Attention-Deficit/Hyperactivity Disorder Trajectories From Childhood to Young Adulthood: Evidence From a Birth Cohort Supporting a Late-Onset Syndrome
Open accessAbstract
IMPORTANCE: 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: 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: 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: 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. At 18 to 19 years of age, ADHD diagnosis was derived using DSM-5 criteria, except age at onset. We estimated the overlap between these groups assessed at 11 and 18 to 19 years of age and the rates of markers of impairment in these 2 groups compared with those without ADHD. RESULTS: 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 comorbidities decreased to 256 individuals (6.3%). Children with C-ADHD had a male preponderance not observed among children without ADHD (251 [63.9%] vs 1930 [47.9%] male, P < .001), whereas the YA-ADHD group had a female preponderance (192 [39.0%] vs 1786 [50.4%] male, P < .001). Both groups had increased levels of impairment in adulthood, as measured by traffic incidents, criminal behavior, incarceration, suicide attempts, and comorbidities. However, only 60 children (17.2%) with ADHD continued to have ADHD as young adults, and only 60 young adults (12.6%) with ADHD had the disorder in childhood. CONCLUSIONS AND RELEVANCE: The findings of this study do not support the assumption that adulthood ADHD is necessarily a continuation of childhood ADHD. Rather, they suggest the existence of 2 syndromes that have distinct developmental trajectories.
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More than two-thirds of people with adult ADHD have ever had childhood ADHD.
“several prospective longitudinal studies have revealed that more than two-thirds of people with adult ADHD have ever had childhood ADHD [7-9].”
From The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis (2021) · cites this paper as [9]
The Persistence and Overlap section reports that only 60 of 492 young adults with ADHD (12.2%) had childhood ADHD, while 416 (84.6%) did not. This is contrary to the attributed claim that more than two-thirds had childhood ADHD. (LLM, conf=0.95)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredChildren with ADHD do not outgrow the disorder when they reach adulthood.
“Recent evidence supports the view that children with ADHD do not “outgrow” the disorder when they reach adulthood”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [11]
The Abstract reports that only 17.2% of children with ADHD continued to have ADHD as young adults, contrary to the claim that children with ADHD do not outgrow the disorder. The discussion adds that the childhood-ADHD group could remain impaired in adult life despite no longer qualifying for an ADHD diagnosis. Page numbers are not provided in our copy. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredRecent evidence has demonstrated that ADHD does not necessarily begin in childhood.
“Although ADHD has been traditionally under the umbrella of neurodevelopmental disorder, recent evidence has demonstrated that ADHD does not necessarily begin in childhood [7-9].”
From The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis (2021) · cites this paper as [9]
The Abstract reports that only 12.6% of young adults classified as having ADHD had childhood ADHD, supporting the possibility of later onset. But the authors say their findings “suggest” distinct developmental trajectories; they do not claim to have demonstrated definitively that ADHD can begin after childhood. Young-adult ADHD was also assessed without the age-at-onset criterion. (LLM, conf=0.83)
Experimental — accuracy not yet measuredRecent longitudinal studies have found evidence for an adult-onset ADHD type.
“Moreover, recent longitudinal studies have found evidence for an adult-onset ADHD type; meaning individuals with adult ADHD who have never been diagnosed with ADHD during childhood (Moffitt et al. 2015; Agnew-Blais et al. 2016; Caye et al. 2016).”
From ADHD and associated psychopathology in older adults in a German community sample (2023) · cites this paper as Caye et al. 2016
There exist two separate syndromes of ADHD with distinct developmental trajectories.
“Taken together, such observations suggest the existence of two separate syndromes that have distinct developmental trajectories [11].”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [11]
Adult ADHD is not necessarily a continuation of childhood ADHD since a substantial proportion of adults with ADHD lack a history of the disorder in childhood.
“adult ADHD is not necessarily a continuation of childhood ADHD since a substantial proportion of adults with ADHD lack a history of the disorder in childhood [11][12][13]”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [11]
Recent community cohort studies have suggested that there may be cases of 'adult onset' ADHD among individuals without a prior history of ADHD in childhood.
“Recent community cohort studies have suggested that there may be cases of “adult onset” ADHD among individuals without a prior history of ADHD in childhood”
From The descriptive epidemiology of DSM-IV adult ADHD in the world health organization world mental health surveys (2017) · cites this paper as Caye et al. 2016a
More than two-thirds of adults with ADHD report symptoms present in childhood.
“Retrospective data indicate that more than two-thirds of adults with ADHD report symptoms present in childhood”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [34]
The Design and Sample and Persistence and Overlap sections describe prospective childhood assessments and report that 12.6% of assessed young adults with ADHD had childhood ADHD. That is different from asking adults retrospectively whether they had any childhood symptoms. I searched for retrospective reports and a two-thirds estimate, but our copy provides neither. (LLM, conf=0.76)
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References 29 · Cited by 349
- Authors
- Caye, A., Rocha, T. B.-M., Anselmi, L., Murray, J., Menezes, A. M. B., Barros, F. C., Gonçalves, H., Wehrmeister, F., Jensen, C. M., Steinhausen, H.-C., Swanson, J. M., Kieling, C., & Rohde, L. A.
- Affiliations
- Universidade Federal do Rio Grande do Sul (BR)
- Universidade Federal de Pelotas (BR)
- Aalborg University Hospital (DK)
- University of Basel (CH)
- University of California, Irvine (US)
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil8National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2016-07-01
- Volume
- 73
- Issue
- 7
- Pages
- 705
- ISSN
- 2168-622X (ISSN-L)
- OpenAlex
- W2400468990
- Cited by
- 349
- References
- 29
- Citations by year
- 2026: 22 · 2025: 31 · 2024: 23 · 2023: 27 · 2022: 32 · 2021: 39 · 2020: 35 · 2019: 38 · 2018: 47 · 2017: 40 · 2016: 14 · 2012: 1
- FWCI
- 41.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Wellcome Trust (086974/Z/08/Z)
- Associação Brasileira de Saúde Coletiva
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- attention deficit hyperactivity disorder, childhood-onset ADHD, age of onset, sex differences, comorbidities, functional disability, traffic incidents, criminal behavior, suicide attempts, incarceration, Pelotas Birth Cohort Study, Strengths and Difficulties Questionnaire, DSM-5 diagnostic criteria, longitudinal cohort follow-up
- MeSH terms
- Late Onset Disorders, Adolescent, Age Factors, Attention Deficit Disorder with Hyperactivity, Brazil, Child, Female, Humans, Interview, Psychological, Longitudinal Studies, Male, Cohort Studies, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
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