaret H Sibley1, Luis A Rohde1, James M Swanson1, Lily T Hechtman1, Brooke S G Molina1, John T Mitchell1, L Eugene Arnold1, Arthur Caye1, Traci M Kennedy1, Arunima Roy1, Annamarie Stehli1. 1. From the Department of Psychiatry and Behavioral Health, Florida International University, Miami; the Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; the Child Development Center, School of Medicine, University of California, Irvine; the Division of Child Psychiatry, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada; the Departments of Psychiatry, Psychology, and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh; the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C.; the Department of Psychiatry, Ohio State University, Nisonger Center, Columbus, Ohio; the Division of Molecular Psychiatry, University Hospital Wuerzberg, Germany; and the Department of Pediatrics, University of California, Irvine.
Abstract
OBJECTIVE: Adolescents and young adults without childhood attention deficit hyperactivity disorder (ADHD) often present to clinics seeking stimulant medication for late-onset ADHD symptoms. Recent birth-cohort studies support the notion of late-onset ADHD, but these investigations are limited by relying on screening instruments to assess ADHD, not considering alternative causes of symptoms, or failing to obtain complete psychiatric histories. The authors address these limitations by examining psychiatric assessments administered longitudinally to the local normative comparison group of the Multimodal Treatment Study of ADHD. METHOD: Individuals without childhood ADHD (N=239) were administered eight assessments from comparison baseline (mean age=9.89 years) to young adulthood (mean age=24.40 years). Diagnostic procedures utilized parent, teacher, and self-reports of ADHD symptoms, impairment, substance use, and other mental disorders, with consideration of symptom context and timing. RESULTS: Approximately 95% of individuals who initially screened positive on symptom checklists were excluded from late-onset ADHD diagnosis. Among individuals with impairing late-onset ADHD symptoms, the most common reason for diagnostic exclusion was symptoms or impairment occurring exclusively in the context of heavy substance use. Most late-onset cases displayed onset in adolescence and an adolescence-limited presentation. There was no evidence for adult-onset ADHD independent of a complex psychiatric history. CONCLUSIONS: Individuals seeking treatment for late-onset ADHD may be valid cases; however, more commonly, symptoms represent nonimpairing cognitive fluctuations, a comorbid disorder, or the cognitive effects of substance use. False positive late-onset ADHD cases are common without careful assessment. Clinicians should carefully assess impairment, psychiatric history, and substance use before treating potential late-onset cases.
OBJECTIVE: Adolescents and young adults without childhood attention deficit hyperactivity disorder (ADHD) often present to clinics seeking stimulant medication for late-onset ADHD symptoms. Recent birth-cohort studies support the notion of late-onset ADHD, but these investigations are limited by relying on screening instruments to assess ADHD, not considering alternative causes of symptoms, or failing to obtain complete psychiatric histories. The authors address these limitations by examining psychiatric assessments administered longitudinally to the local normative comparison group of the Multimodal Treatment Study of ADHD. METHOD: Individuals without childhood ADHD (N=239) were administered eight assessments from comparison baseline (mean age=9.89 years) to young adulthood (mean age=24.40 years). Diagnostic procedures utilized parent, teacher, and self-reports of ADHD symptoms, impairment, substance use, and other mental disorders, with consideration of symptom context and timing. RESULTS: Approximately 95% of individuals who initially screened positive on symptom checklists were excluded from late-onset ADHD diagnosis. Among individuals with impairing late-onset ADHD symptoms, the most common reason for diagnostic exclusion was symptoms or impairment occurring exclusively in the context of heavy substance use. Most late-onset cases displayed onset in adolescence and an adolescence-limited presentation. There was no evidence for adult-onset ADHD independent of a complex psychiatric history. CONCLUSIONS: Individuals seeking treatment for late-onset ADHD may be valid cases; however, more commonly, symptoms represent nonimpairing cognitive fluctuations, a comorbid disorder, or the cognitive effects of substance use. False positive late-onset ADHD cases are common without careful assessment. Clinicians should carefully assess impairment, psychiatric history, and substance use before treating potential late-onset cases.
Entities:
Keywords:
Attention Deficit Hyperactivity Disorder; Diagnosis And Classification
Authors: Gregory A Fabiano; William E Pelham; Daniel A Waschbusch; Elizabeth M Gnagy; Benjamin B Lahey; Andrea M Chronis; Adia N Onyango; Heidi Kipp; Andy Lopez-Williams; Lisa Burrows-Maclean Journal: J Clin Child Adolesc Psychol Date: 2006-09
Authors: Stephen V Faraone; Roy H Perlis; Alysa E Doyle; Jordan W Smoller; Jennifer J Goralnick; Meredith A Holmgren; Pamela Sklar Journal: Biol Psychiatry Date: 2005-01-21 Impact factor: 13.382
Authors: J M Swanson; H C Kraemer; S P Hinshaw; L E Arnold; C K Conners; H B Abikoff; W Clevenger; M Davies; G R Elliott; L L Greenhill; L Hechtman; B Hoza; P S Jensen; J S March; J H Newcorn; E B Owens; W E Pelham; E Schiller; J B Severe; S Simpson; B Vitiello; K Wells; T Wigal; M Wu Journal: J Am Acad Child Adolesc Psychiatry Date: 2001-02 Impact factor: 8.829
Authors: Brooke S G Molina; Stephen P Hinshaw; L Eugene Arnold; James M Swanson; William E Pelham; Lily Hechtman; Betsy Hoza; Jeffery N Epstein; Timothy Wigal; Howard B Abikoff; Laurence L Greenhill; Peter S Jensen; Karen C Wells; Benedetto Vitiello; Robert D Gibbons; Andrea Howard; Patricia R Houck; Kwan Hur; Bo Lu; Sue Marcus Journal: J Am Acad Child Adolesc Psychiatry Date: 2013-02-08 Impact factor: 8.829
Authors: Arthur Caye; Thiago Botter-Maio Rocha; Luciana Anselmi; Joseph Murray; Ana M B Menezes; Fernando C Barros; Helen Gonçalves; Fernando Wehrmeister; Christina M Jensen; Hans-Christoph Steinhausen; James M Swanson; Christian Kieling; Luis Augusto Rohde Journal: JAMA Psychiatry Date: 2016-07-01 Impact factor: 21.596
Authors: Brooke S G Molina; Stephen P Hinshaw; James M Swanson; L Eugene Arnold; Benedetto Vitiello; Peter S Jensen; Jeffery N Epstein; Betsy Hoza; Lily Hechtman; Howard B Abikoff; Glen R Elliott; Laurence L Greenhill; Jeffrey H Newcorn; Karen C Wells; Timothy Wigal; Robert D Gibbons; Kwan Hur; Patricia R Houck Journal: J Am Acad Child Adolesc Psychiatry Date: 2009-05 Impact factor: 8.829
Authors: Jessica C Agnew-Blais; Guilherme V Polanczyk; Andrea Danese; Jasmin Wertz; Terrie E Moffitt; Louise Arseneault Journal: Br J Psychiatry Date: 2018-06-29 Impact factor: 9.319
Authors: Irene J Elkins; Gretchen R B Saunders; Stephen M Malone; Sylia Wilson; Matt McGue; William G Iacono Journal: Drug Alcohol Depend Date: 2020-02-27 Impact factor: 4.492
Authors: Irene J Elkins; Gretchen R B Saunders; Stephen M Malone; Sylia Wilson; Matt McGue; William G Iacono Journal: J Child Psychol Psychiatry Date: 2018-10 Impact factor: 8.982
Authors: Timothy E Wilens; Benjamin M Isenberg; Tamar A Kaminski; Rachael M Lyons; Javier Quintero Journal: Curr Psychiatry Rep Date: 2018-09-17 Impact factor: 5.285
Authors: C D Ladouceur; B S G Molina; A Versace; N P Jones; H M Joseph; R A Lindstrom; T K Wilson; J P Lima Santos; E M Gnagy; W E Pelham Journal: Mol Psychiatry Date: 2021-05-25 Impact factor: 15.992
Authors: Margaret H Sibley; Mercedes Ortiz; Paulo Graziano; Anthony Dick; Elena Estrada Journal: Eur Child Adolesc Psychiatry Date: 2019-08-06 Impact factor: 4.785